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We report a nosocomial outbreak caused by a multidrug-resistant carbapenemase-producing Klebsiella pneumoniae (MDRCP Kp), that was detected in six patients admitted to the medical intensive care unit between 20th of December 2023 and 15th of January 2024 in Ankara, Turkey. The investigation of this outbreak was started on 29th of December 2023. During the outbreak 11 samples were collected from the six patients with MDRCP Kp. Pulsed-field gel electrophoresis (PFGE) was performed to determine the genetic relatedness and clonality of MDRCP Kp strains. MDRCP Kp was isolated in the tracheal aspiration culture, blood, urine, and screening samples. Five patients with MDRCP Kp colonization developed healthcare-associated infection. In one patient MDRCP Kp was isolated from tracheal aspirate and the screening cultures were considered as colonization not infection. PFGE analysis revealed that all isolates belonged to the same K. pneumoniae clone. MDRCP Kp strain of this outbreak exhibited multidrug resistance and co-produced OXA-48 and NDM-1. This outbreak ended after application of strict infection control measures. An outbreak of MDRCP Kp can occur in hospitals, especially in the intensive care units; thus, it should be detected early by infection control teams. A strong collaboration between infection control team and microbiology laboratory is essential to cope with MDR bacterial outbreaks in hospitals. [ABSTRACT FROM AUTHOR]

Introduction: In this short review, the effect of climate change on nature and human health with a special focus on infectious diseases in the Mediterranean region is discussed. This research is a part of the Mediterranean Convention of Human Rights project, which is an organizational work on human rights issues that was established in cooperation with civil society and the national authorities of the Mediterranean Region. Methodology: Previously published data were collected by retrieving published literature from PubMed, Google Scholar, and Web of Science using "climate change", "the Mediterranean region", "infections in Mediterranean Region", "infectious diseases", "biodiversity", and "the Mediterranean Sea" as keywords. The collected data were then evaluated and reviewed. The recommendations and guidelines were analysed by the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Conclusions: The Mediterranean region presents a typical example witnessing a dramatic change in climate events and their adverse impact on biodiversity, ecosystems and public health are multiple. This negative impact is in part due to the geographical particularities, and sociocultural and geopolitical conflicts that are progressively worsening the burden of climate change. While most of these changes cannot be totally avoided, many of the health risks related to climate change could be monitored. This can be done by establishing health systems with policies to reduce and prevent the risks of infectious diseases and to recover and support the affected areas, which may identify priority and management of highrisk events. [ABSTRACT FROM AUTHOR]

Introduction: Klebsiella pneumonia causes serious infections in hospitalized patients. In recent years, carbapenem-resistant infections increased in the world. The molecular epidemiological investigation of carbapenem-resistant K. pneumoniae isolates was aimed in this study. Methodology: Fifty carbapenem-resistant K. pneumoniae isolates from six geographical regions of Turkey between September 2019-2020 were included in the study. The disk diffusion method was used for the antibiotic susceptibility testing. The microdilution confirmed colistin susceptibility. Genetic diversity was investigated by MLST (Multi-Locus Sequence Typing). Results: The resistance rates were as follows: 49 (98%) for meropenem, 47 (94%) imipenem, 50 (100%) ertapenem, 30 (60%) colistin and amoxicillin-clavulanate, 49 (98%) ceftriaxone, 48 (96%) cefepime, 50 (100%) piperacillin-tazobactam, 47 (94%) ciprofloxacin, 40 (80%) amikacin, 37 (74%) gentamicin. An isolate resistant to colistin by disk diffusion was found as susceptible to microdilution. ST 2096 was the most common (n:16) sequence type by MLST. ST 101 (n:7), ST14 (n:6), ST 147 and ST 15 (n:4), ST391 (n:3), ST 377 and ST16 (n:2), ST22, ST 307, ST 985, ST 336, ST 345, and ST 3681 (n:1) were classified in other isolates. In İstanbul and Ankara ST2096 was common. Among Turkey isolates, the most common clonal complexes (CC) were CC14 (n:26) and CC11 (n = 7). Conclusions: In Turkey, a polyclonal population of CC14 throughout the country and inter-hospital spread were indicated. The use of molecular typing tools will highlight understanding the transmission dynamics. [ABSTRACT FROM AUTHOR]

