The features of infectious diseases departments and anti-infective practices in France and Turkey: a cross-sectional study

The aim of this study was to assess the infectious diseases (ID) wards of tertiary hospitals in France and Turkey for technical capacity, infection control, characteristics of patients, infections, infecting organisms, and therapeutic approaches. This cross-sectional study was carried out on a single day on one of the weekdays of June 17-21, 2013. Overall, 36 ID departments from Turkey (n = 21) and France (n = 15) were involved. On the study day, 273 patients were hospitalized in Turkish and 324 patients were followed in French ID departments. The numbers of patients and beds in the hospitals, and presence of an intensive care unit (ICU) room in the ID ward was not different in both France and Turkey. Bed occupancy in the ID ward, single rooms, and negative pressure rooms were significantly higher in France. The presence of a laboratory inside the ID ward was more common in Turkish ID wards. The configuration of infection control committees, and their qualifications and surveillance types were quite similar in both countries. Although differences existed based on epidemiology, the distribution of infections were uniform on both sides. In Turkey, anti-Gram-positive agents, carbapenems, and tigecycline, and in France, cephalosporins, penicillins, aminoglycosides, and metronidazole were more frequently preferred. Enteric Gram-negatives and hepatitis B and C were more frequent in Turkey, while human immunodeficiency virus (HIV) and streptococci were more common in France (p < 0.05 for all significances). Various differences and similarities existed in France and Turkey in the ID wards. However, the current scene is that ID are managed with high standards in both countries.

Prevalence of toxoplasmosis, cytomegalovirus and rubella IgG antibodies in Hatay women and children

OBJECTIVE

Toxoplasmosis, cytomegalovirus and rubella may cause congenital infections. The aim of this study is to investigate toxoplasmosis, cytomegalovirus and rubella IgG antibodies in women and children who were admitted to the Hatay Women and Children Hospital between January 1 and December 31, 2009.

METHODS

Levels of IgG antibodies for toxoplasmosis, cytomegalovirus and rubella established with chemiluminescence immunoassay (Architect i2000, Abbott, USA) method were evaluated, retrospectively.

RESULTS

The results were obtained from 1103 cases. Seropositivity of IgG antibodies for toxoplasmosis (n = 743), cytomegalovirus (n = 929) and rubella (n = 746) were 59.9%, 98.9% and 93.6%, respectively

CONCLUSION

Routine serological screening should be recommended in women of childbearing age. Seronegative subjects should be vaccinated for rubella and educated for protection from toxoplasmosis.

The prevalence of interdigital erythrasma in southern region of Turkey

BACKGROUND

Erythrasma is a skin infection which is caused by Corynebacterium minutissimum. Interdigital erythrasma is the most common form.

OBJECTIVE

The aim of this study was to detect the frequency and risk factors of interdigital erythrasma in patients with clinically suspected tinea pedis.

METHODS

This study was conducted between June and December 2010 and included 122 patients who had interdigital foot lesions. All patients were examined using a Wood's lamp. The smears were stained using Gram's method. Direct examination was performed using 20% potassium hydroxide. Sabouraud dextrose agar and brain heart infusion agar were used for cultures. Moreover, the demographical characteristics of patients, concomitant diseases and clinical findings were also recorded. Cases that were found to be positive on Wood's lamp examination and/or Gram staining/culture were considered as erythrasma.

RESULTS

The rate of erythrasma was found to be 46.7%. The mean age was 43.6 years, and the disease was more prevalent in men. The most common clinical finding was desquamation. Mycological examination was found as positive in 40.35% of the patients. No growth was observed in bacteriological cultures. It was found that using only Wood's lamp examination or Gram staining resulted in 11 (9%) and 19 positive patients (15.6%), respectively, whereas using both Wood's lamp examination and Gram staining concurrently resulted in 27 positive patients (22.1%).

CONCLUSION

Interdigital erythrasma is a commonly seen condition and can clinically mimic tinea pedis. A Wood's lamp is a good diagnostic tool, but Gram staining, particularly in those with a negative Wood's lamp result, may be a useful method.

