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Öğe Antimicrobial susceptibility of Brucella melitensis isolates from blood samples(2008) Açıkgöz, Ergin Ayaşlıoğlu; Kılıç, Selçuk; Aydın, Kemalettin; Kılıç, Dilek; Kaygusuz, Sedat; Ağalar, CananAmaç: Bruselloz tüm dünyada yaygın olarak görülen ve ülkemizde kırsal alanlar başta olmak üzere önemli bir sağlık sorunu oluşturan zoonotik bir hastalıktır. Bu çalışmada, kan örneklerinden izole edilen Brucella cinsi bakterilerde tür/biyotip tayini yapılması ve bu suşların antimikrobiyal duyarlılıklarının belirlenmesi amaçlanmıştır. Yöntem ve Gereç: Çalışmaya Kırıkkale ilinde kan kültürlerinden izole edilmiş 46 Brucella suşu alınmıştır. ‹zolatların identifikasyon ve tür/biyotip tayininde konvansiyonel yöntemler kullanılmıştır. Tetrasiklin, streptomisin, rifampisin, siproşoksasin ve azitromisin için minimal inhibitör konsantrasyon (M‹K) değerlerinin belirlenmesinde E-test yöntemi kullanılmıştır. Bulgular: Tüm izolatlar B. melitensis (45’i biyotip-3) olarak belirlenmiştir. Antibiyotik duyarlılık sonuçlarına bakıldığında, izolatların tümü tetrasiklin, streptomisin, siproşoksasin ve azitromisin’e duyarlı bulunmuştur. Kırkdört suş rifampine duyarlı, iki suş ise orta duyarlı olarak saptanmıştır. Tetrasiklin, streptomisin, rifampin, siproşoksasin ve azitromisin için M‹K90 değerleri sırasıyla 0,25 mg/l, 0,50 mg/l, 1,0 mg/l, 0,25 mg/l ve 1,0 mg/l olarak değerlendirilmiştir. Sonuç: Son yıllarda, Brucella suşlarının identifikasyon ve antimikrobiyal duyarlılıklarının belirlenmesi üzerine büyük bir ilgi artışı vardır. Antibiyotik duyarlılık sonuçları Brucella suşlarında kullanılmakta olan konvansiyonel ilaçlara karşı in vitro direnç olmadığını göstermektedir. Bu çalışmadan elde edilen bulgular, Türkiye’de bu konuda yapılan benzer çalışmalar ve dünya verileri eşliğinde gözden geçirilmiştir.Öğe Diagnosis of acute brucellosis by polymerase chain reaction technique(Refik Saydam National Public Health Agency (RSNPHA), 2015) Çeken, Sabahat; Kaygusuz, Sedat; Kiliç, Dilek; Ağalar, CananObjective: Brucellosis is a zoonotic disease which is a public health problem in our country like many parts of the world. The illness has nonspecific symptoms and physical signs. Bacterial culture is gold standard in the diagnosis of brucellosis but it is difficult and time consuming, so serologic techniques are used routinely. But serologic techniques have low specificity because of cross reactions. Molecular methods like polymerase chain reaction (PCR) are good alternatives in the early and rapid diagnosis of brucellosis, as it is in other infectious diseases. The aim of this study was to compare PCR method with conventional methods in the diagnosis of brucellosis. Methods: The study included 35 patients and 20 healthy volunteers. Sera for serology and whole blood samples for PCR were collected from each subject in both groups. DNA was extracted from peripheral mononuclear cells obtained from the blood samples and an in house PCR assay was used to detect brucella DNA. Results: Standart tube agglutination (STA) titers of most patients were ?1/160, except one patient which was 1/80. Blood cultures were positive for 16 patients. The STA titers of all controls were negative. PCR was positive for 97% of the patients and all of the volunteers were negative. Conclusion: It is concluded that the tested PCR assay has high sensitivity in the diagnosis of brucellosis and it may be used in rapid and accurate diagnosis of brucellosis.Öğe Effect of chlorhexidine on oral airway biofilm formation of Staphylococcus epidermidis(2015) Büyükkoçak, Ünase; Ağalar, Canan; Deniz, Turgut; Çeken, Sabahat; Ağalar, FatihAmaç: Airway yüzeyinde biofilm oluşması supraglottik kolonizasyona, bu da alt solunum yolu enfeksiyonlarına neden olabilir. Lokal dezenfektanların biofilm oluşumuna etkisini araştıran pek fazla çalışma bulunmamaktadır. Bu çalışmanın amacı airwayleri klorhekzidinle kaplamanın Staphylococcus epidermidis'in biofilm oluşturmasına etkisinin araştırılmasıdır.Yöntemler: Biofilm deneyi için kültür ve elektron mikroskobi yöntemleri kullanıldı. Airwayler, klorhekzidinin