Complementary medicine methods have a long history, but modern medicine has just recently focused on their possible modes of action. Medicinal leech therapy (MLT) or hirudotherapy, an old technique, has been studied by many researchers for possible effects on various diseases such as inflammatory diseases, osteoarthritis, and after different surgeries. Hirudo medicinalis has widest therapeutic usage among the leeches, but worldwide, many different species were tested and studied. Leeches secrete more than 20 identified bioactive substances such as antistasin, eglins, guamerin, hirudin, saratin, bdellins, complement, and carboxypeptidase inhibitors. They have analgesic, anti-inflammatory, platelet inhibitory, anticoagulant, and thrombin regulatory functions, as well as extracellular matrix degradative and antimicrobial effects, but with further studies, the spectrum of effects may widen. The technique is cheap, effective, easy to apply, and its modes of action have been elucidated for certain diseases. In conclusion, for treatment of some diseases, MLT is not an alternative, but is a complementary and/or integrative choice. MLT is a part of multidisciplinary treatments, and secretes various bioactive substances. These substances vary among species and different species should be evaluated for both treatment capability and their particular secreted molecules. There is huge potential for novel substances and these could be future therapeutics.

Background/aim: This prospective study aimed to determine the presence of the most common carbapenemase genes, blaOXA-48, blaKPC, blaIMP, blaVIM and blaNDM on carbapenem resistant clinical K.pneumoniae and E.coli isolates. Materials and methods: Isolates were selected according to EUCAST guideline; gradient test and disc diffusion with both meropenem and ertapenem discs. Resistance rates of these isolates to other antimicrobial agents were also examined by disc diffusion method. Carbapenem resistance gene were investigated by using Real-Time PCR. Results: A total of 3845 E. coli and 1689 K.pneumoniae isolates from clinical samples between January 2015 and April 2017 were evaluated. The 419 isolates were found as carbapenem resistant but only the first resistant isolate (n=155; 126 K.pneumoniae and 29 E.coli) of each patient were included. Carbapenem resistant isolates were most frequently isolated from intensive care units (48.8%). Colistin was the most effective antibiotic (91.0%). The 121 (78.1%) of the tested isolates were positive for OXA-48 (103 K.pneumoniae and 18 E.coli) and 9 K. pneumoniae carrying blaNDM were also positive for blaOXA-48. VIM, IMP and KPC type carbapenemases were not detected in any isolates. Conclusion: Carbapenem-resistant pathogens have been shown to be able to develop resistance mechanisms with more than one carbapenemase encoding gene.

Objective: The present study aimed to evaluate the performances of the BACTEC MGIT 960 SL DST kit and the GenoType MTBDRsl test for detecting second-line antituberculosis drug resistance in Multidrugresistant TB (MDR-TB) cases. Materials and Methods:Forty-six MDR-TB strains were studied. Second-line antituberculosis drug resistances were detected using the BACTEC MGIT 960 SL DST kit and the GenoType MTBDRsl test. The Middlebrook 7H10 agar proportion method was used as the reference test.Results: The sensitivity and specificity values for the BACTEC MGIT 960 SL DST kit were both 100% for amikacin, kanamycin, capreomycin (4 µg/mL), and ofloxacin; 100% and 95.3%, respectively, for capreomycin (10 µg/mL); and 85.7% and 100%, respectively, for moxifloxacin (0.5 µg/mL). The sensitivity and specificity values for the GenoType MTBDRsl test to detect fluoroquinolone and aminoglycoside/cyclic peptide resistance were 88.9% and 100%, respectively, for ofloxacin and 85.7% and 94.9%, respectively, for moxifloxacin (0.5 µg/ mL). The accuracy of the GenoType MTBDRsl assay for kanamycin, capreomycin, ofloxacin, and moxifloxacin was lower than that of the BACTEC MGIT 960 SL DST. Conclusion:The BACTEC MGIT 960 SL DST kit and the GenoType MTBDRsl were successful in detecting second-line antituberculosis drug resistance. Preliminary results of the GenoType MTBDRsl are very valuable for early treatment decisions, but we still recommend additional BACTEC MGIT 960 SL DST kit usage in the routine evaluation of drug-resistant tuberculosis.Keywords: Mycobacterium tuberculosis, agar proportion method, MDR-TB, second-line drug susceptibility ÖZ Amaç: Bu çalışmanın amacı, çok ilaca dirençli tüberküloz (ÇİD-TB) vakalarında, BACTEC MGIT 960 SL DST kitinin ve GenoType MTBDRsl testinin, ikincil antitüberküloz ilaçlara karşı duyarlılığı saptamasındaki performansının değerlendirilmesidir.Gereç ve Yöntem: 46 tane ÇİD-TB suşu çalışıldı. BACTEC MGIT 960 SL DST kiti ve GenoType MTBDRsl testi ile ikincil antitüberküloz ilaçlara karşı direnç durumu tespit edilmiştir. Middlebrook 7H10 agar proporsiyon metodu referans yöntem olarak kullanılmıştır.Bulgular: BACTEC MGIT 960 SL DST kitinin duyarlılık ve özgüllüğü; amikasin, kanamisin, kapreomisin (4 µg/ mL) ve ofloksasin için her ikisi de %100; kapreomisin (10 µg/mL) için sırasıyla %100 ve %95,3; moksifloksasin (0,5 µg/mL) için sırasıyla %85,7 ve 100% olarak bulunmuştur. GenoType MTBDRsl testinin florokinolon ve aminoglikozid/siklik peptit direnci tespitinde duyarlılık ve özgüllüğü; ofloksasin için sırasıyla %88,9 ve %100; moksifloksasin (0,5 µg/mL) için sırasıyla %85,7 ve %94,9 olarak bulunmuştur. GenoType MTBDRsl yönteminin kanamisin, kapreomisin, ofloksasin ve moksifloksasin için doğruluğu, BACTEC MGIT 960 SL DST kitine göre daha düşük saptanmıştır.Sonuç: BACTEC MGIT 960 SL DST kiti ve GenoType MTBDRsl testi ikincil antitüberküloz ilaçlara karşı direncin saptanmasında başarılı bulunmuştur. GenoType MTBDRsl testi ile elde edilen ön bilgiler, erken dönemde tedavi kararlarının alınmasında değerlidir,...

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