Evaluation of serum indirect hemagglutination test results of suspected cystic echinococcosis cases from 2009-2017

Objective: To evaluate the serological, radiological and epidemiological analysis of suspected cystic echinococcosis patients, and to assess the positivity rate in the region. Method: The retrospective study was conducted at Bursa Uludag University Hospital, Bursa, Turkey, and comprised data from January 2009 to December 2017 related to patients of either gender with suspected cystic echinococcosis who underwent indirect haemagglutination testing. Demographic and clinical data of patients who tested positive were analysed. Statistical analysis was done using SPSS 23. Results: Of the 3910 patients with a mean age of 41.6±19.35 years (range: 0-93 years) who underwent indirect haemagglutination testing, 692(17.7%) tested positive; 390(56.4%) females, and 302(43.6%) males. The highest seropositivity rate 107(15.5%) was observed in 2011, followed by 104(15%) in 2016. Seropositive cases were predominantly seen in those aged 40-49 years 131 (18.9%), followed by those aged 50-59 years 124 (17.9%). Conclusion: Cystic echinococcosis was found to be a public health problem South Marmara region of Turkey. Key Words: Echinococcus granulosus, Cystic echinococcosis, Indirect haemagglutination, Seroprevalence.

Serological Prevalence of Toxoplasma gondii in Faculty of Medicine of Bursa Uludağ University During 2016-2018

OBJECTIVE

This study aimed to retrospectively investigate Toxoplasma gondii IgG and IgM distribution and IgG avidity in serum samples with suspected toxoplasmosis in the medical microbiology serology laboratory of Faculty of Medicine Hospital at Bursa Uludağ University over a 24-month period (January 2016 to December 2018).

METHODS

An enzyme-linked fluorescent assay using the VIDAS automated analyzer (BioMérieux, France) was used to determine T. gondii IgM antibodies, T. gondii IgG antibodies, and T. gondii IgG avidity.

RESULTS

The T. gondii IgM antibody positivity was found to be 1.7% (101/6104), whereas the T. gondii IgG antibody positivity was 37.9% (1.149/3024). The seropositivity of T. gondii IgG was 31.5% in women belonging to the childbearing age group. In this group, T. gondii IgG high and low avidity rates were 70.1% (134/191) and 15.2% (29/191), respectively.

CONCLUSION

Screening and diagnosis of toxoplasma serology in women of childbearing age is important. The results of this study may be useful for designing optimal control and preventive measures against T. gondii infection.

Laboratory Results of Cystic Echinococcosis in 2017 and 2018

Objective

This study aimed to retrospectively examine the indirect haemagglutination (IHA) test results of patients suspected of cystic echinococcosis (CE) and admitted to Bursa Uludağ University Health Practice and Research Center Hospital.

Methods

Serum samples in the serology laboratory of our hospital were evaluated using the commercial Cellognost^® echinococcosis IHA (Siemens Healthcare Diagnostics, Marburg, Germany) test based on the manufacturer's recommendations. In the IHA test, ≥1:64 serum titres were accepted as positive.

Results

Seropositivity was determined in 213 (19.9%) of 1.072 patients suspected of having CE by the IHA method. Of the patients with seropositivity, 120 (56.3%) were female and 93 (43.7%) were male. The highest positivity rate in both sexes was found in patients aged 20-29 years (22.5% in women; 14.1% in men).

Conclusion

The results indicate that CE maintains its importance as a public health problem in Bursa as in Turkey.

Investigation of Toxoplasma gondii Seropositivity in Uludağ University Hospital between 2009-2016

Objective

The aim of this study is to investigate the distribution of anti-Toxoplasma gondii immunoglobulin G (IgG) and immünoglobulin M (IgM) antibodies in patients with suspected toxoplasmosis admitted to the Practice and Research Center of Health of the Medical Faculty of Uludağ University.

Methods

The blood samples examined for the presence of anti-T. gondii IgG antibody and anti-T. gondii IgM antibody by an enzyme linked fluorescent assay test, anti-T. gondii IgG avidity value was evaluated by VIDAS (BioMérieux, France) kit.

