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Dikmen D.,Public Health Institution of Turkey | Irmak H.,Public Health Institution of Turkey
Turk Hijyen ve Deneysel Biyoloji Dergisi | Year: 2016

Introduction: The twinning project entitled "Alignment in Bathing Water Monitoring" was implemented within the framework of EU Pre-Accession Financial Assistance IPA I-2010 Programming by the Ministry of Health, Public Health Institution of Turkey together with France-Italy consortium between the I. quarter of 2013 and II. quarter of 2015. The major aims of the project was to transpose the new bathing water Directive 2006/7/EC into the Turkish National Legislation and strengthening the bathing water quality monitoring system of Ministry of Health - Public Health Institution of Turkey within the framework of the new directive. Methods: The project was designed such as to ensure the alignment of the new bathing water Directive 2006/7/EC and preparation of the draft bylaw on bathing water quality management, transition from 76/160/EEC to 2006/7/EC Directive regarding the classification and quality assessment of bathing water starting gradually with the pilot applications and then disseminating to the whole bathing areas, the practice of establishing experimental bathing water profiles in the selected areas of the pilot provinces, compiling of sets of bathing water quality data, improvement of the bathing water quality monitoring system of the Ministry of Health in the direction of 2006/7/EC Directive, improvement of the technical capacity of the Public Health Laboratories to perform analysis according to the new bathing water directive. Results: The draft "By-law on bathing water quality management" has been prepared with the transposition of 2006/7/EC EU Directive by the Ministry of Health, Public Health Institution of Turkey with the contribution of the relevant institutions. Trainings and workshops were organized. Six guidance documents were prepared, published and distributed. Data quality assessment and classification practice were done at pilot provinces Antalya, çanakkale and Istanbul. Conclusion: The all activities given in the project contract have been successfully completed and all project mandatory results were reached. The technical and institutional capacity for the full implementation of the 2006/7/EC Directive by the Ministry of Health was impoved successfully with the project.


Dikmen D.,Public Health Institution of Turkey | Irmak H.,Public Health Institution of Turkey
Turk Hijyen ve Deneysel Biyoloji Dergisi | Year: 2016

EU twinning light project entittled "Emergency case management and risk analysis in drinking water for the protection of public health" was implemented within the frame of Support Activities to Strengthen the European Integration Process SEI-2009 programming by the Ministry of Health, Public Health Institution of Turkey, Consumer and Employee Safety Vice-Presidency, Environmental Health Department with the cooperation of Italy - the Istituto Superiore di Sanita, (Italian National Institute of Health - ISS), Inland Water Hygiene Section, Environmental Primary Prevention Department for six months period between January 2013 and June 2013. The aim of the Project was to strengthen the Ministry of Health, Public Health Institution of Turkey in the field of drinking water by means of building institutional capacity for risk assessment, early warning and management of emergency cases in line with EU Drinking Water Legislation (98/83/EC). The project had four mandatory results. Result 1 was to improve the risk assessment capacity of Ministry of Health - Public Health Institution of Turkey in drinking water. Result 2 was to develop methodologies for identifying contamination in drinking water. Result 3 was to improve the early warning capacity of the Ministry of Health - Public Health Institution of Turkey in drinking water. Result 4 was to improve the emergency case management capacity of the Ministry of Health - Public Health Institution of Turkey in drinking water. The all project mandatory results were successfully reached. Besides extensive trainings and workshops, four guidance documents concerning the instructions for decision-making following non-compliance results in drinking water monitoring, identification of contamination, early warning and emergency case/crisis management in drinking water were prepared, published and distributed. The technical and institutional capacity of the Ministry of Health in the field of drinking water were improved both at the central level and provincial level involving 81 provinces.


