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Öğe Brucellosis is a major problem: A five years experience(Acta Medica Mediterranea, 2013) Dal T.; Celen M.K.; Ayaz C.; Dal M.S.; Kalkanli S.; Mert D.; Yildirim N.Brucellosis is a chronic granulomatous infection which is endemic in Mediterranean countries and Turkey. The aim of this study is to analyze the clinical, laboratory findings and therapeutic features in patients with brucellosis. A retrospective study was conducted with 91 patients who developed brucellosis between 2005 to 2009. The diagnosis was based on clinical findings compatible with brucellosis, serological tests positive, and/or isolation of Brucella species from blood, or other tissues. The mean age was 33 years (16-67 years). Sixty-threes of patients (69.2%) were male. Forty (44%) cases had an occupational history relevant for Brucella exposure and 85 (93%) cases consumption with contaminated animal product. The mean diagnostic delay was 15 days, much longer in focal brucellosis. A total of 77 (85 %) cases had acute brucellosis. The focal brucellosis complications were observed in 39 (42.8%) cases: osteoarticular involvement 32 (82%), epididymo-orchitis 4 (10%), and central nervous system involvement 3 (8%). Chronic brucellosis occurs in 3 (3.3%) cases. Clinical manifestations included non-specific symptoms such as fever (95%), sweats (90%), arthralgia and lower back pain (63%). Of the patients 84 (92%) had serological titre =1/160 and 28 (31%) blood cultures were positive. All of the patients were cured by antibiotic therapy (Doxycycline+rifampicin/streptomycine, streptomycine+rifampicin/Doxycycline, ceftiraxone/rifampicin). Relapse was observed in 5 (5.4%) patients. Brucellosis is an infection with multiple presentations. Its early diagnosis was mandatory to avoid severe complications.Öğe Idiopathic thrombocytopenic purpura associated with splenic tuberculosis: Case report(2013) Dal M.S.; Dal T.; Tekin R.; Bodakçi E.; Düzköprü Y.; Ayyildiz M.O.Tuberculosis is still one of the most prevalent and fatal infectious diseases in spite of considerable improvements in medical science. Splenic tuberculosis is a rare form of extrapulmonary tuberculosis. There are limited numbers of cases in which immune thrombocytopenia is associated with splenic tuberculosis. We report a case of immune thrombocytopenic purpura due to splenic tuberculosis. Our case was a 58-year-old female with headache, gum bleeding, redness in legs, and ecchymoses on the arms for 10 days. On admission to hospital, laboratory tests were as follows: platelet count 6.000/mm3 (150 000-450 000), haemoglobin: 12 g/dl, WBC: 8000/mm3, erythrocyte sedimentation rate: 58 mm/h and C-reactive protein was in normal ranges. After standard laboratory tests, the pa tient was diagnosed with idiopathic thrombocytopenic purpura. The patient presented abdominal lymphadenopathies and spleen in normal size in radiological examinations. Diagnostic laparotomy and splenectomy and lymph node excision was performed and splenic tuberculosis was detected in pathologic and microbiologic examination. The patient was successfully treated with apheresis platelets suspension, intravenous immunoglobulin and antituberculous therapy. In conclusion, splenic tuberculosis should be suspected in patients who have fever, abdominal lymphadenopathies and immune thrombocytopenic purpura. Histopathological examination is still an ideal method to confirm the diagnosis, suitably aided by microbiological examination.Öğe Plasma homocysteine levels in patients with acute ischemic stroke: A cross-sectional study(Turkiye Klinikleri, 2013) Sönmezler A.; Ulaş T.; Dal M.S.; Demir M.E.; Karababa I.F.; Büyükhatipo?lu H.Objective: In this study, we aimed to investigate plasma homocysteine (Hcy) changes in patients within the acute period of ischemic stroke. Material and Methods: In this cross-sectional study, a total of 110 patients with acute ischemic stroke presenting within 48 hours of onset and 45 age and gender-matched healthy subjects were evaluated. Hcy was measured on 2nd, 4th, 7th, 10th and 14th days of the hospitalization. Control samples were also collected after a 12-hour fasting period. Results: Statistically significantly lower Hcy levels were found in acute ischemic stroke patients on the 2nd day compared to the control group (p<0.001). No significant difference was found in the 4th day between the groups (p=0.478). In all other days on which test was performed, Hcy levels were statistically significantly higher in acute ischemic stroke group compared to the control group (p<0.001 for all). Conclusion: This study suggests that Hcy levels are not significantly elevated after recent ischemic stroke, but rise in the 2nd week of admission, and our findings do not support the hypothesis that raised plasma Hcy levels predate ischemic stroke. Therefore, increased plasma Hcy level is a consequence of disease process, and has no value as a predictor of ischemic stroke. © 2013 by Türkiye Klinikleri.Öğe Synbiotic therapy increases eradication rate in Helicobacter pylori eradication(Acta Medica Mediterranea, 2013) Şahin Ö.; Yeşil A.; Şenateş E.; Akdoğan M.F.; Konür S.; Erdem E.; Dal M.S.Background: Probiotics are used in combinations of H. pylori eradication regimens with variable results. Many strains tested had shown positive effects on side effect profiles. However, a clear effect on eradication rate is studied thoroughly. We aimed to investigate the beneficial effect of a synbiotic combination in clarithromycin-based triple eradication therapy. Methods: Ninety-two patients who were infected with H. pylori (confirmed via endoscopic biopsy) were randomized into two groups: those undergoing standard triple treatment (control group (rabeprozol plus amoksisilin plus clarithromycin bid) n=49) and those receiving symbiotic (triple plus symbiotic bid group n=43). The symbiotic product contained lactobacillus, bifidobacterium and enterococcus. The 13C-breath test was performed at least 6 weeks after completing both therapy regimens. Results: In the synbiotic group, 3 of the patients complained of metallic taste (7.0%), 1 complained of diarrhea (2.3%), 3 had nausea (7.0%), 2 had gas (4.7%), 3 experienced vomiting (7.0%) and 1 had constipation (2.3%). In the control group, 3 of the patients experienced a metallic taste (6.3%), 7 had diarrhea (14.6%), 5 had nausea (10.4%), 3 had intestinal bloating (6.3%), 3 experienced vomiting (6.3%) and 1 had constipation (2.1%). There was no significant difference between the two groups. However, side effect intensity and eradication rates were significant different between the groups (p<0.05). The eradication rate in the synbiotic group was 88.4%, while it was 68.8% in the control group (p<0.05). Conclusion: The addition of synbiotic to triple therapy decreases the rate of antibiotic-related side effects. It also increases H. pylori eradication rates in clarithromycin-based triple therapy.