Results

In our study, anti-T. gondii IgG seropositivity in 3311 (30.7%) of 10.603 cases and anti-T. gondii IgM seropositivity in 1423 (9.7%) of 14.618 cases were detected. Seropositivity of anti-T. gondii IgG was 37.5% in women of childbearing age group. The avidity value was high in 56.1% (n=156) and low in 28.9% (n=80) of childbearing age group women with positive anti-T. gondii IgG and anti-T. gondii IgM test.

Conclusion

Especially in regions where seroprevalence is high, we think that pregnant women and women of childbearing age should be investigated in terms of T. gondii antibodies.

A Clinical Scoring System for Diagnosis of Ocular Demodicosis

Background

Demodex may cause chronic and refractory blepharitis with associated ocular surface problems, and its diagnosis and treatment can be quite challenging. In this study, our aim was to assess the efficacy of tea tree oil in Demodex treatment on caucasian patients in an industrialized region of Turkey, and to develop a systematic scoring system for extremely accurate diagnosis in the absence of advanced facilities.

Material/Methods

Charts of 412 patients with blepharitis were reviewed. A group of 39 out of 412 cases were identified as chronic and treatment-refractory, and therefore were enrolled in this study. Eyelashes from each of the lower and upper eyelids of both eyes were evaluated at ×40 and ×100 magnification using light microscopy. Treatment was started with 4% tea tree oil eyelid gel and 10% eyelash shampoo. Symptoms and findings were scored according to the most common complaints.

Results

The mean age of the patients was 54.1±15.4 years. Seventeen (43.5%) patients were male and 22 (56.5%) patients were female. In 30 out of the 39 patients (76.9%) D. folliculorum was detected. Symptoms disappeared in 25 patients. The mean score of patients who were Demodex-negative was 2.7±1.0, and the mean score of patients who were Demodex-positive was 3.8±1.6 (p=0.047). Ninety-four percent of those with a score of 4 and over were found to be Demodex-positive (p=0.025).

Conclusions

Treatment with tea tree oil can be successful. If there is no facility to identify Demodex under light microscopy, we recommend starting treatment for patients who have scores of 4 and over using the scoring chart developed in this study.

[Evaluation of Two Methods (Nativ-Lugol Preparation and Enzyme-Linked Immunosorbent Assay) for Detection of Entamoeba histolytica in Stool Samples]

OBJECTIVE

This study aims to compare the performance of Native-Lugol examination and EIA Antigen Detection Test using stool samples obtained from patients diagnosed as clinical gastroenteritis and submitted to the Parasitology Laboratory in Uludağ University between January 2010 and February 2011.

METHODS

The stool samples taken from 116 patients and sent to the laboratory of parasitology from various clinics including outpatient services have been investigated using Native-Lugol examination and EIA Antigen Detection Kit (Wampole® E. histolytica II Techlab®, Inc., Blacksburg, Virginia) methods on all the samples.

RESULTS

In one of 116 stool samples (%0,86), E. histolytica/E. dispar cysts and/or trophozoites were detected by using direct microscobic (nativ-lugol) method. E. histolytica specific antigen was detected in 34 (29.3%) out of the sample set, and the patients were given adequate treatment. The highest rate of E. histolytica specific antigen positivity were observed in 11-19 age group.

CONCLUSION

On account of the fact that the sensitivity of direct microscopy is quite low, it is concluded that, from the viewpoint of preventing the amebiasis suspected patients from false diagnosis and hence from receiving inadequate treatment, the use of the ELISA method is more appropriate and advantageous, as it is cost effective and does not require highly qualified staff.

[The Pneumocystis jirovecii colonization in bronchoalveolar lavage (BAL) and bronchial washing and the comparison of methods which are used in diagnosis]

INTRODUCTION

Pneumocystis pneumonia (PCP) which is caused by Pneumocystis jirovecii is usually seen in the patients whose immune system is supressed. It is seriously seen an opportunist infection. In our study; totally 100 bronchoalveolar lavage (BAL) and bronchial washing samples collected by pulmonary disease department. Which belong to the patients in the clinics, and out patient clinic of the bronchoscopy material were evaluated.

MATERIALS AND METHODS

The BAL and bronchial washing were evaluated by the help of methenamine silver stain (Gomori/Grocott), toluidine blue O stain, Wright-Giemsa stain, immun fluorescent antibody (IFA) stain, nested polymerase chain reaction (PCR).

