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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 The complications of chronic otitis media: report of 93 cases(Headley Brothers Ltd, 2000) Osma, U; Cureoglu, S; Hosoglu, SThe aim of this study was to investigate the incidence, mortality and morbidity of complications due to chronic otitis media (COM). During the nine-year period 1990-1999, 2890 cases of COM were reviewed, 93 (3.22 per cent) having 57 (1.97 per cent) intracranial complications (IC) and 39 (1.35 per cent) extracranial complications (EC). In three patients more than one complication was observed. Meningitis and brain abscess were common in the IC group. Subperiosteal abscess (mastoid and Bezold's abscess) was a common complication in the EC group. Cholesteatoma and granulation/polyp in the middle ear/mastoid were the major findings in both groups. Fifteen patients died from IC. Overall, the mortality rate was 16.1 per cent in all patients having complications, and in patients with IC it was 26.3 per cent. In all of the patients with complications, the morbidity rate was 11.8 per cent. Our study supports the finding that meningitis and brain abscess are the common complications of COM and the main reason for mortality.Öğe CT of the brain in tuberculous meningitis.: A review of 289 patients(Munksgaard Int Publ Ltd, 2000) Özates, M; Kemaloglu, S; Gürkan, F; Özkan, Ü; Hosoglu, S; Simsek, MMPurpose: In this retrospective study, CT findings of 289 patients with tuberculous meningitis (TBM) are presented and diagnostic criteria are discussed. Material and Methods. The medical records of patients who were diagnosed as having central nervous system tuberculosis were investigated. Cranial CT investigations of 289 patients with TBM were reviewed. Of these 289 patients. 214 were children and 75 adults. 157 patients were male and 132 were female. CT images were obtained with and without i.v. contrast administration. Results: CT findings were normal in 35 patients and abnormal in 254. The abnormalities were hydrocephalus (172 children, 32 adults), parenchymal enhancement (56 children, 6 adults), contrast enhancement of basal cisterns (32 children, 17 adults), cerebral infarct and focal or diffuse brain edema (29 children, 10 adults), and tuberculoma (9 children, 5 adults). Conclusion: CT is pathologic in the great majority of patients with TBM and is helpful in assessing the complications associated with the disease.Öğe The effect of a restriction policy on the antimicrobial consumption in Turkey: a country-wide study(Springer, 2005) Hosoglu, S; Esen, S; Ozturk, R; Altindis, M; Ertek, M; Kaygusuz, S; Caylan, RBackground: The total annual expenditure of antimicrobials in Turkey in 2002 was 24% of all drug spending. In order to reduce the cost of drug expenditure, the Turkish government introduced a new restriction policy on the prescription of antimicrobials in June 2003. This new policy is based on the justification that the physicians specializing in infectious diseases should be primarily responsible for the prescription of antimicrobials. Objectives: Compare and contrast the usage of antimicrobials at hospitals before and after the implementation of the new restriction policy. Methods: The data was collected from the same departments in two different periods in 2003 at 15 hospitals throughout Turkey. The first set of data was collected a few days before the new policy was implemented in May 2003 and the second data set 6 months after that. Antimicrobial usage was calculated as defined daily doses (DDDs) per 100 patient days according to ATC-DDD index. The change in antimicrobial consumption was determined by comparing the mean DDD values before and after the implementation of the new policy. Results: Before the intervention, the mean antimicrobial use density was 71.56 DDD/100 patients-day at the hospitals in the study. Six months after the implementation, the mean antimicrobial use density was 52.64 DDD/100 patients-day. There was a 26.4% decrease in the antimicrobial usage between that prior to and that after the intervention (P < 0.025). Conclusions: The study shows that the implementation of the new policy resulted in a significant reduction in the prescription of antimicrobials.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 Efficacy and tolerability of pegylated-interferon alpha-2a in hemodialysis patients with chronic hepatitis C(Wiley, 2006) Kokoglu, OF; Uçmak, H; Hosoglu, S; Cetinkaya, A; Kantarceken, B; Buyukbese, MA; Isik, IOBackground and Aim: Hepatitis C virus (HCV) is prevalent in hemodialysis (HD) patients. These patients experience more side-effects with antiviral treatment. The aim of the present study was to evaluate the efficacy and tolerability of pegylated interferon (PEG-IFN) alpha-2a in chronic hemodialysis patients with chronic hepatitis C. Methods: Twenty-five patients were included into the study. All of the patients were interferon naive, anti-HCV antibodies positive and polymerase chain reaction HCV-RNA positive. Twelve of the patients received PEG-IFN alpha-2a at a dose of 135 mu g weekly for 48 weeks (Group 1). The remaining 13 patients who received no specific treatment were used as controls (Group 2). The patients were prospectively followed up for a period of 18 months. Biochemical and virological responses were evaluated at the end of the study period (end-of-treatment response) and 6 months after the completion of therapy (sustained response). Results: Virological end-of-treatment response was observed in 10 patients (83.4%) in Group 1 and one patient (7.7%) in Group 2 (P < 0.001). Sustained virological response was observed in nine patients (75%) in Group 1 and one patient (7.7%) in Group 2 (P < 0.001). Alanine aminotransferase (ALT) levels were initially increased in seven patients in Group 1 and normalized in five of these patients at the end of the treatment and sustained biochemical response was 71.4%. In contrast, ALT levels in Group 2 were initially high in five patients and normalized in two of them (40%) at the end of the 48 weeks. Even if most of the patients experienced several side-effects (anemia 75%, fatigue 58.3%, thrombocytopenia 33.3% and leukopenia 33.3%), they did not impose the discontinuation of the treatment. Conclusion: The present study showed that PEG-IFN alpha-2a for 48 weeks is efficacious and well tolerated in hemodialysis patients with HCV. (C) 2005 Blackwell Publishing Asia Pty Ltd.