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Öğe Assesment of Paediatric Varicella Pneumonia(Univ West Indies Faculty Medical Sciences, 2016) Aktar, F.; Tekin, R.; Bektas, M. S.; Kostu, M.; Aktar, S.; Gunes, A.; Uluca, U.Background: The objective of the study was to determine the clinical presentation, diagnosis, treatment, and respiratory complications of varicella zoster pneumonia (VZP) in children. Material and methods: Relevant data, age, gender, month of admission, demographic data, past medical and family histories, physical findings during admission, laboratory findings, treatments given, and outcome of these treatments with diagnosis of varicella pneumonia were collected retrospectively. Results: In a two-year period, 15 cases were identified and their data were analysed. Eight patients were male (53%) and seven were female (43%). The mean age was 4.7 +/- 3.7 months. Twelve cases (80%) were under six months of age and nine patients (60%) had household contact with persons with chicken pox infection. After onset of the chicken pox rash, the mean time for development of respiratory symptoms was 3.5 +/- 1.0 days. The mean hospital stay was 13 +/- 1.8 days and ranged from 9-17 days. The persisting fever, fatigue, and cough episodes were major presenting symptoms upon admission in almost all the patients. All patients received acyclovir and non-specific pneumonia treatment and all recovered. None of the children were previously immunized against varicella. Conclusions: Varicella zoster pneumonia should be considered in patients with prolonged fever and accompanying cough in patients with chicken pox. Probably the best approach would be a trial of high dose acyclovir treatment in children who develop VZP.Öğe Community-acquired urinary tract infections in children: pathogens, antibiotic susceptibility and seasonal changes(Verduci Publisher, 2013) Yolbas, I.; Tekin, R.; Kelekci, S.; Tekin, A.; Okur, M. H.; Ece, A.; Gunes, A.AIM: Urinary tract infections (UTIs) are common infections affecting children. The aim of our study is to determine microorganisms that cause community-acquired urinary tract infections and their antibiotic susceptibility in children. MATERIALS AND METHODS: Our investigation includes 150 cases which has positive urine culture. The cases are detected at Pediatric Polyclinics of Dicle University between June 2010 and June 2011. RESULTS: The study included 118 (78.7%) female and 32 (21.3%) male children. Urinary tract infections were seen in autumn 10.7% (n = 16), summer 35.3% (n = 53), winter 30.7% (n = 46) and spring 23.3% (n = 35). The culture results indicated 75.3% (n = 113) Escherichia coli; 20.7% (n = 31) Klebsiella; 2.7% (n = 4) Proteus and % 1.3 (n = 2) Pseudomonas. The antibiotic resistance against Escherichia coli was found out is amikacin (3%), ertapenem (7%), imipenem (0%), meropenem (0%), nitrofurantoin (9%), trimethoprim/sulfamethoxazole (58%), piperacillin (83%), amoxicillin/clavulanate (50%), ampicillin/sulbactam (65%), cefazolin (54%), cefotaxime (51%), cefuroxime sodium (51%) and tetracycline (68%). The resistance ratios of Klebsiella are amikacin (0%), imipenem (0%), levofloxacin (0%), meropenem (0%), amoxicillin/clavulanate (57%), ampicillin/sulbactam (79%), ceftriaxone (68%), cefuroxime sodium (74%) and trimethoprim/sulfamethoxazole (61%). CONCLUSIONS: The results represent the increasing antibiotic resistance against microorganisms among the community-acquired UTI patients in a developing country such as Turkey. So, the physicians should consider resistance status of the infectious agent and choose effective antibiotics which are nitrofurantoin and cefoxitin for their empirical antibiotic treatment. Furthermore, they should be trained about selection of more effective antibiotics and check the regional studies regularly.