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Amaç: Santral sinir sistemi enfeksiyonları, acil tanı ve tedavi gerektiren morbidite ve mortalitesi yüksek enfeksiyonlardır. Hastanemizde takip edilen toplum kaynaklı santral sinir sistemi (SSS) enfeksiyonları irdelenerek hasta yönetiminde yardımcı olmak amaçlanmıştır.Yöntem: Ümraniye Eğitim ve Araştırma Hastanesi’nde 2013 ve 2020 yılları arasında SSS enfeksiyonu tanısı konan 56 hasta retrospektif olarak değerlendirildi. Bulgular: Yedi yıl içinde SSS enfeksiyonu tanısı konan 56 hastanın klinik sınıflaması incelendi. En sık akut pürülan menenjit (%51.8), ikinci sırada aseptik menenjit-ensefalit (%35.7) ardından tüberküloz menenjiti (%12.5) olduğu görüldü. Akut pürülan menenjit hastalarının %82.9’unda BOS kültürü sterildi. Bos kültüründe üreme olan hastalarda S. pneumonia (%10.3) ve E. coli (%6.8) saptandı. Aseptik menenjit ve ensefalitte %10 oranında HSV1 PCR pozitifliği mevcuttu. Başvuru esnasında klinik ayırım yapılamadığı için ampirik olarak antiviral ve antibiyotik tedavisi beraber başlanan hasta oranı %21.4 idi.Sonuç: Çalışmamızda başvuru esnasında ensefalit ve menenjit ayrımı yapılamayan hastaların oranı dikkati çekicidir. Ayrıca hastaların çoğunluğunda etkenin izole edilemediği görülmüştür. Genel olarak kullanılan ampirik tedavilerin etken izolasyonunu etkileyebileceği kanaatine varılmıştır. Hastaların yönetiminde SSS enfeksiyonlarına neden olan etkenlerin dağılımının bilinmesi ampirik tedavi seçiminde yol gösterici olmaktadır.

Objective: Frontline healthcare workers (HCW) exposed to coronavirus disease-2019 (COVID-19) patients at their work environment are at a higher risk of acquiring the disease. The aim of this study was to research the COVID-19 risks due to the occupational exposure of HCW and the clinical characteristics of the affected. Material and Methods: In this retrospective study, HCW, employed by The Umraniye Research and Training Hospital, who were diagnosed with COVID-19 between 20th March 2020 to 20th May 2020 were analysed. Results: A total of 128 (3.8%) HCW were diagnosed with COVID-19. Most of the infected HCW were medical staff (34%), nurses (24%), physicians (22%) and staff with no patient contact (20%). Fifty-six percent of the infected HCW were working in COVID-19 wards and out-patient clinics. Twenty-nine percent acquired the infection in hospital from an index patient and 32% of them from an infected HCW. The highest transmission was during the sharing of the same environment (53%) like offices. Thirteen per cent of the HCW took the virus during examination or treatment, 31% of the individuals were unaware of the transmission. The number of the infected HCW was higher during the beginning of the outbreak in Turkey. The symptomatic cases were more (88%) than the asymptomatic cases (12%). A total of 28 (22%) HCW were hospitalised and only 4% of the cases were severe. Conclusion: The asymptomatic COVID-19 carrying HCW are to be considered as the source of the spread of the disease among their colleagues. Stricter measures should be implemented to prevent in-hospital transmission. © 2021 by Turkiye Klinikleri.

Introduction The human population is aging at an astonishing rate. The aim of this study is to capture a situation snapshot revealing the proportion of individuals aged 65 years and over among inpatients in healthcare institutions in Turkey and the prevalence and type of infections in this patient group in order to draw a road map. Materials and Methods Hospitalized patients over 65 years at any of the 62 hospitals in 29 cities across Turkey on February 9, 2017 were included in the study. Web-based SurveyMonkey was used for data recording and evaluation system. Results Of 17,351 patients 5871 (33.8%) were ≥65 years old. The mean age was 75.1 ± 7.2 years; 3075 (52.4%) patients were male. Infection was reason for admission for 1556 (26.5%) patients. Pneumonia was the most common infection. The median length of hospital stay was 5 days (IQR: 2–11 days). The Antibiotic therapy was initiated for 2917 (49.7%) patients at the time of admission, and 23% of the antibiotics prescribed were inappropriate. Healthcare-associated infections developed in 1059 (18%) patients. Urinary catheters were placed in 2388 (40.7%) patients with 7.5% invalid indication. Conclusion This study used real data to reveal the proportion of elderly patients in hospital admissions. The interventions done, infections developed during hospitalization, length of hospital stay, and excessive drug load emphasize the significant impact on health costs and illustrate the importance of preventive medicine in this group of patients.

