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Aim: The aim of the study is to classify patients infected with Covid-19 in our population according to the radiological consensus defined by Radiology Society of North America (RSNA) and American College of Radiology (ACR) and to show the relationship of the patients with clinical-laboratory findings. Material and Methods: 127 cases (74 males, 53 females; age range 19-92 years) who applied to Ankara City Hospital with symptoms such as fever, cough and respiratory distress and whose laboratory findings were compatible with Covid-19 were included in our study. The thorax computed tomography (CT) findings of the cases were classified according to the RSNA criteria and their relationship with clinical-laboratory data was statistically evaluated. Results: 47.2% of them had fever, 62.2% cough, 22 dyspnea, 4.7% diarrhea and 28.3% fatigue-malaise symptoms. When the thorax CT findings were evaluated, 55% of the patients had a typical appearance, 21% intermediate appearance, 11% atypical appearance and 13% negative appearance. Conclusion: It is obvious that thoracic CT examination has many advantages in evaluating Covid-19 pneumonia. However, it was concluded that more observations should be made in order to classify the findings better and to reveal their relationship with clinical-laboratory findings.

Purpose: This study aims to evaluate the correlations between the severity of the disease and serum steroid levels by analyzing the serum steroid levels in COVID-19 patients with different levels of disease progression and the control group.Methods: Morning plasma Aldosterone, 11-deoxycortisol, Androstenedione, 17- hydroxyprogesterone, Dihydrotestosterone (DHT), Dihydroepiandrostenedion (DHEA), Corticosterone, Dihydroepiandrostenedion sulfate (DHEAS), Estrone, 11- deoxycorticosterone, Cortisol, Corticosterone, Androsterone, Pregnenolone, 17- hydroxypregnenolone levels were measured in 153 consecutive patients were grouped as mild, moderate, and severe based on the WHO COVID-19 disease severity classification and the control group. Steroid hormone levels were analyzed at once with a liquid chromatography-tandem mass spectrometric method (LC-MS/MS). Results: In our study, all of the steroids except DHT and DHEAS were statistically significantly higher in the patients’ group than in the control group (p>0.001). Also, DHEA was an independent predictor of the disease severity with COVID-19Conclusions: Our study reveals that altered steroid hormone levels have a negative impact on COVID-19 prognosis by simultaneous measurement of steroid hormones levels with LC-MS/MS. Also, adrenal insufficiency due to COVID-19 is an endocrinological pathology that should be followed up.

Objectives: The aim of this study was to share the results, follow-up, and treatment characteristics of our pregnant women who were followed-up with anti-Toxoplasma gondii Immunoglobulin (Ig) M positivity during pregnancy. Methods: Anti-T. gondii IgM- and IgG-positive pregnant women were evaluated between 2014-2018. Demographic characteristics, treatment, and information about pregnancy were obtained from the electronic database. Pregnant women were divided into three groups; primary infection, no infection, and suspected infection in pregnancy. Primary and suspected infection in pregnancy were followed up congenital toxoplasmosis risky pregnancy. Fetal ultrasonography (USG), T. gondii DNA polymerase chain reaction (PCR) result in amniotic fluid were recorded. Results: Twenty-four pregnant women with a mean age of 27.9 years were followed up. IgG avidity results were low in 37.5% (n = 9), intermediate avidity in 8.3% (n = 2), and high avidity in 54.2% (n = 13) of pregnant women. Eleven (45.9%) pregnant women had congenital toxoplasmosis risky pregnancy. Fetal USG was performed on ten pregnant women, and no signs of congenital toxoplasmosis were found. Amniocentesis was performed in 72.7% (n = 8) of the participants, and the amniotic fluid T. gondii DNA-PCR result was negative in all of them. Ten (90.9%) pregnancies resulted in mature birth and one (9.1%) resulted in miscarriage. Conclusions: Anti-T. gondii IgM positivity is an indication of acute infection. But IgM can persist for years, and be false-positive in pregnancy. Therefore, additional tests are required, and leading to emotional distress and unnecessary interventions in pregnacy women. These results can aid in developing an approach to screening and diagnosis of T. gondii infection in pregnancy.

Introduction: Candidemia causes high mortality and is occuring at increasing rate in intensive care units (ICUs). (1,3)- β-D-glucan (BDG) testing is recommended in neutropenic patients. However the usefulness of BDG in ICUs is unclear. Methodology: This study was conducted to compare the diagnostic value of Candida score (CS), colonization index (CI), serum BDG detection, and routine laboratory parameters in ICU patients. Characteristics and laboratory data of 83 patients (15 patients with candidemia and 68 patients without candidemia) were evaluated. Results: Median serum BDG was significantly higher in the candidemia group (129 pg/mL vs. 36 pg/mL, p < 0.001). BDG assay with standard cut-off value ≥ of 80 pg/mL had 93.33% sensitivity and 64.18% specificity (Areas under the ROC curve (AUC): 0.788). This study concluded that the optimal cut-off value for BDG assay was 112 pg/mL with sensitivity of 86.67% and specificity of 82.09% (AUC: 0.844). C-reactive protein (CRP) with optimal cut-off value ≥ 85 mg/L and BDG ≥ 80 pg/mL had the highest AUC (0.862, 95% CI: 0.768 - 0.928) with sensitivity 93.33% and specificity 79.1%. Conclusions: Predicting candidemia is essential in critically ill patients who are at high risk and have high mortality rates. The results of this study suggest that BDG testing is useful for predicting candidemia in ICU. However, BDG combined with CRP may be a stronger predictor for candidemia.