Öğe Comparison of snakebite cases in children and adults(Verduci Publisher, 2015) Tekin, R.; Sula, B.; Cakir, G.; Aktar, F.; Deveci, O.; Yolbas, I.; Celen, M. K.OBJECTIVE: There are very few studies that compare the snakebite cases in children and adults. The present study aimed to compare the demographic characteristics, clinical presentations, laboratory findings, and developed complications in pediatric and adult patients due to snakebites. PATIENTS AND METHODS: This study included the patients admitted to the hospital and monitored due to snakebite between July 1999 and December 2012. The condition of each patient who had been bitten was admitted to the hospital was monitored from the time of admission to the end of their hospital stay. The fact that a snakebite occurred was recorded if the subjects saw the snake or if the appearance of the puncture sites was convincingly a snakebite. RESULTS: The present work included 290 patients, of whom 123 were children and 167 were adults. The most common location of the bites was the lower extremity with 78.9% (n=97) and 63.5% (n=106) in pediatric and adult patients, respectively. All of the pediatric patients received prophylactic treatment with antibiotics, whereas 62 (37.1%) adult patients received antimicrobial treatments due to the soft tissue infection. The most common complication developed was pulmonary edema in children at a rate of 33.3% (n=41) and compartment syndrome in adult patients at a rate of 3% (n=5). CONCLUSIONS: Patients admitted to the hospital due to snakebite should be monitored for at least 12 hours, even if there is no sign of clinical envenomation. Antivenom treatment should be administered to the patients requiring clinical staging. Patients should be kept under close monitoring to prevent the development of serious complications such as cellulitis, pulmonary edema, compartment syndrome, and disseminated intravascular coagulation.Öğe Complications of chronic suppurative otitis media: a retrospective review(Springer, 2013) Yorgancilar, E.; Yildirim, M.; Gun, R.; Bakir, S.; Tekin, R.; Gocmez, C.; Meric, F.The purpose of this study was to review our patients with complications of chronic suppurative otitis media (CSOM) and compare with literature. This retrospective study was performed over 10 years in our tertiary referral university hospital. During this period 4,630 patients with CSOM were admitted to the department and 906 patients underwent a surgery. From the records of the 4,630 patients, 121 patients (2.6%) with complications were identified. Of the 906 CSOM patients that underwent a surgery, 511 had cholesteatoma, and 395 had granulation and/or polyp tissue. Ninety-four of 511 (18.4%) patients with cholesteatoma and 27 of 395 (6.8%) patients with granulation and/or polyp tissue had a complication. Of the 121 complicated CSOM patients, 57 extracranial (47.1%) and 37 intracranial (30.6%). Multiple combined complications were occurred in 27 (22.3%) patients. The mastoid abscess was the commonest extracranial complication (28.3%); it was followed by labyrinthitis (9%), facial nerve paralysis (8.4%), and Bezold's abscess (1.3%). The most common intracranial complication was lateral sinus thrombophlebitis (19.5%), followed by perisigmoid sinus abscess (13.5%), meningitis (9%), brain abscess (6.5%), and extradural abscess (4.5%). Most frequent intraoperative finding of complicated CSOM patients was cholesteatoma, with the exception of patients with facial nerve paralysis. There was no mortality in any of our patients. The additional morbidities were recorded in 25 patients (20.6%). In this study, we emphasize the importance of an accurate and early diagnosis, followed by adequate surgical therapy and a multidisciplinary approach.Öğe The effects of caffeic acid phenethyl ester (CAPE) on bacterial translocation and inflammatory response in an experimental intestinal obstruction model in rats(Verduci Publisher, 2015) Firat, U.; Senol, S.; Gelincik, I.; Kapan, M.; Tokgoz, O.; Tekin, R.; Evliyaoglu, O.OBJECTIVE: Intestinal obstruction (IO) is a disease which generates approximately 20% of emergency surgery and tends to with high mortality. Prevention of oxidative stress, bacterial translocation and tissue damage caused by IO is an important medical issue. Caffeic acid phenethyl ester (CAPE) is an anti-inflammatory, antioxidant, anti-bacterial and immunomodulatory agent. In this experimental study, we aimed to investigate the effects of CAPE on bacterial translocation, inflammatory response, oxidative stress and tissue injury caused by intestinal obstruction in a rat model. MATERIALS AND METHODS: Breafly, thirty Wistar albino rats divided into three groups as Sham (n=10), IO (n=10) and IO + CAPE (10 mu mol/kg day, intraperitoneal) (n=10). The tissues from the study groups were examined biochemically, microbiologically and histopathologically. RESULTS: In CAPE treated group, decreased serum levels of proinflammatory cytokines (TNF-alpha, IL-6, IL-1 beta) and CRP (p < 0.05), additionally increased serum levels of antioxidant parameters (PONS, TAS) (p < 0.05), were observed after IO. Microbiologically, the rates of positive cultures of the lymph node, spleen, liver and blood were significantly decreased in CAPE treated group compared to the IO group. Also histopathological examination showed that the intestinal mucosal injury score and hepatic portal inflammation score were significantly decreased in the CAPE treated group (p < 0.05). CONCLUSIONS: It is suggested that intraperitoneal administration of CAPE might has potential antibacterial, anti-inflammatory, antioxidant and immunomodulatory effects in IO. So, further studies on IO are needed to evaluate exact antibacterial, antiinflammatory, antioxidant and immunomodulatory effects of CAPE.