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Background: Respiratory viruses such as SARS-CoV-2 spread via different transmission routes. While the droplet path plays the most important role in transmisson, contamination of the mucous membranes with contaminated hands also plays an important role in the spread. Thus, the aim of the present study was to assess the face-touching behaviors of HCWs and intern doctors during the COVID-19 pandemic. Methods: This study was conducted in July 2020 and in the Selcuk University Faculty of Medicine in Konya, Turkey. While 1-hour COVID-19 training was given to healthcare personnel and interns, participants face-touching behavior was monitored through video recording and was tallied with a scoring sheet. Results: A total of 141 intern doctors, 46 assistant doctors, 14 nurses, 10 associate doctors, and eight staff members participated in the study. On average, each of the participants touched their face a mean of 17.2 times (median: 16; range: 0–45) per hour. Of all the face touches, 85.2% (3,228/3,787) involved contact with a face mask, whereas 14.7 % (559/3787) involved contact with the eye mucosa. Intern doctors touched their faces significantly less often with a mean of 13.7 times per hour (P < 0.001), while nurses touched their faces more often with a mean of 28 times per hour (P < 0.001). Although nurses touched their eye mucosa more often than interns and assistant doctors (P < 0,001), their contact with the face mask was significantly less frequent than that of the other participants (P < 0.001). Conclusions: To date, there are no effective vaccines or antiviral drugs for SARS-CoV-2. For the time being, isolation, social distancing measures, and individuals’ protective behaviors are essential for preventing infection. HCWs, medical students, and the broader community should be informed about self-inoculation, which can result from touching one’s mucosa or mask with contaminated hands.

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis that can affect all organs and tissues. The clinical forms of primary cutaneous tuberculosis are tuberculosis primary complex (tuberculosis chancre) and tuberculosis cutis miliaris (miliary cutaneous tuberculosis). Secondary cutaneous tuberculosis includes lupus vulgaris, tuberculosis cutis verrucosa, scrofuloderma, tuberculosis cutis officials, and metastatic tubercular abscesses. The most common form is lupus vulgaris. Cutaneous tuberculosis is a rare form of tuberculosis presenting with nonspecific lesions. It is difficult to diagnose due to its non-specific clinical characteristics thus it can be confused with many other diseases. In this paper, we reviewed five patients with cutaneous tuberculosis who presented to our clinic within the past one year and we aimed to emphasize that cutaneous tuberculosis can manifest in different clinical forms.

Introduction: The COVID-19 pandemic continues to affect the world with serious number of cases and deaths. For this reason, knowing the clinical findings and course of the disease is important for early diagnosis and treatment. In this article, COVID-19 cases followed up after quarantine were discussed. Materials and Methods: In this study, the data of 99 patients who were followed up during travel and post-Umrah quarantine between 31 March and 15 April 2020 were retrospectively reviewed. Results: Of the 99 patients included in the study, 66 (66.7%) were females, 33 (33.3%) were males, and mean age was 59.8 ± 11.4 years. SARS-CoV-2 RT-PCR test was positive at the time of admission in 97 (98.0%) of the 99 patients. Thirty-nine (39.4%) of the patients were symptomatic and 25.3% of the patients had cough, 8.1% had fever, and 7.1% had shortness of breath. While SARSCoV-2 RT-PCR test was negative in 2 (3.3%) of the 60 patients without complaints, 58 (96.7%) of them were positive for SARS-CoV-2 RT-PCR test. Leukopenia was detected as 3%, lymphopenia 66.7%, D-dimer height 47.5%, LDH elevation 38.4%, CRP elevation 45.5%. Ground glass opacities were present in 81 (81.8%) of the patients with lung involvement, and consolidation areas were present in 40 patients (40.4%). Underlying disease was present in 38 (38.4%) of the patients. Hypertension and diabetes mellitus were the most common underlying diseases. It was observed that 89 (89.4%) of our cases had negative SARS-CoV-2 RT-PCR test on the 5th day. Conclusion: COVID-19 infection is an infectious disease that can present with many different clinics. In asymptomatic COVID-19 cases, lung involvement findings and disorders in laboratory parameters may be observed. It should be kept in mind that asymptomatic cases pose a risk in terms of transmission.

Objective We aimed to evaluate the relationship between perceived social support, coping strategies, anxiety, and depression symptoms among hospitalized COVID-19 patients by comparing them with a matched control group in terms of age, gender, and education level. Method The patient group (n = 84) and the healthy controls (HCs, n = 92) filled in the questionnaire including the socio-demographic form, Hospital Anxiety Depression Scale, Multidimensional Perceived Social Support Scale, and Brief Coping Orientation to Problems Experienced through the online survey link. Results The COVID-19 patients had higher perceived social support and coping strategies scores than the HCs. However, anxiety and depression scores did not differ significantly between the two groups. In logistic regression analysis performed in COVID-19 patients, the presence of chest CT finding (OR = 4.31; 95% CI = 1.04–17.95) was a risk factor for anxiety and the use of adaptive coping strategies (OR = 0.86; 95% CI = 0.73–0.99) had a negative association with anxiety. In addition, the use of adaptive coping strategies (OR = 0.89; 95% CI = 0.79–0.98) and high perceived social support (OR = 0.97; 95% CI = 0.93– 0,99) had a negative association with depression symptoms. Conclusions Longitudinal studies involving the return to normality phase of the COVID-19 pandemic are needed to investigate the effects of factors such as coping strategies and perceived social support that could increase the psychological adjustment and resilience of individuals on anxiety and depression.

