INTRODUCTIONBrucellosis is a public health problem that is prevalent in several developing countries.

METHODSThe clinical and laboratory characteristics of 164 cases of brucellosis in Bursa, Turkey, were retrospectively evaluated.

RESULTSThe ages of the 164 patients ranged from 15-85 years. All of the patients underwent the Rose Bengal test and 163 (99.4%) patients tested positive. 122 (74.4%) patients were diagnosed with acute brucellosis, 31 (18.9%) with subacute brucellosis and 11 (6.7%) with chronic brucellosis. Focal involvement was found in 101 (61.6%) patients. Although patients with focal involvement had a higher white blood cell count (p = 0.002), those without focal involvement had higher aspartate transaminase and alanine transaminase values, and lower platelet values (p = 0.005, 0.007 and 0.039, respectively). Spondylodiscitis was observed on imaging in 58 (66.7%) of the 87 patients who presented with back pain. Among the 118 patients who were examined within the first month of treatment, 79 (66.9%) responded to treatment. The relapse rate was 11.6% among all 164 patients.

CONCLUSIONBrucellosis should be considered as a differential diagnosis among patients who present with fever, and joint or back pain. Focal involvement should be investigated in the presence of leucocytosis, and subacute or chronic forms of brucellosis. To identify cases of spondylodiscitis, radiography should be performed in patients who present with back pain.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Back Pain ; diagnosis ; Brucellosis ; diagnosis ; epidemiology ; therapy ; Chronic Disease ; Diagnosis, Differential ; Female ; Fever ; Humans ; Male ; Middle Aged ; Prevalence ; Retrospective Studies ; Risk Factors ; Turkey

Turkey remains an intermediate area for prevalence of hepatitis B virus (HBV) surface antigenemia. The sheep-raising areas of Turkey also pose a high risk for cystic hydatid disease (CHD). Both HBV infection and CHD are major public health issues particularly in eastern parts of Turkey; however, there is no data regarding HBV infection in patients who have had CHD. The aims of this study were to evaluate the association between HBV infection and CHD and suggest ways to reduce HBV infection which is still widespread in Turkey. A retrospective study was conducted with 94 adult patients with active CHD referred to the hepatology department, Yuzuncuyil University School of Medicine from December 2010 to December 2012. All subjects came from rural areas of the region and underwent ultrasonography of abdomen which detected CHD of the liver. All the patients were serologically positive for Echinococcus granulosus. The control group consisted of 500 patients (300 men and 200 women) referred to the internal medicine clinics for other reasons. The patients with CHD and in the control group were tested for the existence of HBs antigen according to the standard procedures. The seroprevalence of HBs antigen was significantly higher in patients with active CHD than those in the control group (12.7% vs 5.2%; P=0.0017). Our data indicate that there is significant association between HBV infection and CHD. All patients with CHD should be screened for HBV infection.
Abdomen/ultrasonography ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Animals ; Echinococcosis/*complications ; Echinococcus granulosus/immunology ; Female ; Hepatitis B/*epidemiology ; Hepatitis B Surface Antigens/*blood ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Rural Population ; Seroepidemiologic Studies ; Turkey/epidemiology ; Young Adult

BACKGROUND/AIMS: Chronic arthritis of familial Mediterranean fever (FMF) involves weight-bearing joints and can occur in patients without a history of acute attack. Our aim was to investigate a possible causal relationship between FMF and osteoarthritis in a population in which FMF is quite common. METHODS: Patients with late stage primary osteoarthritis were enrolled, and five MEFV gene mutations were investigated. The frequency of MEFV gene mutations was compared among patients with osteoarthritis and a previous healthy group from our center. RESULTS: One hundred patients with primary osteoarthritis and 100 healthy controls were studied. The frequency of MEFV gene mutations was significantly lower in the osteoarthritis group (9% vs. 19%). M694V was the most frequent mutation (5%) in the osteoarthritis group, whereas in the control group, E148Q was the most common (16%). In subgroup analyses, the mutation frequency of patients with hip osteoarthritis was not different from that of patients with knee osteoarthritis and controls (7.1%, 9.7%, and 19%, respectively). There were no differences among the three groups with respect to MEFV gene mutations other than E148Q (8.1% vs. 3.6%). E148Q was significantly lower in the osteoarthritis group than in the controls (16% vs. 1%), although the mutations did not differ between patients with knee osteoarthritis and controls. CONCLUSIONS: In a population with a high prevalence of MEFV gene mutations, we did not find an increased mutation rate in patients with primary osteoarthritis. Furthermore, we found that some mutations were significantly less frequent in patients with osteoarthritis. Although the number of patients studied was insufficient to claim that E148Q gene mutation protects against osteoarthritis, the potential of this gene merits further investigation.
Adolescent ; Adult ; Case-Control Studies ; Chi-Square Distribution ; *Cytoskeletal Proteins ; DNA Mutational Analysis ; Familial Mediterranean Fever/diagnosis/epidemiology/*genetics ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; Humans ; Male ; Middle Aged ; *Mutation ; Osteoarthritis, Hip/diagnosis/epidemiology/*genetics/surgery ; Osteoarthritis, Knee/diagnosis/epidemiology/*genetics/surgery ; Phenotype ; Risk Factors ; Turkey/epidemiology ; Young Adult

