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Öğe A Typical Chest CT Appearance of a Case with Coronavirus Disease 2019 (COVID-19)(Erciyes Univ Sch Medicine, 2020) Imre, Ayfer[Abstract Not Available]Öğe Acinetobacter baumannii Infections and Antibiotic Resistance in Hospitalized Patients in an Education and Research Hospital: A Six-Year Analysis(Bilimsel Tip Yayinevi, 2020) Arslan Gulen, Tugba; Imre, Ayfer; Odemis, Ilker; Kayabas, UnerIntroduction: Acinetobacter baumanii causes difficulties in the treatment of nosocomial infections due to increasing resistance worldwide. With an increase in resistant infections, the use of colistin has come to the fore. We aimed to investigate the antimicrobial resistance profile of A. baumanii strains isolated from clinical specimens as hospital-acquired colonizations and infection agents and to evaluate the clinical and microbiologic responses and adverse effects of antibiotic regimens used in patients who were isolated because of having infectious agents. Materials and Methods: A retrospective descriptive study of 326 adult patients with nosocomial A. baumannii colonizations and infections was conducted between January 2012 and December 2017 in Nigde Education and Research Hospital. In addition, a total of 212 adult patients who received at least 72 hours of antimicrobial therapy were evaluated. Standard and automated methods were used to identify isolated strains and antibiotic susceptibility. The antimicrobial susceptibility profile change over the 6-year period was evaluated. Adverse effects, and clinical and microbiologic response were evaluated in patients receiving antimicrobial therapy. Analysis of the variables was performed using SASS 22.0 (IBM Corporation, Armonk, New York, United States). Results: When antimicrobial resistance rates were examined, it was seen that imipenem (99.7%), ampicillin sulbactam (81.6%), cefoperazone sulbactam (60.3%), netilmicin (89.4%), tobramycin (88.4%), gentamicin (83.1%), amikacin (91.6%) and tigecycline (33.7%) had resistance rates; colistin resistance was not detected in the isolates. Resistance rate to other antibiotic groups was 100%. The resistance rates of ampicillin sulbactam, cefoperazone sulbactam, gentamicin, amikacin, and tigecycline were found to be statistically significant (p< 0.05). There were no significant differences in terms of nephrotoxicity, and clinical and microbiologic response among patients in whom colistin was used in combination with carbapenem, ampicillin/sulbactam, cefoperazone/sulbactam, and tigecycline (p> 0.05). Conclusion: In accordance with the global data, antimicrobial resistance rate in A. baumanii isolates was found to be high in our study. Treatment regimens in which colistin is used with other antimicrobial agents have no superiority in terms of efficacy and adverse effects. There is a clear need for new and effective antimicrobial agents in the treatment of resistant A. baumanii infections.Öğe Adult Tetanus With Fatal Course: A Case Report(Aves, 2019) Arslan-Gulen, Tugba; Destegul, Dilek; Ortakoylu-Kilickaya, Refika; Imre, Ayfer; Atan-Ucar, Zuhal; Kayabas, UnerDespite improvements in medicine, tetanus is still a fatal infectious disease which can be prevented by immunoprophylaxis and it should always be kept in mind after injuries. In this case report, we present a patient who had no previous immunization history and did not have tetanus prophylaxis completed at the first visit of the emergency department after injury. The patient was followed with a clinical picture of generalized tetanus in intensive care unit, but autonomic dysfunction could not be taken under control despite treatment and resulted in mortality. Tetanus prophylaxis should be questioned in patients applying with injury or trauma. Strategies should be developed in order to achieve regular vaccination, with respect to adult immunization in particular.Öğe Choroidal thickness and retinal nerve fiber layer analysis in acute systemic brucellosis(Sage Publications Inc, 2021) Zor, Kursad Ramazan; Gulen, Tugba Arslan; Bicer, Gamze Yildirim; Kucuk, Erkut; Imre, Ayfer; Odemis, Ilker; Kayabas, UnerIntroduction This study aims to detect changes in choroidal thickness and retinal nerve fiber layer (RNFL) thickness in acute stage brucellosis. Methods Fnewly diagnosed patients with acute brucellosis and 19 healthy individuals as control group were included in the study. Choroidal thickness and RNFL thickness were measured using the Spectral Domain Cirrus OCT Model 400 (Carl Zeiss Meditec, Jena, Germany) for each participant in the patient and control group. Results In the brucella group, in the right eyes, the mean nasal choroidal thickness was 272.77 +/- 50.26 mu m (p = 0.689), the mean subfoveal choroidal thickness was 321.14 +/- 33.08 mu m (p = 0.590), the mean temporal choroidal thickness was 278.86 +/- 48.84 mu m (p = 0.478), and the mean RNFL thickness was 90.43 +/- 8.93 mu m (p = 0.567). In the left eyes, the mean nasal choroidal thickness was 282.29 +/- 48.93 mu m (p = 0.715), the mean subfoveal choroidal thickness was 316.79 +/- 39.57 mu m (p = 0.540), the mean temporal choroidal thickness was 284.93 +/- 50.57 mu m (p = 0.392), and the mean RNFL thickness was 92.64 +/- 8.95 mu m (p = 0.813). Conclusion No difference was found between the control and the brucella groups regarding to all choroidal regions and RNFL thickness.