Objective: Understanding the natural course of COVID-19 and determining its clinical findings are essential for early diagnosis and treatment In this study, we aimed to investigate clinical and laboratory characteristics of cases followed with a diagnosis of COVID-19 in Selcuk University Faculty of Medicine Department of Infectious Diseases and Clinical Microbiology Methods: Among patients followed with a diagnosis of pos-sible/definitive COVID-19, those with a positive SARS-CoV-2 RT-PCR test were evaluated retrospectively in terms of their clin-ical, laboratory and thorax computed tomography (CT) data Results: Among 407 patients followed with a diagnosis of pos-sible/definitive COVID-19, 149 (36 6%) were SARS-CoV-2 RT-PCR test-positive 82 (55%) of the patients were female and 67 (45%) were male Mean age was 49 3±7 6 years 11 (7 4%) were health care workers While the most common symptom was cough with 46 3%, fever was observed in 29 5%, sore throat in 27 5% and malaise in 26 8% of the patients 94 (63 1%) of the patients had underlying diseases Hypertension and diabetes mellitus were the most common underlying disease Laboratory findings were leukopenia in 12 (8 1%), lymphopenia in 34 (22 8%), throm-bocytopenia in 24 (16 1%), elevated D-dimer levels in 43 (28 9%), elevated lactate dehydrogenase levels in 73 (49%), and elevated C-reactive protein (CRP) levels in 45 (30 2%) patients While 71 (47 6%) of the patients had normal thorax CT, 43 (28 9%) had mild pneumonia, and 35 (23 5%) moderate pneumonia D-dimer and CRP levels were higher in those with pneumonia than those without pneumonia (p=0 001 and p=0 001, respectively) As the pneumonia level increased, the increase of D-dimer and CRP levels became evident (p=0 003 and p=0 001, respectively) Conclusions: The clinical course of COVID-19 patients varies It is noteworthy that there is a positive correlation between the severity of pneumonia and the increase in D-dimer and CRP levels in COVID-19 Klimik Dergisi 2020;33(2): 122-7

Aims: Laboratory findings in COVID-19 patients vary according to the severity of the disease. This study aimed at defining a system of formulas that may predict the presence of thoracic CT involvement, the extent of such involvement and the need for intensive care stay on the basis of patient laboratory data using the Waikato Environment for Knowledge Analysis (WEKA) software. Methods: This study was conducted with 508 patients whose SARS-CoV-2 RT-PCR test was positive. These patients were divided into 2 groups, with and without thoracic CT involvement typical for COVID-19. Then, those patients who had signs of typical involvement for COVID-19 in their thoracic CT were divided into 3 groups depending on the extent of their lesions. J48 Decision Tree classification and Linear Regression methods were used on the WEKA software. The codes implemented in the Python programming language were used at the estimation, classification and testing stages. Results: Thoracic CT scans showed that lung involvement was absent in 93 of the patients, mild in 114, moderate in 115, and severe in 159. The success rates of WEKA Linear Regression Formulas calculated using laboratory values and demographic data, respectively 78.92%, 71.69% and 91%. The success rate of the J48 Decision Tree formula used to predict the presence of involvement in thoracic CT was found to be 95.95%. The success rate of the J48 Decision Tree, which was used to predict the degree of involvement in thoracic CT, was 84.39%. The success rate of the J48 Decision Tree used to predict the need for intensive care was found to be 93.06%. Conclusion: The results of this study will facilitate revealing the presence of lung involvement and identification of critical patients in the COVID-19 pandemic and particularly under circumstances and can be used effectively to ensure triage.

WOS: 000511173500021, Syphilis is a multisystemic chronic infection caused by Treponema pallidum. As with other sexually transmitted infections, syphilis's tendency to spread in the community is considered to be an indicator of the spread tendency of human immunodeficiency virus (HIV) infection. With the increase in the prevalence of HIV infection, there is a significant increase in syphilis cases. Neurosyphilis is a clinical form of the disease that can be observed at any stage leading to central nervous system involvement. Eye involvement in neurosyphilis often appears in the tertiary period and it might be the first and only finding of neurosyphilis. The most common ocular presentation is uveitis, and it may mimic many ocular pathologies. In this report, a case diagnosed with neurosyphilis while investigating the etiology of uveitis is presented.

Septic arthritis is the inflammation of synovial membrane and synovial fluid in joints, which is caused by bacterial, viral or fungal agents. Staphylococcus aureus is the most common cause in all age and risk groups. In the presence of chronic septic arthritis, Mycobacterium species may be the causative agent. Osteoarticular tuberculosis may mimic many bone joint pathologies. Rapid diagnosis and treatment are important because they can cause destructive osteoarthritic outcomes in untreated cases. In this article, we report a case of recurrent septic arthritis with tuberculous arthritis.

WOS:000648816400007 PMID: 33960939 Background: In this study, we aimed to investigate the efficacy and safety of sofosbuvir-based therapies in the treatment of chronic hepatitis C in real-world clinical practice. Methods: Data from patients with chronic hepatitis C treated with SOF/LDV +/- RBV or SOF/RBV in 31 centers across Turkey between April 1, 2017, and August 31, 2018, were recorded in a nationwide database among infectious disease specialists. Demographics, clinical, and virological outcomes were analyzed. Results: A total of 552 patients were included in the study. The mean age of the patients was 51.28 +/- 14.2, and 293 (55.8%) were female. The majority had HCV genotype 1b infection (65%), 75.04% of the patients underwent treatment, and non-cirrhosis was present at baseline in 381 patients (72.6%). SOF/LDV +/- RBV treatment was given to 477 patients and 48 patients received SOF/RBV according to HCV genotype. The total SVR12 rate was 99% in all patients. Five patients experienced disease relapse during the study and all of them were genotype 2. In patients infected with HCV GT2, SVR12 was 77.3%. SVR was 100% in all patients infected with other HCV genotypes. All treatments were well tolerated by patients without causing severe adverse events. Side effects and side effects-associated treatment discontinuation rates were 28.2% and 0.4%, respectively. Weakness (13.7%) was the common side effect. Conclusion: The present real-world data of 525 patients with HCV genotypes 1, 1a, 1b, 3, 4, and 5 who underwent SOF/LDV +/- RBV treatment in Turkey demonstrated a high efficacy and safety profile. HCV GT2 patients should be treated with more efficacious treatment.