biofilm oluşumu ve bakteri sayısına etkisini araştırmak üzere, iki gruba ayrıldı. Grup 1 (Kontrol Grubu): Katkısız airway, Staphylococcus epidermidis, Grup 2: Klorhekzidinle kaplanmış airway, Staphylococcus epidermidis. Grup 1'e bir işlem yapılmazken, Grup 2'ye 4 saniye boyunca % 0,2 konsantrasyonda klorhekzidin sprey sıkıldı ve kurutuldu. Materyale tutunan bakteri sayısı mikrobiyolojik yöntemle incelendi, biofilm oluşumu elektron mikroskobik inceleme ile gösterildi. İstatistik analiz için Mann-Whitney U testi kullanıldı.Bulgular: Grup 2'de bakteri sayısı 1x102-8x102 cfu/ml iken Grup 1'de 3x103-1x104 cfu/ml idi. Klorhekzidinin airwaye tutunan bakteri sayısını istatistiksel olarak anlamlı oranda azalttığı görüldü (p0,04). Elektron microskobik incelemede de sonuç uyumluydu.Sonuç: Bu çalışmada, klorhekzidinin airway üzerinde biofilm oluşumu ve tutunan bakteri sayısını azaltmada etkili olduğu gösterildiÖğe The effect of G-CSF in an experimental MRSA graft infection in mice(Taylor & Francis Inc, 2005) Ağalar, Canan; Eroğlu, Erol; Sari, Mustafa; Sari, Aliye; Daphan, Çağatay; Ağalar, FatihWound infection after prosthetic material implantation is a troublesome complication with an incidence of 2% to 10%. The effect of granulocyte colony-stimulating factor (G-CSF) was studied in an experimental methicillin-resistant Staphylococcus aureus (MRSA) graft infection model. Eighty adult mice were used. Under general anesthesia an abdominal incision of 2 cm in length was performed. A subcutaneous cavity of 2 x 2 cm in size was created. Polypropylene mesh pieces of 2 x 1 cm and MRSA solution of 0.1 ml of 10(8) CFU/mL were used. G-CSF was applied systemically or locally in a dosage of 0.02 MU/30 g body weight. There were 8 groups: group I, wound + MRSA; group II, wound + mesh + MRSA; group III, wound + mesh + MRSA + G-CSF (ip, 48 h before operation); group IV, wound + mesh + MRSA + G-CSF (ip, 24 h before operation); group V, wound + mesh + MRSA + G-CSF (locally, into the cavity); group VI, wound + mesh (incubated in G-CSF solution for 4 h) + MRSA; group VII, wound + mesh + MRSA + G-CSF, ip, 24 h from operation; and group VIII (positive control group), wound + mesh + MRSA + Teicoplanin (0.03 mg/30 g body weight, ip, 1/2 h before operation). Three days after, animals were killed and incisions were examined for possible infection or abscess formation and wound failure. Meshes were removed; after vortexing and dilution, samples were incubated with 5% agar media. Results of bacterial incubation were evaluated 24 h and 48 h later. There were symptoms of wound infection and abscess formation in all groups except group VIII. In group VIII, MRSA was isolated in 7 events with a colony count below 10(3). Bacterial counts were above 106 (10(6)-10(8)) in all other groups. Thus, it was observed that wound infection could be created with this model, but G-CSF could not prevent the development of wound infection, whether it was administered systemically or locally. Teicoplanin decreased the number of colony-forming units of MRSA, and prevents wound infection in this MRSA wound infection model.Öğe The Effect of Simvastatin on Pulmonary Damage in Experimental Peritonitis in Rats(Springer India, 2015) Altunal, Çetin; Ağalar, Fatih; Ağalar, Canan; Daphan, Çağatay; Saygun, Oral; Aydınuraz, Kuzey; Dom, SedatStatins are widely used in the treatment of hyperlipidemia, as they inhibit cholesterol synthesis. They also have anti-inflammatory, antioxidant, immunomodulatory, and positive endothelial-functional effects. It is hypothesized that simvastatin ameliorates pulmonary damage secondary to peritonitis in rats. Forty Wistar albino rats were divided into four groups. In sham group, laparotomy was the standard procedure. In simvastatin group, simvastatin was given perorally before laparotomy. In sepsis group, peritoneal sepsis was constituted by cecal ligation and puncture technique. In sepsis+simvastatin group, the procedures of simvastatin and sepsis groups were applied together. After sacrification at the 72nd hour, tissue samples from lungs were harvested for histopathological