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Öğe An alternative treatment approach in tetanus: Botulinum toxin(SAGE PUBLICATIONS INC, 2015) Demir, Nazlim Aktug; Sumer, Sua; Ural, Onur; Ozturk, Serefnur; Celik, Jale BengiTetanus is a preventable infectious disease caused by tetanus toxin (tetanospasmin) produced by Clostridium tetani. Tetanus is still an important health problem in low- and middle-income countries (LMICs). Botulinum toxin administration is a treatment approach that has been used in recent years to reduce rigidity and spasms in tetanus patients. This case report focuses on its efficacy.Öğe ANTHRAX IN UPPER EYELID(NOBEL ILAC, 2013) Koktekir, Bengu Ekinci; Sumer, Sua; Gedik, Sansal; Okudan, SuleymanAnthrax is an acute infection caused by Bacillus anthracis. Although it is a zoonotic disease that mainly affects herbivorous animals, it might also be contagious to humans by infected animals. The most common type is skin anthrax. When eyelid is involved; echymosis, bulla formation and necrosis can be observed. We report a 75 years old woman presenting with bilateral extensive lid echymosis and edema and diagnosed as anthrax. The clinical findings resolved with appropriate systemic and topical antibiotic treatment, and the lesions on the eyelid resulted with scatrizating ectropion. In failure of early diagnosis and treatment, there is a high risk of mortality and sequela with this particular disease which rarely involves eyelids.Öğe Are bone morphogenetic protein-7 (BMP-7) serum levels correlated with development of hepatic fibrosis?(J INFECTION DEVELOPING COUNTRIES, 2014) Demir, Nazlim Aktug; Kolgelier, Servet; Inkaya, Ahmet Cagkan; Sumer, Sua; Demir, Lutfi Saltuk; Pehlivan, Fatma Seher; Arslan, MahmureIntroduction: Bone morphogenetic protein-7 (BMP-7) is a key protein in organogenesis and liver development. The protein has been studied in the context of liver fibrosis and regeneration. The aim of the present study was to explore any possible association between fibrosis levels (as revealed by liver biopsy) and serum BMP-7 levels. Methodology: A total of 189 patients with chronic hepatitis B and 51 healthy controls were enrolled in the study. Results: The study group contained 120 (63.5%) males and 69 (36.5%) females, and the control group contained 25 males (49.0%) and 26 females (51%). In general, serum BMP-7 values of patients were higher than those of controls (p = 0.001). Serum BMP-7 values of patients with liver fibrosis of stages 1, 2, 3, or 4 were higher than control values (all p values = 0.01), but the serum BMP-7 levels of patients with stage 5 fibrosis were similar to that of controls. Associations between fibrosis stage and the serum levels of BMP-7, ALT, HBVDNA, platelets, and albumin were all statistically significant (p = 0.001). The AUROC for the BMP-7 level in advanced stage fibrosis was found to be 0.23. The data were analyzed using the binary logistic regression analysis (backward stepwise method) and BMP-7, HBVDNA, and platelet levels were found to be risk factors associated with fibrosis (p values 0.031, 0.040, and 0.001, respectively). Conclusions: BMP-7 may play anti-inflammatory and anti-fibrogenic roles in the pathogenesis of chronic hepatitis B infection.Öğe Association of sociodemographical features, antiviral treatment, and necroinflammatory activity with depression and anxiety in chronic hepatitis B patients(CUMHURIYET UNIV TIP FAK PSIKIYATRI ANABILIM DALI, 2015) Celik, Mustafa; Demir, Nazlim Aktug; Sumer, Sua; Demir, Lutfi SaltukObjective: Psychiatric disorders like depression and anxiety are known to be more prevalent in patients with chronic hepatitis B than healthy individuals. This increased prevalence may be due to multiple factors such as psychological distress associated with having a chronic disease, necroinflammatory activity in liver, side effects of treatment with antiviral agents or interferons, and/or direct effect of hepatitis viruses on central nervous system. Purpose of this study was to evaluate several risk factors that may be associated with anxiety and depression in patients with chronic hepatitis B. Methods: This study included 195 chronic hepatitis B patients. A