Aim To investigate the frequency of fatigue and musculoskeletal symptoms and their correlation with laboratory data in patients with COVID‐19. Methods This study included 80 patients hospitalised and treated for COVID‐19 in the infectious diseases clinic between March 2020 and May 2020. Data analysis was performed retrospectively from the hospital medical charts. Demographic data, clinical symptoms, and laboratory findings were noted. Clinical symptoms and correlations with laboratory results were assessed. Besides, an analysis of patients with and without chronic disease was performed for clinical symptoms and laboratory findings. Results The frequencies of myalgia and fatigue were 46.1% and 50%, respectively. In the laboratory data, there was a significant increase in creatinine kinase (CK) level and lymphocyte count in the patients with myalgia symptoms (P

Background Procalcitonin (PCT) and C-reactive protein (CRP) are used most widely in the diagnosis/treatment of bacterial infections. These are not infection-specific and may also show increases in other inflammation-causing cases. Aim To establish a new cut-off value for PCT and CRP to eliminate confusion in the diagnosis and treatment of bacterial infections in haemodialysis (HD) patients. Methods A total of 1110 patients, 802 with undocumented infection and 308 with documented infection, was included in the study. Results A total of 802 patients with undocumented infection had a mean CRP value of 12.2 ± 9.6 mg/dL and a mean PCT value of 0.51 ± 0.96 ng/mL and the 308 patients with documented infection had a mean CRP value of 125.9 ± 83.3 mg/dL and a mean PCT value of 13.9 ± 26.9 ng/mL at the time of admittance. In HD patients, the cut-off values for CRP was determined as 19.15 mg/dL and for PCT as 0.685 ng/mL in the presence of infection. The use of these two parameters in combination (CRP ≥19.15 mg/dL and PCT ≥ 0.685 ng/mL) was found to have 95% positive predictive value (PPV) and 93% negative predictive value (NPV) for the diagnosis of infectious diseases in HD patients. When CRP ≥100 mg/dL and PCT ≥5 ng/mL, this was found to have 100% PPV and 94% NPV for the diagnosis of sepsis in HD patients. Conclusion We specified PCT and CRP cut-off values with high PPV and NPV for revealing the presence of bacterial infection and sepsis in HD patients.

Toka, Onur/0000-0002-4025-4537; Yoruk, Gulsen/0000-0002-0357-5884; Cinar, Gule/0000-0002-7635-8848; Hakyemez, Ismail Necati/0000-0001-6133-9604; Tulek, Necla/0000-0002-3952-4982 WOS:000511173500009 Objective: Both chronic hepatitis B (CHB) and hepatosteatosis may lead to necroinflammation in liver. Therefore, the presence of hepatosteatosis might negatively affect the efficacy of antiviral therapy. We aimed to determine the effect of hepatosteatosis on virological response in patients with CHB receiving entecavir (ETV) and tenofovir (TDF) treatment. Methods: The study was designed retrospectively. All patients receiving antiviral therapy due to CHB in the departments of Infectious Diseases and Clinical Microbiology of 29 different hospitals between January 2012 and June 2017 were searched by examining medical records. Results: A total of 1069 patients were included. Six hundred and fifty of the patients had been receiving TDF and 419 of them had been receiving ETV. The rate of virological response obtained at the 48'h week of TDF was higher in patients with steatosis (p=0.029). Virological response at the 24th week and 48th week of ETV were higher in the patients without steatosis (p=0.001). TDF and ETV therapies were compared in the patients with hepatosteatosis and it was found that the virological response at 48th week was higher in the TDF group. Conclusion: Although steatosis has an effect on virological response in the short-term results of nucleos(t)ide therapy, it does not have any effect on virological response in the long-term results.

Objective: this study aimed to evaluate the awareness and knowledge levels of all physicians administering immunosuppressive treatment concerning hepatitis B virus (HBV) reactivation, and draw attention to the importance of the subject through evaluation. Methods: the study was carried out by infectious diseases and clinical microbiology specialists in 37 health centers, and it was performed in Turkey between January and March 2017. All specialists providing a written consent and working in the departments of Medical Oncology, Hematology, Dermatology and Venereology, Physical Medicine and Rehabilitation, and Rheumatology of each study center were included in the study. Results: a total of 430 physicians participated in the study. Their mean age was 39.87 +/- 7.42 years, and 47.9% of them were males. During their career, 39.3% of these physicians had encountered patients developing HBV reactivation while receiving immunosuppressive treatment. The rate of encountering patients who died due to HBV reactivation was 6.5%. 97% of physicians who participated, considered the risk of HBV reactivation to be important. 70.2% of physicians stated that guidelines related to HBV reactivation and antiviral treatment for these patients were discussed in the congresses they participated, regarding their specialties. The rate of performing hepatitis screening among physicians whose patients developed HBV reactivation was statistically significantly higher than those physicians who had no patients with HBV reactivation (p, NA

Pulmoner enfeksiyonlar, tuberkuloz disi mikobakterilerin neden oldugu enfeksiyonlarin en sik gorulen formlaridir. Oksuruk, kanli balgam, halsizlik ve kilo kaybi sikayetleri olan ve amamnezinde tedavi edilmis pulmoner tuberkuloz hikayesi bulunan 54 yasinda erkek hasta vakasini bildiriyoruz. Radyolojik bulgular ve sabah alinan aclik mide suyunun mikobakteriyolojik kulturu, M.szulgai’nin neden oldugu fibrokaviter akciger enfeksiyonuna isaret etmistir. Hasta, 12 ay boyunca her 2 ayda bir yeniden degerlendirilmek uzere standart 6 aylik antituberkuloz tedavi rejimi ile basariyla tedavi edilmistir. Klinisyenler, ozellikle risk faktorlerini tasiyan bireylerde, klinik uyumlulugun olmasi ve mikrobiyolojik bulgularin da desteklemesi durumunda, tuberkuloz disi mikobakterilerin neden oldugu enfeksiyonlari dusunmelidirler. M.szulgai, izole edildigi zaman, enfeksiyon etkeni patojen olarak degerlendirilmelidir.

Malaria is an infectious disease caused by an intracellular parasite, Plasmodium, which is transmitted to humans after the bite of an Anopheles mosquito. This disease has been prevalent for decades. It has caused great epidemics in history and has also delayed social and economic development. It is endemic in the Eastern Mediterranean and Southeastern Anatolia regions of our country. The most common plasmodium in our country is P. vivax. In P. vivax infections, patients should be treated with primaquine to eradicate hypnozoites. Here, we present a case of relapse with P. vivax, and we emphasize the importance of primaquine in the treatment.

