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The goals of this study were to report our clinical experience in a single center at a high-volume tertiary university hospital in Istanbul and to introduce a diagnostic algorithm based on a 5-year follow-up of 152 women with biopsy-proven idiopathic granulomatous mastitis (IGM). IGM is an uncommon, non-malignant, chronic inflammatory disease of the mammary gland with an unknown etiology. The symptoms, clinical presentation, and radiologic findings of IGM may resemble carcinomas. To our knowledge, this study comprises the largest series of IGM, especially with a 5-year follow-up, yet reported in the English literature. The present study reported our single-center clinical experience at a tertiary university hospital in Istanbul, Turkey, and introduced a diagnostic algorithm using our treatment protocol based on a 5-year follow-up of 152 women with biopsy-proven IGM. Our database of 10 years’ experience containing over 700 patients with IGM was evaluated. However, to assess recurrence and resistance to treatment, only the 152 patients with a long follow-up period of 5 years were included in the study group. The analysis included 152 women with biopsy-proven IGM who were treated between January 2009 and March 2014. The clinical data of the presentation, histopathology, and treatment modalities were analyzed by reviewing the medical records. Of the 152 patients diagnosed with granulomatous mastitis, 32 (21%) recovered by expectant management, while 14 (9%) responded to antibiotics, 65 (43%) received corticosteroids, 20 (13%) had antituberculosis medication, 16 (11%) underwent excision, and 5 (3%) responded to non-steroidal anti-inflammatory drugs. Fifty-one patients (33%) had recurrence; of these, 30 achieved a cure with second-line treatment, 16 underwent excision, and 5 achieved a cure with observation. IGM is a rare benign breast disorder, and clinicians need a high index of suspicion to diagnose it, as IGM can be mistaken for breast cancer. Unlike periductal mastitis, IGM does not evolve secondary to nicotine addiction and is typically seen in women of childbearing age with a recent history of pregnancy and lactation. The diagnosis can be challenging, and an evaluation with a multidisciplinary team is necessary. There is no consensus concerning the definitive treatment approach. We suggested a diagnostic algorithm in the present study, using our treatment protocol based on the 5 years’ follow-up of 152 women.

HIV/AIDS-related stigma remains a crucial public health problem in the world. Unfortunately, health provider staffs such as nurses and physicians are the major source of stigmatization and discrimination against peoples living with HIV (PLHIVs) including in Turkey. The aim of this study was to assess HIV-related stigma towards to PLHIV by nurses and physicians and to examine related factors. Descriptive Assessment Form and the HIV-Related Stigma Scale used for data collection. The study consisted of 405 health workers including 251 nurses and 154 physicians. Over 86% of physicians and 69.3% of nurses had no specific education about HIV. More than 11% of the nurses and 8.4% of the physicians expressed that HIV can be transmitted with handshaking or breathing in a shared environment. Fear-driven stigma was significantly different by age, education, occupation, and work experience. Over 14% of the discrimination (Adjusted

Aims: The COVID-19 pandemic has substantially changed lives and presented several barriers to health services. HIV care continuum needs a high rate of diagnosis, effective treatment, and sustained suppression of viral replication. The COVID-19 pandemic has affected these three steps of HIV care. This study investigated the characteristics of newly diagnosed patients living with HIV/AIDS (PLWH) during the COVID pandemic and compared them with those before the pandemic. Methods: All newly diagnosed patients in three HIV healthcare centers, in Istanbul, Turkey, were included in the study. The pandemic period included April 1, 2020, to April 1, 2021, and the prepandemic period included March 1, 2019, to March 1, 2020. Results: 756 patients were diagnosed with HIV/AIDS. In the pandemic period, this figure was 58% less: 315. Patients in the pre-pandemic and pandemic period had comparable age and gender distributions. PLWH diagnosed in the pandemic period had higher rates of low CD4 cells: low CD4 ( Conclusion: A low number of newly diagnosed PLWH can be explained by less HIV testing, less admission to health care, or an actual decrease of HIV prevalence during the pandemic. Sexual behaviors may have changed during the COVID-19 pandemic, leading to HIV transmission restriction. Lower CD4 counts among the newly diagnosed PLWH suggest that admittance to health care is late and a significant portion of PLWH remain undiagnosed.

Tenofovir use is associated with lower risk of mother-to-infant transmission of the virus, and discontinuation of the treatment is not safe. However, the safety of the drug during pregnancy and breastfeeding is not clear. In this study, we aimed to determine the tenofovir concentration in plasma of mother-infant pairs along with breast milk in chronic hepatitis B patients during the lactation period. A total of 11 mother-infant pairs were enrolled in the study. All the mothers received tenofovir disoproxil fumarate (TDF) 245mg/day for at least 1 month because of chronic hepatitis B infection. Maternal blood, breast milk, and infant blood samples were obtained concomitantly. Tenofovir concentrations were determined by liquid chromatography-tandem mass spectrometry. The median concentrations of tenofovir in maternal plasma and breast milk samples were 88.44 (interquartile range [IQR], 62.47 to 116.17) ng/ml and 6.69 (IQR, 4.88 to 7.03) ng/ml, respectively. Tenofovir concentrations were undetectable (,4ng/ml) in all of the infant plasma samples. The ratio of tenofovir concentration in breast milk to that in maternal plasma was 0.07. Tenofovir disoproxil fumarate passes through the breast milk in a small amount. Infants had no detectable tenofovir level in their plasma. Our study suggests that tenofovir disoproxil fumarate treatment is safe during the breastfeeding period in chronic hepatitis B patients. Viral Hepatitis Society ; Istanbul University