BACKGROUNDJuvenile Fibromyalgia Syndrome (JFMS) is a chronic health condition characterized by widespread musculoskeletal pain and multiple tender points (TP). The objective of this study was to determine the prevalence of JFMS in the urban population of Samsun and to determine the impact of JFMS on depression symptoms, school performance and quality of life (QOL).

METHODSA cross-sectional study was conducted in 1109 children (mean age (14.8 ± 2.0) years old). A questionnaire was applied to the children and a medical examination including TP was performed. Yunus and Masi's criteria were used for diagnosis of JFMS. The children with JFMS were compared with an age and sex matched non-JFMS group. Depression was assessed with Children's Depression Inventory (CDI) and QOL was evaluated with Pediatric Quality of Life Inventory 4.0 (PedsQL4.0).

RESULTSSixty-one (5.5%) (13 boys and 48 girls) of 1109 children met the diagnostic criteria of JFMS. While PedsQL scores of children with JFMS were lower than the non-JFMS group for physical, emotional, social, school functioning and total score (P = 0.001), CDI total score was higher in the JFMS group than in the non-JFMS group (P = 0.001). The JFMS group reported more school absences (P = 0.001) and the average school grade was lower in the JFMS group than in the non-JFMS group (P = 0.03).

CONCLUSIONThe prevalence of JFMS is high in school age children. Since JFMS is a common problem of childhood, early diagnosis and identification of the disorder and more comprehensive and successful treatment approaches with appropriate psychological assistance may prevent more complex and severe problems in adulthood.

Adolescent ; Cross-Sectional Studies ; Depression ; etiology ; Female ; Fibromyalgia ; epidemiology ; psychology ; Humans ; Male ; Prevalence ; Quality of Life ; Surveys and Questionnaires ; Syndrome ; Turkey ; epidemiology ; Urban Population

INTRODUCTIONThis study aimed to determine the incidence and risk factors of infections among patients admitted to intensive care units (ICUs) in tertiary care hospitals in Turkey.

METHODSAdult patients who were admitted to the ICUs of five tertiary care hospitals for over 48 hours between June and December 2007 were monitored daily. Potential risk factors such as age, gender, comorbidities, diagnosis at admission, severity of disease (Acute Physiology and Chronic Health Evaluation II scores), exposure to antibiotics, history of invasive procedures and significant medical interventions were evaluated. A multivariate analysis of these risk factors was carried out using Cox regression.

RESULTSA total of 313 patients with a median ICU stay of 12 days were selected for the study. 236 infectious episodes (33.8/1,000 ICU-days) were diagnosed among 134 patients (42.8/100 patients) in this group. Multivariate analysis revealed that exposure to a cephalosporin antibiotic (hazard ratio [95% confidence interval] 1.55 [1.10-2.19]) was an independent risk factor, whereas having a tracheostomy cannula (0.53 [0.36-0.81]) or nasogastric tube (0.48 [0.33-0.70]) was protective. Patients admitted to the ICUs from surgical wards were significantly more exposed to cephalosporins.

CONCLUSIONICU-associated infections, which are quite high in Turkey, are largely due to inadequate infrastructure and facilities and understaffing. Abuse of antibiotics, particularly in patients who have undergone surgery, and prolonged ICU stays are significant risk factors for such infections.