WOS: 000429311800001, Background: Hepatitis B virus (HBV) has a high mutation rate due to its unusual replication strategy leading to the production of a large number of virions with single and double mutations. The mutations, in turn, are associated with the development of drug resistance to nucleos(t)ide analogs (NUCs) in patients before and during NUCs therapy. Objectives: The current study aimed at investigating the molecular characterization of HBV in Turkish patients with chronic hepatitis B (CHB) infection. Methods: Polymerase chain reaction (PCR) amplification and direct sequencing procedures were used to analyze mutations. The detected drug resistance mutations were divided into the nucleos(t) ide analogs primary, partial, and compensatory resistance groups. The amino acid substitutions of hepatitis B surface antigen (HBsAg) were categorized into antiviral drug - associated potential vaccine-escape mutations (ADAPVEMs) and typical HBsAg amino acid substitutions, which included hepatitis B hyperimmunoglobulin (HBIg) - selected escape mutation, vaccine escape mutation, hepatitis B misdiagnosis, and immune - selected amino acid substitutions. Results: The number of patients included in the study was 528 out of which 271 (51.3%) were treatment - naive and 351 (66.3%) were hepatitis B e antigen (HBeAg) - negative. Moreover, 325 (61.6%) were males with a mean age of 38 years (range: 18 - 69). Primary, partial, and compensatory resistance to NUCs was reported in 174 (32.9%) patients. Six different ADAPVEM motifs were determined in both treatment - naive and treatment - experienced patients, namely, sF161L/rtI169X, sE164D/rtV173L, sL172L/rtA181T, sL173F/rtA181V, sS195M/rtM204V, and sS196L/rtM204I. The prevalence of ADAPVEMs and typical HBsAg escape mutations was 5.3% (n = 28) and 34.8% (n = 184), respectively. Conclusions: The analysis of drug resistance should constitute a fundamental part of the follow - up period of patients with CHB undergone treatment with NUCs. The surveillance of development of drug resistance mutations, while receiving treatment for hepatitis B is of paramount importance to monitor and control the emerging resistance.

WOS: 000357330600005, PubMed: 26185714, Background: The use of pegylated interferon alpha and ribavirin (PegIFN/RBV) for the retreatment of chronic hepatitis C virus (HCV) infection without a sustained virological response (SVR) prior to PegIFN/RBV treatment has resulted in low success rates. Aims: To investigate the efficacy and safety of telaprevir (TVR) in combination with PegIFN/RBV in patients infected with HCV genotypes 1 and 4 who were previously treated with PegIFN/RBV and failed to achieve SVR. Study Design: Multi-center, retrospective, cross-sectional study. Methods: The study included 111 patients: 80 prior relapsers, 25 prior null responders, and six prior partial responders to PegIFN/RBV treatment. The patients were given TVR/PegIFN/RBV for 12 weeks, followed by a 12-week PegIFN/RBV treatment; virological response results were assessed at weeks 4, 12, and 24. Treatment was discontinued in patients with HCV RNA >1000 IU/mL at week 4 or with negative RNA results at week 4 but >1000 IU/mL at week 12. Rapid virological response (RVR), early virological response (EVR), extended rapid virological response (eRVR), and virological response at 24th week of treatment were evaluated. The side effects of combination therapy and the rates of treatment discontinuation were investigated. Results: The mean age of the patients was 56.02 +/- 9.96 years and 45.9% were male. Ninety-one percent of the patients were infected with viral genotype 1, 69.6% with the interleukin (IL) 28B genotype CT and 20.2% were cirrhotic. The RVR rate was 86.3% in prior relapsers, 56% in prior null responders, and 50% in prior partial responders (p=0.002). EVR rates in those groups were 91.3%, 56%, and 83.3%, respectively (p

Aims: Toll - like receptors ( TLR s) play a central role in initiating innate response by mediating inflammatory reactions against a wide range of pathogens. We aimed to determine if TLR2 Arg753Gln, TLR4 Asp299Gly and Thr399Ile polymorphisms are associated with chronic hepatitis B (HBV) infection. Study Design: A case - control study . Methodology: Genomic DNA was obtained from peripheral blood of 100 patients with chronic HBV infection and 108 healthy volunteer controls. The TLR2 and TLR4 polymorphisms were Original Research Article

This article describes the emergence of resistance and predictors of fatality for 1556 cases of healthcare-associated Gram-negative bloodstream infection in 2014 and 2015. The colistin resistance rate in Klebsiella pneumoniae was 16.1%, compared with 6% in 2013. In total, 660 (42.4%) cases were fatal. The highest fatality rate was among patients with Acinetobacter baumannii bacteraemia (58%), followed by Pseudomonas aeruginosa (45%), Klebsiella pneumoniae (41%), Enterobacter cloacae (32%) and Escherichia coli (28%). On multi-variate analysis, the minimum inhibitory concentrations for carbapenems [odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01-1.04; P = 0.002] and colistin (OR 1.1, 95% CI 1.03-1.17; P = 0.001) were found to be significantly associated with fatality. (C) 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved. WOS: 000426316700011 29248504 Q1

WOS: 000419248500008, Objective: Nosocomial infections (NI) are serious threats for patients, especially those treated in intensive care units (ICU), which have high risk. Therefore, determining the infectious agents in this area and treating the infections are crucial for both the prognosis of primary disease and the time of stay in hospital. In this study, we aimed to perform an active infection surveillance in the neurological ICU (NICU). Materials and Methods: Two hundred ninety-one patients who stayed in NICU over a twelve-month period were included in the study. Data obtained by infection control committee of our faculty according to "Centres for Disease Control and Prevention" diagnostic criteria were used for the diagnosis of NI. Isolated microorganisms and their systemic involvement were examined. Results: The infections in NICU constituted 6.39% of all NI in the hospital. These were skin and soft tissue infections (3.13%), bloodstream infections (9.38%), pneumonia not associated with mechanical ventilator (9.38%), pneumonia associated with mechanical ventilator (6.25%), and urinary tract infections (UTI) (71.88%). Fourteen different microorganisms were determined in the unit over the twelve months. Conclusion: Caution is advised regarding urinary catheter insertion and care because catheters are the most common cause of infection, UTI, in the ICU. Also, diagnosis of NI and determining the antibiotic sensitivity of the causal microorganisms are very important for the determination of empiric treatment and reducing mortality and morbidity.