RESULTS

In the BAL and bronchial washing samples the agent couldn't be shown by the help of methenamine silver (Gomori/Grocott), toluidine blue O, Wright-Giemsa staining. In 13 patients with IFA test the cysts of P. jirovecii were determined. In 16 patients with nested PCR; the DNA of P. jirovecii were determined. In 8 patients by using PCR and IFA test P. jirovecii was determined. When the samples which had P. jirovecii were analyzed; 13 of them were BAL and 8 of them were bronchial washing. When the phenomenon groups were evaluated according to age, gender, smoking, hypertension, diabetes mellitus, chronic obstructive pulmonary disease (COPD), cerebrovascular accident (CVA), congestive cardiac failure (CCF), staying in the hospital in the last three months, using antibiotics and radiological findings; there wasn't a statistical meaningful relation between P. jirovecii positivity and these situations. When the phenomenon groups were evaluated according to PCR and IFA positivity; in IFA and PCR positive patients for immunosupressive there was a meaningful differances (p= 0.003). The positive 28.6 % of cases were immunosuppressed and the 3.8% of PCR or IFA negative cases were immunosupressed. When PCR method was compared with IFA which is called gold standard for sensitivity and specificity; sensitivity was found 61.5% and specificity was found 90.8%. IFA and PCR diagnosis test results were compatible (With McNemar test p= 0.581).

CONCLUSION

Diagnostic sensitivity of staining methods for P. jirovecii in immunocompromised HIV negative patients are found to be low and it was shown that IFA and nested PCR methods have not parallel results.

Investigation of serological results of patients with suspected toxoplasmosis admitted to the ELISA Laboratory of Uludağ University Hospital between 2002-2008

OBJECTIVE

The aim of this study is to investigate the distribution of anti-Toxoplasma gondii IgG and IgM antibodies in patients with suspected toxoplasmosis referred to the Uludağ University Medical School, Department of Medical Microbiology Enzyme-Linked Immunosorbent Assay (ELISA) laboratory over a 72-month period (March 2002-December 2008).

METHODS

The samples were analyzed using VIDAS (BioMérieux, France) IgG-avidity tests and the fluorescent enzyme-linked assay (ELFA) technique.

RESULTS

Results showed that the prevalence of anti-T. gondii IgG and IgM among women (29.2% and 2.02%, respectively) was higher than that of men (21.2% and 1.7%, respectively). The seroprevalence of anti-T. gondii IgG was 30.7% in childbearing-aged women, with rates ranging from 35.8% and 27.4% over the years. Avidity was found to be high, borderline, and lower (81.9%, 10.2%, and 7.9%, respectively) in the fertile age group of 166 women receiving the IgG avidity test.

CONCLUSION

Although the study data may not reflect our entire province, it virtually turns out that the risk of toxoplasmosis must be seriously taken into account, particularly when approaching some risk groups, such as seronegative women of fertile age, pregnant women, and immunocompromised patients.

[The epidemiology of malaria in Bursa--2009-2012]

OBJECTIVE

Malaria is a common disease in many tropical and subtropical areas, which may threaten life. In this study, we examined the epidemiology of malaria in Bursa province using the data provided by the Province Health Directorate, collected over 2009 to 2012.

METHODS

The data include a total of 29.683 blood samples taken by active and passive surveillance. Giemsa-stained thin and thick blood smears were examined with a 100X oil immersion objective using a standard microscope.

RESULTS

A total of 21 (0.07%) malaria cases were detected. Of these, 20 (95.2%) cases were male and 1 (4.8%) case was female, with highest rates occurring in June and September. All of the cases were imported, of whom 10 (47.6%) were caused by Plasmodium vivax and 11 (52.4%) by P. falciparum. All P. falciparum cases were found to be imported cases that traveled to African nations (Côte d'Ivoire, Sudan, Equatorial Guinea, Nigeria, Senegal, Mali, Somalia). Malaria cases were mainly observed in the 15-to-44-year-old range.

CONCLUSION

We believe that these results will lead to better-targeted and more effective malaria control programs.

Coring-out fistulectomy with a newly designed 'fistulectome' for complicated perianal fistulae: a retrospective clinical analysis

AIM

Conventional surgery for complex anal fistula (AF) is associated with continence disturbance and recurrence. In the hope of reducing these we developed a new mechanical device, the 'fistulectome', to excise the entire fistula tract.