OBJECTIVE: Turkey is one of the latest countries that COVID-19 disease was reported, with the first case on March 11, 2020, and since then, Istanbul became the epicenter of the pandemic in Turkey. Here, we reveal sequences of the virus isolated from three different patients with various clinical presentations. METHODS: Nasopharyngeal swab specimens of the patients were tested positive for the COVID-19 by qRT-PCR. Viral RNA extraction was performed from the same swab samples. Amplicon based libraries were prepared and sequenced using the Illumina NextSeq platform. Raw sequencing data were processed for variant calling and generating near-complete genome sequences. All three genomes were evaluated and compared with other worldwide isolates. RESULTS: The patients showed various clinics (an asymptomatic patient, patient with mild disease, and with severe pulmonary infiltration). Amplicon-based next-generation sequencing approach successfully applied to generate near-complete genomes with an average depth of 2.616. All three viral genomes carried the D614G variant (G clade according to GISAID classification) with implications for the origin of a spread first through China to Europe then to Istanbul. CONCLUSION: Here, we report the viral genomes circulating in Istanbul for the first time. Further sequencing of the virus isolates may enable us to understand variations in disease presentation and association with viral factors if there is any. In addition, the sequencing of more viral genomes will delineate the spread of disease and will guide and ease the necessary measures taken to stem the spread of the novel coronavirus.

Background: As the Modified Anticoagulation and Risk Factors in Atrial Fibrillation Risk Score (M-ATRIA-RS) encompasses prognostic risk factors of novel coronavirus-2019 (COVID-19), it may be used to predict in-hospital mortality. We aimed to investigate whether M-ATRIA-RS was an independent predictor of mortality in patients hospitalized for COVID-19 and compare its discrimination capability with CHADS, CHA2DS2-VASc, and modified CHA2DS2-VASc (mCHA2DS2-VASc)-RS. Methods: A total of 1,001 patients were retrospectively analyzed and classified into three groups based on M-ATRIA-RS, designed by changing sex criteria of ATRIA-RS from female to male: Group 1 for points 0–1 (n = 448), Group 2 for points 2–4 (n = 268), and Group 3 for points ?5 (n = 285). Clinical outcomes were defined as in-hospital mortality, need for high-flow oxygen and/or intubation, and admission to intensive care unit. Results: As the M-ATRIA-RS increased, adverse clinical outcomes significantly increased (Group 1, 6.5%; Group 2, 15.3%; Group 3, 34.4%; p

Background: The current knowledge about novel coronavirus-2019 (COVID-19) indicates that the immune system and inflammatory response play a crucial role in the severity and prognosis of the disease. In this study, we aimed to investigate prognostic value of systemic inflammatory biomarkers including C-reactive protein/albumin ratio (CAR), prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in patients with severe COVID-19. Methods: This single-center, retrospective study included a total of 223 patients diagnosed with severe COVID-19. Primary outcome measure was mortality during hospitalization. Multivariate logistic regression analyses were performed to identify independent predictors associated with mortality in patients with severe COVID-19. Receiver operating characteristic (ROC) curve was used to determine cut-offs, and area under the curve (AUC) values were used to demonstrate discriminative ability of biomarkers. Results: Compared to survivors of severe COVID-19, non-survivors had higher CAR, NLR, and PLR, and lower LMR and lower PNI ( P < .05 for all). The optimal CAR, PNI, NLR, PLR, and LMR cut-off values for detecting prognosis were 3.4, 40.2, 6. 27, 312, and 1.54 respectively. The AUC values of CAR, PNI, NLR, PLR, and LMR for predicting hospital mortality in patients with severe COVID-19 were 0.81, 0.91, 0.85, 0.63, and 0.65, respectively. In ROC analysis, comparative discriminative ability of CAR, PNI, and NLR for hospital mortality were superior to PLR and LMR. Multivariate analysis revealed that CAR (⩾0.34, P = .004), NLR (⩾6.27, P = .012), and PNI (⩽40.2, P = .009) were independent predictors associated with mortality in severe COVID-19 patients. Conclusions: The CAR, PNI, and NLR are independent predictors of mortality in hospitalized severe COVID-19 patients and are more closely associated with prognosis than PLR or LMR.

Objective: This study aimed to identify the effect of tocilizumab (TCZ) on clinical outcomes in severe COVID-19 patients. Material and Methods: We included hospitalized COVID-19 patients with an initial WHO scale ≥4. We matched the patients with baseline characteristics by using propensity scores. Then, we selected patients with C-reactive protein levels above 30 and showing an upward trend. We assessed the effect of TCZ in patients on clinical outcomes by using Mann – Whitney U and Chi-square tests. Results: Of 200 patients who had an initial WHO scale ≥ 4, 42 (21%) were given TCZ in addition to standard of care (SOC). Twentyfive patients (50%) needed mechanical ventilation (MV) in the TCZ group, compared with 35 (21%) of 158 patients with SOC (p

To describe the change in the epidemiology of health care-associated infections (HAI), resistance and predictors of fatality we conducted a nationwide study in 24 hospitals between 2015 and 2018. The 30-day fatality rate was 22% in 2015 and increased to 25% in 2018. In BSI, a significant increasing trend was observed for Candida and Enterococcus. The highest rate of 30-day fatality was detected among the patients with pneumonia (32%). In pneumonia, Pseudomonas infections increased in 2018. Colistin resistance increased and significantly associated with 30-day fatality in Pseudomonas infections. Among S. aureus methicillin, resistance increased from 31 to 41%. WOS:000617831800002 2-s2.0-85101454721 PubMed: 33586014