Background and Aim: In chronic hepatitis B infection, antiviral therapy significantly reduces the incidence of complications. This study aimed to present real-life 12-month effectiveness and safety data for TAF. Materials and Methods: This Pythagoras Retrospective Cohort Study included patients from 14 centers in Turkiye. The study presents 12-month results of 480 patients treated with TAF as initial therapy or after switching from another antiviral drug. Results: The study shows treatment of about 78.1% patients with at least one antiviral agent (90.6% tenofovir disoproxil [TDF]). The rate of undetectable HBV DNA increased in both treatment-experienced and naive patients. In TDF-experienced patients, the rate of alanine transaminase (ALT) normalization increased slightly (1.6%) within 12 months, but the change was not statistically significant (p=0.766). Younger age, low albumin, and high body mass index and cholesterol were identified as risk factors for abnormal ALT after 12 months, but no linear relationship was detected. In TDF-experienced patients, renal and bone function indicators showed significant improvement three months after the transition to TAF and remained stable for 12 months. Conclusion: Real-life data demonstrated effective virological and biochemical responses with TAF therapy. After switching to TAF treatment, gains in kidney and bone functions were achieved in the early period. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis aims to estimate the prevalence of coronavirus disease 2019 (COVID-19) vaccine hesitancy in Turkey, which can aid future health policies and strategies. A comprehensive search was conducted on various databases using keywords related to COVID-19 vaccine hesitancy in Turkey. Quality assessment was performed using Joanna Briggs Institute (JBI) checklist for prevalence studies. Data extraction was conducted. The random effect model (DerSimonian and Laird method) was used in pooled prevalence data analysis (95% confidence interval [CI]). A total of 1,072 articles were identified. After removing duplicates and excluding articles, 61 articles remained for bias assessment. Among these, 19 articles with low risk of bias were included in the review and meta-analysis. Total population included in the analysis was 15,164, vaccine hesitancy was 30.5% (95% Cl: 24.3–36.8%). Prevalence of the vaccine hesitancy was found to be 39.8% (95% Cl: 31.4–48.2%) in studies conducted before the initiation of vaccination, while in studies conducted after the commencement of vaccination, hesitancy was 20.4% (95% Cl: 12.9–28%). We suggest conducting high-quality studies in different populations to understand the level of vaccine hesitancy, as many of the previous studies have mainly focused on healthcare workers and students, and rest were community-based studies, which have generally shown high bias. Also, we suggest that early vaccination can reduce vaccine hesitancy. [ABSTRACT FROM AUTHOR]

Objective: Occult hepatitis B infection (OHBI) appears to have a higher prevalence in populations at high risk for hepatitis B virus (HBV) infection with concomitant liver disease. The aim was to assess the prevalence of OHBI in a sample of human immunodeficiency virus -1 positive and HBV surface antigen-negative (HIV-1+/HBsAg-) Turkish patients.Methods: Ten centres in Turkey were included in the study. Patients were selected on the basis of a power calculation with a known population size of HIV-positive patients and a reported prevalence of OHBI. Gender, age, occupation, place of residence, treatment and clinical status, and laboratory results, including immunodeficiency panel, antibody tests, hemogram, biochemistry, and coagulation studies were evaluated retrospectively.Results: The number of HIV-infected patients followed in these centres was 3172 and the sample population numbered 278. All 278 were HBsAg negative. The mean age of the sample was 37.2 ± 13.1 years and 235 (84.5%) were male. All but one patient (99.6%) had been treated with antiretroviral therapy. Of the 278 patients, 169 (60.6%) were positive for Anti-HBs and 125 (44.8%) were positive for Anti-HBc IgG. HIV RNA was detected in 203/278 (73%) of the patients. Four HBV DNA (1.4%) were diagnosed with OHBI. There was no significant difference in hemogram, hemoglobin or bilirubin concentrations in those with OHBI compared with the other patients.Conclusion: In a representative sample of HIV+ patients from 10 Turkish centres, the prevalence of OHBI was found to be 1.4%. In HIV positive patients, it is important to identify those with OHBI for optimal clinical management and prognosis. [ABSTRACT FROM AUTHOR]

There are currently no licensed vaccines or therapeutics for COVID‐19. Anti‐SARS CoV‐2 antibody‐containing plasmas, obtained from the recovered individuals who had confirmed COVID‐19, have been started to be collected using apheresis devices and stored in blood banks in some countries in order to administer to the patients with COVID‐19 for reducing the need of intensive care and the mortality rates. Therefore, in this review, we aim to point out some important issues related to convalescent plasma (CP) and its use in COVID‐19. CP may be an adjunctive treatment option to the anti‐viral therapy. The protective effect of CP may continue for weeks and months. After the assessment of the donor, 200‐600 mL plasma can be collected with apheresis devices. The donation interval may vary between countries. Even though limited published studies are not prospective or randomized, until the development of vaccines or therapeutics, CP seems to be a safe and probably effective treatment for critically ill patients with COVID‐19. It could also be used for prophylactic purposes but the safety and effectiveness of this approach should be tested in randomized prospective clinical trials. [ABSTRACT FROM AUTHOR]