Öğe The effects of pomegranate on bacterial translocation in rats with obstructive jaundice(Verduci Publisher, 2013) Gumus, M.; Tekin, R.; Firat, U.; Onder, A.; Kapan, M.; Boyuk, A.; Aldemir, M.BACKGROUND: Obstructive jaundice may promote bacterial overgrowth and altered intestinal barrier function, with resultant increased bacterial translocation. AIMS: This study aimed to evaluate potential effects of pomegranate on bacterial translocation after bile duct ligation in rats. MATERIALS AND METHODS: Wistar albino rats were randomized into four groups. Group 1 underwent sham operation; Group 2 underwent sham operation and simultaneous treatment with pomegranate; Group 3 underwent common bile duct ligation, and Group 4 underwent common bile duct ligation and simultaneous treatment with pomegranate. After 8 days, the samples of systemic blood, liver, spleen and mesenteric lymph nodes (MLNs) were obtained under sterile conditions for microbiological culture. The segments of the ileum were removed for histopathological examination. RESULTS: Bacterial translocation significantly decreased in Group 4 compared to Group 3 (p = 0.007). The bacterial counts (Colony forming unit: CFU/g) of Group 3 were significantly higher than those of Groups 1, 2 and 4 (p < 0.05). The mean ileal villus heights in the Groups 1, 2, 3 and 4 were 480.5 +/- 20.5 mu m, 494.7 +/- 17.3 mu m, 356.3 +/- 25.7 mu m and 420.7 +/- 23.7 mu m, respectively. The mean villus height in Group 4 was higher than that of Group 3 (p = 0.010). CONCLUSIONS: Pomegranate has significant protective effects on intestinal mucosa barrier in obstructive jaundice and reduces bacterial translocation.Öğe Evaluation of Adults with Acute Viral Hepatitis A and Review of the Literature(Soc Editrice Univ, 2013) Tekin, R.; Yolbas, I.; Dal, T.; Demirpence, O.; Kaya, S.; Bozkurt, F.; Deveci, O.Aim. In developing countries HAV infection is very common in the first years of life and it is often asymptomatic. However especially in regions of intermediate endemicity, exposure to the virus may delay and outbreaks of hepatitis A may be encountered in adults. The aim of this study is to evaluate the clinical and laboratory findings and risk factors of adults with acute viral hepatitis A. Materials and Methods. In present study we evaluated 203 patient with acute viral hepatitis A, who were admitted to four different hospitals of three cities of Turkey between January 2000-December 2011, retrospectively. The diagnosis of acute viral hepatitis A was performed by laboratory findings and clinically. Results. In a total of 203 patients, 120 (59.1%) patients were male and 83 (40.9%) were female. Mean age of cases with acute viral hepatitis A was 24.7 + 11.8 years (ranged 15 to 82 years old). Acute viral hepatitis A were seen in patient who were 15-20 years and 21-30 years old, commonly. Jaundice (74%), fatigue (68%), nausea-vomiting (56%) and dark urine (48%) were the most common symptoms in cases. Prolonged cholestasis (6.8%) was the most common atypical manifestation. Prolonged jaundice was more frequent in the cases with positive HBsAg (P<0.001). Conclusions. Acute viral hepatitis A can cause atypical presentations such as prolonged cholestasis, acute kidney injury and fulminant hepatitis. Some precautions such as routine vaccination program, improvement of hygiene conditions and informing people about it, should be taken for reducing of acute viral hepatitis A infection incidence.