Öğe Deep Venous Thrombosis as a Complication of Brucellosis: A Case Report on Diagnosis and Treatment Management(Galenos Yayincilik, 2019) Arslan Gulen, Tugba; Serhatlioglu, Faruk; Imre, Ayfer; Kayabas, Uner[Abstract Not Available]Öğe Examination of Tuberculin Skin Test Results of Health Care Workers in a Hospital and Healthy Individuals Who Are Not in Risk of Tuberculosis(Aves, 2020) Imre, Ayfer; Arslan-Gulen, Tugba; Kocak, Muradiye; Bas-Sarahman, Emine; Kayabas, UnerObjective: This study was carried out to determine the Bacillus Calmette-Guerin (BCG) vaccination status and tuberculin skin test (TST) responses in health care workers and to compare the results with the results of healthy individuals who had TST screening in Tuberculosis Dispensary. Methods: Demographic characteristics of the two groups were analysed by survey form. The TST results and BCG scar counts on the left shoulder of the participants were obtained from Infection Control Committee and Tuberculosis Dispensary records and evaluated retrospectively. After data were recorded in IBM SPSS Statistics for Windows. Version 22.0 (Statistical Package for the Social Sciences, IBM Corp., Armonk, NY, USA) statistical program, descriptive statistics were used for demographic variables, Shapiro -Wilk test was used for normality test, Mann -Whitney U test was used for continuous variables and Pearson chi(2) test were used for the other categorical variables. Results: A total of 294 cases were included in the study. Number of scars ranged from one to four in each group, and the BCG vaccination rate was 98.6% in health care workers and 87.1% in control group (p<0.05). The TST induration diameters of the healthcare workers ranged from 0 to 22 mm, and the results of 32 (21.8%) employees were found to be positive. In the control group, the induration diameters were between 0-18 mm, and 12 (8.2%) were found to be positive. Differences between groups in terms of both mean diameters of induration and the TST positivity were statistically significant (p<0.05). The TSTpositive health care workers were evaluated for tuberculosis (TB) and TB was not detected in any of them. Conclusions: Health care workers are in the risk group for TB. For this reason, employee health units of each hospital should implement TST and tuberculosis screening programs in a planned way. We determined that health care workers had high TST induration diameters, but none of them had active TB. This may be explained by repeated BCG vaccinations and exposure to mycobacteria other than Mycobacterium tuberculosis.Öğe Factors Affecting the Colistin Nephrotoxicity: Advanced Age and/or Other Factors?(Galenos Yayincilik, 2022) Gulen, Tugba Arslan; Imre, Ayfer; Kayabas, UnerIntroduction: The population is aging, and older adults comprise most patients in the intensive care units. Colistin (COL) has been re-introduced to treat increasingly common resistant Gram-negative bacterial infections. Our study aims to investigate the factors affecting COL nephrotoxicity in a general population and geriatric age group. Materials and Methods: This retrospective study included 170 patients, a total of 116 (68.2%) of whom were in the geriatric group (age >= 65). Acute renal failure was evaluated using the RIFLE score. Factors associated with COL nephrotoxicity were described firstly in a general population and then in the geriatric group patients. Results: Advanced age [Odds ratio (OR): 1.043; 95% confidence interval (CI): 1.018-1.068; p=0.001] and initial serum creatinine level (OR: 23.122; 95 % CI: 3.123-171.217; p=0.002) were found to be the independent risk factors associated with nephrotoxicity. In the evaluation of the geriatric population based on nephrotoxicity, the initial serum urea and creatinine levels, and overall mortality rates were found to be statistically significantly higher in the group with nephrotoxicity (p<0.05). Initial serum creatinine level (OR: 22.48; 95 % CI: 2.835-178.426; p=0.003) and concomitant nephrotoxic agent use (OR: 2.516; 95 % CI: 1.275-4.963; p=0.008) were independent risk factors associated with nephrotoxicity in geriatric patients. Conclusion: Advanced age was found to be a risk factor for COL nephrotoxicity. Closed observation should be done especially in the geriatric patients who have initial serum creatinine levels close to the upper limit, concomitant use of the nephrotoxic drugs should be avoided, and if possible, evaluation should be made in terms of non-COL treatment options in these patients.