Objective: Today, antibiotic resistance is increasing and evolving into an important health problem. Therefore, it is important to research on alternative therapies to antibiotics. This study aimed to investigate the inhibitory effect of four garlic derivatives on microorganisms commonly isolated in ear infections. Methods: The antimicrobial activities of allicin, s-allyl cysteine (SAC), diallyl disulfide (DADS), and s-allyl mercaptocysteine (SAMC) were investigated on standard strains of commonly isolated microorganisms using the broth microdilution method. The test strains were selected among the microorganisms responsible for chronic suppurative otitis media and otitis externa. These microorganisms were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus, Enterococcus faecium, Candida albicans, and Candida tropicalis. Results: Minimum inhibitory concentration (MIC) values of allicin and SAC ranged from 0.125 to 20 µg/mL for fermentative bacteria (E. coli and K. pneumoniae), 20 to 80 µg/mL for non-fermentative bacteria (P. aeruginosa and A. baumannii), 5 to 10 µg/mL for gram-positive cocci (S. aureus and E. faecium), and 40 to 80 µg/mL for yeasts (C. albicans and C. tropicalis). MIC values of DADS ranged from 40 to 80 µg/mL for fermentative bacteria, 40 to 160 µg/mL for non-fermentative bacteria, 40 to 80 µg/mL for gram-positive cocci, and 20 to 40 µg/mL for yeasts. The MICs of SAMC were >640 µg/mL for the tested bacteria and yeasts. Conclusion: Both allicin and SAC showed antimicrobial activity against the tested microorganisms, even at low concentrations. These two derivatives may be used to treat infections in the future. [ABSTRACT FROM AUTHOR]

Introduction: Carbapenem-resistant Klebsiella pneumoniae are a major problem. We aimed to investigate carbapenemase-encoding genes and transferable mcr-1 genes among 57 carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates from hospitalized patients. Methodology: Antibiotic susceptibility tests were performed by Phoenix (BD). Results for ertapenem and colistin were confirmed by gradient diffusion and microdilution methods. Carbapenemase and mcr-1 genes were investigated by Polymerase Chain Reaction (PCR). Results: Thirty-two (56.14%) isolates were from intensive care units (ICU). Antibiotic resistance rates by Phoenix: 52.63% for amikacin; 73.69% trimethoprim sulfamethoxazole; 91.23% cefepime; 82.46% tigecycline; 59.65% colistin. Carbapenemases positivity: 82.45% (47) for blaOXA-48, 40.35% (23) blaOXA-55, 3.50% (2) blaOXA-51, 1.75% (1) blaOXA-23, 1.75% (1) blaOXA-24, 1.75% (1) blaIMP. blaOXA-58, blaKPC, blaNDM-1, and blaVIM were not detected. Twenty (35.08%) isolates had both blaOXA-48 and blaOXA-55. Three isolates were mcr- 1 (+) and blaOXA-48 (+). One mcr-1 (+) isolates was blaOXA-51 (+). One colistin sensitive isolate determined by Phoenix, was found colistin resistant by microdilution. Conclusion: OXA-48 and OXA-55 co-harboring isolates and mcr-1 gene (+) isolates were spreading. Automated colistin susceptibility results should be confirmed by microdilution method. Resistance mechanisms in Enterobacteriaceae should be determined and the isolates should be monitored by molecular epidemiological methods. Effective infection control measures will contribute to reduce risk of antibiotic resistant bacterial infections and dissemination of antibiotic resistance. [ABSTRACT FROM AUTHOR]

Objective To evaluate the febrile neutropenic patients with hematological malignancies hospitalized in hematology clinic with poor hygiene standards. Methods A total of 124 patients with hematological malignancies (69 male, 55 female) hospitalized in hematology clinic with poor hygiene conditions depending on hospital conditions, between January 2007 and December 2010, were evaluated, retrospectively. Results In this study, 250 febrile neutropenia episodes developing in 124 hospitalized patients were evaluated. Of the patients, 69 were men (56%) and 55 women (44%). A total of 40 patients (32%) had acute myeloid leukemia, 25 (20%) acute lymphoblastic leukemia, 19 (15%) non-Hodgkin's lymphoma, 10 (8%) multiple myeloma, and 8 (8%) chronic myeloid leukemia. In our study, 56 patients (22%) were diagnosed as pneumonia, 38 (15%) invasive aspergillosis, 38 (15%) sepsis, 16 (6%) typhlitis, 9 (4%) mucormycosis, and 4 (2%) urinary tract infection. Gram-positive cocci were isolated from 52% ( n = 20), while Gram-negative bacilli 42% ( n = 16) and yeasts from 6% ( n = 2) of the sepsis patients, respectively. The most frequently isolated Gram-positive bacteria were methicillin-resistant coagulase-negative staphylococci ( n = 18), while the most frequently isolated Gram-negative bacteria was Escherichia coli ( n = 10). Conclusions Febrile neutropenia is still a problem in patients with hematological malignancies. The documentation of the flora and detection of causative agents of infections in each unit would help to decide appropriate empirical therapy. Infection control procedures should be applied for preventing infections and transmissions. [ABSTRACT FROM AUTHOR]