Introduction: We evaluated neutralizing antibody and anti-spike antibody (anti-S) response against omicron variant in solid organ (SOT) or hematopoietic stem cell (HSTC) receivers after third dose of BNT162b2 (BNT) or CoronaVac (CV) following two doses of CV. Methods: In total, 95 participants who underwent SOT (n=62; 44 liver, 18 kidney) or HSCT (n=27; 5 allogeneic, 22 autologous) were included from five centers in Turkey. The median time between third doses and serum sampling was 154 days. The vaccine-induced antibody responses of both neutralizing antibodies and Anti-Spike antibodies were assessed by plaque neutralizing assay and immunoassay. Results: Neutralizing antibody and anti-spike IgG levels were significantly higher in transplant patients receiving BNT compared to those receiving CV (GMT:26.76 vs 10.89; p=0.03 and 2116 Au/ml vs 172.1 Au/ml; pConclusion: This study highlights the superiority of BNT responses against omicron as a third dose among transplant recipients after two doses of CV. Lack of neutralizing antibody against omicron after CV in liver transplant recipients should be taken into consideration particularly in countries where inactivated vaccines are available in addition to mRNA vaccines.

Aim Chest computed tomography (CT) imaging plays a diagnostic and prognostic role in Coronavirus disease 2019 (COVID‐19) patients. This study aimed to investigate and compare predictive capacity of main pulmonary artery diameter (MPA), ascending aorta diameter (AAo), and MPA‐to‐AAo ratio to determine in‐hospital mortality in COVID‐19 patients. Materials and methods This retrospective study included 255 hospitalized severe or critical COVID‐19 patients. MPA was measured at the level of pulmonary artery bifurcation perpendicular to the direction of the vessel through transverse axial images and AAo was measured by using the same CT slice at its maximal diameter. MPA‐to‐AAo ratio was calculated by division of MPA to AAo. Results Multivariate logistic regression model yielded MPA ≥29.15 mm (OR: 4.95, 95% CI: 2.01–12.2, p = 0.001), MPA (OR: 1.28, 95% CI: 1.13–1.46, p

The development of candidemia is a highly fatal condition in severe COVID-19 infection.This study aimed to develop a candidemia prediction score in COVID-19 patient based on the patient's clinical characteristics, and healthcare-related factors during intensive care units (ICU) follow-up.Severe COVID-19 patients hospitalised in ICU in Ankara City Hospital during the one-year period (August 15, 2020, and August 15, 2021) were included. After univariate analysis, multivariate analysis was applied using variable selection approach to investigate the effects of variables together and to create a score model for candidemia. Statistically significant factors were included in the development process of candida prediction score.Of 1305 COVID-19 ICU patients, 139 had a candidemia episode. According to the final model, four variables, presence of central venous catheter (CVC) (OR 19.07, CI 8.12-44.8, p .0001), multifocal colonisation (OR 2.28, CI 1.39-3.72, p 0.001), length of ICU stays ≥14 days (OR 3.62, CI 2.42-5.44, p .0001) and corticosteroids (OR 0.51, CI 0.34-0.76, p 0.0011) were the only statistically significant independent risk factors for candidemia. Score model was demonstrated by a nomogram, and the risk for candidemia was calculated to be high in patients who scored ≥56 points by using the criteria [CVC = 51, multifocal colonisation = 14, prolonged hospitalisation = 23, no steroid use = 12 points]. The AUC of the score is 0.84 (CI 0.81-0.87).We developed and validated an easy-to-use clinical prediction score for candidemia in severe COVID-19 infection. In COVID-19 ICU patients, the risk of candidemia is high if one of the other risk factors is present together with CVC.

Objectives:Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is isolated as the cause of coronavirus disease-2019 (COVİD-19). Middle ear and mastoid air cells are covered with the airway mucosa. In COVİD-19, an involvement occurs in the airway mucosa; however, although the involvement of eustachian tube covered with this mucosa, middle ear, and mastoid is not known, there can be an intervention. The aim of the study is to investigate the findings of temporal tomography and evaluate the middle ear and mastoid in COVİD-19.Materials and Methods:A retrospective observational study was planned. Patients with a positive polymerase chain reaction (PCR) test for SARS-CoV-2 and diagnosed with COVİD-19 were included in the study. COVİD-19 patients, who had temporal bone tomography scans (CT), were evaluated. One hundred twenty-nine COVİD-19 patients with positive PCR, who also had temporal bone scans, were included in the study. A grading system was used to evaluate the effusion in the middle ear and mastoid cells. According to this grading system, left and right middle ear and mastoid were evaluated separately. In the grading system, the scores were evaluated as 0=no effusion, 1=partial effusion, and 2=100% effusion. The maximum score was accepted as 8. Bilateral tympanic membranes of all the patients were normal.Results:Involvement was observed in three patients. Bilateral partial effusion and middle ear involvement were observed in two patients. In one patient, bilateral partial mastoid and unilateral partial middle ear involvement was detected. Temporal CTs of other patients were normal.Conclusion:No specific finding was found regarding temporal bone involvement from the temporal CT. Three patients had effusion in the middle ear and mastoid. SARS-CoV-2 generally does not affect the temporal bone; however, it rarely causes effusion in the mastoid and middle ear.

