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Öğe Acute bacterial meningitis as a complication of otitis media and related mortality factors(Yonsei Univ Coll Medicine, 2002) Geyik, MF; Kokoglu, OF; Hosoglu, S; Ayaz, CThe aim of this study was to evaluate the characteristics of patients with acute bacterial meningitis (ABM) developed secondary to acute and chronic otitis media (OM). Between 1991 and 2001, among 269 adult patients with ABM, 56 who were secondary to OM were included in the study. We reviewed the charts of patients who were diagnosed as ABM following acute or chronic OM. Risk factors associated with mortality were determined by using a logistic regression model. The mean age of the patients, 38 male and 18 female, was 25.8 +/- 10.8 years (range 14-65). Forty-four of these cases (79%) have had chronic OM, of whom 19 (43% of the 44) have also had chronic mastoiditis and 12 (27% of the 44) acute OM. Twenty-three patients (41%) died, during either hospitalization or the follow-up period. Univariate analysis revealed comatose mental status on admission, inappropriate antibiotic treatment before admission, and elevated erythrocyte sedimentation rate (ESR) as significant risk factors for mortality. In multifactorial analysis, comatose mental status (OR=42.5, CI=6.4-280.1, p=0.001) and elevated ESR (OR=1.0, CI=1.01-1.07; p=0.005) remained as significant predictors for mortality. In conclusion, die primary sources of infection leading to the development of ABM should be investigated carefully to reduce the morbidity and mortality rates. It is hoped that this study will raise awareness among general practitioners and otolaryngologists concerning the role of ABM as one of the most important complications of OM.Öğe Acute bacterial meningitis in adults: Analysis of 218 episodes(Royal Academy Medicine, 1997) Hosoglu, S; Ayaz, C; Geyik, MF; Kokoglu, OF; Ozen, AA retrospective study was conducted to examine the laboratory, clinical features and outcome of 206 adult acute bacterial meningitis patients (218 episodes) during the years 1985-1996, Pneumonia (8.7 per cent), head trauma (7.8 per cent) and chronic otitis media (6.0 per cent) were identified as the main predisposing factors for acute bacterial meningitis, Aetiology was described only in 61 episodes (28.0 per cent), Streptococcus pneumonia was the most commonly identified pathogen overall, causing 33 of the 218 episodes (15.2 per cent), Antibiotic treatment before admission was given to 48.4 per cent of patients, On admission, the following symptoms of meningitis were predominant: 83 per cent had neck stiffness, 81 per cent had a headache and 73 per cent had fever. Case fatality rate was 27.1 per cent (59 patients), The important factors in mortality were as follows: old age, a long duration of symptoms before admission, a lack of neck stiffness, obtunded mental state on admission, low glucose levels in first CSF,low CSF/blood glucose ratio, and abnormality in computerised tomography scanning.Öğe Anti-hepatitis delta virus seroprevalence and risk factors in patients with hepatitis B in Southeast Turkey(Saudi Med J, 2006) Celen, MK; Ayaz, C; Hosoglu, S; Geyik, MF; Ulug, MObjective: To obtain regional epidemiological data on hepatitis delta virus (HDV, a defective virus) infections, the incidence of anti-HDV positivity and the associated risk factors in asymptomatic hepatitis B virus surface antigen (HBsAg) carriers and in patients with chronic active hepatitis B. Methods: The study took place at Dicle University Hospital (Diyarbakir, Southeast of Turkey) between January 2002 and July 2004. Anti-HDV screening was performed in asymptomatic hepatitis B carriers (N=889) and in patients with chronic active hepatitis B infection (N=120). We explored the association between anti-HDV positivity and asymptomatic hepatitis B carrier status, presence of active hepatitis B. age, gender, the durations of HBsAg positivity and hepatitis B e antigen (HBeAg) positivity. Results: In 6% of asymptomatic hepatitis B carriers (53/889) and in 27.5% of patients with chronic active hepatitis B (33/120) anti-HDV was positive. The incidence of anti-HDV positivity was significantly higher in patients with chronic