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

Introduction: Secondary Bacterial Infections (SBIs) of the respiratory system are one of the biggest medical concerns in patients undergoing hospitalization with a diagnosis of COVID-19. This study aims to provide relevant data for the initiation of appropriate empirical treatment after examining the etiology and antimicrobial resistance of SBIs in COVID-19 patients under care in the Intensive Care Units (ICUs) in the largest pandemic hospital of our country. Methodology: Between March 16, 2020 and December 31, 2021, 56,993 COVID patients were hospitalized, of which 7684 were admitted to ICUs. A total of 1513 patients diagnosed with SBIs have been included in this study. During the course of the study, demographic data, clinical course, etiology and antimicrobial resistance data of all patients were collected. Results: The most common causative agents of SBIs were inferred as Acinetobacter baumanii (35.1%), Staphylococcus aureus (15.2%), Klebsiella pneumoniae (12.3%) and Pseudomonas aeruginosa (10.4%). The isolation rates of carbapenem-resistant and colistin-resistant A. baumannii, K. pneumoniae and P. aeruginosa were 83.7%; 42.7%, 79.2%, and 5.6%, 42.7%, 1.7%, respectively. Acinetobacter pittii clustering was seen in one of the ICUs in the hospital. Multidrug resistant 92 (5.4%) Corynebacterium striatum isolates were also found as a causative agent with increasing frequency during the study period. Conclusions: SBI of the respiratory system is one of the major complications in patients hospitalized with COVID-19. The antimicrobial resistance rates of the isolated bacteria are generally high, which indicates that more accurate use of antibacterial agents is necessary for SBIs in patients hospitalized with COVID-19 diagnosis.

Objective: In this study, it was aimed to evaluate the healthy and infected area volumes and elementary lesion characteristics in thorax computed tomography examinations of mild-moderate and severe patient groups according to the clinical severity scoring determined by the World Health Organization, and to compare the obtained findings with laboratory and clinical data.Material and Methods: A total of 100 cases (59 males, 41 females; age range 18-95 years) were retrospectively and randomly selected from the patients who had non-contrast thoracic computed tomography scan and were diagnosed with Covid-19 pneumonia by reverse transcription polymerase chain reaction test. According to clinical severity scoring, patients were classified as mild-moderate and severe groups. Volumetric measurements were made in the lungs using quantitative analyses. In addition, lesion characteristics (ground glass opacity, consolidation, air bronchogram) in the infiltration areas were recorded. The relationship between radiological findings and clinical-laboratory data was statistically evaluated.Results: The age of the patients ranged between 58.80±14.74 years; 52% of the cases were in the severe category, 48% of them were in the mild-moderate category. Lung volumes did not differ significantly between disease groups. According to computed tomography findings, there was a statistically significant correlation between subpleural reticulations and air bronchogram and disease groups. IL-6, D-dimer, ferritin, neutrophil lymphocyte ratio and C-Reactive Protein values were higher in the severe disease group than in the mild-moderate group.Conclusion: Volumetric values associated with laboratory parameters are thought to be an important indicator of the immune response that determines the course of the disease.

Patients with coronavirus disease 2019 (COVID-19) might be at risk for pulmonary aspergillosis. The role of computerised tomography in early diagnosis, prediction of disease severity and managing of COVID-19 patients is critical. Herein, we presented pulmonary aspergillosis in a COVID-19 patient diagnosed and followed-up with computerised tomography imaging.