The present guideline updates the Turkish recommendations for the screening, diagnosis and management of Hepatitis C virus (HCV) infection prepared by the Turkish Association for the Study of the Liver (TASL) and Viral Hepatitis Society (VHS). The aim of this guidance was to provide updates recommendations to physicians, who are interested in HCV care on the optimal screening, diagnosis and pre-treatment management for patients with HCV infection in Turkey. These recommendations, produced by panel experts, were aimed to addresses the management issues ranging from diagnosis and linkage to care, to the optimal treatment regimen in patients with HCV infection. Recommendations are based on evidence and opinions of more than 70% of the panelists. This guidance is supported by the memberships of two societies and not by pharmaceutical companies. This guidance will be updated frequently as new data become available.

WOS: 000366655100045, PubMed ID: 26386176, BACKGROUND CONTEXT: No direct comparison between brucellar spondylodiscitis (BSD) and tuberculous spondylodiscitis (TSD) exists in the literature. PURPOSE: This study aimed to compare directly the clinical features, laboratory and radiological aspects, treatment, and outcome data of patients diagnosed as BSD and TSD. STUDY DESIGN: A retrospective, multinational, and multicenter study was used. PATIENT SAMPLE: A total of 641 (TSD, 314 and BSD, 327) spondylodiscitis patients from 35 different centers in four countries (Turkey, Egypt, Albania, and Greece) were included. OUTCOME MEASURES: The pre- and peri- or post-treatment spinal deformity and neurologic deficit parameters, and mortality were carried out. METHODS: Brucellar spondylodiscitis and TSD groups were compared for demographics, clinical, laboratory, radiological, surgical interventions, treatment, and outcome data. The Student t test and Mann-Whitney U test were used for group comparisons. Significance was analyzed as two sided and inferred at 0.05 levels. RESULTS: The median baseline laboratory parameters including white blood cell count, C-reactive protein, and erythrocyte sedimentation rate were higher in TSD than BSD (p

Objectives To describe the epidemiology and susceptibility of pathogens (including ESBL producers) from hospital-acquired (HA) versus community-acquired (CA) urinary tract infections (UTIs) and ICU- versus non-ICU-associated intra-abdominal infections (IAIs) in Turkey as a part of the SMART study. Methods : For this report, Gram-negative pathogens (363 from UTIs and 458 from IAIs) were collected in 2011 and 2012 at six hospitals in Turkey. HA versus CA UTIs and ICU- versus non-ICU-associated IAIs were compared for the species isolated, percentage of ESBL-positive isolates by species and susceptibility for overall and individual Gram-negative species. Results : Escherichia coli was the most common pathogen identified in HA (40.2%) and CA (73.9%) UTIs and ICU-associated (25.8%) and non-ICU-associated (43.3%) IAIs. The rate of ESBL-positive E. coli was significantly higher in HA than in CA UTIs (50.5% versus 38.2%, P < 0.001) and in non-ICU-associated than in ICU-associated IAIs (52.5% versus 29.2%, P = 0.029). Of the drugs studied, only amikacin was active against ≥90% of pathogens in UTIs, while ertapenem, imipenem and amikacin were active against ≥90% of E. coli ; and imipenem, amikacin and cefoxitin were active against ≥90% of Klebsiella pneumoniae in IAIs. Conclusions Our findings demonstrated that E. coli continues to be the principal pathogen of UTIs and IAIs in Turkey. Along with a high rate of ESBL-positive isolates, high antimicrobial resistance among Gram-negative bacilli from either UTIs or IAIs was noted particularly in the case of HA UTIs and ICU-associated IAIs, with a higher likelihood of carbapenem- or amikacin-based therapy to provide the broadest activity against bacterial pathogens.

This study evaluated the presence of carbapenem hydrolysing β-lactamase genes and plasmid-mediated quinolone resistance (PMQR) determinants in 22 Klebsiella pneumoniae isolates collected from the Istanbul Medical Faculty, Turkey, which reduced the susceptibility or resistance to carbapenem. The VITEK® 2 system and E-tests were used to determine the minimum inhibitory concentrations needed to inhibit bacterial growth. Genes were screened by polymerase chain reaction, and gene transferability was evaluated by transconjugation. Strain clonality was investigated by pulsed-field gel electrophoresis (PFGE). All strains were OXA-48 β-lactamase producers and three (13.6%) were also positive for the aac(6′)-Ib-cr gene. Most of the strains harboured other b-lactamase (bla) genes such as blaTEM, blaSHV, blaCTX-M and blaVEB-1. The transconjugants mostly harboured blaOXA-48 and other β-lactamases separately. PFGE revealed eight pulsotypes among the isolates. The coexistence of blaOXA-48 and PMQR in K. pneumoniae isolates may present a significant threat to health, especially in the nosocomial setting.

