Mustafa Gul

Kahramanmaras Sutcu Imam University, Marache, Kahramanmaraş, Turkey

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Publications (25)46.63 Total impact

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    ABSTRACT: Brucellosis is still endemic in Turkey and presents a major public health risk. The aim of this study wasto investigate the clinical and laboratory properties and complications of brucellosis cases. The files of 370 patients (162 males, 208 females) with brucellosis between March 2006 and January 2012 were analyzed retrospectively. The mean age of patients was 39, 6±18.2 years. The major risk factor was unpasteurized dairy products in 155 (41.8%) cases. The complications included hematological (58.1%), osteoarticular (48.3%), hepatobiliary (26.7%), gastrointestinal (10%), and genitourinary system involvement (4.8%). The most frequently seen symptoms were weakness (64.3%), fever (63.2%), sweating (62.7%), arthralgia (59.1%), and lack of appetite (47.8%). A total of 261 patients (70.5%) were acute, 73 patients (19.7%) were subacute, and 36 patients (9.7%) were chronic. In the laboratory tests, AST, ALT and CRP levels were found as elevated in 27.6%, 21.6%, and 69.6% of the patients, respectively. On complete blood count analysis, leukopenia (21.4%), thrombocytopenia (23%), and anemia (70%) were determined. Pancytopenia was more common in acute cases (p = 0.019). Osteoarticular complications increased significantly with increased age (p = 0.005). Brucellosis is a common disease that may be accompanied by serious complications. In endemic regions of brucellosis, people should be taught to avoid unpasteurized dairy products. Clinicians must be aware of multiple system involvement in brucellosis, especially hematological and musculoskeletal systems. Hematological abnormalities occurring during the course of the disease may be misdiagnosed as hematological malignancies.
    The Journal of Infection in Developing Countries 05/2014; 8(5):581-8. · 1.00 Impact Factor
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    ABSTRACT: Serratia ficaria was first described in 1979 as a Gram-negative facultative anaerobic rod. S. ficaria was found in figs, but also isolated from human specimens in a few cases. We now report an isolate of S. ficaria from sputum specimen.A 46-year-old man was suffering from a chronic renal failure of five years, four months of peritoneal dialysis and one week of fever due to respiratory tract infection, accompanied by cough. Sputum culture yielded a Gram-negative rod. It was identified as S. ficaria and the antibiotic susceptibility test was performed by automated Vitek II (bioMerieux). The tested S. ficaria strain was susceptible to amikacin, gentamicin, cefepime, trimethoprim-sulfamethoxazole, imipenem, meropenem, tigecycline and ciprofloxacin. This strain was resistant to ampicillin, amoxicillin-clavulanic acid, cephalothin, cefoxitine, cefuroxime and ceftriaxone. The patient was treated successfully (80 mg trimethoprim/400 mg sulfamethoxazole twice daily for 7 days)S. ficaria is an opportunistic pathogen responsible for intestinal colonization or serious infections such as septicaemia, gall bladder empyema in immunocompromised patients. The fig tree and fig play an important role in human colonization. It should be remembered that S. ficaria infections may be encountered frequently especially in fig tree culture zones.
    Acta Microbiologica et Immunologica Hungarica 09/2011; 58(3):235-8. · 0.65 Impact Factor
  • M Gul, A Yasim, M Aral
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    ABSTRACT: The aim of this study was to investigate the circulating levels of IL-1, IL-6, IL-10 and TNF-? in serum following the use of topical and intra-peritoneal vancomycin and teicoplanin, as well as topical fusidic acid to prevent MRSA vascular graft infection in a rat model. Graft infections were established in the subcutaneous tissue of rats by implantation of Dacron prostheses. Circulating levels of IL-1, IL-6, IL-10 and TNF-alpha were measured in serum samples of all rats obtained by ELISA at sacrifice. The mean serum levels of IL-1, IL-6 and IL-10 were found indifferent in all groups. The mean serum levels of TNF-alpha were as follows: 32.9 +/- 9.9 pg/ml in uncontaminated control group, 59.9 +/- 7.1 pg/ml in untreated contaminated group, 41.4 +/- 11.5 pg/ml in intraperitoneal vancomycin group, 39.6 +/- 10.1 pg/ml in intraperitoneal teicoplanin group, 35.6 +/- 8.2 pg/ml in topical vancomycin group, 37.3 +/- 19.5 pg/ml in topical teicoplanin group, 35.5 +/- 16.7 pg/ml in topical 10% fusidic acid group, 36.4 +/- 6.9 pg/ml in topical 40% fusidic acid group. The level of TNF-alpha in untreated contaminated group was significantly higher than in all of the other groups (p < 0.01, p < 0.05, p < 0.02, p < 0.01, p < 0.01, p < 0.01, p < 0.01, respectively). TNF-alpha was determined to be a more accurate cytokine than IL-1, IL-6 and IL-10 in a rat model in which intra-peritoneal and topical glycopeptides as well as fusidic acid were administered for the prevention of vascular graft infection (Tab. 3, Fig. 2, Ref. 20).