Objective To detect the subtype characterization and drug-resistant mutations in HIV-1 strains after the refugee movement from Syria to Turkey between 2011 and 2014 in south east border lines. Methods A total of 65 patients were included in this study, of which 57 (88%) patients were antiretroviral therapy-naive patients. HIV-1 RNA was detected and quantified by real-time PCR assay. HIV-1 subtypes and circulating recombinant forms (CRFs) were identified by phylogenetic analysis (neighbor-joining method), and drug-resistant mutations were analyzed. Results Three major HIV groups were indicated. Two of these groups were located in subtype B. The other group showed heterogeneity. Subtype B (48/65, 73.8%), followed by CRFs (12/65, 18.5%) was the most common strain. Subtype of CRFs consisted of CRF01_AE (9/65, 13.8%) and CRF02_AG (3/65, 4.6%). Subtype C (1/65, 1.5%), sub-subtypes A1 (2/65, 3.1%) and F1 (2/65, 3.1%) were also detected with low prevalence. The rate of overall primary antiretroviral resistance was 4.9% (3/61). Drug-resistant rate for non-nucleoside reverse transcriptase inhibitors was 4.9%. The thymidine analogue mutation rate was 13.1% (8/61). Conclusions HIV molecular epidemiology studies are necessary to determine transmission patterns and spread. Subtype B and CRF01_AE, CRF02_AG are the most prevalent strains in the south-east of Turkey. However, subtype C, sub-subtypes A1 and F1 are of low prevalence but persist in the south-east of Turkey. In the near future, changing of HIV epidemiology will be possible in Turkey due to migration movement in border lines and resistance testing will play an important role in HIV management. [ABSTRACT FROM AUTHOR]

Aim: To investigate antibacterial and antifungal effectiveness of orthophenylphenol (Fumispore, LCB, La Salle, France) with a new administration method in healthcare environments. Materials and methods: This study was performed in 3 units of the Dicle University Hospital. Surface swab and ambient air samples were collected just before the application of Fumispore and 6 h later. All samples were inoculated onto plate count agar and Sabouraud dextrose agar. The total aerobic colony count (ACC) was determined by using the standard method based on quantitative bacterial measurement. Results: In total, 30 surface swabs and 6 ambient air samples were collected. The mean values of the total ACC were determined on surface swabs: 12.1 colony CFU/cm² for total microorganisms and 2.9 CFU/cm² for fungi before application, and 1.6 CFU/cm² for total microorganisms and 0.4 CFU/cm² for fungi after application. The mean values of the total ACC were detected in ambient air samples: 258 CFU/m³ for total microorganisms and 208 CFU/m³ for fungi before application, and 20 CFU/m³ for total microorganisms and 15 CFU/m³ for fungi after application. Conclusion: The total ACC values obtained before and after applications have shown that orthophenylphenol (Fumispore) is suitable for adequate disinfection in healthcare environments. [ABSTRACT FROM AUTHOR]