psychiatrist made clinical interviews with the patients and filled Sociodemographic Data Form, Hamilton Anxiety Rating Scale (HARS), and Hamilton Depression Rating Scale (HDRS). Needle biopsies were performed to 175 patients who met biopsy criteria of American Association for the Study of Liver Diseases. Knodell Histological Activity Index was used to evaluate biopsy materials. HBV DNA and ALT levels were measured from patients' sera. Findings: In the study sample, 119 patients were males and 76 were females. Mean HARS score was 7.3 +/- 6.2 and mean HDRS score was 8.8 +/- 6.6. Both HARS and HDRS scores were higher in females than males. HARS score was higher in patients with a family history of chronic hepatitis and both HARS and HDRS scores were higher in patients with comorbid medical illness. Alanine aminotransferase, HBV DNA levels, and level of fibrosis in liver biopsy didn't affect HARS or HDRS scores. Also, there wasn't a difference in HARS or HDRS scores according to patients' usage of pegylated interferon, or oral antiviral therapy. Conclusion: Multiple factors affect the relation between chronic hepatitis and psychiatric disorders like anxiety and depression. Results of our study suggest that female sex, presence of a family history for chronic hepatitis B, comorbidity of other medical diseases, and ethnic origin affect more than the level of necroinflammatory activity and cellular damage in the liver or antiviral treatments.Öğe ATYPICAL HSV ENCEPHALITIS WITH INITIAL NEGATIVE POLYMERASE CHAIN REACTION FOR HSV DNA(NOBEL ILAC, 2014) Sumer, Sua; Ural, OnurHSV-DNA in cerebrospinal fluid by polymerase chain reaction is considered as the gold standard in the diagnosis of Herpes Simplex Virus (HSV) encephalitis. Sometimes the test may be negative in the initial stage of the disease. HSV-DNA quantitation by polymerase chain reaction should be repeated in 3-7 days if a patient is thought to have HSV encephalitis, as indicated by electroencephalography / magnetic resonance imaging of brain fin. clings even though the initial HSV-DNA quantitation by polymerase chain reaction is negative. We presented two cases with a tentative diagnosis of HSV encephalitis with atypical course, whose polymerase chain reaction results were negative for HSV-DNA initially.Öğe A CASE OF SJOGREN'S SYNDROME ACCOMPANIED BY SIGNS OF NON-CARDIAC PULMONARY EDEMA AND INFECTION(NOBEL ILAC, 2013) Sumer, Sua; Efe, Pakize Basak; Ural, Onur; Yilmaz, SemaAt first presentation connective tissue diseases may mimic infectious diseases. But recurrent non-cadiac pulmonary edema accompanied by serious infectious signs is observed rarely This patient presented with signs of pneumonia, and developed recurrent non-cadiac pulmonary edema, and had to be intubated despite appropriate treatment and Sjogren's syndrome was diagnosed after examinations and detailed history which were warranted by lath of treatment response. She was treated with hydroxychloroquine. This patient's problem was thought to be due to both findings of systemic involvement of connective tissue disease and increased frequency of infectious diseases in these patients.Öğe The Clinical Significance of Serum Apoptotic Cytokeratin 18 Neoepitope M30 (CK-18 M30) and Matrix Metalloproteinase 2 (MMP-2) Levels in Chronic Hepatitis B Patients with Cirrhosis(KOWSAR PUBL, 2013) Sumer, Sua; Demir, Nazlim Aktug; Kolgelier, Servet; Inkaya, Ahmet Cagkan; Arpaci, Abdullah; Demir, Lutfi Saltuk; Ural, OnurBackground: Serum apoptotic cytokeratine 18 neoepitope M30 (CK-18 M30) and matrix metalloproteinase 2 (MMP-2) have been popular markers for detecting liver fibrosis in recent years. CK-18 is a major intermediate filament protein in liver cells and one of the most prominent substrates of caspases during hepatocyte apoptosis. MMP-2 plays an important role in tissue remodeling and repairing processes during physiological and pathological states. Objectives: The objective of this study was to investigate the significance of CK-18 M30 and MMP-2 levels for clinical use in patients with chronic hepatitis B (CHB), as well as their sensitivity in determining cirrhotic patients. Patients and Methods: This study included 189 CHB patients and 51 