examination, wet and dry weight measurements, and tissue culture, tissue malondialdehyde, and nitric oxide tests. Blood samples were taken for C-reactive protein and whole blood count. While the malondialdehyde levels were found to be significantly higher in sepsis group, nitric oxide levels were found to be significantly lower in simvastatin+sepsis group. Alveolar hemorrhage was highest in simvastatin+sepsis group. There was no difference for C-reactive protein, leukocyte levels, and histopathological examination between any groups. The ratios of wet and dry lung weights were higher in simvastatin-given groups. Simvastatin has no positive effect in terms of lung dysfunction on experimental sepsis model. For a better understanding of the effects of simvastatin on lung injury in peritoneal sepsis, experimental models of longer duration that enable to search the effects of simvastatin beyond 3 days will be more useful.Öğe Effects of granulocyte-colony stimulating factor on peritoneal defense mechanisms and bacterial translocation after administration of systemic chemotherapy in rats(Baishideng Publishing Group Inc, 2007) Çerçi, Celal; Ergin, Çagrı; Eroğlu, Erol; Ağalar, Canan; Ağalar, Fatih; Çerçi, Sureyya; Bülbül, MahmutAIM: To investigate the effects of granulocyte-colony stimulating factor (G-CSF) on peritoneal defense mechanisms and bacterial translocation after systemic 5-Fluorouracil (5-FU) administration. METHODS: Thirty Wistar albino rats were divided into three groups; the control, 5-FU and 5-FU + G-CSF groups. We measured bactericidal activity of the peritoneal fluid, phagocytic activity of polymorphonuclear leucocytes in the peritoneal fluid, total peritoneal cell counts and cell types of peritoneal washing fluid. Bacterial translocation was quantified by mesenteric lymph node, liver and spleen tissue cultures. RESULTS: Systemic 5-FU reduced total peritoneal cell counts, neutrophils and macrophage numbers. It also altered bactericidal activity of the peritoneal fluid and phagocytic activity of polymorphonuclear leucocytes in the peritoneal fluid. 5-FU also caused significant increase in frequencies of bacterial translocation at the liver and mesenteric lymph nodes. G-CSF decreased bacterial translocation, it significantly enhanced bactericidal activity of the peritoneal fluid and phagocytic activity of polymorphonuclear leucocytes in the peritoneal fluid. It also increased total peritoneal cell counts, neutrophils and macrophage numbers. CONCLUSION: Systemic 5-FU administration caused bacterial translocation, decreased the bactericidal activity of peritoneal fluid and phagocytic activity of polymorphonuclear leucocytes in the peritoneal fluid. G-CSF increased both bactericidal activity of the peritoneal fluid and phagocytic activity of polymorphonuclear leucocytes in the peritoneal fluid, and prevented the bacterial translocation. We conclude that intraperitoneal GCSF administration protects the effects of systemic 5-FU on peritoneal defense mechanisms. (C) 2007 The WJG Press. All rights reserved.Öğe Gold and gold-palladium coated polypropylene grafts in a S-epidermidis wound infection model(Academic Press Inc Elsevier Science, 2006) Saygun, Oral; Ağalar, Canan; Aydınuraz, Kuzey; Ağalar, Fatih; Daphan, Çağatay; Saygun, Meral; Denkbaş, Emir BakiBackground. The use of non-absorbable mesh grafts in both abdominal wall defects and inguinal hernias are impossible in the presence of contamination. This study was conducted for evaluation of the efficiencies of polypropylene mesh grafts coated with gold and palladium-gold. Materials and methods. Ten piece of 1 x 2 cm. of polypropylene mesh grafts were used in each group of naive, gold-coated, and palladium-gold-coated. The grafts were incubated in physiological saline buffered and 0.5 McFarland slime positive Staphylococcus epidermidis for 24 h. At intervals of 6,12,24,48, 72 h grafts were washed with saline and vortexed for 2 min in 2 ml of physiological saline. There were 100 mu l of samples of vortexed material incubated in blood agar and 24 h later, colony numbers were assessed. In the