Investigation of clonal relationships of K. pneumoniae isolates from neonatal intensive care units by PFGE and rep-PCR

Introduction: Clonal relationships of Klebsiella pneumoniae strains obtained during an epidemic and after a one-year post-epidemic (non-epidemic) period in the same neonatal intensive care unit (NICU) using pulsed-field gel electrophoresis (PFGE) and repetitive polymerase chain reaction (rep-PCR) by the DiversiLab (DL) system were investigated, and the results of both molecular techniques were evaluated. Methodology: Fifteen K. pneumoniae strains were included in this study. All identified bacterial strains were confirmed by 16S rDNA sequencing and analyzed by PFGE and the DL system. Results: According to the PFGE results, 15 isolates showed 10 different band profiles. Nine of these 15 isolates were included in one of the formed clusters, and the remaining six isolates were not included in any of them. According to the DL system results, 15 isolates showed two different clusters, with three strains in one cluster and four strains in the other. The remaining strains could not be placed any one of the clusters. PFGE was used as the gold standard based on its strong genetic discriminatory power. The DL system results showed that  PFGE missed the relationship of the two epidemic-related strains and demonstrated one epidemic-unrelated strain to be epidemic related. Conclusions: Both systems may easily be used for clonal relationships of K. pneumoniae strains. The DL system was clearly more rapid and convenient than PFGE, but its discriminatory power seemed to be inferior to that of PFGE based on 15 K. pneumoniae strains.

Evaluation of antimicrobial activities of minocycline and rifampin-impregnated silicone surfaces in an in vitro urinary system model

OBJECTIVE

To evaluate the antimicrobial activity in urinary catheters and silicones in antibiotic-coated prosthetic urinary systems in order to reduce morbidity and mortality caused by catheter-associated infection.

METHODS

The study was initiated in 1993 at Houston, USA and continued in Turkey till 1996. A sterileplastic bag was used as kidney in the in vitro urinary system. Physiological renal jet streams (50 cc/h) were generated with an intravenous metric pump. The temperature was kept at body temperature. The bladder drainage was achieved at the physiological drainage period of 4-6 hours during the 72-hour experiment. Silicone surfaces coated with pure silicone and impregnated with Minocycline-Rifampin were exposed to the urine contaminated with the targeted bacteria in the in vitro urinary model for 72 hours. Antimicrobial activities occurring in the Eosin methylene blue and blood agar media in the infected silicones were assessed.

RESULTS

Minocycline-Rifampin silicone surfaces exposed to the urine contaminated with Escherichia coli and Pseudomonas aeruginosa reported reproduction. No reproduction was observed in the culture of Minocycline- Rifampin-impregnated silicone surfaces for Proteus mirabilis.The difference with the control group was regarded as statistically significant for Proteus mirabilis (p < 0.005). Minocycline-Rifampin-coated silicones were closely monitored only for Proteus mirabilis in the in vitro urinary medium. Although inhibition zones (< 10 mm) in the cultures were observed for Minocycline-Rifampin-coated silicones for Escherichia coli and Pseudomonas aeruginosa, but the microbial efficacy was not regarded sufficient.

CONCLUSION

There is still need for evidence-based in vivo and in vitro studies where antimicrobial activity is evaluated on the surface of catheters.

Risk factors of hepatitis B virus infection in Turkey: A population-based, case-control study: Risk Factors for HBV Infection

BACKGROUND

Although the World Health Organization (WHO) classifies Turkey as a country with a moderate-high prevalence of hepatitis B virus (HBV) infection, there is little data on HBV transmission in this country.

OBJECTIVES

To identify risk factors for HBV infection, we performed a retrospective case-control study between January 2007 and December 2009.

PATIENTS AND METHODS

Acute HBV patients and population controls were selected, and data from these groups were analyzed by logistic regression method.

RESULTS

The study included 129 patients with acute HBV infection and 219 controls. Hemodialysis (OR:8.2, 95% CI: 4.17-16.61, p < 0.05), having an HBsAg (+) spouse (OR: 4.3, 95% CI:2.17-8.53, p < 0.05), living with an HBsAg (+) parent(s) (OR: 3.25, 95% CI:1.73-6.12, p < 0.05), and being male (OR: 1.34, 95% CI: 0.82-2.21, p < 0.05) were independent risk factors that were potentially associated with HBV infection. More than one-third of female patients had a significantly higher risk (34.5% vs. 13.5%, p < 0.05) of acquiring HBV from their sexual partners. Hemodialysis was the most frequent risk factor (46.9% vs. 20%, x (2) = 10.45, p < 0.05) for patients aged over 31 years, and living with HBsAg (+) parents was a significantly higher risk factor (28.8% vs. 10.2%, x (2) = 6.15, p < 0.05) that is more likely to lead to HBVin patients aged under 30 years.