active hepatitis B compared with asymptomatic carriers (p < 0.001). A significant association between the duration of HBsAg carrier status (3.2 +/- 1.4 years) and anti-HDV positivity was also found (p < 0.001). Age, gender, and HBeAg positivity were not significantly associated with anti-HDV positivity (p > 0.05). Conclusion: Anti-HDV positivity was significantly more common in patients with chronic hepatitis B compared with asymptomatic hepatitis B virus (HBV) carriers in a region with a high prevalence of HBV infection. We found a significant relationship between the duration of HBsAg carrier status and anti-HDV positively, however, age, gender, and presence of HBeAg were not significantly associated with the development of anti-HDV positivity.Öğe Clinical and laboratory features of brucellosis in two university hospitals in Southeast Turkey(Royal Soc Medicine Press Ltd, 2006) Kokoglu, OF; Hosoglu, S; Geyik, MF; Ayaz, C; Akalin, S; Buyukbese, MA; Cetinkaya, AThis prospective study was carried out in two university hospitals between January 2000 and December 2002. The diagnosis of brucellosis was made with compatible clinical findings, positive Brucella agglutination >= 1/160 titres, and/or the isolation of Brucella species. The patients were followed up without intervention. One hundred and thirty-eight patients with active brucellosis were evaluated. Of the participants, 79 (57.2%) cases were acute, 23 (16.7%) sub-acute and 36 (26.1%) chronic. Brucella melitensis was isolated in the specimens of 24 (26.9%) out of 89 patients. The most frequent symptoms were fever (78.3%), arthralgia (77.5%) and sweating (72.5%). The most common physical findings were fever (40.6%), splenomegaly (36.2%), and hepatomegaly (26.8%). The osteoarticular involvement was found in 64 patients (46.4%). Ten (7.5%) patients had orchiepididymitis. Meningitis, pulmonary involvement, endocarditis, and hepatitis were found in five (3.6%), three (2.1%), two (1.5%) and one (0.7%) patient, respectively. Relative lymphomonocytosis was found in 80 cases (58.8%), anaemia in 46 (33.3%) and leucopoenia in 30 cases (21.7%). Clinical relapse was observed in 14 patients (10.1%).Öğe Complications of brucellosis in different age groups(Yonsei Univ Coll Medicine, 2003) Gür, A; Geyik, MF; Dikici, Bünyamin; Nas, K; Çevik, R; Saraç, J; Hosoglu, SWe carried out a retrospective analysis of 283 patients diagnosed with brucellosis in our hospital, which serves almost 5.5 million inhabitants in Southeastern Anatolia in Turkey. Our study focuses on the frequency of complications in cases with brucellosis across different age groups. Patients were classified into three groups according to age: less than 15 years old (group A), 15-45 years old (group B) and over 45 years old (group C). Of 283 patients, 138 (49%) were female and 145 (51%) male. Fifty-three (19%) were younger than 15 years old (group A), 178 (63%) were 15-45 (group B), and 52 (18%) were over 45 (group C). When the distribution of all cases was examined according to months of the year, an increase was seen in June. Osteoarticular complications were the most frequent, found in 195 (69%) cases, followed by cutaneous (17%), genitourinary (8%), nervous (7%), respiratory (5%) and hematological (4%) complications. Treatment failed in 15 patients (5%), owing to true relapse in ten and to non-compliance and drug side effects in the other five. Two hundred seventy-two patients received medical treatment alone and 11 required medical and surgical treatment as well (9 spondylitis and 2 carditis). Complications in brucellosis were frequent because 25% of all patients with brucellosis had more than one complication, more so in group C (38%) than in group A (28%) or B (20%). Cutaneous, hematological and respiratory complications in childhood; osteoarticular and cardiac complications in adults; and genitourinary, neurological and gastrointestinal complications in middle aged were more prominent. In conclusion, the frequency of brucella complications was variable in different age groups in Southeastern Anatolia of Turkey. Since brucellosis is a preventable disease, knowledge and early diagnosis of the complications are especially important. Therefore, population education and medical precautions are necessary to prevent the harmful effects of brucella and its complications. In addition, primary health care physicians should be alerted regarding the clinical and laboratory findings of brucella complications.