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

Background In this study, we aimed to compare the intensive care unit (ICU) admission rate of hospitalized mild/moderate COVID-19 patients treated with hydroxychloroquine (HCQ), favipiravir, and HCQ plus favipiravir. Methods Single center retrospective designed observational study conducted in Ankara City Hospital. Patients who were hospitalized between March 15, 2020 and June 1, 2020 in COVID-19 inpatient clinics with laboratory confirmed diagnosis of COVID-19 were included in the study. An inverse probability of treatment weighting (IPTW) for multiple treatment groups approach was used to balance the differences in several variables on admission. Results Among 2441 patients hospitalized with diagnosis of COVID-19 during the study period, 824 were eligible for the analysis. Median age of patients was 42 (18−93 years). Among all, 347 (43.2%) of the patients had mild disease, 470 (56.8%) had pneumonia. Propensity scores ranged from 0.1841 to 0.9381 in the HCQ group, from 0.03643 to 0.29885 in the favipiravir group, and from 0.03542 to 0.56184 in the HCQ plus favipiravir group. After IPTW for multiple treatment groups was applied, all the covariates in the planned propensity score had weighted standardized effect sizes below 10% which were ranged from 0.005 to 0.092. Multivariate analysis of treatment effect (adjusted effect of treatment) was indicated that there is no statistically significant difference between HCQ, favipiravir, and HCQ plus favipiravir treatment. After using combination of SMOTE and Bootstrap resampling approach, we found no statistically significant difference between HCQ and HCQ plus favipiravir groups in terms of ICU admission. However, compared with the HCQ group, ICU admission rate was statistically significantly higher in the favipiravir group. We obtained the similar results after the sensitivity analysis. Conclusions HCQ with or without favipiravir treatment is associated with reduced risk of ICU admission compared to favipiravir alone in mild to moderate COVID-19 adult patients.

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

Comamonas testosteroni is a gram-negative bacillus, known before 1987 as Pseudomonas testosteroni. Although considered as a rare pathogen, its frequency has been increasing. Data regarding its antibiotic susceptibility are insufficient. To date, forty-four cases have been reported in the literature. In this study, we identified the C. testosteroni infections observed in our hospital and evaluated their antimicrobial agent susceptibility patterns compared with cases reported in the literature.For the purposes of the present study, patients admitted to hospital between November 2019 and December 2020 were screened. Those with clinical and laboratory signs of infection with positive C. testosteroni growth in culture were enrolled. Clinical isolates obtained from the samples processed in accordance with standard microbiological examination procedures in our laboratory were defined by MALDI-TOF mass spectrometry with 99.9% probability as C. testosteroni.C testosteroni infection was detected between November 2019 and December 2020 in eight patients in our hospital. Six of them had a bloodstream infection (BSI), one had pneumonia, and one had urinary tract infection due to C. testosteroni. Coexistence of COVID-19 was detected in four patients. Six out of the eight cases with BSI had hospital-acquired infection and all of the infections were healthcare-associated. When antimicrobial agent susceptibility results reported in the literature were evaluated in combination with the current results, ceftazidime and meropenem were found to be the most susceptible agents (96.1% and 80%, respectively).The frequency of nosocomial C. testosteroni infections and resistance to antimicrobial agents are gradually increasing. While resistance to carbapenems is on the upswing, third-generation cephalosporins are still seen as suitable treatment options.

Liver transplant recipients have been reported to be a high-risk population for severe disease from COVID-19 infection. In this crosssectional, single-center study, we investigated whether liver transplant increased the risk of death and severe disease in patients with SARS-CoV-2 infection.We collected data and serum anti-SARS-CoV-2 immunoglobulin M and immunoglobulin G results of 91 liver transplant recipients seen from September 2020 to March 2021. Liver transplant recipients were enrolled during presentation for scheduled routine follow-up visits. All patients who required serum anti-SARS-CoV-2 immunoglobulin M and immunoglobulin G tests completed a ques-tionnaire on clinical symptoms during the previous 6 months.Among the 91 patients with SARS-CoV-2 immunoglobulin M and G results, 7 patients had a known history of symptomatic COVID-19 during the previous 6 months. Of the 84 participants who completed the questionnaire, 21 (25%) had positive anti-SARS-CoV-2 immunoglobulin M and G results. These 21 patients also received COVID-19 polymerase chain reaction tests, which were negative in all 21 patients. Overall, only 7 patients stated that they experienced flu-like upper respiratory tract infection symptoms or diarrhea.We documented past SARS-CoV-2 infection in only 25% of our outpatient liver transplant recipients, and most were asymptomatic. We found no significant relationship between symptoms and seropositivity for SARS-CoV-2.