CONCLUSIONS

This study suggests that persons in Turkey who undergo hemodialysis are at high risk for acquiring HBV. Having an HBsAg (+) spouse (sexual transmission) or living with HBsAg (+) parents (household transmission) are significant risk factors for HBV transmission. Vaccination appears to be better preventive method against the spread of HBV.

Demographic and microbial characteristics of extrapulmonary tuberculosis cases diagnosed in Malatya, Turkey, 2001-2007

BACKGROUND

Extrapulmonary tuberculosis (EPTB) has an increasing rate in Turkey. The reason remains largely unknown. A better understanding of the demographic and microbial characteristics of EPTB in the Turkish population would extend the knowledgebase of EPTB and allow us to develop better strategies to control tuberculosis (TB).

METHODS

We retrospectively evaluated clinical and laboratory data of 397 bacteriologically-confirmed TB cases diagnosed during an eight year-period using by chi-square analysis and multivariate logistic regression model.

RESULTS

Of the 397 study patients, 103 (25.9%) had EPTB and 294 (74.1%) had pulmonary tuberculosis (PTB). The most commonly seen two types of EPTB were genitourinary TB (27.2%) and meningeal TB (19.4%). TB in bone/joints, pleural cavity, lymph nodes, skin, and peritoneal cavity occurred at a frequency ranging from 9.7% to 10.7%. The age distribution was significantly different (P<0.01) between PTB and EPTB, with patients older than 45 years tending to have an increased risk of EPTB. Furthermore, the distribution of different types of EPTB differed significantly among age groups (P=0.03). Meningeal and bone and/or joint TB were more commonly observed among the male patients, while lymphatic, genitourinary, and peritoneal TB cases were more frequently seen among females. Unique strain infection was statistically significantly associated with EPTB (OR: 2.82, 95% CI [1.59, 5.00])

CONCLUSIONS

EPTB accounted for a significant proportion of TB cases in Malatya, Turkey between 2001 and 2007. The current study has provided an insight into the dynamics of EPTB in Malatya, Turkey. However, the risk factors for having EPTB in Malatya, Turkey remain to be assessed in future studies using population-based or randomly selected sample.

Thrombin-activatable fibrinolysis inhibitor in breast cancer patients

OBJECTIVE

To evaluate the levels of thrombin-activatable fibrinolysis inhibitor (TAFI) activity and also its relationship with other homeostasis markers in breast cancer patients.

SUBJECTS AND METHODS

Forty-two female patients with breast cancer and 24 healthy women (controls) were enrolled in the study and fasting blood samples of all cases were drawn from a large antecubital vein for assay of TAFI and other homeostasis tests.

RESULTS

The TAFI levels were 79.5 ± 15.5 and 39.3 ± 12.1 in patients and controls, respectively, and the difference was statistically significant (p < 0.001). In the patient group, the serum fibrinogen level was 504.9 ± 224.8, while in the control group it was 393.9 ± 100.5, and the difference was also statistically significant (p < 0.001).

CONCLUSION

The data showed that increased levels of TAFI are a contributing factor of thrombotic disorders in breast cancer patients.

A waterborne outbreak of epidemic diarrhea due to group A rotavirus in Malatya, Turkey

We characterized an outbreak of acute diarrheal disease caused by group A rotavirus that occurred during the Autumn of 2005 in Malatya City, Turkey. A total 9907 patients between 0 to 91 years old (mean age: 25.05�19.67) were included in the epidemic. The patients� data were prospectively collected and statistically analyzed. Microbiologic analyses were performed to determine the etiologic agent. Rapid onset diarrhea (98.36%), abdominal cramps (69%), fever (44.4%) and vomiting (69.6%) were the most common symptoms observed in patients. Rotavirus antigen was detected in 52.7% of the studied patients. RT-PCR analysis led to identification of Group A rotavirus as the causative agent of this epidemic. Simultaneous measurements of the drinking water samples yielded very low chlorine levels; as low as 0 to 0.05 mg/L. The outbreak investigation team indicated possible contamination of a large water depository from a water well, which supplies drinking water to two major districts of the city. Effective chlorination and blockage of the passage between the well and the water depository stopped the outbreak. This outbreak shows the high epidemic potency of rotavirus in large human populations, including all age groups, and underlines the importance of water safety in pipeline systems.

