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PURPOSE: This paper aimed to evaluate the effects of the COVID-19 pandemic on healthcare-associated infections (HAIs), antibiotic resistance and consumption rates in intensive care units (ICUs) of a tertiary care university hospital. PATIENTS AND METHODS: Between 1 January 2018 and 31 December 2021, adult patients diagnosed with HAIs in ICUs were investigated retrospectively. Patients were divided into pre-pandemic (2018–2019) and pandemic periods (2020–2021). Antibiotic consumption index was calculated via using the formula of (total dose (grams)/defined daily dose (DDD) x total patient days) x1000. A p value below 0.05 was accepted as statistically significant. RESULTS: The incidence of HAIs (per 1000 patient days) in the ICU of COVID-19 patients was 16.59, while it was 13.42 in the other ICUs during the pandemic period (p=0.107). The bloodstream infection (BSI) incidence was 3.32 in the pre-pandemic period and 5.41 in the pandemic period in ICUs other than the ICU of COVID-19 patients (p0.05). In the pandemic period, the ESBL positivity rates for K. pneumoniae and E. coli were 83% and 100% in the ICU of COVID-19 patients, respectively. Meropenem (p

Background/aim: Remdesivir, which was first developed for the treatment of Ebola disease but failed to meet expectations, has become hope in the fight against the COVID-19 pandemic. This study aimed to evaluate risk factors for mortality and prognosis of adult moderate/severe COVID-19 patients treated with remdesivir, and safety and tolerability of 5 days of remdesivir treatment. Materials and methods: This multicenter prospective observational study was conducted in 14 centers in Turkey. Pregnancy or breastfeeding, multiorgan failure, or usage of vasopressors for septic shock, ALT>5 x the upper limit of the normal range, or eGRF, Health Institutes of Turkey [COVID-19-PMSRMD], Health Institutes of Turkey (Project ID: COVID-19-PMSRMD).

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WOS: 000417628500023, PubMed ID: 29081366, Previous multicenter/multinational studies were evaluated to determine the frequency of the absence of cerebrospinal fluid pleocytosis in patients with central nervous system infections, as well as the clinical impact of this condition. It was found that 18% of neurosyphilis, 7.9% of herpetic meningoencephalitis, 3% of tuberculous meningitis, 1.7% of Brucella meningitis, and 0.2% of pneumococcal meningitis cases did not display cerebrospinal fluid pleocytosis. Most patients were not immunosuppressed. Patients without pleocytosis had a high rate of unfavorable outcomes and thus this condition should not be underestimated. (C) 2017 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases., Grant-A-Starr Foundation, Grant-A-Starr Foundation.

Bu çalışmada kronik hepatit C (KHC) tedavisinde, NS3/4A proteaz inhibitörleri (telaprevir ve boceprevir) içeren üçlü tedavinin etki ve yan etki profilleri araştırıldı. Polikliniğimize başvuran; proteaz inhibitörü, pegile interferon ve ribavirin uygulanan hastaların demografik özellik-leri retrospektif olarak elektronik dosyadan elde edildi. Sekiz hastaya telaprevirli rejim, üç hastaya boceprevirli rejim verildi. Genotip 1 ile enfekte hasta sayısı dokuz idi, hepsinde kalıcı viral yanıt (KVY) elde edildi. Genotip 4 ile enfekte hasta sayısı ise iki idi, bir hastada KVY elde edildi. En sık görülen yan etkiler anemi, döküntü, kaşıntı ve anorektal yan etkilerdi. Döküntü sebebiyle bir hastada tedavi kesildi. Bu hastada da KVY gelişti. Sonuç olarak iyi yan etki yönetimiyle, olgularımızda KVY oranı çok yüksek bulundu (10/11). Bu nedenle sosyal güvenlik kurumu tarafından geri ödeme kapsamında olan proteaz inhibitörü içeren üçlü tedavinin ücret ödeyemeyecek ve siroza yakın/siroz olup bekleyemeyecek hastalara verilmesi düşünülmelidir., In this study, treatment outcome and side effects in chronic hepatitis C (CHC) of triple therapy containing NS3/4A protease inhibitors (telaprevir and boceprevir) is evaluated. Demographic data of patients from our outpatient clinic who is administered protease inhibitors, pegylated interferon and ribavirin were recorded from electronic files retrospectively. Of 11 patients, eight patients were treated with telaprevir based regimen and three patients with boceprevir based regimen. All of nine patients with genotype 1 achieved sustained virologi-cal response (SVR). The study consisted of two genotype 4 patients one of whom achieved SVR. The most common side effects were ane-mia, rash, pruritus and anorectal discomfort. One patient discontinued treatment due to rash. This patient also achieved SVR. As a result, high SVR rate was achieved in our patients (10/11). Therefore, triple therapy including protease inhibitors which is within the scope of social security payments should be considered for precirrhotic/cirrhotic patients who are unable to pay and can not wait.