Thiol-disulphide homeostasis (TDH) is a new parameter indicating oxidative stress that plays a role in the pathogenesis of various clinical disorders. Our study planned to investigate TDH in COVID-19 patients. Age and gender-matched healthy subjects (n = 70) and COVID-19 patients (n = 144) were included in the study. In addition to the routine laboratory parameters of the groups, their native thiol (NT), total thiol (TT) and disulphide levels were measured. Primarily, we compared COVID-19 patients to the healthy control group for inflammatory parameters, NT, TT and disulphide levels. Then, COVID-19 patients were divided into two groups according to the severity of the disease as mild to moderate and severe COVID-19, and the three groups were compared with each other. Predictive value of thiol parameters in the diagnosis of COVID-19 and in the determining its severity, and its correlation with presence and duration of symptoms were investigated. Severe COVID-19 patients had lower NT and TT levels compared with healthy controls and mild to moderate patients (P < 0.001 for both). The results of ROC analysis show that the greatest AUC was IL-6 and NT (AUC = 0.97, AUC = 0.96, respectively) between control and COVID-19 patients, while it was CRP and NT (AUC = 0.85, AUC = 0.83) between mild to moderate and severe patients. A negative correlation was found between duration of symptoms of dyspnoea, cough, fever, and sore throat and NT (r = −0.45, P = 0.017, r = −0.418, P < 0.001, r = −0.131, P = 0.084, r = −0.452, P = 0.040, respectively). NT and TT levels have a strong predictive value in the diagnosis of COVID-19 and in determining disease severity. Our results support that changing TDH parameters appears to have an important role in disease pathogenesis and it can be used in clinical management of patients., Graphical abstract Image 1

Background Vitamin D is recognized to be an immune regulator. Also, it is known to have antiviral effects by several mechanisms, including reducing inflammatory cytokines. Objectives To examine the 25-hydroxyvitamin D (25(OH)D) status for assessing the severity of COVID-19. Methods This study consisted of 596 patients confirmed as SARS-CoV-2 infection and 59 healthy individuals. The cases separated into non-severe group, severe survival, and severe non-survival group. 25(OH)D and other laboratory parameters were evaluated retrospectively. Results In all COVID-19 groups 25(OH)D levels were low compared to controls (p Conclusions 25(OH)D deficiency was observed among patients with COVID-19. Declined steadily 25(OH)D levels make a huge contribution to the scale of the progression of the disease. Correlations support that 25(OH)D may be a substantial tool for utilizing the severity of the disease and estimating the survival. Also, supplementation of 25(OH)D might slow down the course of the COVID-19.

Introduction: Worldwide influenza vaccination rates remain low despite guideline recommendations to support vaccinations. It is important to identify attitudes, barriers and motivating factors influencing patients’ vaccination behaviours. We aimed to evaluate the knowledge, attitudes and factors influencing the vaccination behaviours against influenza and sources of information used by patients about influenza vaccine. Materials and Methods: This was a cross-sectional, self administered questionnaire-based study of 229 patients who visited infectious diseases and clinical microbiology outpatient clinic between December 2018 and February 2019. The questionnaire consisted of 39 items in 5 sections: Demographic data (8), questions about influenza vaccine (9), vaccination history (2), factors influencing vaccination behaviours (18) and sources of information used by patients about influenza vaccination (2). Results: Vaccinated group had a higher education level compared to the unvaccinated group, and the difference was statistically significant (p= 0.007). Vaccination against any diseases in adulthood was also statistically higher in the influenza-vaccinated group (p= 0.000). Other features were similar in both groups. The percentage of correct answers to proposals were similar and high between the two groups. Correct answers given to “People with chronic illness should have a flu vaccine” was statistically higher in the vaccinated group (80.5% vs. 61.8%, p= 0.004). Regular annual vaccination rate was only 10.3% in the vaccinated group. The most common motivating factor in vaccination was doctor’s advice (54.5%). The most common barrier against influenza vaccination was the idea that they did not need vaccination (51.3%). The information source affecting the patients mostly was the doctors in both vaccinated and unvaccinated groups. Conclusion: In order to increase the knowledge level and vaccination rates, doctors should be informed rigorously about advising influenza vaccine to patients, especially high risk groups. Education and advice from healthcare professionals about vaccine is crucial for increasing vaccination rate.

Objectives: It has been not yet fully understood whether chronic liver diseases may be considered as risk factors for critical course of Coronavirus disease-2019 (COVID-19) Considering the importance of managing with COVID-19, we aimed to investigate the impact of the COVID-19 pandemic on treatment, follow-up and behavioral characteristics of chronic viral hepatitis (CVH) patients Materials and Methods: Patients followed-up in our clinic with diagnosis of chronic hepatitis B or C were screened retrospectively and a total 213 adults included in the study We performed a telephone survey with patients Results: The mean age of participants was 49 9±13 4 years Of the participants, 62% were male Totally 75 (35 2%) patients disrupted their follow-up visits due to COVID-19 pandemic The only risk factor for disruption in follow-up was found as anxiety The vast majority of CVH patients paid attention to prevention measures for COVID-19 Conclusion: We can say that CVH patients' awareness about COVID-19 and application of control measures were well enough Continuity of treatment can be provided in patients with chronic illness during crisis period with informing patients in a way not to cause anxiety and efficient implementations in healthcare system

Critically ill COVID-19 patients have a high risk for the development of candidemia due to being exposed to both well-defined classical risk factors and COVID-19-specific risk factors in ICU.In this study, we investigated the incidence of candidemia in critically COVID-19 patients, and the independent risk factors for candidemia.COVID-19 patients hospitalised in ICU during 1-year period (August 2020 to August 2021) were included. Clinical and laboratory characteristics of all COVID-19 patients, applied treatments, and invasive procedures that may predispose to candidemia were recorded.Of 1229 COVID-19 patients, 63 developed candidemia. Candidemia incidence rate was 4.4 episodes per 1000 ICU days. The most common species was Candida albicans (52.3%). Only 37 patients (58.7%) received antifungal therapy. The presence of central venous catheter (OR 4.7, 95% CI 1.8-12.2, p .005), multifocal candida colonisation (OR 2.7, 95% CI 1.4-5.2, p .005), a prolonged ICU stay (≥14 days) (OR 1.9, 95% CI 1.08-3-37, p .05), the absence of chronic lung disease (OR 0.4, 95% CI 0.1-0.9, p .05) and the absence of corticosteroid use (OR 0.3, 95% CI 0.14-0.52, p .0001) were significantly associated with candidemia.Our study filled the knowledge gap in the literature about the impact of COVID-19-associated risk factors for the development of candidemia. The classical risk factors for candidemia had a significant effect on candidemia, and contrary to expectations, corticosteroids had a protective effect against the development of candidemia. The results of these studies showing interesting effects of corticosteroids in critically ill COVID-19 patients should be confirmed by further studies.