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 The frequency of Toxocara infection in mental retarded children(Fundaco Oswaldo Cruz, 2004) Kaplan, M; Kalkan, A; Hosoglu, S; Kuk, S; Özden, M; Demirdag, K; Ozdarendeli, AHuman toxocariasis is commonly seen in places where stray and Toxocara canis-infected dog population is high. There is a strong correlation between frequency of Toxocara infection, life style, and infection risk. Institutionalization of mental retarded patients increases to risk of toxocariasis. In this study, we aimed at investigating the frequency of Toxocara infection among children with mental retardation not requiring institutionalization. The study included 96 cases, who had educatable mental retardation and 85 healthy subjects who comprised the control group. Anti-Toxocara IgG or IgM antibodies were investigated in all serum samples, using ELISA method. The frequency of Toxocara infection was found significantly higher in mental retarded cases than in those in the control group (18.8% and 7.1% respectively) (p < 0.05). There was no significant difference between mental retarded children and the control group in terms of mean age, age groups, gender, owning dogs and cats and duration of their ownership, socio-economic level and behavioural factors, and personal hygiene (p > 0.05). We did not find any significant difference between Toxocara seropositive and seronegative mental retarded children in terms of demographic factors and epidemiological factors that could increase the risk of Toxocara infection (p > 0.05). The present study is the first seroprevalence study carried out with a mental retarded group not requiring institutionalization. Determination of high frequency of Toxocara infection suggests that these subjects constitute a risk factor for Toxocara infection, which may be attributed to their behavioural patterns.Öğe Genetic and enzymatic properties of metallo-?-lactamase VIM-5 from a clinical isolate of Enterobacter cloacae(Amer Soc Microbiology, 2005) Gacar, GG; Midilli, K; Kolayli, F; Ergen, K; Gundes, S; Hosoglu, S; Karadenizli, AA VIM-5-producing Enterobacter cloacae isolate (EDV/1) was identified in a collection of clinical strains stored before 2002. The gene, blav(VIM-5), was located on a 2,712-bp BamHI-HindIII fragment of a 23-kbp (approximately) nonconjugative plasmid (pEDV5) in a class 1 integron as a single gene cassette.Öğe Improved sensitivity of nucleic acid amplification for rapid diagnosis of tuberculous meningitis(Amer Soc Microbiology, 2004) Johansen, IS; Lundgren, B; Tabak, F; Petrini, B; Hosoglu, S; Saltoglu, N; Thomsen, VOEarly diagnosis of tuberculous meningitis (TBM) is essential for a positive outcome; but present microbiological diagnostic techniques are insensitive, slow, or laborious. We evaluated the standard BDProbeTec ET strand displacement amplification method (the standard ProbeTec method) for the detection of Mycobacterium tuberculosis complex organisms in parallel with the ProbeTec method with a modified pretreatment procedure with 101 prospectively collected cerebrospinal fluid specimens from 94 patients with suspected TBM. By the modified method, the sample-washing step was omitted. A definitive diagnosis was attained by culture. Thirteen specimens from 12 patients were culture positive for M. tuberculosis complex organisms; three specimens (23%) were microscopy positive for acid-fast bacilli. Among the culture-positive specimens, the standard ProbeTec method was positive for 8 (61.5%) and the modified assay was positive for 10 (76.9%). The overall specificity by both procedures was 98.8% compared to the results of culture. After discrepancy analysis, conducted by reviewing the patients' previous laboratory data, the specificity increased to 100%. If the cutoff value for respiratory specimens was adjusted from the recommended value of 3,400 to 1,000, the sensitivity of the modified procedure increased to 84.7%, with unchanged specificity. Results were obtained in 3 to 4 h. The new pretreatment procedure with the ProbeTec assay described here provides a rapid, simple, and sensitive tool for the diagnosis of TBM.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 A national survey of surgical antibiotic prophylaxis in Turkey(Slack Inc, 2003) Hosoglu, S; Sunbul, M; Erol, S; Altindis, M; Caylan, R; Demirdag, K; Ucmak, HOBJECTIVE: To assess the quality of antibiotic prophylaxis for clean and clean-contaminated elective surgical procedures. DESIGN: A cross-sectional, country-wide survey. SETTING: Thirty-six hospitals in 12 cities in Turkey. PARTICIPANTS: Four hundred thirty-nine surgeons from 6 different specialties who performed selected procedures of interest. METHODS: A random sample of surgeons from different hospitals was selected. A standardized data collection form was used to record the type of procedure, the names, doses, timing of the first doses, and duration of antibiotics, important decisive factors, and problems in the management of prophylactic antibiotic use for surgical procedures. RESULTS: Fifty-five percent of surgeons addressed completed the survey. For clean-contaminated procedures, 6% of surgeons did not use antibiotic prophylaxis, whereas 88% used more than a single dose. Inappropriate antibiotics were chosen for 32% of procedures. In 39% of procedures, the first dose of antibiotics was not administered during induction of anesthesia. Duration of prophylaxis was longer than 24 hours in 80% and longer than 48 hours in 46% of all procedures. Only 112 surgeons (2696) were using definitely appropriate prophylaxis in all ways. Multivariate analysis revealed that surgeons in university hospitals (OR, 2.353; CI95, 1.426-3.884; P = .001) and general surgeons (OR, 4.986; CI95, 2.890-8.604; P < .001) used antibiotic prophylaxis more appropriately. Patients not covered by health insurance (OR, 0.417; CI95, 0.225-0.772; P<.001) were associated with inappropriate prophylaxis. CONCLUSION: Given the high frequency of antibiotics prescribed for surgical prophylaxis in Turkey, adherence to surgical prophylaxis guidelines is urgently needed.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.