The intensity of antibiotic usage in the university hospital and the investigation of an inappropriate use of antibiotics

AIMS

In the present study, we intended to investigate the intensity of antibiotic administration in our hospital and the ratio of an inappropriate antibiotic usage.

MATERIAL AND METHOD

Related data was collected during 3 consecutive days between 1-3 July 2009 at the Mustafa Kemal University, Faculty of Medicine Hospital. The antimicrobial usage was calculated as defined daily doses (DDDs) per 100 bed-days (BD) according to 2009 ATC-DDD index.

RESULTS

Antibiotics were administered to 74 patients (61.5%) out of 121 who were hospitalized in our hospital. Antibiotic usage in the internal clinics was intended for therapeutical reasons in 18 patients (94.7%) and for prophylactic reasons in 35 patients (77.8%) in the surgical clinics. The use of antibiotics in 44 patients (59.7%) out of 74 was appropriate. However, an inappropriate antibiotic use was detected in 30 patients (40.5%). The inappropriate antibiotics were administered to 21 patients (70%) who were hospitalized in the surgical clinics. A three days total antimicrobial consumption index value in the hospital was 81,19 DDD/100 BD, while this value was found 25,45 DDD/100 BD for the internal clinics and 38,39 DDD/100 BD for the surgical clinics. A positive correlation was observed among the inappropriate antibiotic usage and the antibiotic consumption (p<0.001).

DISCUSSION

Consequently, the ratio of an inappropriate antibiotic usage in our hospital is high and parallel to this, the antibiotic consumption ratio is excessive. It is necessary to share microbiological data and provide an adequate education to reduce the antibiotic consumption and enable a better and rational antibiotic consumption (Tab. 2, Fig. 2, Ref. 22).

A medically treated multiple cerebral hydatid cyst disease

Echinococcosis is a potentially fatal parasitic disease that can affect many animals and humans. The disease results from infection by tapeworm larvae of the genus Echinococcus--notably, E. granulosus, E. multilocularis, E. vogeli andE. oligarthrus. Cyst hydatid disease is usually seen in adults, and mainly affects liver and/or lungs (90%). Cerebral involvement is very rare (1-3%), and more common in children. Therapy consists of medical treatment and surgical intervention if it is possible. The authors report the case of a 55-year-old male patient with multiple intracranial hydatid cysts, who was successfully treated with albendazole (10 mg/kg/day) alone without any surgical intervention.

The effect of growth hormone on ovarian follicular response and oocyte nuclear maturation in young and aged mice

The aim of this study was to investigate the possible effects of recombinant human growth hormone (rhGH) on the ovarian follicle numbers and the nuclear maturity status of ovulated oocytes. Aged and young Balb-C mice were randomly divided into three groups: (i) control, (ii) stimulated with follicle stimulating hormone (FSH) and (iii) stimulated with FSH+rhGH. Ovaries were collected for histological and morphometric investigations. For the determination of nuclear maturation of ovulated oocytes, additional aged and young mice were randomly divided into two groups: (i) stimulated with FSH and (ii) stimulated with FSH+rhGH. In young mice, developing ovarian follicle numbers were significantly higher with rhGH; while in aged mice, there was no statistically significant difference between groups. In young mice co-stimulated with FSH and rhGH, atretic follicle numbers were significantly higher. In aged mice, atretic follicle numbers significantly decreased with FSH while there was a slight decrease with rhGH and this was not significant. The percentage of metaphase-II oocytes were significantly higher in both young and aged mice groups co-stimulated with FSH and rhGH. In conclusion, co-treatment with FSH and rhGH for ovarian stimulation in older mice appears to cause a slight decrease in the number of atretic follicles and thus improves the collection of high numbers of mature, fertilizable oocytes.

Cutaneous anthrax in Eastern Turkey: a review of 85 cases

BACKGROUND

Anthrax is a zoonotic disease diminishing worldwide. Although a very rare disease in developed countries, anthrax is still endemic in developing countries.