The COVID-19 pandemic has created a major alteration in the medical literature including the sepsis discussion. From the outset of the pandemic, various reports have indicated that although there are some unique features pertinent to COVID-19, many of its acute manifestations are similar to sepsis caused by other pathogens. As a consequence, the old definitions now require consideration of this new etiologic agent, namely SARS-CoV-2. Although the pathogenesis of COVID-19 has not been fully explained, the data obtained so far in hospitalized patients has revealed that serum cytokine and chemokine levels are high in severe COVID-19 patients, similar to those found with sepsis. COVID-19 may involve multiple organ systems. In addition to the lungs, the virus has been isolated from blood, urine, faeces, liver, and gallbladder. Results from autopsy series in COVID-19 patients have demonstrated a wide range of findings, including vascular involvement, congestion, consolidation, and hemorrhage as well as diffuse alveolar damage in lung tissue consistent with acute respiratory distress syndrome (ARDS). The presence of viral cytopathic-like changes, infiltration of inflammatory cells (mononuclear cells and macrophages), and viral particles in histopathological samples are considered a consequence of both direct viral infection and immune hyperactivation. Thromboembolism and hyper-coagulopathy are other components in the pathogenesis of severe COVID-19. Although the pathogenesis of hypercoagulability is not fully understood, it has been pointed out that all three components of Virchow’s triad (endothelial injury, stasis, and hypercoagulable state) play a major role in contributing to clot formation in severe COVID-19 infection. In severe COVID-19 cases, laboratory parameters such as hematological findings, coagulation tests, liver function tests, D-dimer, ferritin, and acute phase reactants such as CRP show marked alterations, which are suggestive of a cytokine storm. Another key element of COVID-19 pathogenesis in severe cases is its similarity or association with hemophagocytic lymphohistiocytosis (HLH). SARS-CoV-2 induced cytokine storm has significant clinical and laboratory findings overlapping with HLH. Viral sepsis has some similarities but also some differences when compared to bacterial sepsis. In bacterial sepsis, systemic inflammation affecting multiple organs is more dominant than in COVID-19 sepsis. While bacterial sepsis causes an early and sudden onset clinical deterioration, viral diseases may exhibit a relatively late onset and chronic course. Consideration of severe COVID-19 disease as a sepsis syndrome has relevance and may assist in terms of determining treatments that will modulate the immune response, limit intrinsic damage to tissue and organs, and potentially improve outcome.

Increasing rates of extended-spectrum beta-lactamase (ESBL) producing E. coli and K. pneumoniae over time made empirical treatment complicated. Knowing local antimicrobial resistance patterns of common pathogens can make it easier to decide on empirical antibiotics. We aimed to investigate the prevalence and risk factors of ESBL positivity of E. coli and K. pneumoniae strains in uncomplicated and complicated pyelonephritis acquired in community and healthcare associations and to evaluate the appropriateness of empirical treatment. Adult patients hospitalized with diagnosis of community-acquired or healthcare-associated uncomplicated/complicated pyelonephritis initiated empirical antimicrobial therapy were included in the study. Appropriateness of empirical treatment at 48-72 h based on culture results and treatment modifications were evaluated. A total of 369 uncomplicated (94) and complicated (275) episodes of pyelonephritis were evaluated. The most common agents were E. coli (71.0%) and K. pneumoniae (17.7%), and the ESBL-production rate was 64.4%, and higher in healthcare-associated pyelonephritis (P 0.013). Being of healthcare-associated infection, previous antibiotic use, and presence of urinary catheters were independent risk factors for ESBL-producing E. coli and K. pneumoniae (P 0.009, 0.001, and 0.024, respectively). The treatment inappropriateness was mostly associated with use of ceftriaxone (56.3%) (P 0.001). Treatment has escalated in 41.5% of ceftriaxone-initiated patients, in only 8.8% and 9.5% ertapenem and piperacillin-tazobactam-initiated patients, respectively. ESBL-production rates are quite high even in community-acquired infections. The use of broad-spectrum antibiotics covering ESBL-producing pathogens to increase the appropriateness of empirical treatment and then narrowing treatment based on culture results appears a better and life-saving choice.

Aim Gram-negative nosocomial meningitis is difficult to treat because bacteria have become increasingly resistant to most common antibiotics. Attaining effective antibiotic concentration is difficult when treatment is given intravenously (IV), because blood-brain barrier decreases antibiotic penetration. Due to this reason, intrathecal (IT) and intraventricular (IVT) antibiotics have been subjects evaluated in past studies. In this study, we aimed to evaluate the gram-negative nosocomial meningitis cases which were treated with IT/IVT antibiotics. Material and methods Medical records were reviewed for IT/IVT antibiotherapy. Gram-negative nosocomial meningitis cases treated with IT/IVT antibiotherapy additional to systemic antibiotics were included. All patients' sex, age, SOFA scores, surgical history, cerebrospinal fluid (CSF) culture results, CSF cell counts, systemic and IT/IVT antibiotics, their dosages and duration, CSF culture sterility and sterility time, 28-day mortality due to meningitis, and all other causes were recorded and analyzed. Results Thirteen patients were included between 2014 and 2018. Most common microorganism was Acinetobacter baumannii (A.baumannii) (8/13). IT/IVT antibiotics were chosen according to susceptibility. Colistin was used in eight patients, amikacin was used in four, and one patient used amikacin and colistin consecutively. Culture negativity could not be achieved in two patients. Eight patients clinically improved but five patients had no clinical response. 28-day mortality due to infection occured in 2 of 13 patients (15%). 28-day all-cause mortality occured in 3 of 13 patients (23%). Conclusion In our study, CSF culture negativity rate was high. IT/IVT antibiotic therapy should be considered as an effective and acceptable treatment option, especially in patients who do not respond to standard IV antibiotherapy.