Aim: To determine the distribution of macrolide resistance genes as well as resistance rates in isolated Streptococcus pneumoniae strains from the southern Marmara region of Turkey. Materials and methods: Antimicrobial resistance rates and MIC values were determined by the E-test method in 300 Streptococcus pneumoniae isolates that were isolated from clinical samples. Resistance genes were determined by the polymerase chain reaction (PCR) method in erythromycin-resistant strains. Results: It was found that 11.4% of Streptococcus pneumoniae isolates were resistant to macrolides. The penicillin MIC value was >= 0.12 mu g/mL in 23% of the strains and 2 mu g/mL in 2% of the strains. The erm(B) genotype was observed in 58.8% of all macrolide-resistant strains, 38.2% were of the mef(A) genotype, and 3% were a combination of both genotypes. Conclusion: Based on the data from this study, it was concluded that the local resistance to antibiotics is not as high as that observed in other countries, and the erm(B) genotype was dominant in macrolide-resistant strains. Therefore, it is suggested that macrolide-group antibiotics still be included in treatment protocols. Son yıllarda Streptococcus pneumoniae suşlarında makrolid ve diğer antibiyotiklere giderek artan bir direnç oranı mevcuttur. Bu çalışmada Türkiye’de Güney Marmara Bölgesi’nden izole edilen S. pneumoniae suşlarında penisilin ve makrolidler için minimum inhibitör konsantrasyonlarının ve makrolid direnç mekanizmasının genetik dağılımının tespit edilmesi amaçlanmıştır. Yöntem ve gereç: Çalışmada klinik örneklerden izole edilen 300 adet S. pneumoniae izolatında E test yöntemi ile antimikrobiyal direnç oranları ve MIK değerleri ve eritromisine dirençli izolatlarda ise PCR yöntemiyle direnç genleri tespit edildi. Çalışmada makrolid direnci % 11,4 oranında bulundu. Penisilin MIC değeri 0,12 μg/mL ve üzeri olan suşlar % 23 oranında, penisilin MIC değeri 2 μg/mL olan suşlar % 2 oranında bulundu. Makrolid dirençli izolatların % 58,8’inde erm(B) genotipi, % 38,2’sinde mef(A) genotipi, ve % 3’ünde her iki direnç genotipi birden tespit edildi. Sonuç: Bölgemizde izole edilen suşlarda antibiyotik direncinin yüksek olmadığı ve makrolid direnci olan suşlarda erm(B) tipi direnç geninin hakim olduğu görüldü. Bölgemizde direnç oranlarının yüksek olmaması nedeniyle tedavi protokolünde makrolid grubu antibiyotikler kullanılabilir.

Ectopic adrenocorticotropic hormone secretion (Ectopic ACTH) is associated with a broad range of tumors, the vast majority of which are neuroendocrine cell origin. Although the syndrome is related with severe hypercortisolism, some classical signs and symptoms of the Cushing syndrome may not be seen. But many neurocognitive functional disorders may be seen such as deppression and anxiety. Suppression of the cellular and humaral immune system in these patients is severe problem for both patients and physicians. In this paper, we aimed to report a small cell lung cancer patient with ectopic ACTH syndrome, who exhibited neutropenic fever and pneumonia after chemotherapy, despite appropriate prophylaxis., Ektopik adrenokortikotropik hormon(ACTH) salınımı, büyük çoğunluğu nöroendokrin hücre kaynaklı olmak üzere geniş bir tümör grubu ile ilişkilidir. En sık akciğerin küçük hücreli kanseri ile birliktelik gösterir. Sendrom şiddetli hiperkortizolemi ile ilişkili olsa da, klinik olarak klasik Cushing sendromunun bazı bulguları gözlenmeyebilir. Ancak depresyon ve anksiyete dahil olmak üzere bir çok nörokognitif fonksiyon bozukluğu görülebilir. Ayrıca bu hastalarda hücresel ve humoral immun sistemin baskılı olması hem doktor hemde hasta için önemlidir. Biz bu makalede, uygun profilaksiye rağmen kemoterapi sonrası nötropenik ateş ve pnömoni gelişen ektopik ACTH sendromlu küçük hücreli akciğer kanserli bir olguyu sunmayı amaçladık.