    Bratislavske lekarske listy 01/2010; 111(6):316-20. · 0.47 Impact Factor
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    ABSTRACT: Postoperative abdominal adhesions represent one of the most common causes of intestinal obstruction in surgical patients. In this study, the effects of intraperitoneal administration of estrogen on the development of postoperative intraabdominal adhesions and peritoneal leucocytes in a rat adhesion model were investigated. Sixty Wistar albino rats were divided into three groups. Group 1 (control group) had their abdomen closed after surgery without administration of any material or drug. Group 2 (saline group) received 2 ml of 0.9% NaCl, and group 3 (estrogen group) animals received a single intraperitoneal dose of 2 cc (1 mg) estrogen (Estradiol propionate, 50.000U, Akrofilline, Biofarma, Turkey). All the groups were exposed to the same adhesion-creating procedure (Swolin K. Experimental studies on the prevention of intra-abdominal adhesions. Studies on rats with an emulsion of lipid and prednisolone. Acta Obstet Gynecol Scand. 1966;45:473-498.). After 7-42 days, all animals were sacrificed. Adhesions were scored and peritoneal leucocytes were counted. The adhesion formation and peritoneal leucocyte count of the estrogen group were significantly less than the control and saline groups and a statistically significant difference was determined in comparison of those groups (p <. 05). Conclusion: We concluded that intraperitoneal estrogen decreases the incidence of postoperative intraabdominal adhesion formation in rat adhesion model.
    Journal of Investigative Surgery 01/2009; 22(4):263-7. · 1.32 Impact Factor
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    ABSTRACT: In the surgical history of hepatic hydatid disease, multiple scolicidal agents have been used for sterilization of the cyst contents. However, none of these agents can be safely used, because most have unacceptable side effects, such as toxicity, caustic sclerosing cholangitis, bile duct stricture, and hypernatremia. Protoscolices were aseptically removed from liver hydatid cysts obtained from sheep slaughtered at the municipal abattoir in Kahramanmaras, Turkey. In this study, the effects of 0.9% NaCl (control group), 20% NaCl (hypertonic saline), 20% silver nitrate, albendazole 20 mg/cm3, 50% dextrose (hypertonic glucose), and 20% mannitol and aminomix-1 solutions on echinococe cysts were investigated under in vitro conditions. After 5, 10, 15, 20, 25, 30, 45, and 60 min for each concentration, the first 100 protoscolices were counted on the 10x microscopical field. Protoscolices, which showed positive staining by eosine were considered as dead ones. The averages of dead and total protoscolices were calculated. Our results showed that all observed protoscolices were dead after the treatments by 20% silver nitrate in 20 min, by 50% dextrose and by aminomix-1 solution in 30 min, and by 20% NaCl and by 20% mannitol in 45 min. Albendazole at 20 mg/cm3 was observed to lead to death of 65% of protoscolices in the first 5 min and 70% of protoscolices at the end of 60 min. Compared with 0.9% NaCl (saline), all of these scolicidal agents were significantly effective (p < .05). Aminomix-1, 20% mannitol, and 50% dextrose solutions may be used in percutaneous and surgical treatment of hydatid cyst. They may be preferred because they are readily available, can be administered intravenously, and have an equal or greater effectiveness than 20% hypertonic saline.
    Journal of Investigative Surgery 01/2008; 21(2):71-5. · 1.32 Impact Factor
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    ABSTRACT: A 15 year old boy presented with fever and acute painful scrotal swelling. Complete blood count showed pancytopenia. Serum brucella antibodies were positive. Pancytopenia and epididymoorchitis are rare complications of brucellosis and clinicians must consider this entity in the differential diagnosis of adolescents with epididiymoorchitis associated with pancytopenia.