Öğe Effects of octreotide acetate and Saccharomyces boulardii on bacterial translocation in an experimental intestinal loop obstruction model of rats(Tohoku Univ Medical Press, 2002) Aldemir, M; Kököglu, ÖF; Geyik, MF; Büyükbayram, HIntestinal obstruction (IO) induces bacterial translocation (BT) due to mucosal disruption, motility dysfunction, and increased intestinal volume, leading to bacterial overgrowth. This study was conducted to investigate the effects of octreotide acetate (OA) and Saccharomyces boulardii (SB) on the BT and intestinal integrity in an animal model of intestinal loop obstruction (LO). Forty adult male Sprague-Dawley rats (250-300 g) were randomized into 4 groups containing 10 rats each. Complete 10 was created in the distal ileum of rats by a single 3-0 silk suture (LO). Group Sham: Sham (Laparotomy only was performed in this group); group LO: LO; group OA: LO plus OA (100,mug/kg, at 0, 12 hours of obstruction); group (SB): LO plus SB (800 mg/kg/day, via orogastric and preoperative for 3 days). After 24 hours, samples of mesenteric lymph nodes (MLN), liver, spleen and blood were obtained and cultured. The terminal ileum specimens were examined histopathologically. There were no BT in group Sham, but BT was noticed totally in 31 (77.5%) cultures in group LO. This rate was reduced to 30% (n = 12), 10% (n = 4) in the groups OA and SB respectively. Bacterial translocations of MLN and the liver in group LO were significantly higher than those of groups OA and SB. Bacterial translocations of the both spleen and blood in group LO were significantly higher than those of groups OA and SB. The mean bacterial counts, colony-forming units per gram tissue (cfu/g), in the MLN, liver and spleen of group LO were found significantly higher than those of groups OA and SB. The mean villus height in group OA was significantly higher than that of group LO and it in the group SB significantly higher than those of groups LO and OA. The present experimental study has demonstrated that OA and SB may have protective effects against BT in mechanical bowel obstruction and additionally SB preserves intestinal mucosal integrity.Öğe Effects of ursodeoxycholic acid, glutamine and polyclonal immunoglobulins on bacterial translocation in common bile duct ligated rats(Blackwell Publishing Asia, 2003) Aldemir, M; Geyik, MF; Kökoglu, ÖF; Büyükbayram, H; Hosoglu, S; Yagmur, YBackground: The present study was conducted to investigate the effects of ursodeoxycholic acid (UDCA), glutamine and i.v. polyclonal immunoglobulins ( IVIG) on the bacterial translocation (BT) and intestinal integrity of obstructive jaundice (OJ) in an animal model. Methods: Fifty rats were randomized into five groups containing 10 rats each. All procedures were performed aseptically under general anaesthesia using intramuscular ketamine ( 25 mg/kg). The abdomen was opened and the common bile duct was identified, mobilized, doubly ligated using 5-0 silk and divided. In group 1 ( the 'sham' group), the rats had a similar incision followed by mobilization of the common bile duct (CBD), without ligation or division. In group 2 rats, only common bile duct ligation (CBDL) was performed. In group 3, CBDL was performed and UDCA was administered by orogastric intubation once daily. In group 4 rats, CBDL was performed and glutamine was given by orogastric intubation once daily. Therapeutic substances were started orally on the day CBDL was fulfilled and were continued for 7 days. In group 5, IVIG was administrated via a femoral vein catheter just before CBDL. The animals were killed at the end of the 7th day, and serum levels of total bilirubin ( TB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT) were measured. Mesenteric lymph nodes (MLN), liver, spleen and blood were cultured. The terminal ileum specimens were examined histopathologically. Results: Bacterial translocation significantly increased in the MLN and spleen of rats