second part of study, the grafts were implanted below the musculoaponeurotic layer at inguinal. region of rats following the same procedure of incubation and washing. On the 8th day, the rats were examined for infection rate and their wound cultures were obtained. Results. The least amount of bacterial growth was detected in the samples obtained from gold-palladium coated grafts; whereas the highest rate of growth was found in samples of naive grafts. The superficial surgical site infection rate was 0% in gold-palladium coated, 30% in gold-coated and 100% in naive polypropylene group. The bacterial growth rate from wound cultures confirmed the superficial surgical site infection rates in all groups. Conclusion. Prosthetic graft infection with S. epidermidis can be prevented by coating the graft with gold-palladium or gold. (c) 2006 Elsevier Inc. All rights reserved.Öğe Inhibition of Staphylococcus epidermidis colonization with fusidic acid-impregnated catheters(Sage Publications Ltd, 2007) Ağalar, Canan; Kılıç, Dilek; Çeken, Sabahat; Özdoğan, Mehmet; Yasar, Erdem; Öztürk, Eylem; Denkbaş, Emir BakiThe aim of this study was the preparation and characterization of fusidic acid-impregnated peripheral catheters. In the first part of the study, in vitro drug release studies were performed, and the effect of fusidic acid impregnation on adherence of slime positive Staphylococcus epidermidis to catheters was evaluated as in vitro studies. Fusidic acid-impregnated and naive catheters were incubated with 10(8) colony forming unit/mL (cfu/mL) slime positive S. epidermidis during the in vitro experiment. After incubation for 2, 4, 6, 8, 12, 24, 48, and 72 h, the number of colonies were determined in an aliquot and adhered to the catheter. During the in vivo experiment, contaminated naive and fusidic acid-impregnated catheters (n = 10 rats in both groups) were implanted subcutaneously in the back of the rats. Rats were killed at the end of the seventh day and catheters were removed. Microbiologic assessments from the explanted catheter segments were performed. Fusidic acid impregnation decreased the number of adherent bacteria to the catheters and the number of free bacteria within the liquid medium significantly. There were 3 positive catheter cultures out of 10 in rats implanted with fusidic acid-impregnated catheters, whereas all explanted catheters from naive group yielded bacterial growth. The mean cfu counts were significantly less in the fusidic acid-impregnated catheter group. In vitro release studies and antibacterial activity studies correlated well. Additionally, morphological evaluations by scanning electron microscopy showed that fewer bacteria were evident on the fusidic acid-impregnated catheters compared with naive catheters. As a conclusion, catheter impregnation with fusidic acid is effective in preventing colonization in these in vitro and in vivo sets of experiments, with slime-producing S. epidermidis.Öğe The interactions between doctors and pharmaceutical companies(2005) Ağalar, Canan; Ağalar, Fatih; Sayek, İskenderIn this review, the interactions between doctors and drug companies were evaluated within the scope of current literature. Unethical deviation from healthy interactions between the pharmaceutical industry and doctors is becoming a serious problem in the era of modern medical practice. Many contemporary guidelines on this issue from different countries and authorities exist. They address various ethical questions such as drug promotion, gift giving, sponsorship, the acceptable range of promotional activities, and continuous medical education and drug companies. The Turkish Medical Association recently declared the tenet of "Medical Doctor and Drug Advertisement Principles". The association has also established a strong relation with topic 15 of "Ethics in Medical Science Profession" and this declaration. There is also a contemporary regulation of the Turkish Ministry of Health addressing the same issue. Their contents are similar to the guidelines and regulations which were presented from other countries. Despite great efforts, the problem remains unresolved. Society-based new application models, statutes and regulatory mechanisms are needed.