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Öğe Molecular epidemiology of the Bacillus anthracis isolates collected throughout Turkey from 1983 to 2011(Springer, 2012) Durmaz, R.; Doganay, M.; Sahin, M.; Percin, D.; Karahocagil, M. K.; Kayabas, U.; Otlu, B.The main perspective of this study was to determine cross-transmissions amongst anthrax cases and provide detailed information regarding the genotypes of Bacillus anthracis isolates circulating in Turkey. A total of 251 B. anthracis isolates were obtained from human (93 isolates), animal (155 isolates), and environmental (three isolates) samples in various provinces of Turkey. All isolates were susceptible to quinolones, vancomycin, tigecycline, and linezolid, but not to ceftriaxone. Excluding human isolates, one of the animal isolates was found to be resistant to penicillin, erythromycin, and doxycycline. Multiple-locus variable-number tandem repeats analysis including 8 loci (MLVA8) revealed 12 genotypes, in which genotype 43 was observed at the highest frequency (41.8 %), followed by genotype 35 (25.5 %) and genotype 27 (10.4 %). Major subtype A3.a was the predominant cluster, including 86.8 % of the isolates. The MLVA25 analysis for the 251 isolates yielded 62 different genotypes, 33 of which had only one isolate, while the remaining 29 genotypes had 2 to 43 isolates, with a total of 218 isolates (86.9 %). These findings indicate very high cross-transmission rates within anthrax cases in Turkey. The genotypes diagnosed in Turkey are populated in the A major cluster. Penicillin prescribed as the first-choice antibiotic for the treatment of anthrax is still effective.Öğe Naturally Occurring Cutaneous Anthrax: Antibiotic Treatment and Outcome(Karger, 2012) Kayabas, U.; Karahocagil, M. K.; Ozkurt, Z.; Metan, G.; Parlak, E.; Bayindir, Y.; Kalkan, A.Objectives: Cutaneous anthrax (CA) is the most common clinical presentation in human anthrax, but the duration of antibiotic therapy in naturally occurring CA is controversial. The aim of this study was to compare the clinical outcomes of patients receiving antibiotic treatment for either 3-5 days (group 1) or 7-10 days (group 2) in uncomplicated CA. Methods: A total of 66 patients were enrolled; 29 (44%) in group 1 and 37 (56%) in group 2. Infections were classified as mild (n = 22, 33%) or severe (n = 44, 67%) CA. Results: There were no significant differences between the groups in symptom resolution time, fever clearance time, healing of lesions, development and healing of eschars, requirement for surgical intervention or the development of complications. Both edema resolution time and duration of hospital stay were longer in group 2. There were no therapeutic failures, relapses or deaths in either group. Steroid therapy was used in 32% of patients with severe CA, but a beneficial effect on resolution of edema was not demonstrated. Conclusions: These results suggest that short-course antibiotic therapy is as effective as standard-duration therapy in uncomplicated CA and that steroid therapy may not be effective. Copyright (C) 2012 S. Karger AG, BaselÖğe Predictors of mortality in septic shock: findings for 57 patients diagnosed on admission to emergency or within 24 hours of admission to intensive care(Sage Publications Ltd, 2012) Yucel, N.; Togal, T.; Gedik, E.; Ertan, C.; Kayabas, U.; Akgun, F. S.; Bayindir, Y.Objective: To identify the risk factors that influence outcome for patients who are diagnosed with septic shock in the emergency department at presentation or within 24 hours after admission to intensive care unit. Methods: A retrospective study of 57 adult patients with septic shock was conducted between March 1, 2006 and August 31, 2009. Results: The patients were 23 males and 34 females with a median age of 67 years (20 to 92 years). Thirty-three (58%) of 57 patients died in hospital and 24 (42%) survived. Multivariate analysis identified low blood pH (OR <0.001; 95% CI <0.001-0.53) and low bicarbonate level (OR 0.81; 95% CI 0.70-0.95) at emergency department or intensive care unit admission as useful predictors of 3-day in-hospital mortality. Low blood pH (OR <0.001; 95% CI <0.001-0.05), low bicarbonate level (OR 0.75; 95% CIs 0.61-0.91), long duration of symptoms (OR 1.49; 95% CI 1.04-2.13), high MEDS score (OR 1.56; 95% CIs 1.06-2.30), and high SOFA score (OR 1.57; 95% CI 1.12-2.20) were risk factors for 14-day in-hospital mortality. Renal failure (OR 7.58; 95% CI 1.28-44.77), lower pulmonary tract infection (OR 3.58; 95% CI 1.10-11.58), high MEDS score (OR 1.42; 95% CI 1.05-1.93) and high APACHE II score (OR 1.34; 95% CI 1.13-1.60) were risk factors for 28-day in-hospital mortality. Conclusions: Several factors signaling poor short-term outcome for this patient group are low blood pH, low serum bicarbonate level, longer duration of symptoms lower respiratory tract infection and renal failure. MEDS and SOFA scores might be helpful in the ED to stratify patients with septic shock according to mortality risk. (Hong Kong j. emerg.med. 2012;19:375-386)Öğe A Rare Cause of Diarrhea in a Kidney Transplant Recipient: Dipylidium caninum(Elsevier Science Inc, 2015) Sahin, I.; Koz, S.; Atambay, M.; Kayabas, U.; Piskin, T.; Unal, B.We report the first case of dipylidiasis in a kidney transplant recipient. Watery diarrhea due to Dipylidium caninum was observed in a male patient who had been undergone kidney transplantation 2 years before. The patient was successfully treated with niclosamide. D caninum should be considered as an agent of diarrhea in transplant patients.