Aim: The aim of this study is to develop and explain an easy-to-use severity score calculation tool to predict severe COVID-19 cases that would need intensive care unit (ICU) follow-up.Material method: The study was carried out in patients with laboratory-confirmed COVID-19 hospitalized in Ankara City Hospital between March 15, 2020, and June 15, 2020. The outcome was severe illness that required ICU follow-up. Univariate and binary logistic regression were used to create a prediction model by using potential predictive parameters obtained on the day of hospitalization. Youden’s J index was calculated with receiver-operator characteristic curves analysis in order to evaluate cut-off points, and predicted probability was calculated. The accuracy of the prediction model was tested by calculating the area under curve (AUC). Results: Of the total of 1022 patients, 152 had a severe illness and required ICU follow-up. Among 68 variables, 20 parameters met the potential predictive factor condition for severe illness and were included in the development process for ANKARA CITY HOSPITAL COVID-19 SEVERITY SCORE (ACCSES). The ACCSES calculation tool was created by the final 9 parameters (sex, oxygen saturation, hemoglobin, platelet count, glomerular filtration rate, aspartate transaminase, procalcitonin, ferritin, and D-dimer). AUC was 0.96 (95% CI, 0.95-0.98).Conclusion: We developed a simple, accessible, easy to use calculation tool, ACCSES, with good distinctive power for a severe illness that required ICU follow-up. The clinician can easily predict the course of COVID-19 and decide the procedure and facility of further follow-up simply using available clinical and laboratory values of patients upon admission.

Background Early identification of severe COVID-19 patients who will need intensive care unit (ICU) follow-up and providing rapid, aggressive supportive care may reduce mortality and provide optimal use of medical resources. We aimed to develop and validate a nomogram to predict severe COVID-19 cases that would need ICU follow-up based on available and accessible patient values. Methods Patients hospitalized with laboratory-confirmed COVID-19 between March 15, 2020, and June 15, 2020, were enrolled in this retrospective study with 35 variables obtained upon admission considered. Univariate and multivariable logistic regression models were constructed to select potential predictive parameters using 1000 bootstrap samples. Afterward, a nomogram was developed with 5 variables selected from multivariable analysis. The nomogram model was evaluated by Area Under the Curve (AUC) and bias-corrected Harrell's C-index with 95% confidence interval, Hosmer–Lemeshow Goodness-of-fit test, and calibration curve analysis. Results Out of a total of 1022 patients, 686 cases without missing data were used to construct the nomogram. Of the 686, 104 needed ICU follow-up. The final model includes oxygen saturation, CRP, PCT, LDH, troponin as independent factors for the prediction of need for ICU admission. The model has good predictive power with an AUC of 0.93 (0.902–0.950) and a bias-corrected Harrell's C-index of 0.91 (0.899–0.947). Hosmer–Lemeshow test p-value was 0.826 and the model is well-calibrated (p = 0.1703). Conclusion We developed a simple, accessible, easy-to-use nomogram with good distinctive power for severe illness requiring ICU follow-up. Clinicians can easily predict the course of COVID-19 and decide the procedure and facility of further follow-up by using clinical and laboratory values of patients available upon admission.

Nobody can be fully prepared to a pandemic. Of course there are signs of it, the scientists can predict, alarming speeches can be made. But there are always alarmist people around, maybe that is why sometimes even the most serious warnings may be not considered by the authorities on time. The first patients may be lost without a proper diagnosis. When everybody realizes that there may be a big problem in the horizon, sometimes it is too late. That is why it is very important to monitor contagious diseases and follow the warnings and releases of national and international disease control centers and other related organizations. China celebrated Lunar New Year with more than 40 thousand families on the 18 of January 2020. Nobody seem to be expecting this emerging new viral pneumonia outbreak appeared in Wuhan, in the last days of 2019, will break the chains and turn out to be a pandemic! But maybe this time it was not too late. There were four important pandemics within the last century: Spanish Flu, Hong Kong Flu, Asian Flu and Swine Flu. Each left different story behind. Millions of people had infected, hundreds, thousands of people died. This time, the Modern World had different tools to limit the SARS CoV2 outbreak. The national and international institutions of our globe were all communicating and taking precautions in a very fast manner than ever. However, this time, unexpectedly, the SARS-CoV-2 contagion was also faster. Besides the international organizations like WHO, UNESCO and UNICEF, the roles of local authorities, health ministries, disease control centers, health protection agencies, research centers and universities are all very important in different operational levels to control and survive from the pandemic. This paper will review the immediate response of different national and international institutions and authorities to COVID-19 pandemic.