MRI Findings in Patients with Hemiparetic Cerebral Palsy

Given the more severe and extensive unilateral brain abnormalities in hemiparetic cerebral palsy (HCP) patients than in other spastic cerebral palsy patients we focused exclusively on the localization of brain lesions in children with HCP. The relationship between neuroradiological findings and side of hemiparesis was investigated in a group of 30 children with HCP. Seventeen boys and 13 girls aged four to 18 years (mean age 9.7±4.2 years) were included in this study. Computed tomography and magnetic resonance imaging examinations were correlated with the birth histories, obstetrical records and clinical summaries. Of the 30 patients with HCP, 2 (6.6%) had normal neuroradiological examinations, 20 (66.6%) had unilateral and eight (26.6%) bilateral brain lesions. A brain lesion on the contralateral side of hemiparesis was found in 93.3% of the neuroradiological examinations. The commonest neuroradiological findings in our study were periventricular leukomalacia (PVL, 80%), atrophy (70%) and porencephalic cyst (50%). There was a significant relationship between the symptomatic side and contralateral PVL, atrophy and porencephalic cyst (40%). PVL, atrophy and porencephalic cyst were significantly concomitant on the same side (46.6%). We demonstrated for the first time in the literature that PVL, atrophy and porencephaly are usually observed concomitantly and contralateral to the side of motor impairement in HCP patients.

Biliary cystadenoma and cystadenocarcinoma: two rare cystic liver lesions

A case of hepatobiliary cystadenoma with mesenchymal stroma and a case of biliary cystadenocarcinoma are presented. Hepatobiliary cystadenoma and cystadenocarcinoma are rare liver lesions that are difficult to diagnose preoperatively. Regardless of the diagnostic modalities used these two pathologies cannot be differentiated with accuracy. The preoperative diagnosis of biliary cystadenoma and cystadenocarcinoma was suggested due to the radiological detection of vascularity in the septa and the invasion of the thoracoabdominal wall. The surgeon was informed in both of the cases. Pathologic examination confirmed the diagnosis in both of our patients. The radiological features of these pathologies are discussed in detail together with a brief review of the literature.

Table-moving contrast-enhanced magnetic resonance angiography in the evaluation of lower extremity peripheral arterial bypass grafts

The aim of this study was to investigate the utility of table-moving contrast-enhanced three-dimensional MR angiography in the evaluation of lower extremity peripheral arterial bypass grafts. Twenty-two lower extremity peripheral arterial grafts (13 autologous saphenous vein, 7 polytetrafluoroethylene and 2 Dacron) in 18 patients were evaluated. Preoperative diagnosis were occlusive arterial segments in 14 cases, 4 aneurysms in 2 cases (3 aneurysms in one case) and traumatic femoral artery injury in 2 cases. 1.5T superconductive magnet was used with torso-phase and whole body coil system on MRI examinations. Lower extremity peripheral arterial grafts were evaluated and anastomosis sites were classified into five groups as normal, insignificant stenosis (< 50%), significant stenosis (> 50%), occlusion and ectatic or aneurysmatic appearance. Contrast-enhanced MR angiography imaging of 66 segments of 22 graft patients were of high quality. No difficulties were confronted in the radiological evaluation of peripheral bypass grafts. Graft stenosis as detected in five grafts. Stenotic segments were at the proximal (n = 4) and distal (n = 3) anastomosis sites. Total occlusion was shown in three grafts. Ectasia or aneurysm was seen in only one graft. In lower extremity peripheral bypass graft patients, table-moving contrast enhanced MR angiography can be used in the evaluation and follow-up of the vascular lesions.

Percutaneous placement of central venous catheters: comparing the anatomical landmark method with the radiologically guided technique for central venous catheterization through the internal jugular vein in emergent hemodialysis patients

PURPOSE

To compare the success and immediate complication rates of the anatomical landmark method (group 1) and the radiologically (combined real-time ultrasound and fluoroscopy) guided technique (group 2) in the placement of central venous catheters in emergent hemodialysis patients.

MATERIAL AND METHODS

The study was performed prospectively in a randomized manner. The success and immediate complication rates of radiologically guided placement of central venous access catheters through the internal jugular vein (n=40) were compared with those of the anatomical landmark method (n=40). The success of placement, the complications, the number of passes required, and whether a single or double-wall puncture occurred were also noted and compared.

RESULTS

The groups were comparable in age and sex. The indication for catheter placement was hemodialysis access in all patients. Catheter placement was successful in all patients in group 2 and unsuccessful in 1 (2.5%) patient in group 1. All catheters functioned adequately and immediately after the placement (0% initial failure rate) in group 2, but 3 catheters (7.5% initial failure rate) were non-functional just after placement in group 1. The total number of needle passes, double venous wall puncture, and complication rate were significantly lower in group 2.

CONCLUSION

Percutaneous central venous catheterization via the internal jugular vein can be performed by interventional radiologists with better technical success rates and lower immediate complications. In conclusion, central venous catheterization for emergent dialysis should be performed under both real-time ultrasound and fluoroscopic guidance.

Extrinsic compression of the left main coronary artery in pulmonary hypertension

Compression of the left main coronary artery by a dilated pulmonary artery can be a life-threatening condition. It can present with angina, symptoms of left ventricular dysfunction, and sudden death. Diagnosis and treatment of this condition is very important. We demonstrate significant compression of the left main coronary artery on coronary angiography and thorax CT examinations.