Lyme disease, that's causative agent Borrelia burgdorferi, is an arthropod-borne disease. This disease is among the “great imitator” infec-tious diseases like tuberculosis, brucellosis and syphilis, due to it's multisystem clinical involvement. The presence of multiple neurological signs during the disease has led the entity named as “neuroborreliosis”. The immunological response against the spirochete and direct dam-age of the agent determines the clinical manifestations of the disease. The agent may be responsible for many different neurological diagno-sis as meningitis, cranial neuritis, facial paralysis, chronic encephalomiyelitis, spastic paraparesis, and even mental changes. Early diagnosis and treatment prevents the persistence of the bacteria as well as the progression of the disease. Because of the presence of the tick vector species in our country, the neuroborreliosis should be included in our differential diagnosis., Lyme hastalığı, Borrelia burgdorferi'nin etken olduğu, artropod aracılı bir hastalık olup, multisistemik tutulum gösteren klinik bulguları ile tüberküloz, bruselloz, sifiliz gibi ‘büyük taklitçi' enfeksiyon hastalıkları arasındadır. Hastalık esnasında görülen çok sayıda nörolojik belirtinin varlığı "nöroborrelyoz" adlı antitenin ortaya çıkmasına neden olmuştur. Spirokete karşı immünolojik yanıt ve etkenin direkt hasarı hastalığın klinik bulgularını da belirlemektedir. Etken menenjit, kraniyal nörit, fasiyal paralizi, kronik ensefalomiyelit, spastik paraparezi ve hatta mental değişiklikler ile seyreden pekçok farklı nörolojik tablodan sorumlu tutulabilir. Erken tanı ve tedavi, hastalığın ilerlemesinin yanı sıra, bakterinin persiste etmesini de önler. Vektör olan kene türlerinin ülkemizde de bulunması nedeni ile nöroborrelyoz ayırıcı tanımızda yer almalıdır.

Enterokoklar'da artan direnç tüm dünyada ciddi bir sorun olarak karşımıza çıkmaya başlarken, tedavide linezolid ve daptomisin gibi antibi-yotikler kullanıma girmiştir. Çalışmamızda enterokok suşlarında ampisilin, moksifloksasin, gentamisin, vankomisin, teikoplanin, linezolid ve daptomisinin in-vitro etkinliklerini değerlendirmek amaçlanmıştır. Çalışmaya, kandan izole edilen 100 enterokok (57 E. faecalis, 40 E. faecium, 1'er E. hirae, E. avium, E.raffinosus) suşu dahil edildi. Linezolid ve daptomisin duyarlılığı E-test yöntemi ile diğer antibiyotikler ise Phoenix otomatize test sistemi ile değerlendirildi. Çalışmamızda E. faecalis suşlarının %100'ü, E. faecium suşlarının ise %8'i ampisiline duyarlı bulundu. İzolatların %51'inde yüksek düzey gentamisin direnci, %60'ında yüksek düzey streptomisin direnci saptandı. Bir E. fa-ecium izolatında vankomisin direnci saptandı. Suşların %91'i linezolide duyarlı, %1'i dirençli olarak belirlendi. İzolatların tamamının dap-tomisine duyarlı olduğu saptandı. Linezolid ve daptomisinin enterokok enfeksiyonlarının tedavisinde etkin ve güvenilir birer seçenek olduğu ancak vankomisine dirençli suşlarda nadir de olsa linezolid direncine rastlanabileceği unutulmamalıdır., Increasing resistance in enteroccoci has become a serious problem all over the world. In recent years, linezolid and daptomycin came into use in the infections caused by resistant gram positive bacterias. The aim of this study was to investigate the in vitro susceptibilities of enterococ-cus to ampicillin, moxifloxacin, gentamicin, vancomycin, teicoplanin, linezolid, daptomycin.100 Enterococcus strains (57 E. faecalis, 40 E. faecium, 1 E. hirae, 1 E. avium, 1 E.raffinosus) isolated from blood cultures were included in the study. Linezolid and daptomycin suscepti-bilities were identified with the E-test method, while other antibiotic susceptibilities were investigated by Phoenix automated system. 100% of E. faecalis strains and 8% of E. faecium strains were found in-vitro susceptible to ampisilin in our study. High level gentamicin resistance and high level streptomycin resistance was detected as 60% and 51% of the isolates, respectively. Vancomycine resistance was detected in one E. faecium isolate. In-vitro susceptibilities of the isolates to linezolid were found as 91% susceptible and 1% resistant. All of the isolates were susceptible to daptomycin. Linezolid and daptomycin are effective and reliable options against enteroccoci infections but it shouldn't be forgotten that vancomycine resistant strains can also be resistant to linezolid in rare occasions.