Öğe Kan bağışçılarında HBsAg, anti-HCV, anti-HIV ve VDRL testi sonuçlarının değerlendirilmesi(2011) Deveci, Özcan; Tekin, Alican; Günbay, Seda Seda; Kılıç, Dilek; Kaygusuz, Sedat; Ağalar, Canan; Özer, Toka TürkanAmaç: Kan ve kan ürünleri transfüzyonu sonrasında en sık karşılaşılan komplikasyon kullanılan ürünlerden bulaşan enfeksiyonlardır. Kan ve kan ürünleri transfüzyonu sonrasında hepatit B virüsü, hepatit C virüsü ve insan immün yetmezlik virüsünün (HIV) neden olduğu enfeksiyonlar halen en önemli sağlık problemi olmaya devam etmektedir. Bu nedenle; HBsAg, anti-HCV, anti-HIV ve Treponema pallidum’a yönelik RPR (Rapid Plasma Reagin) veya VDRL (Venereal Disease Research Laboratory) gibi tarama testleri kan transfüzyonlarından hemen önce bakılması zorunlu olan testlerdir. Bu çalışmada, Kan Merkezi’ne başvuran kan bağışçılarında HBsAg, anti-HCV, anti-HIV ½ ve VDRL testi sonuçları incelenmiş ve sonuçlar ülkemizdeki diğer kan merkezlerinin sonuçları ile karşılaştırılarak değerlendirilmiştir. Gereç ve yöntem: Ocak 2003-Aralık 2004 tarihleri arasında Kırıkkale Üniversitesi Hastanesi Kan Merkezine başvuran toplam 784 kan bağışçısının tarama testi sonuçları retrospektif olarak incelendi. Kan bağışçılarından alınan kan örnekleri Enfeksiyon Hastalıkları laboratuvarında otomatize analiz cihazı kullanılarak kemiluminesans (ELISA) yöntemi ile çalışıldı. VDRL testi ise ticari test kiti kullanılarak yapıldı. Bulgular: Toplam 784 kan bağışçısının 734’ünün (%93.7) cinsiyeti erkek, 50’sinin (%5.4) cinsiyeti ise kadındı. 11’inde (%1.4) HBsAg ve 2’sinde (%0.2) anti-HCV pozitif olarak saptandı. Anti-HIV ve VDRL pozitifliği ise saptanmadı. Sonuçlar: Bulgularımız HBsAg ve anti-HCV seropozitiflik oranlarının Türkiye geneline göre daha düşük olduğunu göstermektedir.Öğe Klinik Örneklerden Elde Edilen Albicans ve Non-albicans Candida Türlerinde Biyofilm Oluşumunun Araştırılması ve Türlere Göre Dağılımı(2017) Alpay, Yeşim; Ağalar, Canan; Karabıçak, Nilgün; Kılıç, Dilek; Kaygusuz, Sedat; Açıkgöz, Ergin Ayaşlıoğlu; Esen, BerrinGİRİŞ ve AMAÇ: Candida türleri, dünya çapında hastane kaynaklı enfeksiyonların önemli nedenleri arasında kabul edilmektedir. Başlıca virülans faktörleri; biyofilm oluşumu, fosfolipaz ve asit proteaz üretimidir. Biyofilm üretimi türleri Candida'lar için önem taşımaktadır ve antifungal direnç ile ilişkilidir. Çalışmada; nonalbicans Candida'lar ve C. albicans türlerinde biofilm oluşumu araştırılmıştır. GEREÇ ve YÖNTEM: Çalışmaya, klinik örneklerden izole edilen 53 Candida suşu alındı. 37°C'de 48-72 saat inkübasyon sonrası sabouraud dekstroz agarda (SDA) saf olarak üretilen kolonilerin tiplendirilmesinde; mikroskopik değerlendirme, germ tüp testi, ve API ID 32C (bio Mérieux, Fransa) kullanıldı. Tüm şuslarda biyofilm üretimi araştırıldı. Biyofilm varlığı tespiti için glukozlu triptik soy broth (modifiye tüp adherens yöntemi) kullanıldı. BULGULAR: Elli üç Candida suşunun 34'ü (%64,1) C. albicans, 11'i (%20,7) C. parapsilosis, 4'ü (%7,5) C. kefyr, 3'ü (%5,6) C. tropicalis ve 1'i (%1,8) C. glabrata olarak saptandı. Tüm suşlar değerlendirildiğinde; biyofilm oluşumu % 47,2 olarak saptandı. Albicans türü Candida'larda %38,2 oranında, non-albicans Candida'larda ise %63,1 oranında biyofilm oluşumu gözlendi. C albicans suşlarının %38,2'inde (13), C parapsilosis suşlarınn %63,6'sinde (7), C. kefyr suşlarının %50'sinde (2), C. tropicalis suşlarının %66,6'sinde (2) ve bir C glabrata (1) suşunda biyofilm üretimi tespit edildi. Biyofilm pozitifliği gösteren suşların; %96'sının, servis ve yoğun bakımlarda yatmakta olan ve uzun süreli antibiyotik tedavisi alan hastalardan izole edildiği gözlendi. TARTIŞMA ve SONUÇ: Doğada mikrobiyal büyümede ve klinik enfeksiyonların gelişmesinde biyofilm oluşumu büyük önem taşımakta olup, mikroorganizmayı konak savunmasından ve antimikrobiyallerden korumaktadır. İlişkili mikroorganizmalarda antimikrobiyal direnç yüksektir. Son yıllarda invazif uygulamaların artışı ile fungal patojenler için risk artışı da söz konusudur. Nonalbicans kandidemilerin artışı ve biyofilm oluşumu artan antifungal dirence neden olmaktadır. Etken profili ve antimikrobiyal duyarlılıkta epidemiyolojik değişimler göz önüne alındığında Candida suşları da dikkatli şekilde değerlendirilmelidir. Etken dağılımı, biyofilm oluşumu, antifungal duyarlılık durumlarının bilinmesi, uygun tedavinin belirlenmesi, lokal verilerin ışığında ampirik tedavi seçimlerinin doğru yapılması ve sonuçlar açısından yararlı olacaktır.