WOS: 000419259100008, Objective: The objective of this study was to compare the anxiety, depression and quality of life scores of chronic hepatitis B (CHB) patients and inactive hepatitis B virus (HBV) carriers with healthy control subjects and to demonstrate the need for a multidisciplinary approach in the follow-up and treatment of patients with HBV infection. Methods: The study was carried out by comparing 200 subjects including 100 CHB patients and 100 inactive HBV carriers, who were admitted to the Outpatient Clinic of Infectious Diseases and Clinical Microbiology Department, Faculty of Medicine, Selcuk University between August 2013 and August 2014 with 100 healthy control subjects. All subjects were given Hospital Anxiety and Depression (HAD) Scale and Short Form-36 (SF-36) to assess their quality of life. Results: Based on the HAD Scale, anxiety risk among the carriers was higher than the control group (p=0.031). Depression risk in the patient (p=0.031) and carrier groups (p=0.046) were higher than the control group. There was no significant difference between the patient and carrier groups with regard to anxiety risk or depression risk (p>0.05). Females had higher anxiety risk in the patient (p=0.015), carrier (p=0.035) and control (p=0.001) groups. Depression risk was also higher in females in the patient (p=0.037) and carrier (p=0.038) groups. There were no significant relations between marital status, family type, place of living and anxiety and depression risks (p>0.05). Three quality of life parameters including general health, role limitations due to physical health and vitality scores in the inactive HBV carriers and CHB patients were lower than those of the control group (p

Malaria and salmonella infections are endemic especially in developing countries, however malaria and salmonella co-infection is a rare entity with high mortality. The basic mechanism in developing salmonella co-infection is the impaired mobilization of granulocytes through heme and heme oxygenase which are released from haemoglobin due to the breakdown of erythrocytes during malaria infection. Thus, a malaria infected person becomes more susceptible to develop infection with Salmonella spp. In this report a case with Plasmodium falciparum and Salmonella Typhi co-infection was presented. A 23-year-old male patient was admitted to hospital with the complaints of diarrhea, nausea, vomiting, abdominal pain, fatigue and fever. Laboratory findings yielded decreased number of platelets and increased ALT, AST and CRP levels. Since he had a history of working in Pakistan, malaria infection was considered in differential diagnosis, and the diagnosis was confirmed by the detection of P.falciparum trophozoites in the thick and thin blood smears. As he came from a region with chloroquine-resistant Plasmodium, quinine (3 x 650 mg) and doxycycline (2 x 100 mg/day) were started for the treatment. No erythrocytes, parasite eggs or fungal elements were seen at the stool microscopy of the patient who had diarrhoea during admission. No pathogenic microorganism growth was detected in his stool culture. The patient's blood cultures were also taken in febrile periods starting from the time of his hospitalization. A bacterial growth was observed in his blood cultures, and the isolate was identified as S. Typhi. Thus, the patient was diagnosed with P.falciparum and Salmonella Typhi coinfection. Ceftriaxone (1 x 2 g/day, 14 days) was added to the therapy according to the results of antibiotic susceptibility test. With the combined therapy (quinine, doxycycline, ceftriaxone) the fever was taken under control, his general condition improved and laboratory findings turned to normal values. However, on the fifth day of his anti-malaria therapy sudden bilateral hearing loss developed due to quinine use. Thus, the treatment was replaced with an artemisinin-based (arthemeter/lumefantrine) combination therapy. No adverse effects were detected due to artemisinin-based therapy, and the patient completely recovered. In conclusion, if a patient is diagnosed with malaria, he/she should be closely monitored in terms of having co-infections and appropriate diagnostic methods including blood cultures taken in febrile episodes should be performed.

Background In the present study, two epidemic episodes of extended spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae in the neonatal intensive care unit (NICU) were evaluated. Methods Routine and surveillance culture samples were taken from seven neonates with signs of infection in the NICU of Selcuk University Faculty of Medicine between 10 March and 25 April 2011, and between 11 June and 30 September 2011. Results ESBL-producing K. pneumoniae strains were isolated in six different samples (one wound, one blood, and four cerebrospinal fluid cultures) of the three neonates in the first episode and in 11 different samples (seven blood and four cerebrospinal fluid cultures) of the four neonates in the second episode. ESBL-producing K. pneumoniae was isolated from inguinal, axillar region, and stool samples of the nine colonized neonates in the second episode. It was determined on pulse field gel electrophoresis that all strains originated from two clones. Conclusions The deficiencies in the infection control measures in an NICU may transform into an epidemic rapidly. Therefore, periodic training, observation, and monitoring of compliance are important.

Otuziki yaşında erkek hasta acil servise sağ temporoparietal alanda 4x11 cm doku defekti ile getirildi. Beyin tomografisinde sağ parietal alanda doku defekti görüldü fakat kemik doku bütünlüğü korunmaktaydı. Kraniyal kemiklerin korunması amacıyla serbest flep operasyonu yapıldı. Hastaneden taburcu olduktan 2 ay sonra nekrotik görünümde kirli akıntılı yara ile başvurdu. Tomografide temporoparietal alanda kemik defekti görüldü. Ampirik antibiyotik tedavisi başlandı. İlk aşamada nekrotik dokular debride edilerek granülasyon dokusu oluşumu için hasta izlendi. Doku ve kemik kültüründe Pseudomonas aeruginosa üremesi saptandı. Patoloji sonuçları kronik osteomiyelit ile uyumlu geldi. Granülasyon dokusu gelişiminden sonra skalpten rotasyon flebi yapıldı. Hastanın antibiyotik tedavisi 6 haftaya tamamlandı. Altı hafta sonrasında 3 boyutlu tomografi görüntülemelerinde osteoblastik aktivite ve kemik oluşumu görüldü, A 32-year-old male came to the emergency room with a crescentric 4x11 cm tissue defect at the right temporo-parietal region. Brain tomography showed a tissue defect in the right parietal region but bone integrity was preserved. A free flap procedure was performed to protect the cranial bones. Two months after discharge from the hospital, he presented with a draining dirty wound that appeared necrotic. Computed tomography showed a bone defect in the temporoparietal area. Empiric antibiotic treatment was initiated. The necrotic tissues were debrided as a first step and the patient was followed for granulation tissue development. Pseudomonas aeruginosa was identified from soft tissue and bone samples. Pathology results were consistent with chronic osteomyelitis. A rotation flap from the scalp was prepared after granulation tissue development. The patient\'s antibiotic treatment was completed in 6 weeks. After 6 weeks, three dimensional computed tomography showed osteoblastic activity and bone formation.