Surgical prophylaxis is one of the areas where antibiotics are used commonly. Nonendication use or prolongation of prophylaxis are the major problems in this topic. In this study, prophylaxis applied to operations by different clinics was evaluated after implicative prophylaxis protocol in April 2010 in our hospital selection and duration of antibiotics were examined in terms of whether or not to change. For this purpose, we examined prophylaxis regimens adminstered in the breast, coronary artery bypass grafting (CABG), prostatectomy, TURP, TUR-M, cholecystectomy, hernia, colorectal surgery, spinal surgery and orthopedic prostheses applied between 01.01.2010 and 31.12. 2010. cefazolin was the most preferred antibiotic, provide to using in the surgery prophylaxis before guide (81.3%) and after (80%). There was no change in using of a single dose of all antibiotics prior guide (31.9%), after (29.3%). It was observed that the presence of the guide does not affect the duration of prophylaxis using more than 24 hours. As a result, the time of antibiotic practices continue to be a problem, more than the decision of choice of antibiotic prophylaxis in many applications., Antibiyotiklerin sık kullanıldığı alanlardan biri cerrahi profilaksidir. Fakat gereksiz ya da gereğinden uzun süreli antibiyotik kullanımı bu konudaki en sık karşılaşılan sorundur. Bu çalışmada; farklı klinikler tarafından yapılan operasyonlarda uygulanan profilaksilerde, Nisan 2010'da hastanemizde yayınlanan cerrahi profilaksi kılavuzu sonrası antibiyotik seçim ve kullanım süresi açısından değişme olup olmadığı değerlendirildi. Bu amaçla 01.01.2010 ile 31.12.2010 tarihleri arasında yapılan meme, koroner arter bypass (CABG), prostatektomi, TUR-P, TUR-M, kolesistektomi, herni, kolorektal cerrahi, spinal cerrahi ve ortopedik protez operasyonlarında uygulanan profilaksiler incelendi. Cerrahi profilakside kullanılan sefazolinin kılavuz öncesi (%81,3) ve sonrası (%80) en sık tercih edilen antibiyotik olduğu görüldü. Tüm antibiyotiklerin tek doz kullanımının kılavuz öncesi (%31,9), sonrasında (%29,3) anlamlı olarak değişmediği tespit edildi. Kılavuzun varlığı profilaksi süresinin 24 saatten uzun kullanılmasını etkilemediği gözlendi. Sonuç olarak, profilaksi uygulamalarında antibiyotik seçiminden çok, antibiyotik uygulama sürelerinde sorunun devam ettiği kararına varıldı.

Typhoid fever is a systemic infection caused by the bacterium Salmonella Typhi. It is characterized by fever, headache, malaise, anorexia, relative bradycardia, constipation or diarrhea. Gastrointestinal bleeding is one of the major intestinal complication of typhoid fever. However, typhoid fever complicated by massive lower gastrointestinal bleeding has rarely been reported in the literature. It is important to include this disease in the differential diagnosis of massive lower gastrointestinal haemorrhage. The classic approach to the management of intestinal haemorrhage due to typhoid infection has been conservative. In the event of massive haemorrhage which does not respond to conservative measures, emergency resection should be considered. Here, we present a case of typhoid fever complicated by massive lower intestinal bleeding and treated conservatively by medical agents., Tifo Salmonella Typhi'nin neden olduğu sistemik bir hastalıktır. Ateş, baş ağrısı, kırgınlık, iştahsızlık, relatif bradikardi, konstipasyon veya diyare ile karakterizedir. Gastrointestinal kanama tifonun major intestinal komplikasyonlarından birisidir. Bununla beraber tifoya bağlı masif alt gastrointestinal kanama literatürde nadir olarak bildirilmiştir. Masif alt gastrointestinal kanama ayırıcı tanısına bu hastalığın da dahil edilmesi önemlidir. Tifoya bağlı intestinal kanamanın tedavisinde klasik yaklaşım konservatiftir. Konservatif tedaviye yanıt vermeyen hastalarda acil rezeksiyon düşünülmelidir. Burada, tifoya bağlı masif alt intestinal kanamanın görüldüğü ve konservatif olarak tedavi edilen bir olguyu sunduk.