METHOD

Between March 2001 and April 2011, 136 patients underwent surgery for a complex AF using the fistulectome. All fistulae were cryptoglandular in origin. Five patients were lost to follow up and were excluded from the analysis.

RESULTS

Of the 131 fistulae, 76 were trans-sphincteric, 14 were suprasphincteric and 16 were extrasphincteric. Seven had a horseshoe extension and 18 were unclassified. Of the 131, 108 had recurred after conventional fistulotomy performed at another centre and 23 were primary. The mean duration of follow up was 34.6 months, the mean hospital stay was 5 days and the healing time was 14 days. Recurrence, flatus incontinence and soiling occurred in 17 (12.9%), four (3.5%) and two (1.52%) patients.

CONCLUSION

The results of this series suggest that coring-out of a fistula using a fistulectome may be a valid treatment for complicated anal fistula.

Synthesis, growth and vibrational spectroscopic study of a novel coumarinoylthiazole

An efficient route was developed for the synthesis of novel 3-(2-morpholinyl-4-phenylthiazol-5-oyl)coumarin (MPTC). FT-IR spectrum of MPTC was recorded and analyzed. The crystal structure data are also described. The vibrational wavenumbers were computed theoretically using the Gaussian03 package of programs using HF/6-31G(d) and B3LYP/6-31G(d) levels of theory. The data obtained from vibrational wave number calculations are used to assign vibrational bands observed in the infrared spectra of MPTC. The first hyperpolarizability, infrared absorption band intensities and intensities of raman active bands are reported. The calculated first hyperpolarizability is comparable with the values reported for compounds of similar structure. The structural parameters of MPTC obtained from XRD studies are in agreement with the calculated values. The unit cell parameters of crystals of MPTC are: a=8.6017(10)Å, b=9.9735(5)Å, c=13.3870(13)Å, α=111.123(6)°, β=90.102(9)°, γ=110.246(6)°, and Z=2,1.397 Mg/m(3).

[The distribution of intestinal parasites detected in the Uludag University Medical School Hospital between 2005 and 2008]

OBJECTIVE

Intestinal parasite infection is still an important public health problem. In this study, patients (outpatients and in-patients) with various gastrointestinal system complaints presenting at various clinics of the Uludag University Medical Faculty, from January 2009-December 2010 were investigated retrospectively for intestinal parasites.

METHODS

Parasitological examinations were done with native-lugol, cellophane-tape methods and trichrome staining in ambiguous cases. Also modified Erlich-Ziehl-Nielsen staining was used to identify Cryptosporidium spp.

RESULTS

In a total of 5,624 cases examined 10.25% were found infected with at least one or more parasite, without difference between genders. Enterobius vermicularis eggs (9.3%) was detected in 227 of 1,971 cellophane tape preparations. The distribution of identified parasites was as follows: Giardia intestinalis, 199 (34.48%); 29 Blastocystis hominis, 136 (23.57%); Entamoeba coli, 83 (14.38%); Enterobius vermicularis, 227 (9.3%). The prevalence of parasite infections in stool samples examined was highest among the age group of 10-29 years old (36.8%), followed by the age group 0-9 years, in which rate was 18.6%. Parasites such as helminth detected in 225 (32.09%) and protozoon in 476 (67.91%) of the patients were included in this study.

CONCLUSION

This study re-emphasises the fact that intestinal parasitic infection is still an important public health problem.

[Travel related urinary schistosomiasis: case report]

Schistosomiasis is the second most frequent parasitic infection worldwide after malaria and is a major public health problem in various countries of the world. In our country due to the increasingf travel to endemic regions, the number of cases is also rising. We report herein a case of schistosomiasis who resided in Africa five years earlier and was referred to hospital with hematuria. Direct microscopic examination of the urine specimen revealed Schistosoma haematobium eggs. Epidemiology and clinical significance of schistosomiasis are also discussed.