Öğe Evaluation of Device-associated Nosocomial Infections in a Paediatric Intensive Care Unit(Univ West Indies Faculty Medical Sciences, 2016) Cevik, S.; Tekin, R.; Gundeslioglu, O. O.; Aktar, F.; Yilmaz, S. M.; Ay, M.Objectives: The aim of this study was to evaluate the rate of device-associated healthcare-associated infections (DA-HAI) in a paediatric intensive care unit (PICU). In addition, the identities of the responsible micro-organisms and of their antibiotic sensitivities were determined. Subjects and Methods: Patients who had been treated and followed-up in a PICU for more than 48 hours between January 2008 and December 2013 were included in the study. Device-associated nosocomial infections were defined by the Centers for Disease Control (CDC) criteria. Results: Nosocomial infections were detected in 244 of the 7376 patients over the six-year period. A diagnosis of DA-HAI was made in 75 (30.7%) of these infections. The rates of device utilization were 26% for mechanical ventilators, 6% for central venous catheters and 0.9% for urethral catheters. The rate of device-associated infections was 30.7%, and their frequency was 1.9/1000 patient-days. The device-associated nosocomial infection rates for mechanic ventilators, central and urethral catheters were 5.6, 1.62 and 3.77 per 1000 patient-days, respectively. Of these infections, Pseudomonas aeruginosa was the most frequent pathogen. Patients who developed hospital infections had longer durations of ICU hospitalizations and more often had to use mechanical ventilators and central and urinary catheters. Conclusions: The duration of hospitalization and the use of mechanical ventilators and central and urinary catheters were related to the increases in nosocomial infections. Therefore, target-oriented active surveillance should be regularly performed, and the superfluous employment of invasive devices should be avoided.Öğe The evaluation of patients with burns during fifteen years period(Soc Editrice Univ, 2013) Tekin, R.; Yolbas, I.; Dal, T.; Okur, M. H.; Selcuk, C. T.Aims. Burn is a major health problem that cause of mortality, morbidity and psychological problems in children and adults throughout the world. The aim of this study was to evaluate the epidemiological, etiological features and outcomes of burns in the southeast region of Turkey. Patients and Methods. A total of 3010 burn patients (age vary between 2 month to 95 years old) that admitted to the Dicle University burn center during the 15 years period (1994-2008) were reviewed. Age, gender, demographic characteristics, length of hospital stay of patients, etiology and degree of burns, cause of nosocomial infections, the total body surface area (TBSA) percentage and outcomes were analyzed. Results. Of 3010 patients, 1602 (53.2%) cases were female and 1408 (46.8%) were male. The mean age was 10.51 +/- 13.45. The most of patients (58.1%, 1748 patients) were <= 5 years old, 19.9% (598) were 6-15, 20.1% (606) were 16-50 and 1.9% (58) were >= 51 years old. Burn type of cases were including: 1956 (65%) scalding burns, 624 (20.7%) flame burns and 430 (14.3%) electrical burns. Degree of burns were including: 22 (0.7%) first-degree, 2706 (89.9%) second-degree and 282(9.4%) third-degree burns. The mean of length of hospitalization was 13.25 +/- 10.77 days. The most frequent isolated microorganisms were Pseudomonas aeruginosa (55%, 553), Acinetobacter spp. (13%, 128), and Escherichia coli (8%, 78). Mortality rate was 4.6%. Conclusions. The epidemiology of burns may vary according to lifestyles, age, living conditions and socio-economic status among different regions and hospitals. Improvement of life conditions and socio-economic status, trainings, periodic studies of nosocomial infections and increasing the number of burn centers, would contribute to reduction of deaths due to burns.Öğe Genitourinary brucellosis: results of a multicentric study(Elsevier Sci Ltd, 2014) Erdem, H.; Elaldi, N.; Ak, O.; Gulsun, S.; Tekin, R.; Ulug, M.; Duygu, F.This study reviewed the clinical, laboratory, therapeutic and prognostic data on genitourinary involvement of brucellosis in this largest case series reported. This multicentre study pooled adult patients with genitourinary brucellar involvement from 34 centres treated between 2000 and 2013. Diagnosis of the disease was established by conventional methods. Overall 390 patients with genitourinary brucellosis (352 male, 90.2%) were pooled. In male patients, the most frequent involved site was the scrotal area (n=327, 83.8%), as epididymo-orchitis (n=204, 58%), orchitis (n=112, 31.8%) and epididymitis (n=11, 3.1%). In female patients, pyelonephritis (n=33/38, 86.8%) was significantly higher than in male patients (n=11/352, 3.1%; p<0.0001). The mean blood leukocyte count was 7530 +/- 3115/mm(3). Routine laboratory analysis revealed mild to moderate increases for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The mean treatment duration and length of hospital stay were significantly higher when there were additional brucellar foci (p<0.05). Surgical operations including orchiectomy and abscess drainage were performed in nine (2.3%) patients. Therapeutic failure was detected in six (1.5%), relapse occurred in four (1%), and persistent infertility related to brucellosis occurred in one patient. A localized scrotal infection in men or pyelonephritis in women in the absence of leucocytosis and with mild to moderate increases in inflammatory markers should signal the possibility of brucellar genitourinary disease.