in group 2 as compared to groups 3, 4 and 5 (P < 0.05, P = 0.001, P = 0.001, respectively). The BT of the liver in group 2 was significantly higher than that of group 5 (P < 0.05). In the blood, the BT was significantly higher in group 2 than groups 3, 4 and 5 ( P < 0.05). The bacterial counts, colony- forming units per gram tissue (cfu/g), were found significantly higher in MLN, liver and spleen of rats in group 2 than those of groups 3, 4 and 5 ( P = 0.000). The average villus height in the group 4 was significantly higher than that of groups 2, 3 and 5 ( P = 0.000). Conclusion: The present experimental study has demonstrated that the administration of glutamine, UDCA and IVIG reduce the incidence of BT and additionally glutamine preserves intestinal mucosal integrity.Öğe Epidemiology and control of nosocomial infections in paediatric surgery(W B Saunders Co Ltd, 2002) Önen, A; Cigdem, MK; Geyik, MF; Kökoglu, ÖF; Otçu, S; Öztürk, H; Dokucu, AIThe purpose of this study was to determine the epidemiology and control of hospital-acquired infections (HAI) in paediatric surgery. We reviewed 2844 hospitalized children in a paediatric surgical clinic between January 1997 and December 2000. The diagnosis of HAI was made based on criteria proposed by Centers for Disease Control and Prevention (CDC). The incidence, type of micro-organisms and infections, age, sex, risk factors, and the economic aspects were recorded. The mortality, duration of hospitalization and economic aspects of patients were compared with 78 control patients matured for age, sex and primary illness and free of HAI. There were 78 children with HAI, the overall incidence was 2.74% (4.99% in 1997, 3.89% in 1998, 1.33% in 1999, 1.44% in 2000). The most frequent infections were surgical wound (28 patients) and urinary tract (25 patients). The most frequent risk factors were urethral catheterization (10.26%), trauma (9.25%), and parenteral nutrition (8.70%). Mean hospitalization was 16 days (range 4-28 days) in patients with infection compared with nine days (range 2-22 days) in control group. Eight patients died in the infection group, while two died in the control group. HAI caused a significant increase in mortality, prolonged hospitalization and increased costs (P < 0.05, P < 0.001, P < 0.001, respectively).Öğe Epidemiology of burn unit infections in children(Mosby-Elsevier, 2003) Geyik, MF; Aldemir, M; Hosoglu, S; Tacyildiz, HIObjective: The aim of this study was to determine the epidemiology of burn unit infections, the effect of these infections on the mortality rate, and antibiotic resistance pattern of the predominant bacteria isolated from children. Patients and method: Epidemiologic data for 610 children, aged 0 to 15 years, admitted to the burn unit at Dicle University Hospital during a 5-year period were collected and analyzed. Results: In 207 patients (33.9%), 279 nosocomial infections were identified. The most common types of infections were burn wound infections (72.4%), urinary tract infections (10.8%), pneumonia (9.3%), and septicemia (7.5%). Pseudomonas aeruginosa (181 isolates) was the most common microorganism. Thirty-six patients (5.9%) died at the hospital. Sepsis was associated with mortality in 18 (50%) cases, pneumonia in 6 (17%), and varied noninfectious reasons in 12 patients (33%). P aeruginosa isolates showed high resistance to commonly used antimicrobials. Antibiotic susceptibility test results suggested that imipenem was the most effective agent for P aeruginosa and Escherichia coli strains. Conclusion: The major type of nosocomial infections in the burn unit was burn wound infections, and the majority of nosocomial infections resulted from multiple drug-resistant, gram-negative bacteria.