Context: Anthrax is a rare disease caused by Bacillus anthracis. Antrax is zoonotic disease and is often encountered in persons engaged in animal husbandry. Cutaneous anthrax is approximately 95% of anthrax in humans. Palbebral involvement is rare. Objective: In this study, we aimed to evaluate the clinical presentation, diagnosis and treatment of cases with cutaneous palpebral anthrax. Methods: In this study, the patients diagnosed of cutaneous palpebral anthrax between January 2000 and December 2012, were investigated and evaluated, retrospectively. Cutaneous palpebral anthrax was diagnosed by the presence of typical anthrax lesion and/or observation of gram-positive encapsulated bacilli in gram prepations and/or culture positive of samples taken from lesions. In the cases who were culture-negative and without bacilli in gram-staining, the diagnosis was based on the presence of characteristic clinical presentation with a history of severe scarring formation, swelling, black eschar and positive response to the treatment. Results: A total of 21 patients with cutaneous palpebral anthrax admitted to the two hospitals between January 2000 and December 2012. Eight patients were male (38.1%) and 13 patients were female (61.9%), and the mean age was 31 ± 21.2 (range 1-82 years). The most common symptoms on admission to the hospital were swelling and redness on the skin. Periorbital lesions were in the right eye in 14 cases and the most common eyelid involvement was seen in upper eyelid with 15 cases. The diagnosis was based on isolation of bacteria in five (23.8%) cases, detection of gram-positive bacilli in direct examination of characteristic lesion material in six (28.5%) cases. Ten (47.7%) cases were diagnosed by the characteristic appearance of the lesion. Malignant pustule was seen in all of our patients and seven cases (33.4%) had malignant edema. In the treatment, penicilin was used for 10 (47.7%) cases, ampicillin-sulbactam for five (23.8%) cases and, ciprofloxacin for three (14.3%) cases. Cicatricial ectropion was observed in 10 (47.7%) patients, lagophthalmos developed in four (19%) patients, and corneal scar in two (9.5%) patients. The distribution of the cases did not differ by the year but showed a density in the months from July to September (62.7%). Conclusion: Early diagnosis and high dose antibiotic treatment can facilitate the treatment and prevent development of eyelid complications including cicatricial ectropion, corneal scars and palpebral symphysis. Prolonged follow-up is necessary in patients who develop complications and surgical intervention. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To investigate the antibiotic resistance genes inserted into class 1 and class 2 integrons in Acinetobacter baumannii (A. baumannii) isolates obtained from nine different cities in Turkey. Methods: A collection of 281 A. baumannii clinical isolates were collected from nine diferent state hospitals in Turkey and were confirmed as A. baumannii by conventional biochemical, API testing and bla-OXA-51 specific PCR. The isolates were examined by PCR for existence of class 1 and 2 integron gene cassettes. Results: They were characterized by antimicrobial susceptibility testing and the highest resistance rates were determined for piperacillin (90.03%), ciprofloxacin (87.54%), cefepime and trimethoprim/sulfamethoxazole (81.13%). The lowest resistance rates was for cefotaxime (3.55%). class I integrons were detected in 6.4% (18/281) of A. baumannii strains and no class 2 integron was detected. The gene cassettes of class 1 integrons AacC1-AAC(3) I-aadA1, AacC1-aadA1, AAC(3)-I, AAC(3)-I -AAC(3)-I -aadA1, TEM-1, AAC(3)-I-aadA1 – AAC(3)-I -AAC(3)-I, AAC(3)-I -AAC(3)-I -AAC(3)-I -aadA1, AAC(3)-I – aadA1, AAC(3)-I-AAC(3)-I, AAC(3)-I-aadA1-AAC(3)-I-aadA1, AAC(3)-I-AAC(3)-I-aadA1-AAC(3)-I-aadA1 were detected in eighteen strains. The aac genes family were most frequently found integrated into the class 1 integrons and it was followed by aadA genes and TEM-1 genes. Conclusions: This is an extensive study on the distribution of class 1 integron among A. baumannii in Turkey. In addition to these, two new alleles were observed. Their percentage rates of similarity to other cassettes are 95% aadA1 (TKA18) and 89% aadA1 (ANKA3). [Copyright &y& Elsevier]

Aspergillosis is a definition including a wide variety of diseases caused by fungi in the genus Aspergillus. Aspergillosis that occurs especially in neutropenic and immunosuppressive patient is an opportunistic infection with a very high mortality rate. In this study, we presented a case of primary cutaneous aspergillosis that caused in a heart transplant recipient. Thirty-nine-years-old male patient with the complaints of high fever lasting for ten days, redness of the right thigh, swelling, and pain, was admitted to our hospital. By the tissue ultrasonography of right thigh, 3x12 cm in size of septated intensive fluid collection (abscess?) in muscle tissue at a depth of 1.5 cm to the skin surface was reported. The biopsy specimens that were taken from the lesion sent to microbiology and pathology laboratories. The branching septate hyphae were observed in Hematoxylin-Eosin and Gram stained preparations. Aspergillus fumigatus was isolated and identified from the biopsy specimen. The patient's symptoms were regressed rapidly and the lesion was improved by surgical debridement and antifungal agent (amphotericin B) therapy. In the light of this case report, we were emphasized that microbiologic examination and culture have an important role for diagnosis of cutaneous aspergillosis. [ABSTRACT FROM AUTHOR]