    Indian pediatrics 10/2007; 44(9):699-700. · 1.04 Impact Factor
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    ABSTRACT: Comamonas testosteroni is an uncommon isolate in the clinical laboratory as a human pathogen. C. testosteroni most commonly emerges in abdominal pathologies especially in perforated appendicitis. In Turkey we report first time a case of bacteremia due to this organism, in a 22-year-old man with perforated acute appendicitis. The organism was shown to be susceptible to routine antibiotics so it was easily eliminated even after having caused a bacteremia.
    Acta Microbiologica et Immunologica Hungarica 10/2007; 54(3):317-21. · 0.65 Impact Factor
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    ABSTRACT: Prophylactic efficiencies of cefazolin, teicoplanin and vancomycin in a dacron graft infection model caused by methicillin-susceptible (MSSA) or -resistant Staphylococcus aureus (MRSA) were investigated. Prospective, randomized, controlled animal study. Infections were established subcutaneously in the back of rats by implantation of Dacron prostheses followed by topical inoculation onto grafts of MSSA or MRSA. Experimental groups were as follows: Uncontaminated group (control), MSSA- or MRSA-contaminated and untreated groups, MSSA- or MRSA-contaminated groups treated with cefazolin, teicoplanin or vancomycin by one of three regimens (one day, two days, or three days regimen). Grafts were removed 7 days after the implantation and evaluated by using sonication and quantitative blood agar culture. Contaminated groups demonstrated graft infections. Cefazolin, teicoplanin and vancomycin profoundly prevented the graft infections in MSSA- or MRSA-contaminated groups. For each antibiotic regimen, the most effective prevention was achieved by the drugs given as three days regimen. For MSSA and MRSA, the order of the effectiveness was as follows: teicoplanin>vancomycin>cefazolin. As a prophylactic agent, teicoplanin seems to be more effective than vancomycin and cefazolin against vascular graft infections caused by MSSA and MRSA in rats.
    European Journal of Vascular and Endovascular Surgery 09/2007; 34(2):182-7. · 2.82 Impact Factor
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    ABSTRACT: Case report. To present a patient with spinal brucellosis, which was initially presented with sciatica and misdiagnosed as a lumbar disc herniation owing to nonspecific neurological and radiological findings. The delay in diagnosis led to rapid progression of the disease and complications. Department of Neurosurgery at a tertiary university teaching hospital (Sutcu Imam University Medical Center in Turkey). A 57-year-old woman with a history of low-back pain for 6 months, fatigue, and severe left-sided sciatica for the last 3 months presented to our hospital. Three months earlier, at another hospital, she had had a negative Rose-Bengal test for brucellosis and a lumbar computed tomography performed at that time showed only minimal L4-5 annular bulging. For 2 months, she was treated with analgesics for 'lumbar disc herniation' without relief of pain. On presentation to our department, her magnetic resonance imaging (MRI) examination showed edema and minimal annular bulging at L3-4 and L4-5. When her Rose-Bengal test returned positive, she was started on triple antibiotics for presumed Brucella infection. When symptoms and neurologic signs worsened while taking antibiotics, repeat MRI scan showed a spinal epidural abscess at the L4-5 level. Emergent surgery and 8 weeks of antibiotics resulted in cure. In areas endemic for brucellosis, subtle historical and exam features should be sought to exclude an infection such as brucellar sponylo-discitis. Appropriate serological tests should be readily available to confirm or exclude this diagnosis in selected patients, to avoid delays in antibiotic treatment.