healthy controls. A modified Knodell scoring system was used to determine the fibrosis level in chronic hepatitis B patients. CK-18 M30 levels were determined with an M30-Apoptosense ELISA assay. MMP-2 levels were determined with the ELISA assay. Results: The study group consisted of 132 (69.8%) males and 57 (30.2%) females, and the control group consisted of 25 males (49.0%) and 26 females (51%). Patients' CK-18 M30 levels were higher than values of the control group (308 [1-762] vs. 168 [67-287], P=0.001). Serum MMP-2 levels were found to be statistically higher in the patient group with respect to the controls (3.0 [1.1-6.8] vs. 2.0 [1.2-3.4], P=0.001). The highest serum CK-18 M30 and MMP-2 levels were measured in patients with cirrhosis. Serum apoptotic CK-18 M30 levels positively correlated with advanced age, fibrosis stage, serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels (P=0.001, 0.033, 0.001, and 0.001, respectively). Serum MMP-2 levels positively correlated with fibrosis stage, serum ALT, and AST levels (P=0.001, 0.001, and 0.001, respectively). Conclusions: Our study indicated that CK-18 M30 and MMP-2 levels were higher in CHB patients compared to healthy controls and they were in association with significant hepatic fibrosis, especially cirrhosis.Öğe Evaluation of the Relation Between Hepatic Fibrosis and Basic Laboratory Parameters in Patients With Chronic Hepatitis B Fibrosis and Basic Laboratory Parameters(KOWSAR PUBL, 2014) Demir, Nazlim Aktug; Kolgelier, Servet; Ozcimen, Serap; Gungor, Gokhan; Sumer, Sua; Demir, Lutfi Saltuk; Inkaya, Ahmet CagkanBackground: The hepatitis B virus is an important healthcare problem. According to current clinical practice, a liver biopsy is required for the diagnosis and treatment of chronic liver disease. However, a liver biopsy is an invasive, inconvenient procedure, which requires an expert pathologist opinion. Therefore requirement of biochemical tests, which are considered to indicate hepatic fibrosis and may be repeated easily, increases gradually today. Objectives: This study evaluated the correlation between hepatic fibrosis and routine laboratory values in patients with chronic hepatitis B. Patients and Methods: The files of 456 patients with CHB (chronic hepatitis B) who were referred to the infectious diseases and clinical microbiology clinic between January 2009 and March 2012 were screened retrospectively. Liver biopsy samples were examined according to Ishak scoring. Laboratory parameters and histopathology reports were recorded, and correlations between the fibrosis grade and laboratory parameters were analyzed. Results: There were 320 male and 136 female patients, with a mean age 36.7 +/- 12.1 years. According to liver biopsy results, a low fibrosis score (stage 0-2) was detected in 281 patients (61.6%), and a high fibrosis score ( stage 3-5) was detected in 175 patients (38.4%). Patients with a high fibrosis score had significantly higher ALT (alanine amino transferase), AST (aspartate aminotransferase), and HBV-DNA values and a significantly lower platelet count compared with those with a low fibrosis score (P=0.001, 0.001, 0.025, and 0.001, respectively). A positive correlation was detected between the fibrosis score and age, BMI, HAI, ALT, and AST values, and a negative correlation was detected between the fibrosis score and albumin and platelet counts. In the regression analysis performed to evaluate the factors associated with high-stage fibrosis, fibrosis was determined to be associated with thrombosis, ALT, and gender. The results of the regression analysis demonstrated that the risk of fibrosis was 4.6 fold higher in men. Conclusions: According to the results obtained in our study, advanced age, higher BMI, AST, ALT, and HBV-DNA levels, and low albumin and platelet levels are correlated with advanced fibrosis in patients with CHB.