Senses-Ergul S.,Public Health Institution of Turkey | Ozbas Z.Y.,Hacettepe University
Ciencia e Tecnica Vitivinicola | Year: 2016

In this research, 20 Saccharomyces cerevisiae isolates obtained during spontaneous fermentation of 'Kalecik Karasi' and 'Emir' grapes were evaluated for their technological characteristics. All of the S. cerevisiae isolates could grow at the tested temperatures, pH values and sugar concentration. Most of the tested isolates (80%) produced the same level of H2S than the control culture. All indigenous S. cerevisiae isolates showed similar carbon assimilation and fermentation profiles, with a few exceptions. Only one isolate (E/S6) was found to have proteolytic activity. The killer phenotype was detected in KK/FS11 isolate. KK/FS3, E/FS12, E/S7 and E/S8 isolates were neutral as to killer phenotype. While only three isolates could tolerate high concentration of ethanol (14%; v/v), 11 isolates could grow in the media containing 200 mg SO2/L. In addition, some of the isolates were distinguished among the others because of their ability to secrete enzyme(s) which may provide advantages for producing wines with specific aromatic characteristics. When some of the tested technological characteristics and enzymatic profiles were evaluated together, four isolates (KK/S17, E/S6, E/S9 and E/FS12) distinguished from others with respect to their superior characteristics, which have potential for further investigation in order to produce wines with specific aroma for Capadoccia region.


Ozdemir K.,Yuzuncu Yil University | Acar S.,Public Health Institution of Turkey
PLoS ONE | Year: 2014

This study was conducted for typing Salmonella enterica subspecies enterica strains in Turkey using pulsed-field gel electrophoresis (PFGE) and plasmid DNA profile analysis. Fourty-two strains were isolated from clinical samples obtained from unrelated patients with acute diarrhea. The samples were collected from state hospitals and public health laboratories located at seven provinces in different regions of Turkey at different times between 2004 and 2010. The strains were determined to belong to 4 different serovars. The Salmonella enterica strains belonged to the serovars Salmonella Enteritidis (n = 23), Salmonella Infantis (n = 14), Salmonella Munchen (n = 2), and Salmonella Typhi (n = 3). Forty-two Salmonella enterica strains were typed with PFGE methods using XbaI restriction enzyme and plasmid analysis. At the end of typing, 11 different PFGE band profiles were obtained. Four different PFGE profiles (type 1, 4, 9, and 10) were found among serotype S. Enteritidis species, 3 different PFGE profiles (type 3, 5, 6) were found among S. Infantis species, 2 different PFGE profiles were found among S. Typhi species (type 2 and 11), and 2 different PFGE profiles were found among S. Munchen species (type 7, 8). The UPGMA dendrogram was built on the PFGE profiles. In this study, it was determined that 4 strains of 42 Salmonella enterica strains possess no plasmid, while the isolates have 1-3 plasmids ranging from 5.0 to 150 kb and making 12 different plasmid profiles (P1-P12). In this study, we have applied the analysis of the PFGE patterns and used bioinformatics methods to identify both inter and intra serotype relationships of 4 frequently encountered serotypes for the first time in Turkey. © 2014 Ozdemir, Acar.


Yeslyurt M.,Tekirdag State Hospital | Kilic S.,Public Health Institution of Turkey | Celeb B.,Public Health Institution of Turkey | Gul S.,Sorgun State Hospital
Scandinavian Journal of Infectious Diseases | Year: 2013

Tularemia during pregnancy is exceedingly rare and has been reported infrequently in Europe. A review of the literature identified only 3 documented cases. Herein we report 4 tularemia cases occurring early in the second and third trimesters, which were successfully managed without any adverse pregnancy outcomes. © 2013 Informa Healthcare.


Celebi B.,Public Health Institution of Turkey
Türkiye parazitolojii dergisi / Türkiye Parazitoloji Derneǧi = Acta parasitologica Turcica / Turkish Society for Parasitology | Year: 2014

Capillaria hepatica is a nematode with worldwide distribution, which can cause parasitic hepatitis both in animals and humans. A mouse (Apodemus flavicollis), trapped in Giresun Province was diagnosed as having capillariasis due to the characteristic eggs found in its liver. This is the first reported case of mouse capillariasis in this part of the country. Due to the fact that capillariasis is a zoonotic disease, humans might be also infested; therefore, further investigations are needed.