Öğe Informal consultations in infectious diseases and clinical microbiology practice(Blackwell Publishing Ltd, 2003) Leblebicioglu, H; Akbulut, A; Ulusoy, S; Sunbul, M; Aydin, K; Geyik, MF; Esen, SInformed consultation between physicians is an important part of medical practice. The aim of the study was to evaluate the nature and frequency of such consultations in infectious diseases and clinical microbiology practice. This study was done in five university hospitals. Twenty-one infectious diseases and clinical microbiology specialists participated in informal ('curbside') consultations. In a written questionnaire, physicians were asked to report the number and nature of the informal consultations (ICs) they were asked to provide. A total three hundred and sixty-two such consultations were carried out during a three-month period. The ICs occurred most frequently in the hospital (82.3%). Most of the ICs from outside the hospital were by telephone. Most of the ICs (54.4%) were requested by fellows of specialists. 78.7% of the ICs were requested during working hours. 58.8% of consultations took less than 5 min, 18.8% took 6-10 min, 15.2% took 11-20 min, and 7.2% took over 20 min. The four most common reasons for obtaining ICs were to: help to select an appropriate treatment plan (41.4%), help to select an appropriate prophylaxis (19.3%), interpret laboratory data (10.2%), and provide information about antibiotics (10.2%). 30.1% of ICs resulted in subsequent formal consultation and only four patients (1.1%) were transferred to the consultants' clinics. Informal consultations are a frequent occurrence in the practice of infectious diseases and clinical microbiology (ID&CM). Physicians use this sort of consultation to select an appropriate treatment plan and obtain medical information. This study confirms the importance of the ID&CM specialists as a resource for medical personnel.Öğe Management of spinal brucellosis and outcome of rehabilitation(Nature Publishing Group, 2001) Nas, K; Gür, A; Kemaloglu, MS; Geyik, MF; Çevik, R; Büke, Y; Ceviz, AStudy Design: Review of cases. Objective: To review cases of brucellosis in order to clarify diagnostic guidelines, treatment regimes and prognsis. Setting: University Hospital, Turkey. Methods: Study of 11 patients (9 male, 2 female) with either brucellar spondylitis or epidural brucellar abscess. Diagnosis made on clinical presentation, laboratory findings, radiographic evidence and a minimum brucellar anti body of 1:160, a positive bacteriological culture and/ or histological finding of inflammation of granulomatous tissue. All patients were treated with a combination of oral antibiotics. Surgery was performed in 8 patients. Results: At least 6 months antibiotic therapy using Rifampicin and Doxycycline is recommended. Surgery is indicated in the presence of spinal instability, cord compression or radiculopathy. In our series eight patients required surgery. Conclusion: The patients complaining of back pain, particularly in endemic areas should be University Hospital, Turkey. Study of II patients (9 male, 2 female) with either brucellar spondylitis or epidural investigated as possible cases of brucellosis.Öğe Molecular epidemiology of invasive Salmonella typhi in southeast Turkey(Blackwell Publishing Ltd, 2003) Hosoglu, S; Loeb, M; Geyik, MF; Ucmak, H; Jayaratne, PThe objective of this study was to determine the molecular epidemiology of Salmonella typhi isolates from patients with typhoid fever in southeast Turkey and to determine the relationship between the clinical strains and environmental subtypes. Both demographic and clinical data were obtained by chart review and compared to the molecular subtyping results.Öğe Musculoskeletal involvement in brucellosis in different age groups(E M H Swiss Medical Publishers Ltd, 2002) Geyik, MF; Gür, A; Nas, K; Çevik, R; Saraç, J; Dikici, Bünyamin; Ayaz, CObjective: The aim of the present studs, was to determine the distribution and characteristics of arthritis in 195 patients with musculoskeletal involvement due to brucellosis in different age groups in the southeastern region of Turkey. Patients and methods: We carried out a retrospective analysis of 283 patients with brucellosis records and identified 195 with musculoskeletal involvement. Patients were classified into acute-subacute (<12 months) and chronic (>12 months) brucellosis. Patients were also classified into three age groups: <15 years old (group A), 15-45 years (group B), and over 45 years (group C). In addition, patients were classified into five subgroups according to type of arthritis: peripheral arthritis, polyarthritis, spondylitis, sacroiliitis, and