ÖZETBrucella, insanlarda endokardit, artrit, osteomiyelit, menenjite yol açangram negatif hücre içi bakteridir. Hastalığın kronikleşme riski ve yüksekmorbiditesi nedeni ile etkili aşı ve yeni tanı reaktanlarının geliştirilmesineihtiyaç duyulmuştur. Bu amaçla Brucella antijenlerinden yeni sentetik peptitlergeliştirilmiş ve hayvan modellerinde denenmiştir. Ancak bu peptidlere karşıinsan immün sisteminin yanıtına ait yeterli çalışma yoktur.Çalışmamızda B. abortus'dan elde edilen L7/L12 ve GAPDH peptitlerinekarşı Bruselloz'lu hastaların periferal kan lenfositlerinin profilleri ve sitokinyanıtının araştırılması amaçladık. Akut Bruselloz'lu ve sağlıklı hastaların kanlenfositlerinde bu antijenlere yanıt olarak ortaya çıkan lenfosit alt gruplarındakideğişiklikleri akım sitometrisi ile ve hücre dışı sitokin üretimini bu hücrelerinkültür süpernatantlarında ELISA yöntemi ile araştırdık.Çalışmaya 25 Akut Bruselloz hastası ve 15 sağlıklı birey alındı. Bukişilerden elde edilen periferal mononükleer hücreler PHA, L7/L12, GAPDHile uyarıldıktan sonra lenfosit alt grupları ve hücre dışı sitokin (IFN-γ, IL-4, IL-10) miktarı ölçüldü. Uyarı sonucu Bruselloz'lu hastalarda hücre dışı IFN-γseviyeleri yüksek tespit edildi. Gruplar arasında uyarı sonrası IL-4, IL-10seviyeleri arasında farklılık yoktu. Çalışmada ayrıca CD3+/CD4+, CD3+/CD8+,CD4+/CD25+, CD4+/CD27-, CD3+/CD152+(CTLA4), CD3+/CD69+ lenfositdağılımı araştırıldı. Bu peptidler ile uyarı sonucunda hastalarda CD3+/CD69+lenfosit oranının arttığı saptandı. Ancak diğer lenfosit alt gruplarınındağılımında hasta ve sağlıklı gruplar arasında farklılık tespit edilmedi.Bu çalışmalarda elde edilen veriler ışığında Bruselloz'da koruyucuimmüniteden Th1 tip immünitenin sorumlu olduğunu, GAPDH ve/veyaiiL7/L12'nin yeni Bruselloz aşı preparasyonlarında; bu peptitler ile uyarıyıtakiben IFN-γ yapımını temel alan spesifik hücresel immün yanıtı ölçenimmünolojik tanı testlerinde kullanılabileceğini söyleyebiliriz. Bununla birlikteGAPDH ve L7/L12'nin kompleks immünomodülatör etkilerini açıklığakavuşturacak yeni ve daha ileri çalışmalara gereksinim vardır.Anahtar Kelimeler: Akut Bruselloz, GAPDH, L7/L12, Sitokin, Lenfosit AltGrupları, IFN-γ, IL-4, IL-10.iii SUMMMARYThe Regulation Of Spesific T Cell Response In BrucellosisBrucella is a gram-negative intracellular bacterium that leads toendocarditis, arthritis, meningitidis and osteomyelitis in humans. Because ofthe chronicity risk of the disease and high morbidity, there are requirementsfor effective vaccines and spesific diagnostic reagents to eradicatebrucellosis. For that purpose novel synthetic peptides derived from Brucellaantigens were generated and tested in animal models. However there is alittle known about the human immune response to these peptides.In this study we investigated the profiles of the peripheral bloodlymphocytes and cytokine responses of Acute Brucellosis patients andhealthy subjects in response to two novel peptides derived from Brucella;GAPDH and L7/L12 by evaluating changes in lymphocyte subpopulationsand by measuring the amount of cytokine productions in culture supernatantsusing flow cytometry and ELISA, respectively.Twenty-five Acute Brucellosis patients and fifteen healthy subjects wereincluded in the study. The peripheral blood mononuclear cells obtained fromAcute Brucellosis patients (study group) and healthy subjects (control group)were stimulated with PHA, L7/L12, GAPDH prior to the measurement ofextracellular cytokines (IFN-γ, IL-4, IL-10) and evaluation of the lymphocytessubgroups. As a result of stimulation, extracellular IFN-γ levels increased inbrucellosis patients. There were no differences in the levels of IL-4, IL-10under the stimulation with these peptides between the groups. AlsoCD3+/CD4+, CD3+/CD8+, CD4+/CD25+, CD4+/CD27-, CD3+/CD152+(CTLA4),CD3+/CD69+ lymphoctes were counted. The CD3+/CD69+ counts in patientsincreased under the stimulation with L7/L12, GAPDH. However there wereivno statistically significant differences in the other lymphocytes subpopulationsbetween the healthy and patient groups.In the light of the data obtained in our study, it can be suggested thatTh1 type spesific cellular immunity is responsible for protective immunity inBrucellosis. The more potent vaccines may be developed by includingL7/L12, GAPDH and diagnostic tests using these peptides may be evaluated.However, there are needs for new and further studies which reveals thecomplex immunomodulatory effects of GAPDH and L7/L12.Key Words: Acute Brucellosis, GAPDH, L7/L12, Cytokine, LymphocyteSubpopulation, IFN-γ, IL-4, IL-10v 63