Entecavir (ETV) and tenofovir disoproxil fumarat (TDF) are the two first-line therapies recommended in the treatment of chronic hepatitis B because of having potent antiviral effect and high genetic barriers against resistance. We aimed to compare efficacy of these drugs and to evaluate predictors of viral suppression.This multicenter retrospective study was conducted in nucleos(t)ide analogue-naive chronic hepatitis B (CHB) patients from different 6 centers.Of the 252 patients, 166 received ETV and 86 TDF. The two groups were similar in terms of age, gender, baseline ALT levels and fibrosis scores. ETV had significantly higher baseline HBV DNA, histological activity index and lower hepatitis B early antigen (HBeAg) seropositivity. Treatment duration was longer in ETV group (P0.001). In univariate analysis, undetectable HBV DNA and ALT normalization rates were detected significantly higher in ETV groups (P0.001 and 0.049, respectively). There was no significant difference between groups in terms of HBeAg seroconversion, virological breakthrough, time to virological breakthrough and time to ALT normalization. Entecavir was more effective in reducing HBV DNA levels at the 3rd, 6th and 12th months of the treatment (P=0.06, 0.021 and 0.012, respectively). However, multivariate Cox regression analysis indicated that TDF therapy compared to ETV had an increased probability of achieving complete viral suppression (HR=1, 66; 95% CI 1.21-2.33; P=0.010). Hepatitis B surface antigen (HBsAg) seroconversion was occurred in only one patient in ETV group.ETV leads to an early response on HBV DNA decline in the first year of the treatment. However, TDF is more successful than entecavir in achieving virological suppression.

ObjectivesHealthcare workers (HCWs) are among the risk groups for COVID-19. Determining transmission routes and risk levels during healthcare is of great importance in preventing nosocomial outbreaks. This study aimed to investigate the frequency of nosocomial transmission and factors affecting the transmission in HCW.MethodsHCWs admitted to the infectious diseases outpatient clinic due to contact with a COVID-19 patient and diagnosed with SARS-COV-2 by reverse-transcriptase PCR (RT-PCR) between 20 March 2020 and 30 June 2020 were included in the study.ResultsA total of 822 HCWs with 295 low, 284 intermediate and 243 high-risk exposures were included in the study. 27.1% of the HCWs were male, and the median age was 31.9 years (20–62). 89.5% of these patients were directly in charge of patient care. Of the index cases contacted, 72.6% were HCW, and 27.4% were non-HCW patients. Most of the risky exposure (51.7%) occurred in nurses. The occurrence frequency of high-risk exposure was lower in those assigned to direct patient care when compared with the occurrence frequency of moderate-risk or low-risk exposures (76.5%, 94.7, 95.3, respectively pConclusionsThis study provides particularly useful information on post-exposure COVID-19 follow-up and management of working schedules and procedures of HCWs.

Objective: Intensive care units are high risk units for serious infections like ventilator associated pneumonia. Preventing ventilator associated pneumonia is one of the most important infection control practice in intensive care units. In this study, it was aimed to investigate the effect of the ventilator associated pneumonia prevention checklist use in decreasing ventilator associated pneumonia rates. Material and Method: This study was performed in the intensive care units at Yenimahalle Training and Research Hospital between January 2013 and September 2013. In the first 3 months, the routine infection control measurements were used. At the end of this term a lecture about using the checklist was given to the nurses. At the second 3 months period, the checklist was filled by each patient’s nurse. At the last 3 months period there was no checklist use. The ventilator associated pneumonia rates were registered in all these terms. After and before the intervention term tests about ventilator associated pneumonia prevention with 20 questions were given to the nurses. Results: Between January to March 2013, at the first 3 months, ventilator associated pneumonia rate was 38.2%; at the second term, it was 7.4%; at the third term, it was 3.8%. At the front test, the nurses got 84.5 point success rate and at the last test, the rate was 92.6. The success rate differences between these two tests were statistically significant with the Wilcoxon test (z-3.4, p=0.001). Conclusion: At the end of this study, despite any changes in the other routine and patient population, it was seen that there were obvious decrease in the ventilator associated pneumonia rates during the intervention term and the term after the intervention. Also the checklist use increased the nurses’ knowledge level about the ventilator associated pneumonia prevention and hand hygiene adherence rate.

Aim: The aim of this study was to investigate agreements between COVID-19 reporting systems and radiologists. Materials and Methods: A total of 100 laboratory-confirmed COVID-19 cases (49 males, 51 females;age range 19-88 years) were retrospectively collected. Firstly, computed tomography (CT) images were evaluated by two radiologists independently and blinded to clinical notes and laboratory and radiological reports and they gave their impressions independently according to four COVID-19 reporting systems, then all CTs were interpreted again by the two radiologists for extracting CT features at the same session by consensus. Results: Bilateral, lower lobe, peripheral, dorsal and multifocal lung involvements were predominantly seen, and ground-glass opacities (GGOs) were the most common CT imaging finding in the current study. Reporting systems showed fair to moderate agreements between senior and junior raters (0.246-0.490, p

In this study, we aimed to determine the late relapse rate in hepatitis C patients with sustained virological response after interferon-based regimens, and evaluated the predictors of late relapse while comparing the real-life data of our country with that of others. A multicenter retrospective study was performed to investigate the data of patients infected with HCV who obtained sustained virological response after classical or pegylated interferon alpha (PegIFNα) and ribavirin (RBV) for 48 weeks. Sustained virological response was based on negative HCV RNA level by PCR at the end of six months after the therapy. The information of patients enrolled in the study was retrieved from the hospital computer operating system and outpatient follow-up archives. We evaluated the age, gender, HCV RNA levels, HCV genotype, six-month and further follow-up of patients with sustained virologic response, presence of cirrhosis, steatosis and relapse. In all, 606 out of 629 chronic hepatitis C patients (mean age was 53±12 years; 57.6% of them were female) with sustained virological response were evaluated. We excluded 23 patients who relapsed within six months after the end of treatment (EOT). The mean follow-up period of the patients was 71 months (range: 6-136) after therapy. Late relapse rate was 1.8% (n=11) in all patients. Univariate Cox proportional hazard regression models identified that cirrhosis and steatosis were associated with the late relapse [(p = 0.027; Hazard Ratio (HR) 2.328; 95% confidence interval (CI): 1.309-80.418), (p = 0.021; HR 1.446; 95% CI: 1.243-14.510, respectively]. In multivariable Cox regression analysis, steatosis was the only independent risk factor for late relapse (p = 0.03; HR 3.953; 95% CI: 1.146-13.635). Although the late relapse rate was approximately 2% in our study, clinicians should consider that pretreatment steatosis may be an important risk factor for late relapse.

