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Öğe First case report of neurobrucellosis associated with hydrocephalus(ELSEVIER SCIENCE BV, 2008) Guney, Figen; Gumus, Haluk; Ogmegul, Aysegul; Kandemir, Bahar; Emlik, Dilek; Arslan, Ugur; Tuncer, InciBrucellosis is a common zoonosis in many parts of the world, including Mediterranean and Middle Eastern countries. The disease is primarily related to occupations at risk, such as veterinarians, farmers, laboratory technicians, abattoir workers, and others working with animals and their products. Neurologic complications of brucellosis are quite rare, ranging from 1.7 to 10% of those infected. To date, no cases of neurobrucellosis with hydrocephalus have been reported. A 38-year-old right-handed farmer complained of headaches, nausea, vomiting, gait disturbance, and sweating for 2 days. He also complained of bilateral hearing loss of 4 months duration. On neurologic examination, dysmmetry, dysdiadochokinesis, ataxia on the left, and bilateral sensorineural hearing loss existed. On cranial MRI, a communicating hydrocephalus was noted. Because the patient consumed fresh sheep cheese and was a farmer, brucellosis was considered in the differential diagnosis. Brucella agglutination was positive with a 1/320 titer in the blood and a 1/80 titer in the cerebrospinal fluid. Ceftriaxone, doxycycline, and rifampicin were administered and by the fourth week of treatment, the ataxia was markedly improved, and the patient was able to walk without support. His cranial MRI demonstrated a total regression of the hydrocephalus. As a result, we suggest that neurobrucellosis should be considered in patients with hydrocephalus, especially if they live in an endemic area for brucellosis, even in the absence of other systemic signs. (c) 2008 Elsevier B.V. All rights reserved.Öğe Multipl Bölge Tutulumu Gösteren Hidradenitis Süppürativa Olgusu(2011) Kandemir, Bahar; Arıbaş, Emel Türk; Erayman, İbrahim; Ulu, AyşeHidradenitis süppürativa deri ve deri altı dokuyu tutan kronik seyirli, relapslarla seyreden ve skatrisle sonlanmaya eğilimli bir hastalıktır. Vücudun apokrin bez içeren bölgelerinde; daha çok aksiller, inguinal ve anogenital bölgelerde ağrılı inflame lezyonlar ile karakterizedir. Hastalığın kliniği değişkendir. Hafif olgular rekürren izole nodüller şeklinde ortaya çıkabilirken ağır seyreden olgularda kronik inflamasyon skar dokusu, fonksiyonel yetersizlik ve nadiren de squamöz hücreli karsinoma sebep olabilir. Tedavi seçenekeleri topikal ve sistemik antibiyotikler, oral retinoidler, cerrahi girişim, hormonal tedavi ve immunsupressif tedaviyi içerir. Bu yazıda topikal ve sistemik antibiyotik tedavisine yanıt vermeyen 34 yaşındaki erkek hastada ortaya çıkan ve multipl tutulum gösteren bir hidradenitis süppürativa olgusu sunulmuşturÖğe Nozokomiyal Acinetobacter Baumannii Suşlarının Antibiyotik Duyarlılığı(2010) Balcı, Mehmet; Bitirgen, Mehmet; Kandemir, Bahar; Türk Arıbaş, Emel; Erayman, İbrahimSelçuk Üniversitesi Meram Tıp Fakültesi Hastanesi’nde yatan hastalardan Eylül 2005-Mart 2007 arasında İnfeksiyon Hastalıkları Anabilim Dalı Laboratuvarı’na gönderilen, çeşitli klinik örneklerden izole edilen ve hastane infeksiyon etkeni olarak tanımlanan 79 Acinetobacter baumannii suşu çalışmaya alınmıştır. Suşların % 63’ü yoğun bakım ünitelerinde yatan hastalardan izole edilmiştir. Anestezi ve Reanimasyon Yoğun Bakım Ünitesi % 25 ile A.baumannii’nin en sık izole edildiği klinik olarak tespit edilmiştir. Bu çalışmada suşların % 43’ü solunum sistemi, % 24’ü yara yeri, % 14’ü idrar, % 11’i kan, % 6’sı beyin omurilik sıvısı ve % 1’i kateter örneğinden izole edilmiştir. Kirby-Bauer disk difüzyon tekniği ile üçünçü kuşak sefalosporinlere % 95’in üzerinde direnç saptanmıştır. Tetrasikline % 92, piperasilin/tazobaktama % 84, siprofloksasine % 82, ampisilin/sulbaktama % 81, trimetoprim/sulfametoksazole % 78, levofloksasine % 76, tobramisine % 71, amikasine % 66, meropeneme % 63 ve imipeneme % 49 direnç bulunmuştur.