Adult ; Cross Infection ; epidemiology ; Female ; Humans ; Incidence ; Intensive Care Units ; statistics & numerical data ; Length of Stay ; Male ; Multivariate Analysis ; Prospective Studies ; Risk Factors ; Tertiary Care Centers ; Turkey ; epidemiology

INTRODUCTIONMethyl bromide is a toxic substance that has hazardous effects on human health with acute and chronic exposure. Our previous study showed that methyl bromide applicators frequently use large amounts of methyl bromide haphazardly in greenhouses in the prefectures of Narlidere and Balcova in the Aegean city of Izmir. This study aims to evaluate the health conditions of these workers.

MATERIALS AND METHODSOur previous study showed that there are 38 methyl bromide applicators in our study area. After the informed consent of methyl bromide applicators was obtained, a questionnaire was used for a survey of demography and symptoms. Each subject was examined before and after application of the compound. Blood and urine samples were collected and stored. Blood samples were analysed for methyl bromide and bromide ion, kidney and liver function tests and lipid profile.

RESULTSThe age range of subjects was 19 to 53 years (mean age: 41 +/- 8.57). This study showed that methyl bromide applicators use large amounts of methyl bromide disregarding legal regulations and that some of them had nonspecific complaints. Subjects had been working as methyl bromide applicators for approximately 9.7 +/- 4.15 years. A total of 69.7% of methyl bromide applicators reported that they did not use protective equipment while 33.3% of them had a history of acute methyl bromide intoxication. A statistically significant relationship was found between the usage of protective equipment and the level of blood bromide ion in the blood (P <0.05).

CONCLUSIONUsage of methyl bromide, training, screening and follow-up of applicators must be rigorously controlled in accordance with national legal arrangements and international protocols. Greater efforts are required in the implementation of controls to achieve the targets set by the legal regulations and to ensure continual improvement in the limitation of the risks of this environmental hazard.

Adult ; Case-Control Studies ; Female ; Gardening ; Health Surveys ; Humans ; Hydrocarbons, Brominated ; blood ; toxicity ; urine ; Inhalation Exposure ; adverse effects ; Male ; Middle Aged ; Noxae ; blood ; toxicity ; urine ; Occupational Diseases ; chemically induced ; epidemiology ; Occupational Exposure ; adverse effects ; Protective Clothing ; Surveys and Questionnaires ; Time Factors ; Turkey ; epidemiology

PURPOSE: We describe the epidemiological and clinical characteristics and the efficacy of a delayed initiation to therapy in an oropharyngeal tularemia outbreak in Duzce, Turkey. MATERIALS AND METHODS: Between March and June 2000, 22 patients with tularemia were diagnosed by microagglutination tests. RESULTS: Oropharyngeal and ulceroglandular forms of the disease were discovered. Most of the cases were oropharyngeal (19 cases). The most common symptoms were sore throat (95.4%) and fever (90.9%). Lymphadenopathy (95.4%) and pharyngeal hyperemia (81.8%) were usually observed signs. The lymphadenopathies were localized especially in the left cervical region (66.7%), a finding that has not been previously reported in the literature. The time between the onset of the symptoms and diagnosis was 40.7 +/- 22.8 (10 - 90) days. The patients were treated with streptomycin plus doxycycline and ciprofloxacin. The patients' recoveries took up to 120 days. CONCLUSION: This report describes the first outbreak of tularemia in northwest Turkey. Tularemia may occur in any region where appropriate epidemiological conditions are found and should be kept in mind for differential diagnosis in oropharyngeal symptoms. Late initiation of therapy may delay complete recovery. In this outbreak, cervical lymph nodes predominantly localized on the 1eft side were found, which had not been previously reported.
Adolescent ; Adult ; Aged ; Child ; Diagnosis, Differential ; Disease Outbreaks/*statistics & numerical data ; Female ; Humans ; Lymph Nodes/pathology ; Lymphatic Diseases/*microbiology/*pathology ; Male ; Middle Aged ; Oropharynx ; Tularemia/*epidemiology/*pathology ; Turkey/epidemiology ; Water ; Young Adult

BACKGROUNDHypertension is common, especially in individuals aged 40 years and over, and it affects about half of the population aged 60 years and over. This study aimed to determine the frequency and risk factors of hypertension among individuals aged 50 years and over, and to examine its effect on the health related quality of life (HRQOL).

METHODSThis population-based cross-sectional study was conducted in two settlements in a region of western Turkey between March 1 and April 30, 2007. A questionnaire concerning life habits associated with hypertension, medical histories, and demographic characteristics was filled in by a face to face interview. The SF-36 scale was used to assess HRQOL. Body mass index (BMI) was calculated by measuring the weight and length of the body.