Introduction Brucellosis is a public health problem that is prevalent in several developing countries. Methods The clinical and laboratory characteristics of 164 cases of brucellosis in Bursa, Turkey, were retrospectively evaluated. Results The ages of the 164 patients ranged from 15-85 years. All of the patients underwent the Rose Bengal test and 163 (99.4%) patients tested positive. 122 (74.4%) patients were diagnosed with acute brucellosis, 31 (18.9%) with subacute brucellosis and 11 (6.7%) with chronic brucellosis. Focal involvement was found in 101 (61.6%) patients. Although patients with focal involvement had a higher white blood cell count (p = 0.002), those without focal involvement had higher aspartate transaminase and alanine transaminase values, and lower platelet values (p = 0.005, 0.007 and 0.039, respectively). Spondylodiscitis was observed on imaging in 58 (66.7%) of the 87 patients who presented with back pain. Among the 118 patients who were examined within the first month of treatment, 79 (66.9%) responded to treatment. The relapse rate was 11.6% among all 164 patients. Conclusion Brucellosis should be considered as a differential diagnosis among patients who present with fever, and joint or back pain. Focal involvement should be investigated in the presence of leucocytosis, and subacute or chronic forms of brucellosis. To identify cases of spondylodiscitis, radiography should be performed in patients who present with back pain.

We present a case of multiple intracranial abscesses caused by Cryptococcus neoformans in a patient who presented with no symptoms of immunodeficiency.

Bu çalışmada kronik hepatit C (KHC) tedavisinde, NS3/4A proteaz inhibitörleri (telaprevir ve boceprevir) içeren üçlü tedavinin etki ve yan etki profilleri araştırıldı. Polikliniğimize başvuran; proteaz inhibitörü, pegile interferon ve ribavirin uygulanan hastaların demografik özellikleri retrospektif olarak elektronik dosyadan elde edildi. Sekiz hastaya telaprevirli rejim, üç hastaya boceprevirli rejim verildi. Genotip 1 ile enfekte hasta sayısı dokuz idi, hepsinde kalıcı viral yanıt (KVY) elde edildi. Genotip 4 ile enfekte hasta sayısı ise iki idi, bir hastada KVY elde edildi. En sık görülen yan etkiler anemi, döküntü, kaşıntı ve anorektal yan etkilerdi. Döküntü sebebiyle bir hastada tedavi kesildi. Bu hastada da KVY gelişti. Sonuç olarak iyi yan etki yönetimiyle, olgularımızda KVY oranı çok yüksek bulundu (10/11). Bu nedenle sosyal güvenlik kurumu tarafından geri ödeme kapsamında olan proteaz inhibitörü içeren üçlü tedavinin ücret ödeyemeyecek ve siroza yakın/siroz olup bekleyemeyecek hastalara verilmesi düşünülmelidir. In this study, treatment outcome and side effects in chronic hepatitis C (CHC) of triple therapy containing NS3/4A protease inhibitors (telaprevir and boceprevir) is evaluated. Demographic data of patients from our outpatient clinic who is administered protease inhibitors, pegylated interferon and ribavirin were recorded from electronic files retrospectively. Of 11 patients, eight patients were treated with telaprevir based regimen and three patients with boceprevir based regimen. All of nine patients with genotype 1 achieved sustained virological response (SVR). The study consisted of two genotype 4 patients one of whom achieved SVR. The most common side effects were anemia, rash, pruritus and anorectal discomfort. One patient discontinued treatment due to rash. This patient also achieved SVR. As a result, high SVR rate was achieved in our patients (10/11). Therefore, triple therapy including protease inhibitors which is within the scope of social security payments should be considered for precirrhotic/cirrhotic patients who are unable to pay and can not wait.