Öğe THE IMPORTANCE OF SOLUBLE UROKINASE PLASMINOGEN ACTIVATOR RECEPTOR IN PATIENTS WITH ACUTE BRUCELLOSIS(NOBEL ILAC, 2015) Demir, Nazlim Aktug; Dagi, Hatice Turk; Findik, Duygu; Sumer, Sua; Ural, Onur; Kolgelier, ServetObjective: Brucellosis is a common zoonotic infectious disease especially in Mediterranean countries. Inflammatory markers are elevated during the course of acute brucellosis. C-reactive protein (CRP) is the most commonly used biochemical marker in clinical practice. Soluble urokinase type plasminogen activator receptor (suPAR) is an interesting biomarker which has drawn attention recently. Purpose o f this study is to examine correlation between suPAR and CRP levels as markers o f infectious disease in patients diagnosed with acute brucellosis. Material and Method: This study included 125 acute brucellosis patients and 50 healthy controls. Pretreatment blood samples were taken from the patients. suPAR levels were measured using ELISA and CRP levels were measured with nephelometry. Results: There was a positive correlation between suPAR levels and CRP, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (p=0.045, 0.039, 0.040; respectively). When we compared patient and control groups, CRP and suPAR levels were significantly higher than controls (p=0.001, 0.001; respectively). Growth in blood culture was detected in 14 (11.2%) patients. Tlrere was not a significant difference between patients who have or did not have growth in blood cultures (p=0.117). In the ROC curve analysis performed for suPAR, area under the curve (AUC) was 93.6% (p=0.001). Sensitivity and specificity were calculated as 84.8% and 86.0%, respectively, when suPAR's cut-off value was taken as 3.85 ng/mL according to the ROC curve. Conclusion: Results of this study suggest that suPAR, like CRP, is a promising biomarker in acute brucellosis.Öğe THE IMPORTANCE OF SONICATION IN THE DIAGNOSIS OF PROSTHETIC JOINT INFECTIONS(NOBEL ILAC, 2017) Sumer, Sua; Erkocak, Omer Faruk; Arslan, Ugur; Findik, Duygu; Dagi, Hatice Turk; Aydin, Bahattin Kerem; Demir, Nazlim AktugObjective: The objective of this study is to investigate the efficacy of sonication method used to determine the cause in the diagnosis of prosthetic joint infections (PJI). Material and Method: This study included 30 patients who were operated due to prosthesis infection and as a control group 10 patients whose prostheses were removed due to mechanical reasons and who had no sign of infection. Cultures were prepared from these tissue samples through gram staining and conventional methods. The prostheses removed from the patients were put into the sonication device in sterile water with ringer lactate. After sonication, Gram staining, cultures and polymerase chain reaction (PCR) were made. Results: During the Gram staining done prior to the sonication, microorganisms were found in six patients (20%); after the sonication, microorganisms were seen in nine patients (30%), but this difference was not statistically significant (p>0.05). While agents were found in the cultures of 11 patients (36.7%) that were prepared using the conventional method, agents were found in 20 patients (66.7%) with the sonication method. The rate of detecting the agent in the culture prepared after sonication was statistical significantly higher than in the culture prepared with conventional methods (p=0.004). The sensitivity of PCR was found 63.3%. Conclusion: The sonication method of PJI is basically a procedure performed to increase the detectability of microorganisms. We found in the present study that the sonication method was obviously more precise than conventional methods in the microbiological diagnosis of PJI.Öğe Is serum high-mobility group box 1 (HMGB-1) level correlated with liver fibrosis in chronic hepatitis B?(LIPPINCOTT WILLIAMS & WILKINS, 2017) Inkaya, Ahmet Cagkan; Demir, Nazlim Aktug; Kolgelier, Servet; Sumer, Sua; Demir, Lutfi Saltuk; Ural, Onur; Pehlivan, Fatma SeherBackground: High-mobility group box 1 (HMGB1), identified as an alarmin molecule, was shown to have a role in virus-triggered liver injury. We aimed to evaluate the association between serum levels of HMGB1 and liver fibrosis. Method: This cross-sectional case-control study included 189 chronic hepatitis B (CHB) patients and 51 healthy controls. All patients underwent liver biopsy and modified Knodell scoring system used to determine the fibrosis level in CHB patients. Serum HMGB1 levels were determined with enzyme-linked immunosorbent assay (ELISA). Results: Mean serum HMGB1 levels of patients (58.1 +/- 54.7) were found to be higher than those of the control group (7.1 +/- 4.3) (P=. 