Conference of the Asian-Pacific-Association-for-the-Study-of-the-Liver (APASL) -- MAR 12-15, 2014 -- Brisbane, AUSTRALIA, WOS: 000370967500005, PubMed: 26966614, Background: Before the introduction of direct-acting antivirals in the treatment of chronic hepatitis C patients, the combination of peginterferon alpha and ribavirin was the standard therapy. Observational studies that investigated sustained virological response (SVR) rates by these drugs yielded different outcomes. Aims: The goal of the study was to demonstrate real life data concerning SVR rate achieved by peginterferon alpha plus ribavirin in patients who were treatment-naive. Study Design: A multicenter, retrospective observational study. Methods: The study was conducted retrospectively on 1214 treatment naive-patients, being treated with peginterferon alpha-2a or 2b plus ribavirin in respect of the current guidelines between 2005 and 2013. The patients' data were collected from 22 centers via a standard form, which has been prepared for this study. The data included demographic and clinical characteristics (gender, age, body weight, initial Hepatitis C virus RNA (HCV RNA) level, disease staging) as well as course of treatment (duration of treatment, outcomes, discontinuations and adverse events). Renal insufficiency, decompensated liver disease, history of transplantation, immunosuppressive therapy or autoimmune liver disease were exclusion criteria for the study. Treatment efficacy was assessed according to the patient's demographic characteristics, baseline viral load, genotype, and fibrosis scores. Results: The mean age of the patients was 50.74 (+/- 0.64) years. Most of them were infected with genotype 1 (91.8%). SVR was achieved in 761 (62.7%) patients. SVR rate was 59.1% in genotype 1, 89.4% in genotype 2, 93.8% in genotype 3, and 33.3% in genotype 4 patients. Patients with lower viral load yielded higher SVR (65.8% vs. 58.4%, p=0.09). SVR rates according to histologic severity were found to be 69.3%, 66.3%, 59.9%, 47.3%, and 45.5% in patients with fibrosis stage 0, 1, 2, 3 and 4, respectively. The predictors of SVR were male gender, genotype 2/3, age less than 45 years, low fibrosis stage, low baseline viral load and presence of early virological response. SVR rates to each peginterferon were found to be similar in genotype 1/4 although SVR rates were found to be higher for peginterferon alpha-2b in patients with genotype 2/3. The number of patients who failed to complete treatment due to adverse effects was 33 (2.7%). The number of patients failed to complete treatment due to adverse effects was 33 (2.7%). Conclusion: Our findings showed that the rate of SVR to dual therapy was higher in treatment-naive Turkish patients than that reported in randomized controlled trials. Also peginterferon alpha-2a and alpha-2b were found to be similar in terms of SVR in genotype 1 patients., Asian Pacific Assoc Study Liver

In Behcet’s disease (BD) and Brucellosis, joint involvement is very common and it may share similarities with rheumatoid arthritis (RA). Anti-cyclic citrullinated peptides (CCP) are evaluated as more specific autoantibodies than rheumatoid factor (RF) in RA. The aim of this study is to determine whether anti-CCP antibodies are useful in the differential diagnosis of RA from other arthritis or not. 153 serum samples were used in the study; 34 from RA patients, 26 from brucellar arthritis, 20 from BD with arthritis, 41 from BD without arthritis and 32 from healthy controls. In vitro quantitative, anti-CCP levels were measured by using fluoroenzyme-immunoassay (FEIA) method. Among RA patients, 73.5% were anti-CCP-positive and 70.5% were RF-positive. While there was a statistical difference in the anti-CCP and RF positivity rates between RA and brucellar arthritis patients, BD patients and healthy controls (p = 0.0001), there was no statistical difference between BD patients with arthritis and BD patients without arthritis. Also none of the Brucellar arthritispatients was positive for anti-CCP antibodies, one of them were positive for RF. Our results indicate that anti-CCP antibodies are not associated with brucellar arthritis or BD with joint involvement and since they show high specificity and good sensitivity for RA, they can be evaluated as a better marker than RF especially for the differentiation of RA from other types of arthritis such as BD and brucellar arthritis. Key words: Rheumatoid arthritis, Behcet's disease, brucellar arthritis, anti-cyclic citrullinated peptide antibody, rheumatoid factor.

Türkiye’de bitkisel tedavilere bağlı toksik bulgulara pek sık rastlanmamaktadır. Olgumuz 33 yaşında bir bayan hastadır. Sarılık şikayeti ile başvuran olgunun yaklaşık iki haftadır, her gün Teucrium chamaedrys bitkisini içeren bir çayı aldığı öğrenilmiştir. Hastada akut ikterik hepatit bulguları saptanmış ve akut hepatit yapabilecek başka bir neden tespit edilememiştir. T. chamaedrys alımı sonlandırılıp takip edilen hastada klinik iyileşme izlenmiş ve yaklaşık dokuz hafta içinde serum bilirubin, aminotransferaz, alkalen fosfataz düzeyleri normal sınırlara düşmüştür. Bu olgu T. chamaedrys alımının akut ikterik hepatite neden olabileceği, klinik olarak akut viral hepatitleri taklit edebileceği ve bitkisel tedavilerin genel olarak kabul edildiği kadar güvenli olmadığını göstermektedir., Herbal medicine toxicity has been infrequently reported in Turkey. Our case describes a 33- year-old woman who applied with jaundice. She acknowledged that she was taking daily a tea containing the plant Teucrium chamaedrys for two weeks. It was determined she had symptoms of acute icteric hepatitis. Other causes of acute hepatitis were excluded. After T. chamaedrys was not taken anymore by the patient, she recovered clinically and her serum bilirubin, aminotransferases and alkaline phosphatase values returned to normal levels within 9-weeks. This case suggests that T. chamaedrys intake may cause acute icteric hepatitis which might clinically mimic acute viral hepatitis, and it shows that herbal medicines are not as safe as they have been generally assumed.