Öğe RISC FACTORS ASSOCIATED WITH IMIPENEM RESISTANCE IN NOSOCOMIAL ACINETOBACTER BAUMANNII INFECTIONS(NOBEL ILAC, 2012) Balci, Mehmet; Bitirgen, Mehmet; Kandemir, Bahar; Aribas, Emel Turk; Erayman, IbrahimObjective: This study was conducted to identify the risk factors associated with imipenem resistance in recently increase with frequency of nosocomial Acinetobacter baumannii infections. Material and Method: In the present study, strains of A. baumannii isolated from various clinical samples obtained from the patients followed at the Meram Faculty of Medicine Hospital of Selcuk University between September 2005 and March 2007 and whose samples were sent to the Department of Clinical Bacteriology and Infectious Disease laboratories were evaluated. Results: The imipenem resistance rate of the 79 patients who were evaluated was 54.5%; risc factors associated with imipenem resistance were determined according to the E-test method. Prolonged hospitalization, previous use of a third generation cephalosporin, carbapenem and glycopeptides, use of any antibiotic for longer than 21 days, presence of a central catheter, tracheostomy and/or intubation, mechanical ventilation, transfusion, administration of total parenteral nutrition, use of an antiacid, hemodialysis or hemofiltration and the presence of pneumonia were shown to be resistance-associated factors by using single variance analysis (p<0.05). Independent risk factors associated with imipenem resistance were determined to be the presence of a central catheter [odds ratio (OR) 4.34; 95% confidence interval (CI) 1.1-17.1; p=0.010], carbapenem use (OR 3.769; 95% CI 1.1-12.7; p=0.000), and period of hospitalization for longer than 21 days (OR 3.787; 95% CI 1.01-14.696; p=0.000) by using multiple variance analysis. Isolation of A. baumannii from the surgical site was associated with imipenem sensitivity (OR 0.176; 95% CI 0.45-0.684; p=0.05). Conclusion: The incidence of imipenem resistant A. baumannii infections increased during the last years especially in critical care units. Imipenem resistant Acinetobacter baumannii infections should be considered and required precautions must be taken in patients who had a history of the usage of central venous catheter and carbapenems and in patients with long hospital stay.Öğe Role of Tumor Necrosis Factor Alpha Promoter Polymorphisms in Interferon Related Side Effects in Chronic Hepatitis B Patients Under Interferon Alpha 2b Treatment(2019) İnkaya, Ahmet Çağkan; Arıbaş, Emel Türk; Kandemir, Bahar; Acar, Hasan; Bitirgen, MehmetObjective: Interferon alpha therapy is associated with series of adverse ef-fects leading premature discontinuation of treatment. Here we aimed to de-termine the effects of Tumor necrosis alpha promoter polymorphisms on in-terferon related side effects during interferon alpha 2b treatment in chron-ic hepatitis B patients.Material and Methods: This observational study enrolled 50 chronic hepati-tis B patients, who were treated with interferon alpha 2b 10 tiw plus lamivu-dine 100mg/day at Selçuk University Meram Medical Faculty Department of Infectious Diseases and Clinical Bacteriology between 2006-2007. Patients were followed-up with complete blood count, transaminases and amylase monthly at out patient clinics of our department. All patients were asked to fill a questionnaire to evaluate the interferon related side effects at every vis-it. Tumor necrosis factor alpha -238 and -308 polymorphisms were investi-gated with PCR-Restriction fragment length polymorphisms.Results: Arthralgia was present in 93.8% of patients. Exhaustion, loss of ap-petite, mount dryness and fever are the leading complaints of the patients. Median complaint scores were 9, 9.5, 11 and 5 at 4th, 12th, 24th and 48th week visits, respectively. Thrombocytopenia and leucopenia were detected in 8 (16%) and 5 (10%) patients, respectively. One-third of the patients report-ed depressive mood however, depression was diagnosed in 5 (10%) patients. TNF alpha promoter 238GG and 308GG allele was present in 42/50 and 43/50 patients, respectively. No association was found between TNF pro-moter allele and certain patient-reported side effect, complaint score, hema-tological and psychological adverse effects. Conclusion: TNF alpha promoter polymorphisms do not contribute to oc-currence of IFN alpha treatment related side effects.Öğe Tularemia presenting with tonsillopharyngitis and cervical lymphadenitis: Report of two cases(TAYLOR & FRANCIS AS, 2007) Kandemir, Bahar; Erayman, Ibrahim; Bitirgen, Mehmet; Aribas, Emel Turk; Guler, SelmaTularemia is a zoonotic disease caused by Francisella tularensis. Francisella tularensis is transmitted to humans by direct contact or ingestion of infected animal tissues, through the bite of infected arthropods, by consumption of contaminated food or water, or from inhalation of aerolized bacteria. In this report we describe 2 cases with oropharyngeal tularemia who presented with tonsillopharyngitis and cervical lymphadenitis.