001). HMGB1 levels of patients with advanced-stage fibrosis (stage 4 and 5) were detected to be higher than those of patients with early-stage fibrosis (stage 1-3). However, this difference was not statistically significant (P>. 05). Albumin levels of fibrosis 3 and 4 patients were lower than fibrosis 1 and 2 patients. ALT, HBV DNA, and AFP levels of fibrosis 5 patients were significantly higher than fibrosis 1 and 2 patients, and their platelet and albumin levels are lower than fibrosis 1 and 2 patients (P<. 001). In a logistic regression model, fibrosis levels were correlated with ALT values and inversely correlated with albumin levels. Conclusion: In this study, we demonstrated that serum HMGB1 levels increase in the early course of liver injury and this increase is not correlated with severity of the liver damage.Öğe Ocular effects of pegylated interferon-alpha in patients with chronic hepatitis B(INFORMA HEALTHCARE, 2013) Koktekir, Bengu Ekinci; Sumer, Sua; Bakbak, Berker; Gedik, Sansal; Gonul, Saban; Ural, OnurPurpose: To evaluate the early retinal changes and its reflection on the visual field examination in chronic hepatitis B (CHB) patients using pegylated interferon-alpha (PEGIFN-alpha) monotherapy. Patients and methods: Thirty eyes of fifteen patients with CHB were examined prospectively for changes in the fundus examination and visual field examination (both Humphrey Perimetry and Frequency Doubling Perimetry). The patients were examined before and in 3 months intervals after starting the PEGIFN-alpha treatment. The changes in the fundus examination were noted and the visual field examinations, retinal nerve fiber thickness, Schirmer scores and color vision before and at 3 months of the treatment were compared. The statistical evaluation was performed with paired-t test, using SPSS 16.0 Inc. (Chicago, IL). Results: The mean age of the 15 patients (seven male, eight female) was 52.5 +/- 12.4 years. There was no significant retinal change in none of the patients. Neither the visual field examination with Humphrey Field Analyzer nor the Frequency Doubling Perimetry results has demonstrated any significant change during 3 months follow-up. There was a statistically significant increase in the retinal nerve fiber layer (RNFL) thickness; while Schirmer test scores for dry eye assessment was significantly decreased. Conclusion: PEGIFN-alpha monotherapy, which is used for treatment of CHB, may cause some changes in the thickness of RNFL that may necessitate the close follow-up for further morphological changes of the optic disc in these patients.Öğe Plasmodium falciparum and Salmonella Typhi Co-Infection: A Case Report(ANKARA MICROBIOLOGY SOC, 2014) Sumer, Sua; Ural, Gaye; Ural, OnurMalaria and salmonella infections are endemic especially in developing countries, however malaria and salmonella co-infection is a rare entity with high mortality. The basic mechanism in developing salmonella co-infection is the impaired mobilization of granulocytes through heme and heme oxygenase which are released from haemoglobin due to the breakdown of erythrocytes during malaria infection. Thus, a malaria infected person becomes more susceptible to develop infection with Salmonella spp. In this report a case with Plasmodium falciparum and Salmonella Typhi co-infection was presented. A 23-year-old male patient was admitted to hospital with the complaints of diarrhea, nausea, vomiting, abdominal pain, fatigue and fever. Laboratory findings yielded decreased number of platelets and increased ALT, AST and CRP levels. Since he had a history of working in Pakistan, malaria infection was considered in differential diagnosis, and the diagnosis was confirmed by the detection of P.falciparum trophozoites in the thick and thin blood smears. As he came from a region with chloroquine-resistant Plasmodium, quinine (3 x 650 mg) and doxycycline (2 x 100 mg/day) were started for the treatment. No erythrocytes, parasite eggs or fungal elements were seen at the stool microscopy of the patient who had diarrhoea during admission. No pathogenic microorganism