spondylitis/sacroiliitis. Results: 195 (69%) of the 283 patients [138 female (49%), 145 male (51%)] had musculoskeletal involvement. Of the patients with musculoskeletal involvement 113 (58%) were female and 82 (42%) were male, ranging in age from 3 to 71 years (mean age 33.14 +/- 15.03). Of 195 patients studied, 39 (14%) were <15 years old (group A), 122 (43%) were aged 15-45 (group B), and 34 (12%) were over 45 (group C). The most commonly affected joints were the sacroiliac joint in 108 patients (55%), peripheral joints in 106 (54%), and spondylitis in 60 (31%). Of 108 patients with sacroiliitis, 19 were in group A, 76 in group B, and 13 in group C. Bilateral sacroiliitis was less common in group B (23 patients) than in groups A (3) and C (3) (p <0.05). Spondylitis was more common in group B (18%). Sacroiliitis and polyarthritis were more common than other types of musculoskeletal involvement in females, whereas in males the distribution of all types was similar. In patients aged under 15 and 15-45, sacroiliitis and polyarthritis were common compared with other types of arthritis, but the distribution was similar in patients over 45. Conclusion: In southeastern Anatolia musculoskeletal involvement in brucellosis is frequent. The series presented suggests that musculoskeletal involvement in group A is higher than groups A and C. The prevalence of musculoskeletal involvement appears to differ according to age, sex and clinical type.Öğe Predictors of outcome in patients with tuberculous meningitis(Int Union Against Tuberculosis Lung Disease (I U A T L D), 2002) Hosoglu, S; Geyik, MF; Balik, I; Aygen, B; Erol, S; Aygencel, TG; Mert, AOBJECTIVE: To assess predictors of mortality and neurological sequelae in patients with tuberculous meningitis (TBM). METHODS: Patients with TBM treated at 12 university hospitals in Turkey between 1985 and 1997 were evaluated using a standardised protocol applied retrospectively. Variables associated with hospital mortality as well as with the presence of neurological sequelae at 6 months were determined using logistic regression models. RESULTS: Four hundred and thirty-four patients between the ages of 13 and 83 years (mean 33 years) were evaluated. Sixty-eight per cent of these patients presented with Medical Research Council Stage H or III. One hundred and one patients (23.3%) died and 67 (27%) of evaluable survivors had neurological sequelae. In multivariable analysis, convulsion (OR 3.3, 95%CI 1.2-9.0, P = 0.02), comatose mental status (OR 6.0, 95%CI 3.6-10.2, P = 0.01), and delayed or interrupted treatment (OR 5.1, 95%CI 2.4-11.2, P = 0.01) were shown to be predictors for mortality. The presence of extra-meningeal tuberculosis (OR 2.1, 95%CI 1.1-4.2, P = 0.035), cranial nerve palsy (OR 2.6, 95%CI 1.4-4.2, P = 0.01), hemiparesia/focal weakness (OR 9.3, 95%CI 3.8-22.6, P = 0.01), hemiplegia/multiple neurological deficit (OR 7.1, 95%CI 2.14-23.38, P = 0.01) and drowsiness (OR 4.2, 95%CI 2.04-8.82, P = 0.01) were independent predictors of neurological sequelae at 6 months following hospital discharge. CONCLUSION: The results of this study emphasise the importance of prompt and uninterrupted anti-tuberculosis therapy for tuberculous meningitis. The presence of seizures or coma on admission to hospital are important predictors for mortality, while the presence of focal neurological signs is a predictor for persistent neurological sequelae in survivors.Öğe Prospective surveillance study for risk factors of central venous catheter-related bloodstream infections(Mosby, Inc, 2004) Hosoglu, S; Akalin, S; Kidir, V; Suner, A; Kayabas, H; Geyik, MFObjective: Risk factors of catheter-related bloodstream infection (CR-BSI) caused by central venous catheter (CVC) use at a university hospital were evaluated. Design: A prospective, observational, hospital-wide study was conducted. Setting: The study was conducted at a university hospital with 1050 beds. Methods: Nontunneled catheters were used, and double or triple lumen was observed. Catheters were cultured by semi-quantitative method, and blood cultures were performed if necessary All epidemiologic and clinical data were recorded without intervention during the study Results:Over a 1-year