Öğe Most common infections and antibiotic prescribing habits of residents: Experience of three university hospitals(2005) Aydın, Serpil; Yarış, Füsun; Özçakır, Alis; Ağalar, CananAs the common use of antibiotics is a very important factor in antibiotic resistance, their rational use has to be promoted world. We planned this study in order to define the habits and approach of Turkish residents when prescribing antibiotics, including their selection criteria, and to discover if the availability of laboratory tests affected their approach. In this descriptive study, the residents in the authors' hospitals were visited once during October and November 2001. Anonymous, volunteer-based questionnaires were used, which required the following information: demographic features of resident, the most common types of infections and groups of antibiotics prescribed, any laboratory tests performed, and the antibiotic selection criteria. Chi-square test was used for the statistical analysis. Among 306 residents, 229 (74.8%) participated in the study. We found that upper respiratory tract infection was the most common type of infection, and amoxicillin-clavulonate and ampicillin-sulbactam were the most commonly prescribed antibiotics. Initial selection criteria for antibiotic prescription by our residents were patients' expectations and cost of the therapy. Laboratory did not affect our residents' antibiotic prescription habits. We concluded that the availability of laboratory testing did not affect the residents' decision to prescribe antibiotics. Residents and the community should be educated on rational drug use and prescription.Öğe Plasma modified foley catheters against to catheter associated urinary tract infection (CAUTI)(2008) Erdoğan, Gökhan; Denktaş, Emir Baki; Öztürk, Eylem; Ağalar, Canan; Eroğlu, Muzaffer; Atilla, PelinIn this study; the foley catheters were modified by plasma polymerization technique and coated with alginate gels. This modification processes were applied to prevent bacterial adhesion onto the foley catheter surfaces. Here the most effective parameters were evaluated as the plasma polymerization system power and plasma exposure time for the effective catheter surface modification. The obtained results showed that the plasma power affected hidrophilicity of the surface and wettability of the foley catheters was increased. The plasma exposure time increased the amount of EDA deposition over the catheter surfaces and then caused more hydrophilicity for the foley catheter surfaces also. In this study, the bacterial strain of E. Coli had a hydrophobic nature and therefore the increase in hydrophilicity of the surface of foley catheters decreased the adhesion risk for the E. Coli onto the catheter surfaces. As the numerical values of the obtained data; while the amount of bacterial colony formation unit was at 108 level initially, it was decreased down to 104-103 level by changing the surface hydrophilicities as expected.Öğe Protective Effect of Hypothermia in a Blunt Thoracic Trauma and Hemorrhagic Shock Model(Georg Thieme Verlag Kg, 2014) Ülger, Hüseyin; Deniz, Turgut; Çomu, Faruk; Ağalar, Canan; Kısa, Üçler; Ağalar, FatihBackground The aim of this study was to investigate the effect of volume-controlled hemorrhage and hypothermia on rats with blunt chest trauma, evaluating bacterial translocation (BT), lung tissue malondialdehyde (MDA), nitric oxide (NO) levels, and erythrocyte deformability (ED). Methods In our study, 10 animals each were included in 6 groups. Groups were as follows: a group with blunt chest trauma only (Group T), a group with hemorrhage only (Group H), a normothermic