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    Comparison of five antimicrobial regimens for the treatment of brucellar spondylitis: A prospective, randomized study
    (E I F T Srl, 2003) Bayindir, Y; Sonmez, E; Aladag, A; Buyukberber, N
    Brucellosis, a zoonosis with worldwide distribution, is a systemic infection and still an important public health problem in Turkey. The best antimicrobial combination and schedule for the treatment of brucellosis with spondylitis has not yet been clearly determined. In a prospective and randomized study, we compared the efficacy of five antimicrobial regimens for treatment of 102 patients with lumbar brucellar spondylitis. Patients were randomly assigned to receive antimicrobial combination therapy. Twenty patients received streptomycin 1 g/day intramuscularly for 15 days and tetracycline-HCl, 500 mg every 6 h orally for 45 days (ST), 21 patients received streptomycin 1 g/day i.m. for 15 days and doxycycline 100 mg every 12 h orally for 45 days (SD), 20 patients received doxycycline 100 mg every 12 h orally for 45 days and rifampicin 15 mg/kg per day in a single morning dose orally for 45 days (DR), 19 patients received ofloxacin, 200 mg every 12 h orally for 45 days and rifampicin 15 mg/kg per day in a single morning dose orally for 45 days (OR), and 22 patients received streptomycin 1 g/day i.m. for 15 days and doxycycline 100 mg every 12 h orally for 45 days plus rifampicin 15 mg/kg per day in a single morning dose orally for 45 days (SDR). Initial therapeutic failure occurred in 2 patients (10%) in the ST regimen group, 4 patients (19%) in the SD group, 3 patients (15%) in the DR group and 5 patients (26%) in the OR regimen. In addition, 2 patients (10%) in the DR group and 5 patients (26%) in the OR regimen relapsed during the follow-up period. There was no relapse in any patients in the ST, SD, and SDR groups. The response rates were 90% in the ST and 81% in the SD groups. In contrast, there was a maximum good response (100%) and no relapse in the SDR group. In conclusion, a combination of doxycycline, streptomycin, and rifampicin can be recommended as therapy for brucellar spondylitis and to reduce relapse rates.
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    Comparison of three different combination therapies in the treatment of human brucellosis
    (Royal Soc Medicine Press Ltd, 2005) Ersoy, Y; Sonmez, E; Tevfik, MR; But, AD
    The efficacy and tolerability of three different combination treatment regimens in human brucellosis were compared in 118 uncomplicated patients enrolled in a prospective study between May 1997 and December 2002. Brucellosis was diagnosed using standard clinical and microbiological findings. Patients with central nervous system involvement, spondylitis, endocarditis or children under 16 years of age were excluded from the study. Patients were randomly assigned to receive 400 mg of ofloxacin plus 600 mg of rifampicin (OR, n = 41),200 mg of doxycycline plus 600 mg of rifampicin (DR, n = 45) or 1 g intramuscularly streptomycin (administered for three weeks) plus 200 mg doxycycline (DS, n = 32) daily for 6 weeks. All patients were followed up at least 6 months after cessation of therapy. There was no statistical difference between the groups on relapse rates and clinical response to the treatment (P> 0.05). Five patients in OR (12.8%), six patients in DR (14.3%) and three patients in DS groups (9.7%) suffered relapse. The side-effects were seen in eight (19.5%), 21 (46.7%) and eight (25.0%) patients of OR, DR and DS groups, respectively. The use of combination therapy of ofloxacin plus rifampicin for 6 weeks was found to be as effective as DR and DS. The side-effects of therapy in OR and DS groups was less severe than in the DR group.
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    Effect of the treatment of brucellosis on leukocyte superoxide dismutase activity and plasma nitric oxide level
    (Sage Publications Inc, 2005) Karabulut, AB; Sonmez, E; Bayindir, Y
    Background: The mechanisms by which brucellae evade intracellular killing by polymorphonuclear leukocytes are incompletely understood. In this study, we evaluated changes of leukocyte superoxide dismutase (SOD) activity and plasma total nitrite as an indicator of nitric oxide (NO) levels during brucellosis therapy. Methods: Thirty-two patients with acute brucellosis, 27 patients with chronic brucellosis and 30 healthy controls were included in the study. Patients with acute brucellosis were tested for leukocyte SOD activity and plasma total nitrite levels before, during (21st day), and at the end (45th day) of the combined therapy of rifampicin and doxycycline. The same parameters were also investigated in chronic cases and controls. Results: The SOD activities were lower in patients with acute brucellosis before therapy compared with those 21 and 45 days after starting therapy (P < 0.001). In contrast, total nitrite levels did not change significantly (P > 0.05). Conclusions: In the present study, leukocyte SOD activity was found to be decreased in patients with acute brucellosis. Enzyme activity was increased by treatment, finally reaching the activity of healthy controls. Using an antioxidant agent in addition to classical antimicrobial therapy for acute brucellosis might be a therapeutic approach.
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    False-positive reaction between syphilis and hepatitis C infection
    (Israel Journal Med Sciences, 1997) Sonmez, E; Ozerol, IH; Senol, M; Kizilkaya, N; Sahin, K; Ozbilge, H
    There are limited data about false-positive reactions against hepatitis C virus (HCV) in syphilitic patients and false-positive reactions against syphilis in the patients with HCV infection, The aim of this study was to demonstrate the false-positivity of syphilis in patients with HCV infection, the false-positivity of anti-HCV in patients with syphilis and the validity of the serological tests in such patients. Fifty patients with positive anti-HCV, 21 patients with positive VDRL and 50 healthy subjects were studied. Syphilis serology was determined by the Venereal Disease Research Laboratory (VDRL) test and microhemagglutination for T. pallidum (MHA-TP) test. Hepatitis C serology was determined by a second generation ELISA (Ortho Diagnostics) test for HCV antibody, and anti-HCV positive patients were tested for HCV RNA by polymerase chain reaction (PCR). All assays were performed on all subjects. Not only the false-positive VDRL reaction in the patients with HCV infection but also false-positive anti-HCV tests in syphilitic patients have been observed. Four patients with syphilis had positive anti-HCV and negative HCV-RNA, whereas 10% (5 of 50) of patients with hepatitis C infection had positive VDRL and these patients were negative for MHA-TP test, The rates of false-positivity of VDRL and anti-HCV were higher than within the control group (p<0.05). According to these data, positive anti-HCV in syphilitic patients and positive VDRL in chronic hepatitis C may be false-positive results with regard to the reaginic tests, Therefore, therapeutic measures should not be initiated without confirmation with a treponemal test or PCR. VDRL and HCV-ELISA tests may be interacted with IgM or IgG antibodies. This relationship should be investigated in further studies.