[The investigation of malaria cases in Bursa between 2006-2008]

Malaria caused by Plasmodium parasites is one of the most common infectious diseases and an enormous public health problem. In this study, malaria cases detected and reported by the Malaria Control Dispensary of the Infectious Disease Division of Bursa Health Directory from October 2006 through December 2008 have been reported. The cases were evaluated according to age, gender, occupation and localization of the cases (indigenous or imported cases). A total of 23.416 blood smears were examined during this 26-month period and malaria parasite was found in 9 cases (0.038%). Of the 9 positive cases, 8 (88.9%) were male and 1 (11.1%) was female. Of these, 4 (44.5%) were acquired in Azarbajcan; 1 (1.1%) in Pakistan; 1 (1.1%) in Ghana; 1 (1.1%) in Sudan; 1 (1.1%) in an unknown Africa country; and 1 (1.1%) in the southeastern of Turkey. Except for three cases of foreign origin infected with Plasmodium falciparum, all the other cases were caused by Plasmodium vivax. The 0.05% decrease in malaria cases during the last 26-month, compared with prior data of malaria prevalence in Bursa, resulted primarily from a decrease in the number of cases acquired in Turkey.

[Cystic echinococcosis in Turkey from 2001-2005]

Cystic echinococcosis (CE) caused by the metacestode form of Echinococcus granulosus is a major public health problem especially in animal-raising regions of the world. In the present study, CE cases were determined during 2001-2005 by investigating different hospital and health directorship documents and Health Ministry documents, retrospectively. Our results show that there were 2534 (13.13%) cases in the Marmara region; 2114 (16.94%), in the Aegean region; 2578 (16.09%), Mediterranean region; 5404 (38.57%), in the Middle Anatolian region; 428 (5.70%), in the Black Sea region; 844 (6.80%), in the eastern Anatolian region; and 887 (2.75%), in the southeastern Anatolian region making a total of 14,789 CE cases. Finally, it has been determined that the patients were hospitalized for a total of 149,464 days.

FT-IR and NMR investigation of 2-(1-cyclohexenyl)ethylamine: a combined experimental and theoretical study

FT-IR and (1)H, (13)C, DEPT, HETCOR, COSY, and NOESY NMR spectra of 2-(1-cyclohexenyl)ethylamine (CyHEA) have been reported for the first time. The vibrational frequencies and (1)H, (13)C NMR chemical shifts of CyHEA (C(8)H(15)N) have been calculated by means of the Hartree-Fock (HF), Becke-Lee-Yang-Parr (BLYP) and Becke-3-Lee-Yang-Parr (B3LYP) density functional methods with 6-31 G(d) and 6-31 G(d,p) basis sets, respectively. The comparison between the experimental and the theoretical results indicates that density functional B3LYP method is superior to the scaled HF and BLYP approach for vibrational frequencies and predicting NMR properties.

[Malaria in Bursa]

In this investigation, the records of malaria cases detected by the Malaria Control Unit of the Infectious Disease Division of Bursa Health Directory, from January 1, 2003-October 30, 2006, were retrospectively examined. During this period, a total of 64,529 blood samples were examined and 55 malaria cases (ranging from 01-71 years of age) were reported. Of these, 56.3% were found to be imported cases coming to Bursa from other countries for various reasons. According to the records, the total slide positivity determined during the malaria surveillance was 0.08%. With the exception of three cases of Plasmodium falciparum of foreign origin, the cases were caused by Plasmodium vivax. Of the 55 positive cases, 19 (34.5%) were female and 36 (65.5%), male and the highest rate of cases occurred during September. The aim of this study was to aid the work being done in the control of malaria in our region.

[The prevalence and distribution of intestinal parasites detected by the Uludag University Medical School]

In this study, patients (outpatients and in-patients) with various gastrointestinal system complaints presenting at various clinics of the Uludag University Medical Faculty, Bursa, from January 2001-December 2004 were investigated for intestinal parasites. The prevalence of intestinal parasites was evaluated according to age, gender and the months in which cases were seen. Saline and iodine preparations from 8,351 stool samples before and after formal-ethyl acetate concentration were examined under 100x and 400x magnification. Also, trichrome stained preparations in ambiguous cases and modified Erlich Ziehl Nielsen stained preparations for Cryptosporidium spp. were examined by oil-immersion lens (total magnification 1000x). One or more pathogenic parasites were found in 298 of the 8,381 stool samples. Enterobius vermicularis was detected in 227 of 3,758 cellophane tape preparations. The predominant parasite was E. vermicularis (prevalence of 1.56%), followed by Giardia intestinalis (1.03%) and Blastocystis hominis (0.96%). The overall prevalence of intestinal parasitic infection rate was 4.27%. Of these, 40.4% were female and 59.6%, male. The results indicated that 94.9% of the subjects had one parasite and 5.1%, co-infection with two parasites. The rate of intestinal parasites in the 0-9 age group was higher than that of other groups. The incidence of parasitic diseases was lower in this study as compared to results previously reported in our hospital. Although different infection rates were found in these studies, there were no statistically significant differences in our study.