RESULTSOf 1599 individuals living in the region, 1193 participated in the survey (48.3% men and 51.7% women). The overall prevalence rate of hypertension was 59.5% (n=710), being 58.0% in men and 60.9% in women (P > 0.05). The variables that most positively influenced hypertension (P < 0.05, for each one) were older age (especially the age group of those aged 60 and over), single, no health insurance, consumption of animal fat in meals, and family history of hypertension. The HRQOL of the patients with hypertension was lower than that of those without hypertension (P < or = 0.05). The HRQOL was better in hypertensive patients whose blood pressure was under control, whereas it was worse in those with at least one chronic disorder accompanying hypertension (P < 0.05, for each one).

CONCLUSIONSGreat emphasis should be placed on the need for a public health program for the detection, prevention, and control of hypertension, including other risk factors, as well as for the modification of foods and life habits, specifically in individuals who are most likely to be at risk of hypertension.

Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Exercise ; Female ; Humans ; Hypertension ; epidemiology ; etiology ; genetics ; psychology ; Logistic Models ; Male ; Middle Aged ; Prevalence ; Quality of Life ; Rural Health ; Turkey ; epidemiology

PURPOSE: To investigate the seroprevalence of toxocariasis in patients diagnosed as schizophrenia. PATIENTS AND METHODS: Ninety-eight schizophrenic patients hospitalized at The Elazig Psychiatric Hospital were included in the study. Anti-Toxocara IgG and/or IgM antibodies were determined by using commercial Toxocara canis IgG and/or IgM ELISA kit. RESULTS: Seropositivity for T. canis was detected in 45 (45.9%) of 98 patients and 2 (2.0%) of 100 control subjects the difference was statistically significant (p < 0.001). The seroprevalence was 40.4% (19 cases) and 51.0% (26 cases) for female and male subjects, respectively (p=0.3). When the seropositive and seronegative schizophrenic patients were compared with respect to the age group environment they were living in, occupation period of follow up and number of hospitalizations, there were no differences between the two groups (all, p > 0.05). CONCLUSION: In conclusion, the schizophrenic state seems to present a high risk for Toxocara infection in Turkey.
Adolescent ; Adult ; Animals ; Antibodies, Helminth/blood ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunoglobulin G/blood ; Immunoglobulin M/blood ; Male ; Middle Aged ; Schizophrenia/*blood/parasitology ; Seroepidemiologic Studies ; Toxocara/*growth & development/immunology ; Toxocariasis/*blood/epidemiology ; Turkey/epidemiology

INTRODUCTIONLittle is known of the clinical significance of myocardial bridges, which may be recognised as the narrowing of the systolic coronary artery as seen in an angiography. In this study, our goal was to review the literature information about the anatomic aspects, the clinical manifestations and implications, and the angiographic characteristics.

MATERIALS AND METHODSThe angiographic data of 7200 adult patients undergoing coronary angiography were retrospectively analysed for the diagnosis of myocardial bridge. The main angiographic evidence of a myocardial bridge that we required was the narrowing of a systolic coronary artery resulting in at least 50% reduction of lumen diameter in comparison with the diastolic phase. All coronary angiograms were reviewed independently by at least 2 of the authors and the case was included only if there was a consensus that the myocardial bridge resulted in 50% narrowing or more.

RESULTSMyocardial bridge was present in 29 (0.4%) of the 7200 coronary angiographies. The location of the myocardial bridge was in the left anterior descending coronary artery in 28 cases (96.5%), and the left circumflex coronary artery in 1 case (3.4%). Myocardial bridge was most common in the middle segment of the left anterior descending coronary artery (78.5 %). Each of these patients with myocardial bridge was referred for angiography because of symptom of chest pain alone or symptom of chest pain, palpitations and dyspnoea. Of the 29 patients with myocardial bridge, 2 patients without any symptom, demonstrated ischaemia as assessed by Tc- 99m MIBI myocardial perfusion scintigraphy.

CONCLUSIONChest pain was the common reason for angiography in patients with myocardial bridge. The incidence of myocardial bridge may vary according to population. Myocardial bridge is more frequently found in the middle segment of the left anterior descending coronary artery.

Adult ; Aged ; Angiography ; Female ; Humans ; Male ; Middle Aged ; Myocardial Bridging ; epidemiology ; physiopathology ; Turkey ; epidemiology