Studies regarding effectiveness of anakinra and tocilizumab treatments in coronavirus disease 2019 (COVID-19) have contradictory results. Furthermore, there is scarce comparative data regarding superiority of any agent. To further elucidate any superiority between these two agents, we retrospectively investigated and compared outcomes in hospitalized COVID-19 patients of our inpatient cohort who received anakinra or tocilizumab.This study was designed as a single-center, retrospective, cross-sectional cohort study. Hospitalized patients with confirmed diagnosis of COVID-19 who had Brescia-COVID respiratory severity scale score ≥3 and hyperinflammation (defined as elevation of C reactive protein ≥50 g/L or ferritin ≥700 ng/mL) and received anakinra or tocilizumab in addition to standard care were enrolled in the study. Length of hospital stay after initiation of antiinflammatory treatment, need for mechanical ventilation, need for intensive care unit admission, mortality were set as primary outcomes and compared between tocilizumab and anakinra recipients after propensity score matching.One hundred and six patients were placed in each group after propensity score matching. In the anakinra group, relative risk reduction for intensive care unit admission was 50% when compared to the tocilizumab group and the number needed to treat to avert an intensive care unit admission was 3 (95% CI, 2-5). In terms of mortality, a 52% relative risk reduction was observed with anakinra treatment and the number needed to treat to avert an intensive care unit admission was 8 (95% CI, 4-50). Significantly more patients were observed to receive glucocorticoids in the anakinra group.Anakinra administration in severe COVID-19 patients was significantly associated with better survival and greater clinical improvement compared to the tocilizumab administration in our study. Increased rate of glucocorticoid use in the anakinra group might have contributed to better outcomes.

Comamonas testosteroni is a Gram- negative, aerobic, motile, non-spore-forming bacillus. It has not been recognized as a component of the endogenous human microflora. Due to its ability to survive in liquid environments, it can survive for a long time in a hospital environment and cause opportunistic infections. Although rare, C. testosteroni has been reported as a cause of cellulitis, peritonitis, endocarditis, meningitis, endophthalmitis, tenosynovitis, pneumonia and bacteremia. Here, we present a case of a 4-year-old girl who was operated on for persistent cloaca with C. testosteroni isolated in her urine culture. Identification studies were performed by MALDI-TOF MS (bioMerieux, France) mass spectrophotometer method. Antibiotic susceptibility tests were performed with the automatic device VITEK-2 Compact (bioMérieux, France). Microorganism was found susceptible to ceftazidime and ciprofloxacin; intermediate susceptible to meropenem and piperacillin / tazobactam and resistant to gentamicin, amikacin, imipenem and trimethoprim-sulfamethoxazole. With this case report, C. testosteroni was reported as the first cause of urinary tract infection in our country and the third in the world.

Aim: COVID-19 is a pandemic that causes high morbidity and mortality, especially in severe patients. In this study, we aimed to search and explain the relationship between biochemical markers, which are more common, easily available and applicable to diagnose and to stage the disease. Materials & methods: In this study, 609 patients were evaluated retrospectively. 11 biochemical parameters were included in analysis to explain the relationship with severity of disease. Results: Nearly, all the parameters that have been evaluated in this study were statistically valuable as a predictive parameter for severe disease. Areas under the curve of blood urea nitrogen (BUN)/albumin ratio (BAR), CALL score and lymphocyte/C-reactive protein ratio were 0.795, 0.778 and 0.770. The BUN/BAR and neutrophil/albumin ratios provide important prognostic information for decision-making in severe patients with COVID-19. Conclusion: High BUN/BAR and neutrophil/albumin ratios may be a better predictor of severity COVID-19 than other routinely used parameters in admission., Graphical abstract