Septic arthritis is a serious medical problem that causes rapidly chronic and irreversible joint damage when diagnosis and treatment are delayed. Although, the bacteria are the most frequent cause of septic arthritis, rarely fungi may be responsible for this disease. We presented here a case of septic arthritis caused by Aspergillus fumigatus, developed in a 65 years-old-male patient with diabetes mellitus. The patient admitted to our hospital with complaints of pain, swelling, redness in the right knee and high fever, which are not exceeding despite using vancomycin and ceftriaxone for 18 days. Imipenem was started to the patient in our hospital. At the end of 7 days because of no regression of patient's complaints, arthroscopic synovectomy and lavage were performed for the patient's right knee. Aspergillus fumigatus was isolated from the aspiration biopsy specimen that received during the surgical operation and patient was treated with voriconazole, successfully. [ABSTRACT FROM AUTHOR]

Objective: In reports, abnormal macrophage migration-inhibitory factor (MIF) production has been associated with several diseases. Furthermore, despite scarce data, increasing evidence suggest that MIF plays a central role in glucose homeostasis and in the development of type 1 and type 2 diabetes. However, serum MIF levels in gestational diabetes mellitus (GDM) have not yet been investigated. To address this question, we performed a prospective study between a group of pregnant women with GDM and healthy pregnant controls. Materials and methods: GDM group consisted of 43 pregnant women, whereas the control group consisted of 40 healthy pregnant women. In the morning after an overnight fast, venous blood was sampled for the measurement of serum concentrations of insulin and MIF. Serum was separated by centrifugation and immediately stored at −80°C until the assay. Results: There was no significant difference between the groups for maternal characteristics. Women with GDM had significantly higher levels of serum insulin (14.37 ± 9.92 µU/ml vs. 8.78 ± 4.35 µU/ml; p == 0.001) and serum MIF concentrations (11.31 ± 4.92 ng/ml vs. 5.31 ± 4.07 ng/ml; p < 0.001) when compared with healthy pregnant control group. Conclusion: Our data demonstrated that serum levels of MIF are significantly elevated in patients with GDM. Our findings indicate that MIF might have a role in GDM; however, there is a need for further investigation. [ABSTRACT FROM AUTHOR]

Background: Chronic hepatitis B (CHB) is a viral infection that can result in life-threatening conditions, such as hepatocellular carcinoma and cirrhosis. Tenofovir, which is used for the treatment of CHB, is a nucleotide analog that inhibits HBV-DNApolymerase and has two formulations: disoproxil and alafenamide. In contrast to tenofovir disoproxil fumarate (TDF), tenofovir alafenamide fumarate (TAF) penetrates the whole hepatocyte without being eliminated due to its longer plasma half-life and greater plasma stability. As a result, side effects such as proximal renal tubulopathy and loss of bone density are less common in the treatment of TAF and have similar efficacy to TDF. Objectives: The purpose of the study was to evaluate the effectiveness and reliability of TAF using real-life data. Methods: This retrospective cohort study was carried out in secondary or tertiary healthcare centers in southern Turkey. A total of 480 patients aged 18 years and older were administered TAF for an appropriate indication by the infectious diseases and gastroenterology clinics of the healthcare centers participating in this study. The data collected at t = 0, t = 3, and t = 6 months of treatment were analyzed. The chi-square, Mann-Whitney U, Friedman, Wilcoxon, Cochran's Q, and McNemar's tests were used. Results: The mean age of the patients was 47.40 ± 14.5, and 327 of them (68.1%) were male. A total of 78.l% of the 480 patients who underwent the TAF treatment had previous antiviral therapy experience (TDF, n = 340; 70.8 %), and 2l.9% were treatment-naive. The most common reasons for the initiation of TAF treatment were the use of drugs affecting bone mineral density (BMD) (42.9%) and osteoporosis (22.3%). Patients who had taken TDF experienced a significant improvement in glomerular filtration rate (GFR), hip and spine T-scores, and phosphorus levels from t = 0 months to t = 6 months after switching to TAF (P < 0.05). For this group, no statistically significant difference was observed concerning LDL and cholesterol levels from t = 0 months to t = 6 months. Side effects were reported by 5.7% of patients in the third month and 7.l% in the sixth month, with the most common side effect being hair loss (l%). Conclusions: TAF was found to be an effective and safe alternative to TDF with lower incidences of its long-term effects, such as nephrotoxicity and decreased bone density. [ABSTRACT FROM AUTHOR]