AIM

To evaluate the clinical history and features, treatment and outcome of our patients with anthrax and emphasize the importance of the disease in our region.

METHOD

In this study, the records of all patients diagnosed with cutaneous anthrax admitted to Yüzüncü Yil University Medical Faculty between March 2002 and March 2007, were reviewed, and data on age, gender, occupation, clinical symptoms and findings, location and type of lesions, clinical history, laboratory findings, treatment and outcome were recorded.

RESULTS

There were 85 patients [46 (54.1%) male, 39 (45.9%) female; mean age 30.6 years, range 6-72]. All the patients had a history of contact with infected animals or animal products. The infectious agent was found using direct examination of Gram-stained smears from 17 patients (20%), and Bacillus anthracis was isolated from vesicle fluid cultures from 11 patients (12.9%). Diagnosis was based on clinical findings in the remaining 57 patients (67.1%). All patients, except for two with respiratory tract obstruction, made a full recovery.

CONCLUSION

Anthrax continues to be an endemic disease in Turkey, and should be considered in patients with a relevant contact history having a painless ulcer and vesicular skin lesions surrounded by a zone of oedema. Gram staining and simple culture methods are useful aids to diagnosis, but diagnosis may have to be based on clinical grounds in the majority of patients.

The effect of polypropylene mesh on ilioinguinal nerve in open mesh repair of groin hernia

OBJECTIVES

Repair of groin hernia is one of the most common operations performed by general surgeons, and mesh repair methods have gained wide acceptance. Chronic pain is the most serious long-term complication that can occur after repair of groin hernia. The development of chronic pain after herniorraphy has been attributed to several mechanisms, including damage to sensory nerves and mesh inguinodynia.

MATERIAL AND METHODS

Twenty-four rabbits underwent bilateral inguinal dissection and synthetic polypropylene mesh laid on one side. Bilateral inguinal dissection was performed again after 3 months, and samples of nerve tissue were taken from both sides for histological examination.

RESULTS

Light microscopic examination of the sections of control group peripheral nerves were in normal appearance, but the nerve fascicles in experimental group operated with mesh showed axonal dilation and mild-to-severe loss of myelinated axons. Examination of semi-thin and ultra-thin sections in control group peripheral nerve fascicles showed normal morphology. Ultrastructural nerve morphology in experimental group operated with mesh exhibited endoneurinal edema with thickening of both endoneurium and perineurium, causing separation of nerve fibers. Myelin sheaths of fibers showed an ondulation toward the axoplasm and the endoneurium. Separation of myelin layers from each other as a prominent feature of myelin degeneration in nerve fibers was also observed. Axoplasms exhibited edema and crystallization.

CONCLUSIONS

The light microscopic and ultrastructural changes seen in peripheral nerves in experimental group operated with mesh suggested that mechanical compression of peripheral nerves is associated with myelin degeneration, endoneurinal and perineurial edema, fibrosis, axonal loss, and edema that may cause peripheral neuropathy. Chronic groin pain after hernia repair can be possibly caused by the entrapment of peripheral nerves in the scar tissue formed by the mesh.

Ultrastructural analysis of TESE and semen sperm tails from patients exhibiting absolute immotility on the day of ICSI

Sperm flagellar pathology was found to be the underlying cause of motility disorders that lead to male infertility. Conventional in vitro fertilization (IVF) procedures will fail when sperm show a total absence of motility. In such difficult cases intracytoplasmic sperm injection (ICSI) is the only available technique to fertilize an oocyte. Fertilization rates are low and may also be reduced when immotile sperm are used for ICSI from ejaculate of other than epididiymal or testicular origin. Presence of totally immotile sperm in the ejaculate on the day of ICSI if spermatogenesis is normal testicular sperm recovery can improve ICSI outcomes. But for patients having severe morphological or functional sperm defects embryos of lower quality tend to be produced when totally immotile sperm are used. In this study the 2 patients exhibiting totally immotile sperm in their ejaculates and TESE samples on the day of ICSI showed the same ultrastructural abnormalities. Peri-axonemal and axonemal abnormalities that were seen in association with sperm nucleus structural defects suggested that the source of sperm has no effect on morphologic characteristics and also reflects abnormality in both spermatogenesis and spermiogenesis. In this study the two patients who presented with oligoteratozoospermia with total immotility, using either ejaculate or TESE sperm fertilization and embryo development, can be obtained with ICSI, but no pregnancies were established after embryo transfers.

