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    Clinical review of tuberculous peritonitis in 39 patients in Diyarbakir, Turkey
    (Wiley, 2005) Tanrikulu, AC; Aldemir, M; Gurkan, F; Suner, A; Dagli, CE; Ece, A
    Abdominal tuberculosis (TB) is a rare manifestation, which can be overlooked on long-lasting and non-specific findings unless a high index of suspicion is maintained. The purpose of the present study was to investigate the diagnostic features of 39 patients hospitalized with tuberculous peritonitis (TBP) in Dicle University Hospital, Turkey between January 1994 and August 2003. Twenty-two patients were male; patient age ranged between 1 and 59 years (mean: 16.2 +/- 14.4 years). There were 21 patients (54%) under 15 years of age. Thirteen children had a history of familial TB and seven adults had prior history of TB. Six (29%) of 21 pediatric cases had bacille Calmette-Guerin (BCG) scars and results of 5-tuberculin units (TU) tuberculin test were positive in seven children (18%). Of all cases, the most common presenting findings were abdominal pain (95%), ascites (92%) and abdominal distention (82%). Five of the patients had accompanying pulmonary TB, and six patients (15%) had intestinal TB who were admitted to emergency service with acute abdomen, of whom three (8%) had perforation and three (8%) had ileus. Histopathologically 20 cases (51%) were proven on abdominal ultrasonography, and computed tomography revealed most commonly ascites and thickening of peritoneum. No microbiologic evidence was obtained except three positive culture results for Mycobacterium tuberculosis. As a result, TBP should be considered for diagnosis, in patients with non-specific symptoms of abdominal pain, wasting, fever, loss of appetite, abdominal distension and even symptoms of acute abdomen, because early diagnosis and effective treatment will decrease morbidity and mortality. (C) 2005 Blackwell Publishing Asia Pty Ltd.
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    The evaluation of immune responses that occur after HBV infection and HBV vaccination in hemodialysis patients
    (Elsevier Sci Ltd, 2004) Kara, IH; Yilmaz, ME; Suner, A; Kadiroglu, AK; Isikoglu, B
    The hepatitis B virus (HBV) vaccination never lose its importance; however, we did not get immune response with vaccination in some cases at the hemodialysis (HD) units. In this research, our aim was to evaluate antibody responses that constitute with natural ways and vaccination against HBV infection in chronic HD patients. In this retrospective cohort study (between 1999 February and 2001 December), 34 patients, 19 males and 15 females that were at the HD program, were enrolled. Patients were divided into two groups: group A, vaccination group (n = 15); and group B, anti-HBc IgG (+) cases (n = 19). We injected 40 mug of recombinant HBV vaccine into the deltoid muscle at 0, 11 2, and 6 months. The anti-HBs levels, over 10 mIU/mL, were accepted for enough immunization. In group A, after vaccination 12 of 15 (80%) patients had seroconversion but later, in five of 12 (33.3%) patients, HBs-antibody became negative and in seven of 12 (46.7%) patients the positivity of HBs-antibody continued. However, in group B, 16 of 19 (66.7%) immune patients who faced HBV infection. it was established that antibody response continued (P > 0.05). The patients in group A who had anti-HCV negativity and serum albumin levels greater than or equal to3.5 g/dL (7/0; P < 0.05) had too much antibody response against the vaccine. The difference of our research was that patients under 49 years old, patients who did not respond to HBV vaccine, were proportionally higher as compared to those from other researches. In conclusion, it was realized that the immune response of the HBV vaccine was low in the HD patients and it was affected by several factors such as gender, anti-HCV positivity and nutritional status. But, in spite of getting all universal precautions, still to face with new cases emphasizes the importance of the vaccination. (C) 2004 Elsevier Ltd. All rights reserved.
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    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, MF
    Objective: 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.