Background/aim: Acinetobacter baumannii (A. baumannii) is one of the most common healthcare-associated infectious agents worldwide. The aim of this study was to investigate the in vitro synergistic activities of several antibiotic combinations against carbapenem-resistant (CR) A. baumannii isolates. Materials and methods: Eighteen CR A. baumannii strains were isolated from the patients who were hospitalized in the intensive care unit between June 2012 and August 2012. The in vitro effects of single and binary combinations of meropenem (MEM), colistin (CST), tigecycline (TGC), and sulbactam (SUL) on these isolates were determined using the Epsilometer test (E-test) method. Results: All 18 isolates were resistant to MEM and SUL and susceptible to CST. TGC was detected as susceptible in two of the isolates and intermediate susceptibility results were observed in the remaining isolates. With MEM-CST and MEM-TGC combinations, synergism was determined against all isolates. The synergistic and/or additive effect ratios were detected in MEM-SUL, CST-SUL, TGC-SUL, and CST-TGC combinations as 16.7%, 38.9%, 16.7%, and 5.6%, respectively. Conclusion: Among the tested antimicrobial combinations, the in vitro combination of MEM with TGC or CST was most effective against the CR A. baumannii strains.

Introduction: Infections are an important preventable cause of death in cancer patients. The aim of this study was to clarify the epidemiologic characteristics and resistance patterns of causative isolates and mortality predictors in infections of cancer patients. Methodology: Patients with sterile site infections were evaluated in a retrospective cohort study. Etiological agents, antimicrobial resistance patterns of the isolates, and possible risk factors for mortality were recorded. Survivors and non-survivors on day 30 after each infection onset were compared to identify the predictors of mortality. Results: A total of 205 infection episodes of 132 patients were included in this study. Of them, 75% had hematologic malignancies and 25% had solid tumors. Febrile neutropenia was diagnosed in 61.5%. Bloodstream infections were the most frequent infection (78%). The majority of the pathogens were Enterobacteriaceae (44.3%) and nonfermentative isolates (17.6%). Multidrug-resistant (MDR) infections were responsible for 40% of the episodes. The mortality rate was 23.4%. Inadequate initial antibiotic treatment (OR = 4.04, 95% CI = 1.80–9.05, p = 0.001), prolonged neutropenia (> 7 days) before infection (OR = 3.61, 95% CI = 1.48–8.80, p = 0.005), infection due to Klebsiella species (OR = 3.75, 95% CI = 1.31–10.7, p = 0.013), and Acinetobacter baumannii (OR = 5.00, 95% CI = 1.38–18.2, p = 0.014) were independent predictors of mortality. Conclusions: Gram-negative isolates were found to be the predominant pathogens with higher mortality rates. Local epidemiological data should be taken into account when administering empirical therapy since the inadequacy of initial antibiotherapy is associated with a poor outcome.

OZET Objectives: This study aims to determine the reasons for not being able to access treatment of chronic hepatitis C (CHC) for patients who are followed up without treatment and to serve as a resource for future studies to be conducted to find solutions. Materials and Methods: The study was planned as a multi-center observational study. Universities, training and research hospitals, and public hospitals from different regions, most of which are members of the Association to Combat Viral HepatitisAcademic Camp, participated in the study. The reasons for untreated follow-up of CHC patients followed up without treatment were investigated. Patients who were hepatitis C virus (HCV) RNA negative, who had sustained viral response, and who had been receiving treatment were excluded from the study. Results: Two hundred and ninety patients diagnosed with CHC and followed up without treatment were reviewed in detail. The median age was 58 (23-87) years, the number of female patients was 157 (54%); 241 patients were genotype 1 (83%), 12 patients were genotype 2, 3 and 4 (4%), 37 patients were of unidentified genotypes (13%); 174 patients (60%) were treatment-naive; and 14 patients (12%) out of the Amac: Bu calismada, tedavisiz izlenen kronik hepatit C (KHC) hastalarinin, tedavisiz kalma nedenlerinin ortaya konmasi ve ileriye donuk cozum onerilerinin olusturulmasi

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease characterized by nonspecific symptoms like fever, myalgia, severe headache, nausea, vomiting, diarrhea, and abdominal pain. It can result in various complications during the course of the disease due to the diffuse endothelial injury involved in the pathogenesis of CCHF.Here we present a patient with CCHF complicated by acute pancreatitis, including pleural and intra-abdominal effusions.A 70-year-old patient was referred to our hospital from an endemic area with the suspicion of CCHF. The physical examination of the patient revealed high fever (38°C), somnolence, and petechial eruption. The diagnosis of case was confirmed with positive reverse transcriptase polymerase chain reaction (RT-PCR). The viral load of the patient was 4×10(9) copies/mL. On the fifth day of admission, upper abdominal pain, scleral ichter, and abdominal distention developed. The patient had abdominal tenderness with guarding. The laboratory tests revealed an amylase level of 1740 U/L (28-100), lipase level of 583 U/L (13-60), and total bilirubin level of 3.75 mg/dL (0.3). The diagnosis of acute pancreatitis was confirmed with radiological findings.Until now, atypical presentations of CCHF have been reported in some case reports, but not acute pancreatitis. To the best of our knowledge, this is the first case of acute pancreatitis in the literature seen in the course of CCHF.