Background/aim Invasive aspergillosis (IA) is a fatal infection that is difficult to diagnose in immunocompromised patients. In this study, Aspergillus-specific DNA was searched using real-time PCR (RT-PCR) in serum samples. Galactomannan (GM) and/or beta-D-glucan (BDG) tests were previously performed on these samples for 70 neutropenic patients with hematological malignancy. Materials and methods The patients were categorized according to the criteria of the European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG). Among the patient serum samples, the first positive GM or BDG test sample and the median sample of GM or BDG test for negative patients were used to detect DNA levels by RT-PCR method (Light Cycler 480, Roche Molecular Biochemicals, Meylan, France) using a commercial kit (Way2Gene Fungi; Genmar, Izmir, Turkey). Results When the proven and probable IA group were considered as real patients, sensitivity of Aspergillus-specific DNA test was 90%, specificity was 73.3%, positive predictive value was 81.8%, and negative predictive value was 84.6%. Conclusion This study found that searching for specific DNA by RT-PCR method has a sensitivity as high as the GM test. Although specificity was rather low, it was concluded that it can be used jointly with GM and BDG tests after decreasing contamination by severe laboratory applications.

2011’de düzenlenen 15. Türk Mikrobiyoloji ve İnfeksiyon Hastalıkları Kongresi’nde poster olarak sunulmuştur. In this study it was aimed to investigate interrelationships between complaints, diagnoses, and psychotropic drug usage of children and adolescents applied to a child and adolescent psychiatric outpatient clinic. Medical files of the patients who had been examined for the first time between July 2012, and December 2012 in Outpatient Clinics of Child and Adolescent Psychiatry of Uludag University Hospitals of Medical Faculty were evaluated. The total number of cases evaluated was 953, the age range was 1-17 and the mean age was 9, 5 ± 4, 6. The most frequently encountered presenting complaints were determined as naughtiness, and disobedience (188-19.7 %) and the most frequently detected diagnoses were attention deficit hyperactivity disorder (ADHD) (180-18.8%). Mostly selective serotonin reuptake inhibitors 208 (21.8 %), atypical antipsychotic 143 (14.8%), and psycho stimulants 79 (8.3 %) were recommended in decreasing order of frequency. Recognition of frequently detected complaints, and diagnoses, determination of differences in diagnoses according to gender, and age groups of patients, evaluation of the drugs used, and their relationship with relevant diagnoses will contribute favourably to the improvement and standardization of health care services provided in the outpatient clinics of child and adolescent psychiatry and identifying areas of sociodemographic characteristics.Salmonelloz dünyada yaygın olarak görülen bir halk sağlığı sorunudur. Çok sayıda türü olan Salmonella, farklı klinik tablolara sebep olmaktadır. Ülkemizde zaman zaman küçük çaplı salgınlara yol açması ve bazı bölgelerde hala endemik olması etkene yönelik gıda endüstrisi ve hayvancılıkta çeşitli önlemlerin alınmasına sebep olmaktadır. Son yıllarda tüm ülkelerde nontifoidal salmonelloz olguları artmaktadır. Bu olguların çoğunda kendi kendini sınırlayan enfeksiyonlara sebep olurken immünsüprese hastalarda önemli morbidite ve mortaliteye yol açan değişik yer ve lokalizasyonlarda enfeksiyonlara neden olur. Sunulan hasta uzun süre immünsüpresif tedavi aldıktan sonra yaptırdığı intramusküler (İM) enjeksiyon bölgesinde apse gelişmesi nedeniyle merkezimize başvurmuştur. Gluteal apse materyalinde Salmonella Enteritidis üremesi oldu. Olgu farklı bulaş yolu olması nedeniyle ve nontifoidal salmonellozun etiyoloji ile klinik önemini tartışmak üzere sunuldu. Salmonellosis is a public health problem and common worldwide. Salmonella have a large number of species that cause different clinical manifestations. Various precautions are taken in food and livestock industry because it sometimes causes minor outbreaks and is still endemic in some areas. Cases of nontyphoid salmonellosis tend to increase in all countries in recent years. In most of these cases, it occurs like selflimiting infections. However it results is significant morbidity and mortality in immunocompromised patients in different places and locations. The present case that has been receiving immunosuppressive therapy for a long time admitted to our health center because of an abscess in gluteal region resulted from intramuscular injection. The patient's material yielded Salmonella Enteritidis. It is presented as a case report to discuss nontyphoidal salmonellosis’s etiology and clinical significance.