Sore throat is constitutes 1-5% of all applications. Acute tonsillopharyngitis is the most common cause of pain in the throat. Viral agents of acute tonsillopharyngitis are EBV, CMV, Adenovirus, Rhinovirus .The most common bacterial cause of acute tonsillopharyngitis is group A Beta Hemolytic streptococci (GAS, Streptococcus pyogenes). Untreated Acute tonsillopharyngitis is common complaint in outpatient practice in pediatric practice may be non-suppurative as peritonsil abscess, otitis, mastoiditis after pharyngitis, or non-SUPURATIVE complications such as acute rheumatoid fever (ARA) and acute glomerulonephritis (AGN). Group A betahemolytic streptococci are separately according to M proteins. Of these types, 1,3,5,6,18,19,24 are more responsible for pyodermia and AGN and type 49,55,57 can cause rheumatic fever. Group C and G can cause pharyngitis and AGN and can not cause rheumatic fever. Group A beta hemolytic streptococcal infections are frequently seen in 5-15 years of age, regardless of gender discrimination. It can cause epidemics in crowded environments such as nests, schools and barracks by passing through people through droplets. It can also pass through food, water (human contamination), contaminated dust, clothes, blankets and other items. Group A beta hemolytic streptococcal pharyngitis is characterized by sudden sore throat, fever, headache, dysphagia, abdominal pain, nausea, vomiting, cervical LAP (lymphadenopathy). Diagnosis is made with clinical and throat culture. Tonsil or posterior pharyngeal culture is taken. The false negativity of cultures is around 10%.Carrier distinguish can not do with growing in the culture or not grow. There is also a rapid diagnostic test of streptococci with group A carbohydrate antigen acid extraction. The specificity and sensitivity of this test depends on the appropriate culture taking . Detection of DNA probes by optical immunoassay and combination is also rapid and novel. Throat culture in a child with pharyngitis should be made by considering the age, clinical signs and symptoms of the patient, season, family and community epidemiology, contact history, presence of ARA or AGN in the family. In addition, after treatment, individuals with symptoms should also be cultured. In group A beta hemolytic streptococcal pharyngitis, infectivity is high during acute infection. In untreated cases, transmission is reduced after the first week, and 24 hours after the appropriate antibiotic treatment, the transmission is lost. Despite the decrease in the number of bacteria in the carriers and the risk of transmission due to the removal of the bacteria by nasal secretions, these individuals may be the source of GAS in the community. Group C, G beta hemolytic streptococci can be found as asymptomatic colonized in pharynx. Some of these individuals may develop invasive disease. However, the treatment of Group C, G beta hemolytic streptococci isolated individuals is a controversial. [ABSTRACT FROM AUTHOR]

Background and aim: Turkish pine extract, a type of oil, is a half liquid substance with a vigorous odor. The Turkish pine extract "Pinus brutia" is a prevalent type in Turkey. It is traditionally used topically by humans and animals in Anatolia. Investigating the antimicrobial effect of the Pinus brutia extract was the purpose of this research. Material and methods: In this study, antimicrobial effect of Turkish pine extract in Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC 27853, Klebsiella pneumoniae RSKK 574, Candida albicans ATCC 10231 strains were investigated by agar diffusion. Strains were inoculated in a sterile tube containing saline and the turbidity was set do 1,5x108 μg/ml. Bacterial suspensions were spread on the surface of the Muller-Hinton medium. Wells with a diameter of 6mm were cut open in the medium by a bisturi. We added 50 μl of Turkish pine extract inside the wells and (36 oC) incubated for 24 hours (48 hours for C.albicans) then inhibition zones were calculated in terms of mm's. Ciprofloxacin and fluconazole (C.albicans) were used as control. Results: Inhibition zones of S.aureus and P.aeruginosa were detected as 13mm and 8mm, respectively. Inhibition zone of medium inoculated C.albicans was 16mm. No zones of inhibition were seen for K.pneumonia and E.coli Discussion: Only a few number of studies were aimed to investigate the antimicrobial effect of Turkish pine extract. It was indicated that "Pinus brutia" was effective on P.aeruginosa, S.aereus, B.subtilis, E.coli and C.albicans. In our study, it was demonstrated that Turkish pine extract was effective on S.aureus, P.aeruginosa, and C.albicans. The esensial oil compounds, species diversity, lack of standardization in the procedure, could have an impact on the results. Evaluation of the minimum inhibitor concentration of the Turkish pine extract by microdilution and cytotoxicity tests are required. After determining its effectiviness and reliability, Turkish pine extract can be used as a topical antimicrobial. [ABSTRACT FROM AUTHOR]