period, the study assessed 389 CVCs inserted in 367 patients (mean age 50.9 +/- 18.1 years; 215 [58.6%] men, 152 [41.4%] women). Duration of catheterization was 12.0 +/- 9.9 days. CVCs were inserted into either the subclavian vein (N = 263; 67.6%) or the jugular vein (N = 128: 32.4%). In 250 episodes (64.3%), antibiotics were used concomitantly CR-BSI was found in 43 of all CVCs (11.1%). The rate of CR-BSI per 1000 catheter-days was 9.21 for the whole cohort. In multivariable analysis, only renal failure (OR 4.83; Cl 1.32-17.66; P = .017) was found to be a risk factor for CR-BSI. Conclusion: Renal failure was an independent risk factor for CR-BSI.Öğe Recurrent bacterial meningitis: a 6-year experience in adult patients(W B Saunders Co Ltd, 1997) Hosoglu, S; Ayaz, C; Ceviz, A; Cumen, B; Geyik, MF; Kokoglu, OFTen adult patients with recurrent bacterial meningitis (RBM) of 22 episodes were diagnosed and treated at the Dicle University Hospital from January 1990 to December 1995. Apart from 22 episodes of RBM these patients had an additional 25 episodes treated at other hospitals. The RBM attacks developed after closed head trauma in four patients, asplenia and chronic otitis media in one patient, chronic otitis media and oto-mastoiditis in one patient, chronic maxillar sinusitis in one patient, chronic mastoiditis in one patients, and suppurative foci of facial bones caused by shrapnel pieces and no predisposing condition in one patient. In 10 RBM episodes, Streptococcus pneumoniae was isolated from cerebrospinal fluid (CSF) and/or blood culture, and in one episode Proteus vulgaris was isolated from CSF and otitis media suppuration, In the four episodes both cultures were negative, but direct microscopy showed Gram-positive diplococci on Gram-staining. Three of the patients died from meningitis-related complications.Öğe Risk factors for enteric perforation in patients with typhoid fever(Oxford Univ Press Inc, 2004) Hosoglu, S; Aldemir, M; Akalin, S; Geyik, MF; Tacyildiz, IH; Loeb, MA case-control study was performed using the records of patients hospitalized for typhoid fever at Dicle University Hospital, Diyarbakir, Turkey, between 1994 and 1998. Case patients with enteric perforation were compared with control patients with typhoid fever but no enteric perforation. Risk factors for perforation were determined using logistic regression modeling. Forty case patients who had surgery because of typhoid enteric perforation were compared with 80 control patients. In univariate analyses, male sex (p = 0.01), age (p = 0.01), leukopenia (p = 0.01), inadequate antimicrobial therapy prior to admission (p = 0.01), and short duration of symptoms (p = 0.01) were significantly associated with perforation. In multivariate analysis, male sex (odds ratio (OR) = 4.39, 95% confidence interval (CI): 1.37, 14.09; p = 0.01), leukopenia (OR = 3.88, 95% CI: 1.46, 10.33; p = 0.04), inadequate treatment prior to admission (OR = 4.58, 95% CI: 1.14, 18.35; p = 0.03), and short duration of symptoms (OR = 1.22, 95% CI: 1.10, 1.35; p = 0.001) were significant predictors of perforation. A short duration of symptoms, inadequate antimicrobial therapy, male sex, and leukopenia are independent risk factors for enteric perforation in patients with typhoid fever.Öğe Therapeutic effect of spiramycin in brucellosis(Blackwell Publishing Asia, 2003) Geyik, MF; Dikici, Bünyamin; Kokoglu, OF; Boşnak, Mehmet; Celen, MK; Hosoglu, S; Ayaz, CObjective : This study was undertaken to investigate the usefulness of spiramycin in treatment for brucellosis in an animal model. Methods : Eighty-four Sprague-Dawley rats were infected by intraperitoneal injection of Brucella melitensis suspension. Seven days after inoculation, four rats were selected randomly, killed and spleen cultures and Brucella standard tube agglutination test were carried out. All four rats were found to be infected. Eighty adult rats were randomly divided into four groups of 20 rats each. Tap water was given to the first group. Rifampicin 50 mg/kg per day and doxycycline 40 mg/kg per day were given to the second group, spiramycin 50 mg/kg per day orally was given to the third group, and a combination of spiramycin and rifampicin