growth was detected in his stool culture. The patient's blood cultures were also taken in febrile periods starting from the time of his hospitalization. A bacterial growth was observed in his blood cultures, and the isolate was identified as S. Typhi. Thus, the patient was diagnosed with P.falciparum and Salmonella Typhi coinfection. Ceftriaxone (1 x 2 g/day, 14 days) was added to the therapy according to the results of antibiotic susceptibility test. With the combined therapy (quinine, doxycycline, ceftriaxone) the fever was taken under control, his general condition improved and laboratory findings turned to normal values. However, on the fifth day of his anti-malaria therapy sudden bilateral hearing loss developed due to quinine use. Thus, the treatment was replaced with an artemisinin-based (arthemeter/lumefantrine) combination therapy. No adverse effects were detected due to artemisinin-based therapy, and the patient completely recovered. In conclusion, if a patient is diagnosed with malaria, he/she should be closely monitored in terms of having co-infections and appropriate diagnostic methods including blood cultures taken in febrile episodes should be performed.Öğe Primary hydatid disease of brachialis and biceps brachii muscles: a case report(SAGE PUBLICATIONS INC, 2014) Aydin, Bahattin Kerem; Acar, Mehmet Ali; Sumer, Sua; Demir, Nazlim Aktug; Erkocak, Omer Faruk; Ural, OnurPrimary hydatid cyst of the skeletal muscle is very rare and accounts for less than 1% of all cases. It is often asymptomatic and can pose diagnostic problems. Accurate diagnosis should be made using ultrasonography and magnetic resonance imaging. Proper treatment should be a wide surgical resection of the localized muscle with the aid of antihelmintic chemotherapy pre- and postoperatively. We report a case of primary hydatic cyst located simultaneously in both the biceps brachii and brachialis muscles, treated with wide resection surgery and pre- and postoperative anthelmintic chemotherapy.Öğe RISK FACTORS AND TREATMENT APPROACHES FOR URINARY TRACT INFECTIONS CAUSED BY COMMUNITY AND HOSPITAL ACQUIRED EXTENDED SPECTRUM BETA-LACTAMASE PRODUCING ESCHERICHIA COLI AND KLEBSIELLA PNEUMONIAE(NOBEL ILAC, 2016) Karadogan, Eda; Sumer, Sua; Demir, Nazlim Aktug; Ural, OnurObjective: In recent years, extended-spectrum beta-lactamase (ESBL) producing microorganisms are responsible not only for healthcare-associated but also for community-acquired urinary tract infections (UTI). The aim of this study is to evaluate the risk factors of community acquired and healthcare associated UTI caused by ESBL producing Escherichia coli and Klebsiella pneumoniae and treatment options in outpatients and inpatients. Material and Method: In this study 200 patients with UTI caused by ESBL producing E.coli and K.pneumoniae followed up between 1 January 2012 and 31 December 2013 at Selcuk University Faculty of Medicine Hospital were evaluated with file review. Results: Compared to community-acquired UTI presence of underlying disease, previous antibiotic use, urinary catheterization, hospital admission in the last 6 months were more common in healthcare associated infection When inpatient treatment was evaluated imipenem was more commonly used in healthcare associated infections and when outpatient treatment was evaluated the combination of nitrofurantoin and fosfomycin was more commonly used in community acquired infections. Conclusion: The presence of underlying disease, history of antibiotic use in the past month, hospital admission in the last 6 months and urinary catheterization were highlights in healthcare associated UTI caused by ESBL producing microorganisms. Carbapenems were seen the first choice in the treatment of these infections. According to clinical and laboratory findings, combination of nitrofurantoin and fosfomycin was seen to be o good alternative for treatment of outpatients with UTI caused by ESBL producing E.coli and K.pneumoniae.