Introduction: In recent years, antibiotic resistance in gram negative bacteria has become an important problem. An important cause of mortality in hospitalized patients is infections caused by members of the Enterobacteriacea family, who have multiple antibiotic resistances. Previously, beta lactam group antibiotics were widely used in the treatment of these infections. Carbapenem has been used in the treatment of gram negative bacterial infections with the spread of extended-spectrum betalactamase and AmpC beta lactamase producing strains. However, nowadays, the frequency of infections due to isolates that a reresistant to carbapenems by increasing the production of carbapenemase is increasing. In infections caused by carbapenem resistant gram negative bacteria, resistance to colistin, the lastoption antibiotic, can be spreadhorizontally in the community and hospital environment with the plasmid mcr- 1 gene. All of these reasons, different antibiotic resistance isolates for different treatment options have brought to the agenda. In this study, we aimed to investigate the chloramphenicol susceptibility in carbapenem resistant Klebsiellapneumoniae isolates. Material and Methods: In this study 31 carbapenem resistant Klebsiellapneumoniae isolates isolated from clinical samples of two hospitalized hospitalized patients were included in this study. Chloramphenicol sensitivity was investigated by disk diffusion method in isolates. For this, 0.5 McFarland bacteria solutions were spread on the surface of Müller-Hinton agar media; chloramphenicol discs (30 μg / ml) were placed; After incubation at 37 ° C, the results were evaluated according to the recommendations of the Clinical and Laboratory Standards Institute. Results: In the study, 31 of 31 Klebsiellapneumoniae isolates were susceptible to chloramphenicol (45.1%) and 2 (6.4%) were susceptible. Discussion: In patients with multiple antibiotic resistance Klebsiellapneumoniae infections, chloramphenicol may be an alternative treatment option. However, side effects such as bone marrow suppression, aplastic anemia, neurotoxicity, optic neuritis and gray infant syndrome should be kept in mind. [ABSTRACT FROM AUTHOR]

Objective: Nasocomial infections are major health problems due to their high morbidity and mortality, prolonged hospital duration and higher treatment costs. Methicillin-resistant staphylococcus species became one of the leading bacteria causing nasocomial infections especially in intensive care units, recently. The minimum inhibitory concentration value of an antibiotic gives the concentration of antibiotic needed to inhibit the bacteria in the infection area. Careful monitoring of minimal inhibitory concentration (MIC) values is necessary especially during long-term treatments of meticillin-resistant Staphylococcus aureus (MRSA) and meticillin-resistant coagulase-negative staphylococci (MRCoNS) infections1,2. Increasing antibiotic resistance in methicillin-resistant staphylococci, has led to the need for different antibiotics. Methods: A total of 60 meticillin-resistant staphylococci strains isolated in Microbiology Laboratory of Dicle University Hospital, from clinical specimens of patients in adult İntensive Care Units (ICUs) between April 2013 and March 2014 were included in this study. After identification with conventional and automated system, the antibiotic susceptibility rates of vancomycin, teicoplanin, daptomycin, linezolid, quinupristin/dalfopristin, tigecycline, ceftaroline were determined by E-test method. Results: The majority of the samples (26.7%) were sent from Pulmonary Diseases and Tuberculosis intensive care unit and the blood samples were the most common materials (80%). All staphylococcal strains in our study were determined as susceptible to vancomycin, daptomycin, linezolid, teicoplanin and tigecycline. One (1.6%) MRCoNS isolate was resistant to quinupristin/dalfopristin while 11 (36.6%) of the MRSA isolates were resistant to ceftaroline. In comparison with the MIC values of MRSA and MRCoNS, only tigecycline was significantly different. Thirty MRSA strains were evaluated in terms of vancomycin-intermediate Staphylococcus aureus/heteroresistant vancomycinintermediate Staphylococcus aureus (VISA/hVISA) with macro E-test method; any VISA/hVISA isolate was not detected. Antibiotic concentrations below the MIC level, not only leads to treatment failure but also causes mutant bacteria to appear. In order to control the resistance to antibiotics in the treatment of infections due to MRSA and MRCoNS agents, the clinician should be notified of the MIC values of the drugs and the treatment should be planned accordingly. VISA/hVISA isolates should be considered in treatment failures of infections due to MRSA which are in vitro susceptible to vancomycin. Further testing is needed to detect these isolates. Despite the fact that ceftaroline is not a drug used in our country, the high resistance rate in our study is remarkable. This situation may be due to the intensive use of other beta-lactam antibiotics. Therefore, antibiotic susceptibility results should be taken into consideration during planning the treatment of infections. The high average MIC values of tigecycline in MRCoNS infections should also be monitored carefully. [ABSTRACT FROM AUTHOR]