Öğe IMPLANTABLE CARDIOVERTER DEFIBRILLATOR POCKET INFECTION CAUSED BY KLEBSIELLA PNEUMONIAE(Elsevier Ireland Ltd, 2011) Ertas, F.; Acet, H.; Deveci, O.; Yula, E.; Tekin, R.; Ariturk, Z.; Elbey, M. A.[Abstract Not Available]Öğe Liver involvement in patients with brucellosis: results of the Marmara study(Springer, 2014) Ozturk-Engin, D.; Erdem, H.; Gencer, S.; Kaya, S.; Baran, A. I.; Batirel, A.; Tekin, R.Brucellosis is a zoonotic disease that primarily affects the reticuloendothelial system. But, the extent of liver damage in due course of the disease is unclear. This study included 325 brucellosis patients with significant hepatobiliary involvement identified with microbiological analyses from 30 centers between 2000 and 2013. The patients with a parts per thousand yen5 times of the upper limit of normal for aminotransferases, total bilirubin level a parts per thousand yen2 mg/dl or local liver lesions were enrolled. Clinical hepatitis was detected in 284 patients (87.3 %) and cholestasis was detected in 215 (66.1 %) patients. Fatigue (91 %), fever (86 %), sweating (83 %), arthralgia (79 %), and lack of appetite (79 %) were the major symptoms. Laboratory tests showed anemia in 169 (52 %), thrombocytopenia in 117 (36 %), leukopenia in 81 (25 %), pancytopenia in 42 (13 %), and leukocytosis in 20 (6 %) patients. The most commonly used antibiotic combinations were doxycycline plus an aminoglycoside (n = 73), doxycycline plus rifampicin (n = 71), doxycycline plus rifampicin and an aminoglycoside (n = 27). The duration of ALT normalization differed significantly in three treatment groups (p < 0.001). The use of doxycycline and an aminoglycoside in clinical hepatitis showed better results compared to doxycycline and rifampicin or rifampicin, aminoglycoside, doxycycline regimens (p < 0.05). However, the length of hospital stay did not differ significantly between these three combinations (p > 0.05). During the follow-up, treatment failure occurred in four patients (1 %) and relapse was seen in three patients (0.9 %). Mortality was not observed. Hepatobiliary involvement in brucellosis has a benign course with suitable antibiotics and the use of doxycycline and an aminoglycoside regimen seems a better strategy in select patients.Öğe Seroprevalence of IgG anti-Toxocara canis antibodies and anti-Fasciola sp antibodies in patients with urticaria(Soc Editrice Univ, 2013) Dal, T.; Cicek, M.; Ucmak, D.; Akkurt, M.; Tekin, A.; Dal, M. S.; Tekin, R.Aims. Chronic urticaria (CU) is defined by recurrent episodes occurring at least twice a week for 6 weeks and generally characterized by the rapid appearance of wheals and/or angioedema and may be associated with parasitic infections. We aimed to investigate the seroprevalance of Toxocara canis and Fasciola species in patients with CU. Materials and Methods. We included 55 patients (in age 16-55) with urticaria admitted in study. As a control group we recruited 30 healthy volunteers they had no history of urticaria, rhinitis, asthma, atopic eczema/dermatitis syndrome (AEDS), or other relevant diseases. IgG antibodies to Toxocara canis and Fasciola species were investigated by ELISA method. Results. In a total of 55 patients (mean age: 31.85 +/- 8.92), 8 patients (14.5%) were positive for IgG antibodies to Toxocara canis. Among seropositive patients (mean age: 38.62 +/- 12.46) 6 patients were female. No patient was positive for Fasciola by ELISA. Six of Toxocara canis seropositive cases were frequently visited or lived in rural areas and had contact with pets. Conclusions. Patients with urticaria, should be tested for Toxocara canis and treated with anthelminthic drugs in endemics areas for toxocariasis.Öğe Vancomycin-resistant Enterococcus faecium Meningitis(Univ West Indies Faculty Medical Sciences, 2016) Dayan, S.; Senses, E.; Bekcibasi, M.; Yilmaz, T.; Deveci, O.; Tekin, R.[Abstract Not Available]