Left atrial, pulmonary vein and dural calcification in a patient with arrhythmia and chronic renal failure

Left atrial and dural calcification in chronic renal failure is very rare. Massive atrial calcification can lead to arrhythmia and diagnosis of this condition is important to take prophylactic measures in dialysis patients. Noninvasive diagnosis of left atrial calcification is also important as it can complicate valvular surgery. We report on a patient with chronic renal failure presenting with arrhythmia in whom left atrial calcification involving interatrial septum is diagnosed by thorax CT examination.

Magnetic resonance imaging and diffusion-weighted imaging in methylmalonic acidemia

Methylmalonic acidemia (MMA) is an inborn disorder of amino acid metabolism, often presenting with neurological symptoms. We present the results of magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) of the brain in a 16-month-old male patient with classic neurological and laboratory findings for MMA. MRI demonstrated the hyperintensity within globi pallidi both on T2-weighted image and DWI during the acute episode of metabolic acidosis.

Lhermitte-Duclos disease associated with neurofibromatosis type-1 and non-ossifying fibroma

Lhermitte-Duclos disease (LDD) is a rare cerebellar disorder of uncertain pathogenesis characterized by enlargement of cerebellar folia. Magnetic resonance imaging is the diagnostic modality of choice and usually distinguishes the LDD by its characteristic "striated or laminated pattern" appearance. Various additional abnormalities have been reported in association with LDD. We report a case of LDD coexisting with neurofibromatosis type 1 (NF-1) and non-ossifying fibroma.

Comparison of spiral CT and US in the evaluation of pediatric urolithiasis

The objective of the study was to determine the value of spiral computerized tomography (CT) in detecting urolithiasis in pediatric patients and compare its efficacy with ultrasound (US). Twenty-nine infants aged between 2 to 94 months with clinical presentation suggestive of urolithiasis and a negative or indeterminate plain film were included in the study. Abdominal US and spiral CT were performed in all patients. Presence, size and localization of stones were noted for each patient on both CT and US. The diagnosis of urolithiasis was confirmed by passage of stones spontaneously, extracorporeal shockwave lithotripsy (ESWL), surgery, or clinical follow-up. Presence of stones was confirmed in 23 of 29 patients (79%). Eight patients had single stone and the remaining 15 had multiple stones either in a single localization (single kidney or single ureter) or multiple localizations. Spiral CT detected 57 stones (45 renal and 12 ureteral). US detected 34 stones (59.6%) in 18 (78.2%) patients. US was able to localize 31 stones (68.8%) in 21 kidneys (75%), and 3 stones (25%) in 11 ureters (27.2%). Spiral CT is very effective in the diagnosis of pediatric urolithiasis. Spiral CT is more efficient than US in imaging pediatric patients with symptoms and signs of urolithiasis, when KUB is inconclusive.

Adrenal oncocytoma: US and CT findings

We describe a case of an oncocytoma occurring in the adrenal gland, a rare location, and describe US and CT findings of this tumor in our patient. The mass was well marginated but heterogeneous on both CT and US and unfortunately the imaging findings of the tumor are non-specific.

Detection and typing of extended-spectrum beta-lactamases in clinical isolates of the family Enterobacteriaceae in a medical center in Turkey

To determine and type the extended-spectrum beta-lactamases (ESBLs) among the family Enterobacteriaceae in a medical center, a total of 668 clinical isolates were screened. Of the 668 isolates, the 80 strains were presumptively defined as ESBL producers according to the result of disk method using ESBL marker antibiotics (aztreonam, ceftazidime, and cefoxitin). These 80 strains were retested with the double-disk synergy test (DDST), the E-test ESBL strip, a 5-microg ceftazidime disk, and agar dilution MICs of ceftazidime with and without clavulonic acid. Isoelectric focusing was performed to confirm ESBL production and type the beta-lactamases. By evaluation of the results of all tests used for ESBL detection together with isoelectric focusing, 33 (4.9%) of the 668 isolates were described as ESBL producer. The positive results of the agar dilution test, DDST, the E-test strip, and 5-microg ceftazidime disk were 32, 26, 27, and 26 of the 33 strains, respectively. ESBL positivity was 48.8% in Klebsiella species, 15.4% in Citrobacter species, 4.9% in Enterobacter species and 1.1% in Escherichia coli strains. The ESBL enzymes frequently determined were SHV-2/6-like (pI 7.6), SHV-5-like (pI 8.2), SHV-4-like (pI 7.8), and SHV-3-like (pI 7). SHV-derived enzymes were commonly observed in Klebsiella spp whereas TEM-related enzymes were seen in E. coli strains. The results of this study indicated that SHV-2/6-derived (pI 7.6) ESBL expression among the isolates of the family Enterobacteriaceae is an important problem in our medical center.