[The epidemiology of malaria in Bursa.]

Malaria is still one of the important public health problems in Anatolia. Since Bursa is a well-developed industrial and agricultural province in the Marmara region, migration rate to this region from eastern and southeastern regions of Turkey is quite high. In this retrospective study, malaria cases detected by the Malaria Control Unit Division of the Bursa Health Directorship from 1986-2002 have been evaluated. The total number of slide-positive cases was 700. Out of the 700 cases of malaria, 695 (99.3%) were found to have been caused by Plasmodium vivax and 5 (0.7%), by P. falciparum. Of these cases, 68.8% were male and of the males, 18.4% were soldiers. The majority of the cases (70.5%) had come from the southeastern region of Anatolia. Positivity rates were found to be highest in 1995 (21%) and 1996 (18.5%). In this study, we have reviewed the malaria cases according to age, gender and occupation as well as transmission characteristics, locality and source of infection.

[Evaluation of the distribution of intestinal parasites in the Uludag University Medical Faculty during a period of eight years.]

The purpose of the present study was to investigate retrospectively the distribution and prevalence of intestinal parasites in patients who presented at the routine parasitology laboratory of the Uludag University Medical Faculty, Bursa, during the 8 years from January 1993-December 2000. A total of 32,346 stool specimens were examined for intestinal parasites using native- Lugol and formol ethyl ether methods. Also, 10,897 cellophane- tape preparations were studied directly. Parasites were found in 8.14% of the samples. Of the patients, 46.32% were females and 53.68%, male. G. intestinalis (3.63%) and Enterobius vermicularis (3.41%) were the most prevalent parasites. The distribution of the parasites according the species was as follows: 115 (0.35%) Entamoeba histolytica and/or dispar, 73 (0.22%) Ascaris lumbricoides, 29 (0.089%) Taenia spp., 7 (%0.021) Dicrocoelium dentriticum, 6 (0.018%) Trichuris trichiura, 4 (0.012%) Hymenolepis nana, and 2 (0.006%) Strongyloides stercoralis. At least one parasite was seen in 96.47% of samples. Two parasites were found in 3.53% of the stool specimens,. The results of our study were similar to the rates of the Marmara Region. Our laboratory findings were found to be lower than previous laboratory findings.

Ileosigmoid knotting in Turkey. Review of 68 cases

PURPOSE

The high mortality associated with ileosigmoid knotting prompted us to review the collected experiences of three university hospitals in order to establish a more rational approach to the problem.

METHOD

The clinical records of 68 patients with ileosigmoid knotting from 1970 to 1990 were reviewed with respect to incidence, etiopathogenesis, clinical features, treatment, and clinical outcome.

RESULTS

The most common type of ileosigmoid knotting was Type IA (48.5 percent), in which the active ileum encircled the passive sigmoid in a clockwise manner. Fifty (73.5 percent) patients developed a gangrenous bowel whereas 18 patients did not show any definite evidence of impairment of bowel viability. En bloc removal of gangrenous knot and reestablishment of intestinal continuity by enteroenteric or enterocolic anastomosis combined with the Hartmann procedure, which was employed in 20 (42.6 percent) cases, constituted the most frequently preferred operation. The mortality rate in this series was 30.9 percent (21/68) and toxic shock, which ultimately resulted in multiple organ failure, was the major cause of death. It was remarkable to note that there was an inverse correlation between the duration of symptoms and the mortality rate reflecting the dramatic rapidity and severity of symptoms due to tightness of the knot which led to early and extensive gangrene, thus inevitably urged the patients to seek medical help without delay.

CONCLUSION

The performance of prompt, individualized surgical treatment in conjunction with the use of advanced measures of critical care to combat the disastrous consequences of multiple organ failure would contribute greatly to improve survival rate in victims of this dreadful entity.