at the same dose and period was given to the fourth group. Duration of therapy regimens in all groups was 21 days. The spleens of all 80 rats were removed aseptically, homogenized, and placed onto Brucella agar plates to determine if viable bacteria were present. Results : Bacterial growth occurred in all of the rats' spleens in the first group and in two rats' spleens in the spiramycin group. Mean colony forming unit (c.f.u.) values were at the highest in the first group. The effectivities of spiramycin and rifampicin-spiramycin were similar to rifampicin-doxycycline. There were no differences in the treatment results between the three groups that received combined rifampicin-doxycycline, rifampicin-spiramycin and only spiramycin (P >0.05). Conclusion : The results show that spiramycin cures experimental rat brucellosis and may be an effective alternative in the therapy of human brucellosis.Öğe Transmission of hepatitis C by blood splash into conjunctiva in a nurse(Mosby, Inc, 2003) Hosoglu, S; Celen, MK; Akalin, S; Geyik, MF; Soyoral, Y; Kara, IHThe risk of transmission of hepatitis C virus (HCV) infection is an important problem for the health care worker. HCV transmission by blood splashing into eyes is very rare. In a hemodialyses department, a 23-year-old female nurse splashed blood from a patient who was anti-HCV positive into her eyes, She washed her eyes with water immediately and reported to the infection control department. She had never used intravenous drugs nor received transfusions. At the time of exposure, there was no abnormality in her laboratory tests. Her anti-HCV and HCV-RNA tests produced negative results. She was followed up for anti-HCV and alanine aminotransferase activity. After 6 months, she presented with sore throat, nausea, vomiting, fatigue, and weight loss. She had icterus and hepatomegalia. In laboratory tests, alanine aminotransferase level was 504 U/L, aspartate aminotransferase level was 388 U/L, and anti-HCV and HCV-RNA tests produced positive findings. She was treated with interferon alfa-2a for a 1-year period. After treatment, an HCV-RNA test produced negative results and transaminase levels were normal. In conclusion, splashing blood from patients who are HCV positive into the face or eyes is a risk for health care workers. They should be educated to prevent a nosocomial acquisition of bloodborne infection and they should observe protective precautions.Öğe Tuberculous meningitis in adults: an eleven-year review(Int Union Against Tuberculosis Lung Disease (I U A T L D), 1998) Hosoglu, S; Ayaz, C; Geyik, MF; Kokoglu, OF; Ceviz, AOBJECTIVE: To assess the presentation, diagnosis and outcome of patients with tuberculous meningitis (TBM). DESIGN: The medical records of adults with TBM who were treated at Dicle University Hospital between January 1985 and October 1996 were reviewed. RESULTS: In total, 101 patients were identified and stratified according to the stage of disease at presentation. The mean duration of the symptoms of TBM before admission was 12 days. The majority of patients had headaches (96.0%), fever (91.1%), nuchal rigidity (91.1%), vomiting (81.2%), meningism (79.2%) and abnormal mental state (72.3%). The mean cerebrospinal fluid (CSF) leukocyte count was 0.38 x 10(9)/L, protein 1410 mg/L, glucose 2.0 mmol/L and CSF/blood glucose ratio 27%. Cranial computerized tomography (CT) scans were performed during the course of TBM in 64 patients. The results were normal in 6.3%, and abnormal in 93.7% of the cases; the most frequent abnormality found on CT was hydrocephalus (45.3%). Forty-four patients (43.5%) died. Minor neurological sequelae developed in 11 patients (10.9%), major sequelae in 10 (9.9%), and 31 patients (30.7%) completely recovered. There was no follow-up for five patients (5.0%). Five factors were important in predicting fatal outcome: stage III at presentation, low glucose levels, low CSF/blood glucose ratio, high protein levels, and CT scanning abnormality. CONCLUSION: TBM is a very critical disease in terms of fatal outcome and permanent sequelae: 43.5% of the patients died and only 30.7% experienced complete recovery. Early treatment may reduce fatal outcome and morbidity.