Objective: This study aimed to evaluate the clinical presentations, outcomes, and changes over 8 years period of infective endocarditis (IE) patients in a tertiary hospital in Turkey and to identify predictors of mortality.Materials and Methods: All adult patients who were hospitalized with a diagnosis of definite IE were included in the study. The data were analyzed both collectively and separately in two consecutive four-year periods i.e. 2010-2013 and 2014-2017.Results: There were 72 IE cases in the study. Male/female ratio was 1.57:1 (44 males,28 females). The mean age of the patients was 48.5±17.6 years. Staphylococci were the most common agents (44%). Independent predictors of mortality were heart failure, the invasive procedure before IE, and lower platelet level. Increased invasive procedures before IE and enterococcal endocarditis were found significantly to be higher during the last period (2014-2017).Conclusions: IE is still a serious and deadly disease in the 21st century. Our data indicate that invasive procedures have been increasing before IE and this increase with associated poor prognosis., Amaç: Bu çalışmada, Türkiye'de üçüncü basamak bir hastanede yatan enfektif endokardit (EE) tanılı hastaların klinik özelliklerini, sonuçlarını ve sekiz yıllık dönemdeki değişiklikleri değerlendirmek ve mortalite risk faktörlerini belirlemek amaçlandı.Gereç ve Yöntemler: Çalışmaya kesin EE tanısıyla yatırılarak takip edilen tüm erişkin hastalar dahil edildi. Çalışma verileri toplu şekilde ve iki ardışık dört yıllık dönem şeklinde (2010-2013 ve 2014-2017) analiz edildi. Bulgular: Çalışmada 72 EE hastası mevcuttu. Erkek/kadın cinsiyet oranı 1,57:1 (44 erkek, 28 kadın) idi. Hastaların ortalama yaşı 48,5±17,6 yıldı. Stafilokoklar en yaygın etken olarak bulundu (%44). Kalp yetmezliği, EE öncesi girişimsel işlem varlığı ve düşük trombosit seviyesi, mortalite için bağımsız risk faktörü olarak bulundu. EE öncesi artan girişimsel işlem varlığı ve enterokokal endokardit, son dönemde (2014-2017) anlamlı olarak daha yüksek bulundu.Sonuç: EE, 21. yüzyılda hala ciddi ve ölümcül bir hastalıktır. Verilerimiz, enfektif endokardit tanısı öncesinde girişimsel işlem varlığının artmakta olduğunu ve bu durumun kötü prognozla ilişkili olduğunu göstermektedir.

Aims The impact of ongoing PCR positivity on COVID‐19 patients and the strategy and period of isolation were not fully understood. We aimed to investigate the factors that cause prolonged PCR positivity and its clinical impact on COVID‐19 infection. In addition, we searched for an answer on what length of time would be best for isolation. Methods Patients with confirmed COVID‐19 infection were included in this retrospective study. Patients with PCR positivity (after symptom onset) longer than 14 days and PCR positivity less than 14 days were compared. The relationship between duration of symptoms and PCR negation time was examined. Results A total of 339 patients were included in this study. Fifty (14%) patients had prolonged PCR positivity after 14 days. Demographic and clinical features, and clinical outcomes (disease severity and mortality) were similar among the two groups. Age (p 0.035) and symptom duration at admission (P

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

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

BACKGROUND: Covid-19 pandemic has been affecting whole world by increasing morbidity and mortality rate day by day. Treatment algorithms have been attempted as parallel to the increasing experience with Covid-19. In the pathogenesis of this virus proinflammatory cytokine storm has been called to have the main role. The right timing should be made for treatments. We proposed IL- 1 blocking by anakinra in seventeen Covid-19 patients at high risk of worsening. METHODS: Patients were assessed according to HScore, SOFA [Sequential Organ Failure Assessment Score= SOFA], MuLBSTA Score (Multilobular infiltration, Hypo-Lymphocytosis, Bacterial coinfection, Smoking history, hyper-Tension, and Age), Brescia-COVID respiratory severity scale (BCRSS). RESULTS: In our study, mortality rate was 17.6%. Consequently, 1 (5.9%) patient was receiving low-flow oxygen supply, 3 (17.6%) patients needed no longer oxygen supply and 10 (58.8%) patients were discharged from hospital. CONCLUSION: According to results of our study in the manner of general evaluation; we found that SOFA, MuLBSTA and BCRSS scores were one step ahead according to HScore being insufficient to determine early phases of the disease. In our opinion, the prominent factors those emphasize the use of Anakinra could be listed as comorbidity, risk or presence of secondary infection, ongoing malignant disease. However, the other factors those enhance the use of Anakinra in the situation of viremia also could be sorted as no response to full dose antivirals, antiviral side effects or no success to antiviral treatment. This article is protected by copyright. All rights reserved.