Summary Background Endothelial infection has an important role in the pathogenesis of Crimean-Congo hemorrhagic fever (CCHF). In this study, we investigated the causes of vascular endothelial damage in patients with CCHF. Methods This prospective case-controlled study was carried out at Ankara Numune Education and Research Hospital between April and September 2007. Seventy-five patients with a laboratory-confirmed diagnosis of CCHF and 88 healthy controls were enrolled in the study. Serum levels of soluble cell adhesion molecules (sICAM-1, sVCAM-1, sE-selectin, sP-selectin, sL-selectin), vascular endothelial growth factor (VEGF), and macrophage migration inhibitory factor (MIF) were investigated in these patients by quantitative sandwich ELISA technique. Results In the patient group, serum levels of sVCAM-1, sL-selectin and MIF were significantly higher than in the control group; serum levels of sICAM-1, sP-selectin, sE-selectin, and VEGF were significantly lower than in the control group. Serum levels of sVCAM-1 and sICAM-1 were significantly higher in severe cases than in non-severe cases, whereas the serum level of VEGF was significantly lower. sVCAM-1 was significantly higher in non-survivors than in survivors, while serum VEGF was significantly lower in non-survivors. The optimum cut-offs of sVCAM-1 and VEGF for the prediction of mortality were 205 ng/ml and 125 ng/ml, respectively. At these cut-offs, sVCAM-1 and VEGF had a sensitivity of 100% and specificity of 42.5% and 54.5%, respectively, in identifying CCHF patients who would die from the disease. The positive predictive values were 19% and 23%, respectively; negative predictive values were 100% for both. Conclusion Endothelial activation can affect the course of CCHF, and vascular endothelial damage is probably indirect. Further studies are needed for general conclusions to be drawn.

This study aimed to find markers to predict complicated cases in brucellosis. Patients with and without complications were compared in terms of epidemiological, clinical and laboratory properties.A total of 700 patients hospitalised at the Department of Infectious Diseases and Clinical Microbiology were evaluated retrospectively.Of a total of 700 patients, 383 (54.7%) were male and mean age was 41.5 ± 17.0 years. Of the patients, 517 (73.8%) were classified as acute cases. Complications occurred significantly less frequently in acute infections (p0.001). Increased C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) occurred more frequently in patients with complicated cases (p = 0.005 and 0.021, respectively), whereas malaise, myalgia and blood culture positivity occurred significantly less frequently in those cases (p0.001,0.001 and 0.014, respectively). Fever at examination, loss of malaise and myalgia and blood culture negativity were statistically significant predictive factors for complicated patients in multivariate analysis (p0.001, for each). As compared to patients without orchitis, leukocytosis occurred more often in cases with orchitis (p0.001); leukopenia occurred more often in neurobrucellosis than in cases without neurobrucellosis (p = 0.008). Of patients who attended control regularly, 422 (98%) were treated successfully. All of the nine patients who did not recover fully were cases with osteoarticular involvement.Fever was the most significant predictive marker of complications. Other classical symptoms of brucellosis like myalgia and malaise were absent in most of the complicated cases. Blood culture was of limited value in the diagnosis of complicated cases most of the time.

We aimed to determine the relationship between leukocyte counts and the survival of patients with Crimean-Congo hemorrhagic fever (CCHF), a life-threatening illness. This is the first study to do so. A total of 220 patients with CCHF were evaluated retrospectively. The mortality rate was 16.4%. Analysis of the relationship between leukocyte counts and mortality rates provided insight into the pathogenesis of CCHF. Receiving operating curve analysis revealed that leukocyte counts ≥2,950/mm(3) on the day of admission predicted mortality rate with 62.1% sensitivity. The mean hospitalization stay in patients with fatal disease was 4.3 days; therefore, leukocyte counts were compared on the day of admission and day 3 of the hospital stay. Increases in neutrophil levels and decreases in lymphocyte and monocyte levels were identified as significant risk factors for mortality (P = 0.01, 0.037, and 0.001, respectively). The mortality risk was 7-12 fold higher in patients whose levels of leukocytes (2,950 μL), lactate dehydrogenase (967.5 U/L), and alanine aminotransferase (>119.5 U/L) and activated partial thromboplastin time (42.4 s) exceeded the cut-off values; these were identified as independent predictors of mortality. Depletion of monocytes and lymphocytes and accumulation of neutrophils correlated with poor outcome. These results highlight the importance of the mononuclear immune response for the survival of patients with CCHF.

Abstrat Background/aim: This study was performed to identify the characteristics distinguishing fatal and nonfatal cases of patients diagnosed with Crimean-Congo hemorrhagic fever (CCHF). Materials and methods: A total of 92 patients with confirmed diagnosis of CCHF in 2009-2013 were included in the study. Results: A high level of urea and aPTT on the third day of hospital stay, diarrhea, somnolence, and the interval from the beginning of the symptoms to hospital admission were independently associated with fatality. Each 10-unit increase in aPTT and urea levels increased the fatality rate by 3.379-fold and 1.236-fold, respectively. Delay in hospital admission increased the fatality rate 1.453-fold for each day of delay. When comparing first and third admission-day laboratory values, the increase in leukocyte counts and the decrease in CPK, urea, creatinine, aPTT, PT, INR, and hemoglobin levels were significant in nonfatal cases. Conclusion: This study showed that the course of these laboratory tests helps us to predict the outcome of the disease. In a few days of hospitalization, persistence or progress of the abnormal laboratory parameters may warn us about poor prognosis.