    Spinal Cord 01/2007; 44(12):805-8. · 1.90 Impact Factor
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    ABSTRACT: This study was conducted to investigate whether there is any difference between tonsillar surface and deep tissue cultures in patients who underwent tonsillectomy for recurrent tonsillitis. Tonsillar surface and core tonsillar cultures were taken in all patients. The samples were inoculated into 5% sheep blood, chocolate, and MacConkey agar. The bacteria isolated were identified by using standard methods as well as API kits (Bio Mérieux) if necessary. Pathogenic bacteria were isolated in 77 patients, and no pathogenic bacteria were recovered in 39 of 116 patients included in the study. Of these 77 patients, in 52 patients, different types of bacteria were recovered from the surface and deep tissue cultures, whereas in 25 patients, the same types of bacteria were isolated from both surface and deep tissue cultures. The estimated probabilities of tonsillar bacteriology via surface swabs for Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, and group A beta-hemolytic streptococci were 27.2%, 38.4%, 66.6%. and 62.5%, respectively. H influenzae was less frequently predicted by surface culture than others. We think that the swab cultures taken from the tonsillar surface may not always reveal the real pathogen of the tonsils. In addition, the estimated probability of tonsillar bacteriology by surface swabs varies with the type of the pathogen. If medical therapy is planned on the basis of the tonsillar surface culture, then antibiotics also effective against H influenzae besides the target microorganisms may be chosen.
    American Journal of Otolaryngology 01/2007; 28(3):173-6. · 1.23 Impact Factor
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    ABSTRACT: The purpose of this experimental study was to compare the susceptibility of gelatin-sealed Dacron and PTFE prostheses to infection by MRSA. Prospective, randomized, controlled animal study. Graft infections were established in the subcutaneous tissues of 60 female Spraque-Dawley rats by the implantation of gelatin-sealed Dacron or PTFE prostheses followed by topical inoculation with methicillin-resistant Staphylococcus aureus. The study groups were as follows: (1A) uncontaminated gelatin-sealed Dacron group, (1B) untreated contaminated gelatin-sealed Dacron group, (1C) contaminated gelatin-sealed Dacron group with intraperitoneal teicoplanin treatment, (2A) uncontaminated PTFE group, (2B) untreated contaminated PTFE group, and (2C) contaminated PTFE group with intraperitoneal teicoplanin treatment. The grafts were removed after 7 days and evaluated for infection by counting the number of adherent bacteria on the graft material after rinsing and sonication. The perigraft tissue was harvested for histopathological study. To investigate the existence of any infection, blood samples were collected by cardiopuncture for a culture analysis. No significant difference in bacteria counts was observed between gelatin-sealed Dacron and PTFE grafts. In groups 1A and 2A, there was no infection detected. The bacterial counts for MRSA were 7.4 x 10(5) in group 1B and 8.6 x 10(5) in group 2B. There was also no infection in groups 1C and 2C. While the difference between group 1B and 2B was not significant (p>.05), bacterial counts in group 1B or 2B were significantly higher than those in other groups. Blood cultures were only positive in four rats in group 1B and in two rats in group 2B. The severities of the inflammation of the perigraft tissues was low in groups 1A and 2A, high in groups 1C and 2C, and between the range from low to moderate in groups 1B and 2B. The susceptibility of gelatin-sealed Dacron to bacterial infection was not higher than that of PTFE.
    European Journal of Vascular and Endovascular Surgery 10/2006; 32(4):425-30. · 2.82 Impact Factor
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    ABSTRACT: To compare the efficacy of a single prophylactic dose of intra-peritoneal vancomycin and teicoplanin with anti-biotic treated Dacron grafts (vancomycin, teicoplanin, 10 or 40% fusidic acid-soaked grafts) in preventing vascular graft infections in a rat model. Prospective, randomized, controlled animal study. The graft infections were established in the subcutaneous tissues of 80 female Sprague-Dawley rats by the implantation of Dacron prostheses followed by the topical inoculation with methicillin-resistant Staphylococcus aureus. The study groups were as follows: (1) uncontaminated control group, (2) untreated contaminated group, (3) contaminated group with intra-peritoneal vancomycin, (4) contaminated group with intra-peritoneal teicoplanin, (5) contaminated group received vancomycin-soaked Dacron graft, (6) contaminated group received teicoplanin-soaked Dacron graft, (7) contaminated group received 40% fusidic acid-soaked Dacron graft, and (8) contaminated group received 10% fusidic acid-soaked Dacron graft prophylaxis. The grafts were removed after 7 days and evaluated by a quantitative culture analysis. No infection was detected in controls. The untreated contaminated group had a high bacteria count (6.0 x 10(4) CFU/cm2 Dacron graft). Groups that received intra-peritoneal vancomycin or teicoplanin had less bacterial growth (4.8 x 10(3) and 3.9 x 10(3)CFU/cm2 Dacron graft, respectively). Similarly, the group that received 10% fusidic acid-soaked graft showed less bacterial growth (3.6 x 10(3) CFU/cm2 Dacron graft). The groups with vancomycin-, teicoplanin- and 40% fusidic acid-soaked grafts showed no evidence of infection. Statistical analyses demonstrated that intra-peritoneal prophylactic antibiotic treatment was less effective in inhibiting bacterial growth than high concentration antimicrobial-soaking of grafts. The use of vancomycin-, teicoplanin- and 40% fusidic acid-soaked grafts was effective in preventing primary prosthetic vascular graft infection.