Tetanus is a preventable infectious disease caused by tetanus toxin (tetanospasmin) produced by Clostridium tetani. Tetanus is still an important health problem in low- and middle-income countries (LMICs). Botulinum toxin administration is a treatment approach that has been used in recent years to reduce rigidity and spasms in tetanus patients. This case report focuses on its efficacy.

Hydatid disease should always be kept in mind for the differential diagnosis of cystic soft-tissue tumors, even without specific findings.

Objectives. Aim of this study was to investigate pre-education information level, efficiency of training, persistence of acquired information, and factors affecting information level of recently employed nurses about healthcare associated infections. Methods. One hundred and thirty-two nurses who have just started work were trained about “healthcare associated infections and infection control measures”. Tests were performed pre, post training and one year after training. Factors affecting test success were investigated. Results. Nurses who continued education after high school were more successful ( p =0.002). Duration of work-hours, unit where they work and presence of previous training didn't affect test success ( p =0.705, p =0.040, p =0.105; respectively). Test results were assessed over 100 points. Mean score before the training was 67.95±10.5 and it increased to 85.06±7.6 after the training ( p =0.000). Mean test score at test repeated one year later was 80.04±8.77. Unit where they have worked during previous year, application of isolation in their unit and presence of training didn't affect general success in the test ( p =0.344, p =0.316, p =0.259; respectively). Conclusions. Training programs using individualized, regularly repeated and approved training methods should be conducted in accordance with needs determined by these studies. Next target after knowledge increase will be reflection of this increase to daily practice and behaviour change.

Primary hydatid cyst of the skeletal muscle is very rare and accounts for less than 1% of all cases. It is often asymptomatic and can pose diagnostic problems. Accurate diagnosis should be made using ultrasonography and magnetic resonance imaging. Proper treatment should be a wide surgical resection of the localized muscle with the aid of antihelmintic chemotherapy pre- and postoperatively. We report a case of primary hydatic cyst located simultaneously in both the biceps brachii and brachialis muscles, treated with wide resection surgery and pre- and postoperative anthelmintic chemotherapy.

Brucellosis is a chronic granulomatous infection and may present with various clinical manifestations. Brucellar spondylodiscitis symptoms are initially subtle and nonspecific. Annexin A2 (ANXA2) is involved in various biological functions, including osteoclast formation, bone resorption, and cell growth regulation. In this study, we aimed to determine the clinical significance of serum ANXA2 levels in acute brucellosis and brucellar spondylodiscitis. This prospective study included 96 acute brucellosis patients and 51 healthy controls. Acute brucellosis was diagnosed by a 1/160 or higher titer in a standard tube agglutination (STA) test or a four-fold increase in titers between two STA tests performed two weeks apart in the presence of clinical symptoms within the last eight weeks and/or growth of Brucella spp. in appropriately prepared culture media. ANXA2 levels were determined with an enzyme-linked immunosorbent assay (ELISA). Forty (41.7 %) of 96 acute brucellosis patients were male and 56 (58.3 %) were female. Serum ANXA2 levels were elevated in patients compared to healthy controls (p = 0.001). Eighteen of 96 (18.7 %) acute brucellosis patients had brucellar spondylodiscitis. The serum ANXA2 levels of patients with brucellar spondylodiscitis were higher than those of patients with acute disease without brucellar spondylodiscitis (p = 0.001). ANXA2, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) values were elevated in the brucellar spondylodiscitis group compared to patients without brucellar spondylodiscitis. Serum ANXA2 measurement together with ESR and CRP is thought to be indicative in the diagnosis of brucellar spondylodiscitis, a common complication of brucellosis.

WOS: 000209704000948, …

To evaluate the early retinal changes and its reflection on the visual field examination in chronic hepatitis B (CHB) patients using pegylated interferon-α (PEGIFN-α) monotherapy.Thirty eyes of fifteen patients with CHB were examined prospectively for changes in the fundus examination and visual field examination (both Humphrey Perimetry and Frequency Doubling Perimetry). The patients were examined before and in 3 months intervals after starting the PEGIFN-α treatment. The changes in the fundus examination were noted and the visual field examinations, retinal nerve fiber thickness, Schirmer scores and color vision before and at 3 months of the treatment were compared. The statistical evaluation was performed with paired-t test, using SPSS 16.0 Inc. (Chicago, IL).The mean age of the 15 patients (seven male, eight female) was 52.5 ± 12.4 years. There was no significant retinal change in none of the patients. Neither the visual field examination with Humphrey Field Analyzer nor the Frequency Doubling Perimetry results has demonstrated any significant change during 3 months follow-up. There was a statistically significant increase in the retinal nerve fiber layer (RNFL) thickness; while Schirmer test scores for dry eye assessment was significantly decreased.PEGIFN-α monotherapy, which is used for treatment of CHB, may cause some changes in the thickness of RNFL that may necessitate the close follow-up for further morphological changes of the optic disc in these patients.