The impact of the source of spermatozoa used for ICSI on pronuclear morphology

BACKGROUND

The aim of this prospective study was to find out whether the source of spermatozoa used for intracytoplasmic sperm injection (ICSI) has an impact on the morphological features of pronucleate zygotes, which make up the basis of a pronuclear scoring system for the selection of the most viable embryos for transfer.

METHODS AND RESULTS

The study group consisted of 194 two pronucleate (2PN) ICSI zygotes, of which 144 originated from ejaculated (ES) and 50 from testicular spermatozoa (TS). At 18 h postinjection, 2PN zygotes were assessed for pronuclear alignment, polarity in nucleoli and cytoplasmic appearance; all of which were found to exhibit similar patterns of distribution between the ES and TS groups (P = not significant). At 25 h, the presence of first cleavage was similar for both groups; 11% of zygotes in the ES and 10% of those in the TS group underwent early cleavage (P = not significant). At 48 h, a quality score was obtained for cleaving embryos by multiplying the number of blastomeres with the grade of the embryo. Pronuclear scoring in both groups of spermatozoa correlated with embryo quality score at 48 h postinjection. There was a trend for a higher incidence of early cleavage and a lower incidence of pronuclear arrest with better pronuclear scoring embryos for both types of spermatozoa.

CONCLUSION

The morphological features of pronucleate zygotes at 18 h after microinjection with ES and TS are similar to each other.

Histopathological and functional effects of radiation therapy in obstructive uropathy

Leukocyte influx into the cortex and medulla of the kidney is seen following acute ureteral obstruction. To investigate the macrophage influx and alterations in glomerular filtration rate (GFR) and to evaluate the effects of early radiation therapy on these parameters, we evaluated 20 rabbits in four groups. In the first group preoperative technetium-99m scanning preceding bilateral ureteral complete obstruction was performed. All rabbits received whole body irradiation of 1316 rads. Then the bilateral ureteral obstruction was released after 24 hours. Two hours after releasing, the last scanning was performed. The kidneys were immediately removed and histopathological examination was done. In the second group, all procedures except radiotherapy were done. The third group underwent sham laparotomy to assess the effects of surgical trauma on renal functions. The fourth group of rabbits was considered as control. We have observed an apparent macrophage influx into the cortex and medulla of the kidney following bilateral ureteral obstruction (p=0.000). However, irradiation reduced the infiltration significantly (p=0.000). Also in cases who received radiotherapy GFR was preserved to a significantly higher degree (p=0.000). We concluded that irradiation following acute ureteral obstruction has protective effects on renal function through abolition of the infiltrating cells.

Histopathological and ultrastructural examination of the rat conjunctiva after exposure to tobacco smoke

Exposure to tobacco smoke can cause irritation of the conjunctiva. We conducted this study to identify the effect of tobacco on rat conjunctiva. Animals were divided into experimental and control groups and we exposed the experimental group to tobacco smoke. Control group rats inhaled only room air. Spectrophotometric analysis of the smoke-air mixture revealed that many toxic substances were present in this compound. We found very high levels of plasma thiocyanate after exposure to smoke in experimental group animals but no increase in the control group. So, this data indicates that these animals inhaled smoke effectively in our method. After 3 months conjunctivas were examined by light and electron microscopy. In the experimental group, conjunctivas were thinned, atrophied and microvillous projections and desmosomal connections were absent in comparison with the control conjunctivas. This pathologic change is very similar to conjunctival response to chronic irritants of any type.