    European Journal of Vascular and Endovascular Surgery 04/2006; 31(3):274-9. · 2.82 Impact Factor
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    ABSTRACT: In the study presented here, a new chromogenic medium (CPS ID 3; bioMérieux, Marcy l'Etoile, France) was compared to routine media for the isolation, identification and antimicrobial susceptibility testing of bacteria recovered from urine specimens, and a cost analysis was performed. Escherichia coli, Proteeae tribe, Pseudomonas aeruginosa, Enterococcus spp. and Streptococcus agalactiae grew on the chromogenic medium as typical differentiated colonies and were accurately identified even in mixed cultures. Although the similarity of colors produced by isolates belonging to the Klebsiella, Enterobacter, Serratia and Citrobacter (KESC) group prevents differentiation among them, members of KESC were easily identified as coliforms. No substantial difference was observed when comparing the results of antimicrobial susceptibility testing performed on colonies selected from reference media versus CPS ID 3. Use of the new medium was associated with a savings of 75% over the conventional methods and the API system. Furthermore, this medium facilitated a remarkable reduction in the laboratory workload and consequently resulted in additional time and cost savings.
    European Journal of Clinical Microbiology 03/2006; 25(2):108-11. · 3.02 Impact Factor
  • P Ciragil, M Gul, M Aral
    Journal of Hospital Infection 03/2006; 62(2):247-8. · 2.86 Impact Factor
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    ABSTRACT: Studies about the role of cytokines on the immunopathogenesis of atopic dermatitis (AD) are generally based on in vitro observations and this role has not been completely clarified yet. Serum levels of total IgE, IL-18, IL-12, IFN-gamma and the relationship between these parameters and disease severity, determined using the SCORAD index, in a group of atopic patients were investigated in this study. Serum levels of total IgE were measured by the nephelometric method and serum levels of IL-18, IL-12/p40 and IFN-gamma were measured by ELISA method. Serum levels of total IgE and IL-18 were found significantly higher in study group than in controls (P<.001). There was no statistically significant difference between patients and controls in respect of serum levels of IL-12/p40 (P = .227). A statistically significant relationship between SCORAD values and serum levels of total IgE (P < .001), IL-18 (P < .001), and IL-12/p40 (P < .001) was determined. These results show that serum levels of IL-18 can be a sensitive parameter that importantly correlates with clinical severity of AD, can play a role in the immunopathogenesis of AD, and furthermore may be used in the diagnosis and follow-up of the disease in addition to other parameters.
    Mediators of Inflammation 02/2006; 2006(4):73098. · 3.88 Impact Factor
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    ABSTRACT: We investigated the effects of intraperitoneal tenoxicam on the development of postoperative intra-abdominal adhesions and oxidative stress in a model of bacterial peritonitis. Bacterial peritonitis was induced in 24 rats by cecal ligation and puncture. The rats were randomly assigned to one of three groups. Group 1 (n = 8) received 2 ml saline intraperitoneally, group 2 (n = 8) received 2 ml (0.5 mg/kg) tenoxicam (Oksamen) intraperitoneally, and group 3 (n = 8) was a control, which did not receive any injection. All animals were killed 14 days later so we could assess the adhesion score and measure anastomotic bursting pressures. Tissue antioxidant levels were measured in 1-g tissue samples taken from the abdominal wall. The adhesion score was significantly lower in the tenoxicam group than in the saline and control groups. The anastomotic bursting pressures were higher in the saline and tenoxicam groups than in the control group. The catalase (CAT) levels were higher in the saline and tenoxicam groups than in the control group. The malondialdehyde (MDH) levels were higher in the saline group than in the tenoxicam and control groups. Intraperitoneal tenoxicam inhibited the formation of postoperative intra-abdominal adhesions without compromising wound healing in this bacterial peritonitis rat model. Tenoxicam also decreased the oxidative stress during peritonitis.