WOS: 000322126500008, PubMed: 24032040, Background: Serum apoptotic cytokeratine 18 neoepitope M30 (CK-18 M30) and matrix metalloproteinase 2 (MMP-2) have been popular markers for detecting liver fibrosis in recent years. CK-18 is a major intermediate filament protein in liver cells and one of the most prominent substrates of caspases during hepatocyte apoptosis. MMP-2 plays an important role in tissue remodeling and repairing processes during physiological and pathological states. Objectives: The objective of this study was to investigate the significance of CK-18 M30 and MMP-2 levels for clinical use in patients with chronic hepatitis B (CHB), as well as their sensitivity in determining cirrhotic patients. Patients and Methods: This study included 189 CHB patients and 51 healthy controls. A modified Knodell scoring system was used to determine the fibrosis level in chronic hepatitis B patients. CK-18 M30 levels were determined with an M30-Apoptosense ELISA assay. MMP-2 levels were determined with the ELISA assay. Results: The study group consisted of 132 (69.8%) males and 57 (30.2%) females, and the control group consisted of 25 males (49.0%) and 26 females (51%). Patients' CK-18 M30 levels were higher than values of the control group (308 [1-762] vs. 168 [67-287], P=0.001). Serum MMP-2 levels were found to be statistically higher in the patient group with respect to the controls (3.0 [1.1-6.8] vs. 2.0 [1.2-3.4], P=0.001). The highest serum CK-18 M30 and MMP-2 levels were measured in patients with cirrhosis. Serum apoptotic CK-18 M30 levels positively correlated with advanced age, fibrosis stage, serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels (P=0.001, 0.033, 0.001, and 0.001, respectively). Serum MMP-2 levels positively correlated with fibrosis stage, serum ALT, and AST levels (P=0.001, 0.001, and 0.001, respectively). Conclusions: Our study indicated that CK-18 M30 and MMP-2 levels were higher in CHB patients compared to healthy controls and they were in association with significant hepatic fibrosis, especially cirrhosis.

WOS: 000296752100014 PubMed: 21934508 Objective The aim of this study was to demonstrate the relation between intrahepatic (IH) hepatitis B virus (HBV) covalently closed circular DNA (cccDNA) levels and the other HBV replicative intermediates and hepatocyte expression of HBV antigens. Patients and methods Patients with hepatitis B surface antigen (HBsAg) positivity, hepatitis B early antigen negativity, serum HBV DNA levels 10(4) copies/ml or more, and constantly or intermittently increased alanine aminotransferase levels were included. Results Fifty-nine patients were included. There was a good correlation between the levels of IH HBV cccDNA and serum HBV DNA (P

Genital tuberculosis is a major cause of infertility in countries where tuberculosis is endemic. With recent advances in assisted reproductive technology, women with tuberculous endometritis may become pregnant and ultimately have children with congenital tuberculosis. In vitro fertilisation represents a useful treatment for infertility. Congenital tuberculosis is a rare and severe, rapidly progressive, disease. Making an early diagnosis of congenital tuberculosis is difficult, because it can mimic many neonatal illnesses. To the best of our knowledge, we report the first cases of premature twins with congenital tuberculosis following in vitro fertilisation. After the diagnosis of genital tuberculosis in the mother, the twins were screened and diagnosed for tuberculosis. The twins dramatically improved after anti-tuberculosis therapy. We also wish to draw attention to the importance of searching for genital tuberculosis as the possible cause of congenital infection, even if the mother is asymptomatic.

Mycobacterium tuberculosis, en sık pulmoner tutulumla seyreden ve halen dünyada yaygın olarak görülmeye devam eden bir en- feksiyon hastalığıdır. Ekstrapulmoner tüberküloz tüm tüberküloz vakalarının %15-20'sini oluştururken, abdominal tüberküloz ise ekstapulmoner tüberküloz olgularının yalnızca %3'ünü kapsar. Bu yazıda yüksek ateş, halsizlik, iştahsızlık şikayetleri ile başvuran, dirençli ateşin nedenini bulmaya yönelik yapılan araştırmalar sırasında izole karaciğer ve dalak tutulumu saptanan bir tüberküloz olgusu sunulmuştur, Mycobacterium tuberculosis is an infectious disease which progresses mostly with pulmonary involvement and continues to be seen extensively worldwide. While extrapulmonary tuberculosis comprises 15-20% of all tuberculosis incidences, abdominal tuberculosis comprises only 3% of extrapulmonary tuberculosis cases. This paper presents a case of tuberculosis where the patient had complaints of high fever, weariness and loss of appetite and was diagnosed with isolated liver and spleen involvement during the examinations carried out to find the reason for such resistant high fever

WOS: 000188766800007, PubMed: 14765143, Study design: Prospective analysis. Objectives: To investigate the colonization of the distal urethra and bladder during the initial stages of rehabilitation in acute spinal-cord injury(SCI) and to examine the association between bacteriuria and colonization of the distal urethra. Setting: Selcuk University Meram Faculty of Medicine, Konya, Turkey. Methods: A total of 27 patients with SCI (13 females and 14 males) and 40 controls without evidence of disease of the urinary tract were studied. Cultures were taken from the patients who applied clean intermittent catheterization and compared with normal subjects. Results: Escherichia coli was predominantly isolated from the urine and urethral cultures of both female and male SCI patients. Colonization of other bacteria in the urine and urethral cultures was similar in both female and male patients, except for Pseudomonas, which was colonized in male patients. In all, 72% of patients who had E. coli positive urethral cultures also had E. coli colonization in their simultaneous urine cultures. There was concordance between urethra and urine cultures concerning the growth of E. coli (P=0.82). When urethral cultures collected 1 week before were evaluated in patients with E. coli positive urine cultures (n=24 cultures), 15 of these urethral cultures also had E. coli colonization. There was concordance between urethra and urine cultures concerning the growth of E. coli (P=0.66). Conclusions: Our study suggested that urethral. ora was a significant source for the development of urinary infection in spinal cord-injured patients.

Study design A case report of rarely seen extradural brucellosis granuloma causing spinal root compression in the lumbar region. Objective To point out the possibility of extradural compression caused by brucellosis. Summary of background data Many investigators have indicated that myelopathy or radiculopathy caused by irritation or compression by tiny abscess, disc herniation, or extradural granuloma may occur in brucellosis. Failure to make the correct diagnosis is possible because of the absence of such symptoms of brucellosis as fever, sweating, or fatigue and because findings of physical examination, radiography, and myelography indicate intervertebral disc herniation. Methods Review and discussion of the case history are presented. Results Brucella granuloma compressing the right L5 root and dural sac was diagnosed on computed tomographic scans and was excised subtotally after laminectomy and facetectomy. Conclusion The possibility of extradural compression caused by brucellosis should be considered in endemic areas and must be differentiated from an intervertebral disc herniation by means of agglutination testing and bone scan.