group with comorbidity of trauma and hemorrhage (Group NT), a mild hypothermic group with trauma and hemorrhage (Group MH), a moderate hypothermic group with trauma and hemorrhage (Group MoH), and a control group (Group C). Sodium pentobarbital (50 mg/kg, intraperitoneally) anesthesia was administered. Thoracic trauma was generated using kinetic energy at the middle of the chest (2.45 J). Stage 3 hemorrhagic shock was initiated. After 24 hours, the rats were killed and red blood cell deformability, BT development in the liver, spleen, and mesenteric lymph nodes, and NO and MDA levels in lung tissue, kept at -80 degrees C, were measured. Results In Groups MH and MoH, there was no difference in ED values, though they were lower than those in Group NT (p < 0.05). BT was more prevalent in Group NT than in the other groups. In Group NT, the growth of BT was greater than in other groups (p < 0.05). The level of NO in Group H was higher than in the control group (p < 0.05). In Group MoH, the level of MDA was lower than in Group MH (p < 0.05). Conclusion Hypothermia seems to demonstrate protective effects on ED and BT by reducing oxidative stress. The protective effects of therapeutic hypothermia on ED may be due to the effect of reducing NO and/or MDA. There was no difference in effect between mild and moderate hypothermia in terms of the formation of ED and BT.Öğe A rat model of polypropylene graft infection caused by Staphylococcus epidermidis(Blackwell Publishing, 2006) Ağalar, Canan; Özdoğan, Mehmet; Ağalar, Fatih; Saygun, Oral; Aydınuraz, Kuzey; Akkuş, Abdullah; Aktürk, SelçukBackground: The aim of this study was to constitute a valid graft infection model with Staphylococcus epidermidis in rats. Method: Rats were divided into seven groups. In groups 1 and 2, 2 cm x 2 cm polypropylene grafts were incubated with 10(8) c.f.u./mL slime-positive S. epidermidis at 37 degrees C for 2 and 24 h and were then placed subfascially to the groins of rats. In the third group, naive grafts were placed and 0.5 mL of 3 x 10(7) c.f.u. slime-positive S. epidermidis were injected on the inside of the wounds. Rifampicin (30 mg/kg) in group 4 and teicoplanin (20 mg/kg) in group 5 were applied i.p. to rats with 2-h incubated grafts for prophylaxis. The same prophylactic regimens were given to groups 6 and 7 in which rats were incubated for 24 h. At eighth day, rats were killed and wounds were assessed with macroscopic evaluation and cultures. Results: No death occurred in any of the groups. In groups 1 and 2, 100% infection rates were achieved. However, graft infection was detected in only two (20%) of the rats in group 3 (P = 0.001). Prophylactic application of teicoplanin or rifampicin decreased the infection rates significantly in the short-incubation groups. Conclusion: Incubation of polypropylene grafts with slime-producing S. epidermidis for 2 and 24 h in the pre-application period achieved the occurrence of a standardized graft infection. Prophylactic use of teicoplanin and rifampicin decreased the infection rates. We propose to use this reproducible and reliable animal model of graft infection in future studies.Öğe Staged abdominal repair for treatment of moderate to severe secondary peritonitis(Springer, 2005) Ağalar, Fatih; Eroğlu, Erol; Bülbül, Mahmut; Ağalar, Canan; Tarhan, Ömer Rıdvan; Sarı, MustafaThe aim of this study was to evaluate the effects of planned relaparotomy and to assess factors that may contribute to mortality in patients with moderate to severe secondary peritonitis. A total of 36 consecutive patients with an Acute Physiologic and Clinical Health Evaluation (APACHE) II score of >10 were enrolled the study for a 2-year period. The mean age of the patients was 56 years (17-92 years), and 23% of them were male. One-third of them had postoperative peritonitis; 152 scheduled operations were done, and the overall mortality rate was 36%. For patients whose septic source was in the upper gastrointestinal system, control of the source was more difficult (p = 0.004). Overall, 28 complications developed in 61% of the patients. Initial and second-day