Data related to increasing antibiotic consumption in the world and in Turkey are alarming. This over-consumption is also triggering antibiotic resistance. Unfortunately, Turkey is one of the countries where antibiotic resistance is quite high. Serious efforts have been made in recent years to overcome these problems. However, there are still many distances to be taken. Today, evaluation of antibiotic consumption and consumption in hospitals is determined by antibiotic stewardship. In this report, it is aimed to summarize main items of antibiotic stewardship, global antibiotic consumption and Turkey-wide status, resistance data, evaluation of strategies to prevent resistance, and measures to be taken.

Measurements are one of the most important means of evaluating the quality of antibiotic consumption. This study has evaluated the antibiotic consumption using one-day point prevalence study data collected from different hospitals in Turkey. This research was planned as a multicenter point surveillance study which aimed demonstrating the use of antibiotics among inpatients in Turkey. On the day of surveillance, demographic data from 21,920 inpatients, names of antibiotics used by the inpatients, number of antibiotics approved by infectious disease specialist (IDS), and the length of antibiotic use were recorded. These results showed that 30.3% of patients were using antibiotics and 57.7% of those were IDS-approved. The rate of IDS-approved antibiotic consumption was higher for internal medicine wards and in intensive care units, whereas non-IDS-approved antibiotics were used among inpatients of surgical wards. WOS:000533692700001 2-s2.0-85084830447 PubMed: 32393151

27th International Congress of the Transplantation-Society (TTS) -- JUN 30-JUL 05, 2018 -- Madrid, SPAIN WOS: 000444541201323 … Transplantat Soc, Soc Espanola Trasplante, Soc Madrilena Trasplante

27th International Congress of the Transplantation-Society (TTS) -- JUN 30-JUL 05, 2018 -- Madrid, SPAIN WOS: 000444541201322 … Transplantat Soc, Soc Espanola Trasplante, Soc Madrilena Trasplante

Background Brucellosis produces a variety of non-specific hematological abnormalities. The aim of the present study was to evaluate the hematological findings in childhood brucellosis. Methods Medical records of children with brucellosis admitted to a tertiary hospital in a 1 year period, were analyzed retrospectively. Results Sixty-nine patients (mean age, 14.5 ± 3.3 years) were diagnosed with brucellosis. The most common hematological finding was thrombocytopenia (n = 11, 15.9%). Thrombocytosis was detected in five patients (7.3%), leukopenia in four (5.8%), anemia in three (4.3%), and bicytopenia in three (4.3%). None of the patients had pancytopenia. Blood culture was positive for Brucella spp. in 41 patients (59.4%). Among those patients with positive blood culture, six (14.6%) had serum agglutination test titer ≤1/80. Platelet (PLT) count was significantly lower in the bacteremia-positive group. The OR (95%CI) of bacteremia for PLT cut-off 200 000/mm3 was 0.148 (95%CI: 0.031–0.718) and relative risk was 1.718 (95%CI: 1.244–2.372; P = 0.010). Conclusions Brucellosis should be kept in mind in the differential diagnosis of isolated thrombocytopenia in pediatric patients from endemic areas.