The Clinical and Laboratory Standards Institute (CLSI) Subcommittee on Antifungal Susceptibility Testing has newly introduced species-specific clinical breakpoints (CBPs) for fluconazole and voriconazole. When CBPs can not be determined, wild-type minimal inhibitory concentration (MIC) distributions are detected and epidemiological cutoff values (ECVs) provide valuable means for the detection of emerging resistance. The aim of this study is to determine triazole resistance patterns in Candida species by the recently revised CLSI CBPs. A total of 140 Candida strains isolated from blood cultures of patients with invasive candidiasis hospitalized in various intensive care units in Turkey and sent to our reference laboratory between 2011 - 2012, were included in the study. The isolates were identified by conventional methods, and susceptibility testing was performed against fluconazole, itraconazole and voriconazole, by the 24-h CLSI broth microdilution (BMD) method. Azole resistance rates for all Candida species were determined using the new species-specific CLSI CBPs and ECVs criteria, when appropriate. The species distribution of the isolates were as follows; Cparapsilosis (n= 31 ), C. tropica lis (n= 26 ), Cgtabrata (n= 21), C.albicans (n= 18), Clusitaniae (n= 16), C.kmsei (n= 16), C.kefyr (n= 9), C.guiWermondii (n= 2), and Cdubliniensis (n= 1). According to the newly determined CLSI CBPs for fluconazole and C.albicans, Cparapsilosis, C.tropicalis [susceptible (S), 2 pg/ml; dose-dependent susceptible (SDD), 4 pg/ml; resistant (R), 8 pg/ml], and Cglabrata (SDD, 32 pg/ml; Ite 64 pg/ml) and for voriconazole and C.albicans, Cparapsilosis, Ctropicalis (S, 0.12 pg/ml; SDD, 0.25-0.5 pg/ml; R, 1 (jg/ml), and Ckrusei (S, 0.5 Mg/ml; SDD, 1 pg/ml; R, 2 pg/ml), it was found that three of C.albicans, one of Cparapsilosis and one of Cglabrata isolates were resistant to fluconazole, while two of C.albicans and two of Ctropicalis were resistant to voriconazole. The ECVs of 0.5 pg/ml for voriconazole and C.glabrata were used to differentiate wild-type (MIC ECV) from non-wild-type (MIC > ECV) strains. Five of Cglabrata were non-WT for voriconazole. Due to the lack of CBPs for the less common species, the ECVs for fluconazole, itraconazole and voriconazole, respectively, were used for Clusitaniae (2 pg/ml, 0.5 pg/ml, 0.03 pg/ml), Cguilliermondii (8 pg/ml, 1 pg/ml, 0.25 pg/ml), Cdubliniensis (0.5 pg/ml, 0.25 pg/ml, 0.03 pg/ml), and C.kefyr (1 pg/ml, 0.015 pg/ml) to categorize isolates of these species as wild- And non-wild-type. When the ECVs were used for fluconazole, one each of Clusitaniae, Cdubliniensis and C.kefyr, for voriconazole, three of Clusitaniae and one of Ckefyr were detected as non-wild-type. Overall, a total of five Candida species were resistant to fluconazole and four to voriconazole and among these species one each of Cparapsilosis, Ctropicalis, C.glabrata, Clusitaniae, C.kefyr and three of C.albicans exhibited cross-resistance at least against two azoles. It was concluded that, the strains identified as resistant and non-wild-type in this in vitro study should be supported by molecular and in vivo studies for the determination of their clinical validity.