APACHE II scores were 14.5 (11-27) and 12.0 (9-25), respectively. The initial APACHE II score of survivors was lower than that of nonsurvivors [p = 0.0001, 95% confidence interval (CI) -9.5, -3.6]. Second-day APACHE II scores were not different (p = 0.19; 95% Cl -3.79, 0.80). Striking end or lateral duodenal leaks were clearly associated with high mortality. It is found that the initial APACHE II score, the success of controlling the source, the occurrence of complications, and the type of illness are independent factors that may affect mortality. We concluded that staged abdominal repair should be used with caution in the treatment of lateral or end duodenal leaks. It is a good alternative to conventional laparotomy for moderate to severe forms of secondary peritonitis from other sources.Öğe Submandibüler sialolitiazis zemininde Sphingomonas paucimobilis enfeksiyonu(2011) Karabıçak, Çiğdem; Karabıçak, Hasan; Ağalar, Canan; Kazkayası, MustafaSphingomonas paucimobilis (S. paucimobilis) gram negatif, aerobik, non-fermentatif, oksidaz () ve katalaz () bir bakteridir. S. paucimobilis, nadir şekilde izole edilmesine rağmen, nozokomiyal ve toplumdan kazanılmış enfeksiyonlara neden olabilir. Kliniğimizdeki bir hastanın bir haftadır sağ submandibüler bölgede şişlik ve yemek yerken artan ağrı yakınması vardı. İki elle yapılan muayenesinde sağ Wharton kanalında 1x1x1 cm boyutunda ağrılı şişlik belirlendi. Sağ submandibüler beze yapılan masaj ile Wharton kanal ağzından gelen pürülan akıntıdan kültür alındı ve S. paucimobilis üretildi. Ultrasonografide kanalda ya da bezde taş saptanmadı, fakat tedavi sırasında submandibüler beze masaj yapılarak sağ Wharton kanalından iki adet taş geldiği gözlendi. On dört günlük intravenöz ampisilin-sulbaktam tedavisi ile enfeksiyonun eradike olduğu gözlendi. Hastanın altı ay sonraki kontrol muayenesinde herhangi bir patolojik bulgu ya da belirti saptanmadı ve ultrasonografisi normal idi. Bilgilerimize göre bu hasta sialolitiazis zemininde S. paucimobilis üretilen ilk siyaladenit olgusudur.Öğe Üçüncü basamak bir referans hastanesinde izole edilen metisilin dirençli stafilokok suşlarında duyarlılık(2012) Ağalar, Canan; Göçmen, Jülide Sedef; Kılıç, Sultan Dilek; Kaygusuz, Sedat; Karabıçak, ÇiğdemAmaç: Metisiline dirençli stafilokok suşlarının hastane infeksiyonlarında büyük pay sahibi oldukları bilinmektedir. Hastanemizdeki stafilokok suşlarının antimikrobiyal direnç durumlarını bilmek doğru ampirik tedavi başlamak için son derece önemlidir. Gereç ve yöntem: Tersiyer referans hastanesi konumundaki hastanemizde patojen olarak izole edilen stafilokok suşlarının duyarlılığını geriye dönük olarak değerlendirmeyi amaçladık. Kırıkkale Üniversitesi Tıp Fakültesi Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı laboratuvarında, Kasım 2009-Kasım 2010 tarihleri arasında, hasta örneklerinden etken olarak izole edilen metisiline dirençli 276 stafilokok suşu çalışmaya alındı. Suşların tiplendirimi ve antibiyotiklere duyarlılıkları Vitek (bioMerieux) sisteminde yapıldı. Bulgular: Suşların büyük çoğunluğu kan (%49) ve yara biyopsi materyalinden (%40) izole edildi. Glikopeptidlere dirençli suşa rastlanmamış, suşların linezolide %97’si, eritromisine %16’sı duyarlı bulunmuştur. Sonuç: Bu etkenlerle oluşan infeksiyonların kontrolü ve etkin sağaltımı için sonuçların klinisyenlere bildirilerek özellikle metisilin dirençli stafilokok enfeksiyonlarının tedavisinde uygun ampirik antibiyotik kullanımının sağlanması gerektiğine inanmaktayız.Öğe Yabancı cisimlerde biyofilm gelişimi engellenebilir mi? Bir multidisipliner araştırma grubu modeli(2011) Ağalar, CananMikroorganizmaları ortamdaki olumsuz koşullardan koruyan bir büyüme biçimi olan biyofilm gelişimi bir çok infeksiyon patogenezinde önemli rol oynar. Günümüz tedavi metodları arasında yabancı cisim kullanımı yer aldığı sürece önemi giderek artacaktır. Biyofilmin önlenmesinde patolojik mekanizmalar ve olayın diğer yönlerinin anlaşılmasındaki gelişmelere rağmen, gelinen noktanın yeterli olmadığı açıktır. Günümüz tıp biliminde biofilm ilişkili infeksiyonların önlenmesi çok önem arzetmektedir.