Bloodstream infections (BSIs) are an important cause of mortality in hospitals. Local surveillance data should be taken into account to overcome these challenging infections. The aim of this study is to determine the microbiological characteristics of BSIs and the risk factors for mortality. Material and Method: Active prospective surveillance data based on patient and laboratory were evaluated from January 2011 to June 2015. The first episodes of primary BSIs of the patients were included to the study. CDC case definitions were used to define BSIs. The data were recorded included demographics, underlying conditions, invasive procedures, fever (>=38°C) or hypothermia (, Kan dolaşımı enfeksiyonları (KDE) hastanelerde mortalitenin önemli nedenlerindendir. Bu enfeksiyonları yönetebilmek için lokal surveyans verileri göz önünde bulundurulmalıdır. Bu çalışmanın amacı; kan dolaşımı enfeksiyonlarında mikrobiyolojik karakteristikleri ve mortalite risk faktörlerini belirlemektir. Materyal ve Metot: Ocak 2011 ve Haziran 2015 yılları arası hasta ve laboratuvara dayalı aktif prospektif surveyans verileri değerlendirildi. Çalışmaya primer kan dolaşımı enfeksiyonu olan hastaların ilk epizodları dahil edildi. Kan dolaşımı enfeksiyonlarını tanımlamak için CDC tanı kriterleri kullanıldı. Kaydedilen veriler arasında; demografik veriler, altta yatan hastalıklar, invaziv işlemler, ateş (≥38°C) veya hipotermi (

Cryptococcus neoformans is an encapsulated yeast causing infection in patients with acquired immune deficiency syndrome (AIDS). With the introduction of highly active antiretroviral therapy (HAART), the incidence of infection due to Cryptococcus has significantly decreased. The era of HAART has not only affected the incidence ratebutalso the clinical presentation called immune reconstitution inflammatory syndrome as a consequence of the immune recovery of the host. In this paper, we presented a HIV/AIDS patient with cryptococcal sepsis and discussed clinical manifestations of cryptococcosis, diagnostic and therapeutic approach.

Background/aim: The aim of this study was to investigate the epidemiologic characteristics, the causative microorganisms and their antimicrobial susceptibility patterns, and the prognostic risk factors for mortality in critically ill patients with ventilator-associated pneumonia (VAP). Materials and methods: In this retrospective observational study, all the critically ill patients with VAP hospitalized in a medical/surgical intensive care unit (ICU) between January 2010 and June 2015 were evaluated. Patients' demographic features and microbiological data were reviewed. Results: A total of 417 patients were clinically diagnosed with VAP; 51.1% of them were male and the average age was found as 69.9 ± 15.9 years. VAP was detected at approximately 25.0 ± 18.0 days of ICU stay and 17.9 ± 12.6 days after intubation. Acinetobacter baumannii (69.5%) was isolated as the most frequent VAP agent, and the most effective antibiotic was colistin. The crude mortality rate was detected as 39.8% among the patients. The presence of dyspnea at admission, coronary heart disease as a comorbidity, unconsciousness at admission, steroid usage, and prolonged hospital stay were observed as independent risk factors in multivariate analysis (P < 0.01). Conclusion: According to the etiological microorganisms and antimicrobial susceptibility patterns, colistin was found to be the most reliable antibiotic for empirical antimicrobial therapy.

To evaluate adult measles patients with respect to their clinical and laboratory findings as well as complications.The retrospective study was conducted at YuzuncuYil University, Van, Turkey, between December 2012 and June 2013, and comprised cases diagnosed with measles. The diagnosis was based on clinical findings and all were serologically confirmed with the presence of Anti-measles Immunoglobulin M antibodies.Of the 50 records studied, 41(84%) related to women. Overall mean age was 25.52±4.07 years. The most common symptoms were fever and rash 50(100%), malaise 49(98%), cough 48(96%), headache 44(88%) and sore throat 36(72%). The presence of Koplik spots, lymphadenopathy and hepatomegaly were observed in 3(6%), 6(12%) and 2(4%) patients respectively. Thrombocytopenia and elevated liver enzymes were detected in 26(52%) and 22(44%)patients. Pneumonia was the most common complication in 9(18%) patients. Other respiratory complications were bronchitis 5(10%) and laryngotracheitis 6(12%). Of the cases, 9(18%) exhibited otitis media. Premature delivery and spontaneous abortus occurred in 2(4%) and 3(6%) patients of the 15(30%) pregnant women.Measles continues to be an important health problem in Turkey and needs an effective elimination programme.