Kilic S.,Public Health Institution of Turkey | Celebi B.,Public Health Institution of Turkey | Acar B.,Public Health Institution of Turkey | Atas M.,Public Health Laboratory
Scandinavian Journal of Infectious Diseases | Year: 2013

Background: Tularemia is an infection caused by Francisella tularensis, which has a wide distribution in the northern hemisphere and diverse clinical manifestations. For decades, the drug of choice for the treatment of tularemia has been streptomycin, with tetracycline and chloramphenicol being used as alternatives. The purpose of the present study was to determine the in vitro antimicrobial susceptibility of a large panel of geographically diverse F. tularensis isolates from Turkey against traditional and newer antimicrobial agents. Methods: The antibiotic susceptibilities of 250 F. tularensis strains were examined using the Epsilometer test for 9 antimicrobial agents. Each isolate was identified by conventional and molecular techniques. Results: All the strains were confirmed biochemically and using a combination of species-and subspecies-specific polymerase chain reaction (PCR) assays to be F. tularensis subsp. holarctica. One isolate was assigned to F. tularensis subsp. holarctica biovar japonica based on erythromycin susceptibility, an ability to ferment glycerol, and the nucleotide sequence of the region of difference 1 (RD1). All strains were susceptible to aminoglycosides (streptomycin and gentamicin), tetracyclines (tetracycline and doxycycline), chloramphenicol, 2 fluoroquinolones (ciprofloxacin and levofloxacin), and rifampicin. In addition, all isolates except 1 had a minimal inhibitory concentration (MIC) for erythromycin of > 256 μg/ml. Conclusions: Since the fluoroquinolones showed the lowest MIC values and have advantages such as excellent bioavailability and activity, availability of oral formulations, and lower toxicities, they represent candidate therapeutic options in the first-line treatment of tularemia. To the best of our knowledge, this is the first report of the presence of F. tularensis subsp. holarctica biovar japonica outside Japan. © 2013 Informa Healthcare.


Ata N.,Konya Training and Research Hospital HacI Saban | Kilic S.,Public Health Institution of Turkey | Ovet G.,Konya Training and Research Hospital HacI Saban | Alatas N.,Konya Training and Research Hospital HacI Saban | Celebi B.,Public Health Institution of Turkey
Infection | Year: 2013

Tularemia is a zoonotic infection caused by Francisella tularensis with a worldwide distribution and diverse clinical manifestations. Although F. tularensis has been recognized as a human pathogen for a century, there are few reports regarding the occurrence of tularemia in pregnant women and its effect on the fetus; only seven cases have been reported in the literature. In view of the sparse literature, it is not clear whether tularemia increases the risk of adverse pregnancy outcomes. In this paper we review tularemia infection during pregnancy, its complications and management. In addition, we present a case of tularemia that occurred in the first trimester of pregnancy and resulted in third-trimester intrauterine fetal death, highlighting the consequences of tularemia in pregnancy and the importance of early detection and treatment. © 2013 Springer-Verlag Berlin Heidelberg.


Kilic S.,Public Health Institution of Turkey | Celebi B.,Public Health Institution of Turkey | Yesilyurt M.,Tekirdag State Hospital
Diagnostic Microbiology and Infectious Disease | Year: 2012

Tularemia is an infection caused by Francisella tularensis with a worldwide distribution in the northern hemisphere and diverse clinical manifestations. Serology plays an important role in the diagnosis of tularemia. A commercially available immunochromatographic assay (ICA) for the serologic diagnosis of tularemia (VIRapid Tularemia, Vircell, Granada, Spain) was evaluated, and the performance was compared with that of the current standard, the microagglutination test (MA). A panel of 221 sera from 109 cases of tularemia was tested as well as 236 sera from normal individuals or individuals with other infectious or autoimmune diseases. The ICA demonstrated 91.5% (κ = 0.91) agreement with the reference method (MA) and gave an overall sensitivity of 99.3% and a specificity of 94.6%. No cross-reactivity was observed in the ICA with serum samples from normal individuals and patients with autoimmune diseases and bacterial, viral, and parasitic infections, although 4 of 50 patients with brucellosis demonstrated positive results in the ICA. The performance of ICA was simple, and it requires no specialized equipment. The ease of use and significantly high sensitivity and specificity of ICA make it a good choice for diagnostic testing and a valuable field test to support a presumptive diagnosis of tularemia in remote areas. © 2012 Elsevier Inc.

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