Öğe Serum Levels of Annexin A2 as a Candidate Biomarker for Hepatic Fibrosis in Patients With Chronic Hepatitis B(KOWSAR PUBL, 2015) Kolgelier, Servet; Demir, Nazlim Aktug; Inkaya, Ahmet Cagkan; Sumer, Sua; Ozcimen, Serap; Demir, Lutfi Saltuk; Pehlivan, Fatma SeherBackground: Hepatologists have studied serologic markers of liver injury for decades. Annexins are a prominent group of such markers and annexin A2 (AnxA2) is one of the best characterized annexins. AnxA2 inhibits HBV polymerase among other functions. Its expression is up-regulated in regenerative hepatocytes. Objectives: To determine if serum AnxA2 level has a role in estimating liver damage in chronic HBV infection and investigate whether AnxA2 levels correlate with hepatic fibrosis. Patients and Methods: This study included 173 patients with chronic hepatitis B (CHB) and 51 healthy controls. Liver fibrosis was graded histologically on liver biopsy samples. Blood samples were taken from patients during biopsy and serum AnxA2 levels were measured with ELISA. Results: In a group of adult patients with CHB, AnxA2 values were far higher than those of the control group (P = 0.001). When we assessed AnxA2 levels based on fibrosis stages, serum AnxA2 levels of patients with early stage fibrosis (stages 1 - 3) were significantly higher than those of patients with advanced stage fibrosis (stages 4 - 5; P = 0.001). Conclusions: AnxA2 is a useful biomarker for early stage fibrosis in patients with CHB.Öğe Training to prevent healthcare associated infections(2015) Dikici, Nebahat; Ural, Onur; Ertap, Fadime; Sumer, Sua; Kara, FatihObjectives. Aim of this study was to investigate pre-education information level, efficiency of training, persistence of acquired information, and factors affecting information level of recently employed nurses about healthcare associated infections. Methods. One hundred and thirty-two nurses who have just started work were trained about healthcare associated infections and infection control measures. Tests were performed pre, post training and one year after training. Factors affecting test success were investigated. Results. Nurses who continued education after high school were more successful (p0.002). Duration of work-hours, unit where they work and presence of previous training didn't affect test success (p0.705, p0.040, p0.105; respectively). Test results were assessed over 100 points. Mean score before the training was 67.95±10.5 and it increased to 85.06±7.6 after the training (p0.000). Mean test score at test repeated one year later was 80.04±8.77. Unit where they have worked during previous year, application of isolation in their unit and presence of training didn't affect general success in the test (p0.344, p0.316, p0.259; respectively). Conclusions. Training programs using individualized, regularly repeated and approved training methods should be conducted in accordance with needs determined by these studies. Next target after knowledge increase will be reflection of this increase to daily practice and behaviour change.Öğe Two outbreaks of ESBL-producing Klebsiella pneumoniae in a neonatal intensive care unit(WILEY-BLACKWELL, 2014) Sumer, Sua; Dagi, Hatice Turk; Findik, Duygu; Arslan, Ugur; Demir, Nazlim Aktug; Ural, Onur; Tuncer, InciBackgroundIn the present study, two epidemic episodes of extended spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae in the neonatal intensive care unit (NICU) were evaluated. MethodsRoutine and surveillance culture samples were taken from seven neonates with signs of infection in the NICU of Selcuk University Faculty of Medicine between 10 March and 25 April 2011, and between 11 June and 30 September 2011. ResultsESBL-producing K.pneumoniae strains were isolated in six different samples (one wound, one blood, and four cerebrospinal fluid cultures) of the three neonates in the first episode and in 11 different samples (seven blood and four cerebrospinal fluid cultures) of the four neonates in the second episode. ESBL-producing K.pneumoniae was isolated from inguinal, axillar region, and stool samples of the nine colonized neonates in the second episode. It was determined on pulse field gel electrophoresis that all strains originated from two clones. ConclusionsThe deficiencies in the infection control measures in an NICU may transform into an epidemic rapidly. Therefore, periodic training, observation, and monitoring of compliance are important.