21-25 Mart 2012, 4.Tıbbi Onkoloji Kongresi’nde poster olarak sunulmuştur. Ektopik adrenokortikotropik hormon(ACTH) salınımı, büyük çoğunluğu nöroendokrin hücre kaynaklı olmak üzere geniş bir tümör grubu ile ilişkilidir. En sık akciğerin küçük hücreli kanseri ile birliktelik gösterir. Sendrom şiddetli hiperkortizolemi ile ilişkili olsa da, klinik olarak klasik Cushing sendromunun bazı bulguları gözlenmeyebilir. Ancak depresyon ve anksiyete dahil olmak üzere bir çok nörokognitif fonksiyon bozukluğu görülebilir. Ayrıca bu hastalarda hücresel ve humoral immun sistemin baskılı olması hem doktor hemde hasta için önemlidir. Biz bu makalede, uygun profilaksiye rağmen kemoterapi sonrası nötropenik ateş ve pnömoni gelişen ektopik ACTH sendromlu küçük hücreli akciğer kanserli bir olguyu sunmayı amaçladık. Ectopic adrenocorticotropic hormone secretion (Ectopic ACTH) is associated with a broad range of tumors, the vast majority of which are neuroendocrine cell origin. Although the syndrome is related with severe hypercortisolism, some classical signs and symptoms of the Cushing syndrome may not be seen. But many neurocognitive functional disorders may be seen such as deppression and anxiety. Suppression of the cellular and humaral immune system in these patients is severe problem for both patients and physicians. In this paper, we aimed to report a small cell lung cancer patient with ectopic ACTH syndrome, who exhibited neutropenic fever and pneumonia after chemotherapy, despite appropriate prophylaxis.

WOS: 000329981700003, PubMed ID: 24211227, Background: The aim of this study was to delineate mortality indicators in pneumococcal meningitis with special emphasis on therapeutic implications. Methods: This retrospective, multicenter cohort study involved a 15-year period (1998-2012). Culture-positive cases (n = 306) were included solely from 38 centers. Results: Fifty-eight patients received ceftriaxone plus vancomycin empirically. The rest were given a third-generation cephalosporin alone. Overall, 246 (79.1%) isolates were found to be penicillin-susceptible, 38 (12.2%) strains were penicillin-resistant, and 22 (7.1%) were oxacillin-resistant (without further minimum inhibitory concentration testing for penicillin). Being a critical case (odds ratio (OR) 7.089, 95% confidence interval (CI) 3.230-15.557) and age over 50 years (OR 3.908, 95% CI 1.820-8.390) were independent predictors of mortality, while infection with a penicillin-susceptible isolate (OR 0.441, 95% CI 0.195-0.996) was found to be protective. Empirical vancomycin use did not provide significant benefit (OR 2.159, 95% CI 0.949-4.912). Conclusions: Ceftriaxone alone is not adequate in the management of pneumococcal meningitis due to penicillin-resistant pneumococci, which is a major concern worldwide. Although vancomycin showed a trend towards improving the prognosis of pneumococcal meningitis, significant correlation in statistical terms could not be established in this study. Thus, further studies are needed for the optimization of pneumococcal meningitis treatment. (C) 2013 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. All rights reserved.