Brucellosis produces a variety of non-specific hematological abnormalities. The aim of the present study was to evaluate the hematological findings in childhood brucellosis.Medical records of children with brucellosis admitted to a tertiary hospital in a 1 year period, were analyzed retrospectively.Sixty-nine patients (mean age, 14.5 ± 3.3 years) were diagnosed with brucellosis. The most common hematological finding was thrombocytopenia (n = 11, 15.9%). Thrombocytosis was detected in five patients (7.3%), leukopenia in four (5.8%), anemia in three (4.3%), and bicytopenia in three (4.3%). None of the patients had pancytopenia. Blood culture was positive for Brucella spp. in 41 patients (59.4%). Among those patients with positive blood culture, six (14.6%) had serum agglutination test titer ≤1/80. Platelet (PLT) count was significantly lower in the bacteremia-positive group. The OR (95%CI) of bacteremia for PLT cut-off 200,000/mm(3) was 0.148 (95%CI: 0.031-0.718) and relative risk was 1.718 (95%CI: 1.244-2.372; P = 0.010).Brucellosis should be kept in mind in the differential diagnosis of isolated thrombocytopenia in pediatric patients from endemic areas.

Our aim was to compare the clinical, radiological and prognostic features of spontaneous spondylodiscitis secondary to tuberculosis (TS) and brucellosis (BS). This prospective study involved 41 patients diagnosed with spondylodiscitis. Of these, 18 (43.1%) had BS and 23 (56.1%) had TS. The mean age of TS patients was 52 ± 13.43 years and older than BS patients ( P < 0.001). A prolonged clinical course of the disease, constitutional symptoms, lymphocytosis, increased erythrocyte sedimentation rate (ESR), presence of posterior vertebrae lesions and psoas abscesses were significantly more frequent in the TS group. There are significant clinical, biological and radiological differences between TS and BS. These differences permit a presumptive aetiological diagnosis and orient the initial empirical medical treatment while awaiting a final microbiological diagnosis.

Objective: Patients with neutropenia due to cancer chemotherapy are prone to severe infections. Cancer patients canexperience >1 infectious episode during the same period of neutropenia. This study aimed to determine the etiologicaland clinical characteristics of secondary infectious episodes in cancer patients with febrile neutropenia and to identifythe factors associated with the risk of secondary infectious episodes. Material and Methods: All cancer patients that received antineoplastic chemotherapy at Ankara University, School ofMedicine, Department of Hematology between May 2004 and May 2005 and developed neutropenia were included in thestudy. Data were collected using survey forms that were completed during routine infectious diseases consultation visits.Categorical data were analyzed using the chi-square test, whereas Student’s t-test was used for continuous variables.Multivariate logistic regression analysis was performed to identify independent predictors of secondary infections (SIs). Results: SIs were observed during 138 (53%) of 259 febrile neutropenic episodes. Of the 138 episodes, 89 (64.5%)occurred in male patients with a mean age of 40.9 years (range: 17-76 years). In total, 80% of the SIs were clinically ormicrobiologically documented. Factors on d 4 of the initial febrile episode were analyzed via a logistic regression model. The presence of a central intravenous catheter (OR: 3.01; P

Summary The present study discusses the clinical features and treatment outcomes during an outbreak caused by multidrug resistant (MDR) Salmonella typhi isolates from Van, Turkey. Of the 867 typhoid fever patients from the same village, 154 (17.8%) were hospitalised. A total of 42 (27.3%) cultures were positive. All S. typhi isolates were resistant to chloramphenicol, ampicillin and co-trimoxazole. Ceftriaxone was the most commonly used antibiotic (89%). It was found that the time-to-fever defervescence and the length of the hospital stay were greater for patients who were treated by ciprofloxacin than ceftriaxone ( P