SummaryCOVID-19 is a viral respiratory disease caused by SARS-CoV-2 infection. Global efforts of genomic surveillance of the virus give chance to track the spread of the pandemic. Global emergence of some viral mutations called attention and various studies have been suggested about increased infectivity of the virus. Herein, we sequenced viral genomes isolated from 184 patients in Istanbul and analyzed clinical metadata for the investigation of any viral mutation which affects the disease course of the host. We did not detect any viral mutations affecting the disease outcome in our cohort. Besides, we observed intra-host mutations in 76% of the isolates. Insertion/deletion and stop-gain mutations are also significantly less common among intra-host variants compared to consensus viral genome mutations. Longitudinal genomic surveillance is essential for timely detection of any lineages that might affect clinical outcome, the performance of diagnostic assays, or even the immunological escape of the virus.

INTRODUCTION[|]To evaluate the prevalence of Toxoplasma gondii, rubella and cytomegalovirus (CMV) among the pregnant Turkish women as well as Syrian refugees in Istanbul.[¤]METHODS[|]Among pregnant women who are admitted to \\\"xxxx\\\" Maternity and Children Hospital in İstanbul between January 2014 and January 2015, antibodies against Toxoplasma gondii, rubella and CMV were measured using the micro-elisa method. The test results were evaluated retrospectively.[¤]RESULTS[|]Out of total 1066 pregnant women screened in this study, 963 (90.3%) were Turkish, and 103 (9.7%) were Syrian refugees. IgM positivity rates of T. gondii rubella and CMV were determined as 0,2%, 0%, 0,2% in Turkish women and 0,1%, 0%, 0% in Syrian refugees, IgG positivity rates were determined as 26,3%, 93,8%, 99,5% in Turkish women and 58,3%, 87,4%, 100% in Syrian refugees. The seroprevalence of T. gondii was lower and the rubella seroprevalence was higher among pregnant Turkish women and among pregnant Syrian refugees and statistically significant ( p< 0.05).[¤]DISCUSSION AND CONCLUSION[|]Since immunity against T. gondii in pregnant Turkish women is lower than in Syrian refugees, who are in reproductive age group, should get routine screenings. Immunization against rubella should be considered for Syrian refugees who are in reproductive age group. [¤]

INTRODUCTION[|]Hyperbaric oxygen therapy (HBOT) is a medical treatment method applied by intermittently breathing 100% oxygen and a commonly used supportive therapy for patients with diabetic foot ulcer (DFU). Our study aimed to evaluate the efficacy of HBOT in patients with DFU. [¤]METHODS[|]Thirty patients with HBOT and 42 patients without HBOT who were followed-up between 2016 and 2018 in our hospital were randomly selected and the epidemiologic, clinical characteristics of both groups, clinical outcomes of the patients were compared at the end of treatment.[¤]RESULTS[|]26 patients (86.7%) in the HBOT group and 14 patients (33.3%) in the non-HBOT group were PEDIS 3-4 (p = 0.000). The rates of re-hospitalization were significantly higher in the HBOT group (p = 0.005). Major and minor amputations were found to be similar in both groups, but in the HBOT group (p = 0.035 vs. p = 0.128). [¤]DISCUSSION AND CONCLUSION[|]In our study, it was thought that the rate of recurrent hospitalization and the need for surgical intervention in HBOT receiving group may be related to the presence of advanced stage of diabetic foot ulcers (DFU) in these patients. Amputation rates are similar in both groups and randomized, multicentre prospective studies are needed to evaluate HBOT efficacy. [¤]

Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases convened a meeting to develop a consensus report on management of chronic hepatitis in special hosts and special situations. Relevant literature and international guidelines were reviewed, and recommendations agreed are presented at the end of each section such as therapy of chronic hepatitis B (CHB) in patients with compensated and decompensated cirrhosis, prevention and therapy of recurrent hepatitis B after liver transplantation, management of fulminant hepatitis B, therapy of CHB in hemodialysis patients, management of CHB in nonliver solid organ transplant recipients, management of CHB in immunosuppressed nontransplant patients, therapy of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfection, management of HBV and hepatitis C virus (HCV) coinfection, management of CHB in alcoholic patients and injecting drug users, therapy of CHB in pregnancy and lactation period, extrahepatic manifestations in HBV infection, HBV, HCV and hepatitis D virus coinfection, therapy of chronic hepatitis C (CHC) in patients with compensated and decompensated cirrhosis, treatment of patients with recurrent HCV infection following liver transplantation, therapy of CHC in hemodialysis patients, management of CHC in nonliver solid organ transplant recipients, therapy of HCV, HBV and HIV coinfection, management of CHC in immunosuppressed nontransplant patients, HCV infection and biological agents, HCV infection and chemotherapy, management of CHC in alcoholic patients and injecting drug users, fatty liver and CHC, hemoglobinopathy and CHC, CHC in pregnancy and lactation period, extrahepatic manifestations in HCV infection. Klimik Dergisi © 2014, AVES Ibrahim Kara. All rights reserved.