    Surgery Today 02/2006; 36(4):361-6. · 0.96 Impact Factor
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    ABSTRACT: The aim of this study is to assess the impacts of "Maras powder" and cigarette smoking on the parameters of the humoral immune system. One hundred seventy seven subjects were included in the study. The IgA, IgG, IgM, C3 and C4 levels were detected via nephelometric method. In 1.4% of the control group IgM levels were below normal where it was 10.8% and 18.6% in Maras powder group and in cigarette smoking group respectively. The IgM levels of both groups were significantly lower compared to the control group (P < .05). Nonetheless, the IgE levels of Maras powder group and smoking group were found to be remarkably higher compared to the control group (P < .01). Effects of Maras powder on humoral immune response were found to be similar to that of smoking.
    Mediators of Inflammation 01/2006; 2006(3):85019. · 3.88 Impact Factor
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    ABSTRACT: To investigate the effects of intraperitoneally administered lornoxicam on adhesion formation, bursting pressure, tissue antioxidant levels, morbidity and mortality after ileocolic anastomosis in a rat bacterial peritonitis model. Thirty-six rats were divided into three random groups. Bacterial peritonitis was induced by performing a cecal ligation and puncture, then the cecal was resected and ileocolic anastomosis was performed. Rats of groups 1, 2 and 3 were given 2 mL normal saline, 2 mL lornoxicam, and nothing, respectively. All groups were killed at day 14. Adhesions were scored, and the presence of intra-abdominal abscesses and fistulas were noted. Anastomotic healing was assessed by bursting pressure. Tissue antioxidant levels were tested from left abdominal walls. One day after cecal ligation and puncture, microbiological examination showed polymicrobial bacterial peritonitis. The rats treated with lornoxicam had significantly lower adhesion scores than did the saline and nothing treated rats (P = 0.007). Bursting pressures of groups were unaffected by the treatment. Tissue antioxidant levels of groups were affected by the treatment. Morbidity and mortality were similar in all groups. The present study demonstrated that a single intraperitoneal instillation of lornoxicam in buffer solution at the end of the surgery reduces adhesion formation in rats bacterial peritonitis model. It was also determined that lornoxicam had no negative effect on the healing of intestinal anastomosis, abscess and anastomotic leakage. Use of lornoxicam in peritonitis was effective in decreasing the oxidative stress of tissue during peritonitis.
    ANZ Journal of Surgery 01/2006; 75(12):1115-9. · 1.50 Impact Factor
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    ABSTRACT: Puncture wounds of the foot are relatively common injuries that occur in persons of all ages. A small percentage of puncture wounds becomes infected and can lead to complications such as osteomyelitis, osteochondritis and soft tissue abscess. These wounds must be followed up routinely one week after injury. We report a case of calcaneus osteomyelitis caused by a mixed infection with Escherichia coli and Staphylococcus aureus subsequent to puncture wound of the foot. The characteristics of the patient, the pathogenic organisms, treatment and outcome are presented.
    Journal of Orthopaedics and Traumatology 11/2005; 6(4):194-196.
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    ABSTRACT: The purpose of this study was to determine the effect of urinary tract infection (UTI) on antioxidant systems and lipid peroxidation (LPO) levels during pregnancy. We also investigated if these antioxidant systems and LPO levels differed in each trimester. One hundred forty-three nonpregnant women, as a control group, and 77 pregnant women were included in the study. Urine cultures were performed according to standard techniques. Catalase (CAT), superoxide dismutase (SOD), and LPO levels were measured using a spectrophotometer. UTI was observed in 14 of 77 pregnant women and the isolated microorganisms were Escherichia coli, Klebsiella pneumoniae, and Staphylococcus saprophyticus. CAT, SOD, and LPO levels were increased in pregnant women compared with nonpregnant women (P<.01). CAT, SOD activities, and LPO levels were increased from the first trimester to the third trimester in pregnancy without UTI. However, CAT and SOD activities were decreased, LPO levels were increased from the first trimester to the third trimester in pregnancy with UTI (P<.01). Pregnancy causes oxidative stress and also UTI during pregnancy may aggravate oxidative stress.
    Mediators of Inflammation 11/2005; 2005(5):309-11. · 3.88 Impact Factor