Antiphospholipid syndrome (APS) is defined as the occurrence of thrombosis, recurrent miscarriage, or both in association with laboratory evidence of persistent antiphospholipid antibodies. Owing to protean manifestations and laboratory studies, the diagnosis may be difficult. Because the other signs and symptoms of thrombosis are predominant, prolonged fever is not usually the main clinical finding. We describe a patient who presented with fever of unknown origin (FUO) and was found to have thromboses of the splenic vein, the superior mesenteric vein, and the portal vein due to the primary antiphospholipid syndrome. We also reviewed the medical literature (Medline 1966-2001), including the main FUO series of the previous 40 years, and laparotomy series for FUO. We conclude that although very rare, primary APS and thrombosis may present with FUO. APS should be considered in the differential diagnosis of prolonged fever associated with thrombosis.

Summary Objectives Idiopathic granulomatous mastitis (IGM) is a benign rare inflammatory pseudotumor. Bilateral involvement of IGM has been reported in a few cases. To our knowledge, this study is the largest series of bilateral cases to date. The goals of this study were to present clinical features of bilateral IGM and to evaluate the results of treatments. Materials and methods We performed a retrospective review of the idiopathic granulomatous mastitis database from 2010 to 2013. Ten female patients who met required histologic and clinical criteria of IGM in both breasts were included in study. Demographic data, clinical findings, medication history, and radiologic findings are presented. Results The mean age at onset of the disease was 38.4 ± 8.3 years (range: 29–52 years). Nine patients had no recurrence during a mean follow-up period of 21 months (range: 11–26 months). Additionally, the median time to second breast involvement was 15.6 months. Conclusion Bilateral IGMs have a higher rate of more relapse and greater resistance to medical therapies than do unilateral IGMs. Surgical management should be avoided unless all medical treatment options have been exhausted. Nevertheless, expectant management seems a rational option for the treatment of bilateral IGM.

Brucellosis is an endemic disease in Turkey. Simultaneous infections among family members consuming infected dairy products have been reported. The most frequent signs and symptoms are nonspecific, and most human cases remain unrecognized. We aimed to screen family members of index cases with brucellosis. A questionnaire including demographical and epidemiological data was obtained. All cases were tested by slide agglutination tests (Rose Bengal test). Seropositive ones were further tested by tube agglutination tests (Wrigth test). In the index cases, Brucella antibody titers of > or = 1:160 with and without clinical symptoms and 1:80 with clinical symptoms were considered positive and the household members were enrolled into the study. Twenty-eigth index cases were identified among a total of 110 family members. Among family members, 90 (82%) were seronegative whereas 20 were seropositive. Among seropositive cases, 12 were asymptomatic and 8 were symptomatic. The most frequent symptoms of the index cases were fever, headache and arthralgia. Symptomatic cases were treated and asymptomatic ones followed up without therapy for a period of 6-12 months and none developed brucellosis. In conclusion, family members of the patients with brucellosis are under the increased risk of brucellosis because of a common source. Therefore, it can be considered that family screening may lead to early diagnosis of the disease and to the prevention of the complications.

Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory disease of the breast. It can mimic breast carcinoma clinically and radiologically, and usually affects females of childbearing age. There is no commonly accepted optimal treatment for IGM. In this study, we present the clinical and histopathological features and outcomes of the therapeutic management of IGM, as well as the clinical course of the disease when patients were treated with oral corticosteroids.This retrospective study included 49 of 87 patients who met the required histological criteria for IGM who were followed up between January 2009 and December 2011. All patients had a disease-free follow-up period of at least 6 months. The data regarding the clinical features at presentation, laboratory values and the treatment modalities were obtained from the medical records of the patients.The mean age of the patients was 34.3 ± 4.37 years. Forty patients were treated with prednisolone, five were started on antituberculosis treatment, two received non-steroidal anti-inflammatory drugs, one received antibiotics and one underwent wide excision. All patients who received steroids responded well to the therapy.Systemic therapy with corticosteroids is an effective and appropriate treatment option for IGM. It can provide complete disease resolution and prevent recurrence in the long term. A multidisciplinary approach including specialists in the fields of both general surgery and infectious diseases is essential for the diagnosis, treatment and follow-up of IGM.

This study aimed to determine the incidence and risk factors of infections among patients admitted to intensive care units (ICUs) in tertiary care hospitals in Turkey.Adult patients who were admitted to the ICUs of five tertiary care hospitals for over 48 hours between June and December 2007 were monitored daily. Potential risk factors such as age, gender, comorbidities, diagnosis at admission, severity of disease (Acute Physiology and Chronic Health Evaluation II scores), exposure to antibiotics, history of invasive procedures and significant medical interventions were evaluated. A multivariate analysis of these risk factors was carried out using Cox regression.A total of 313 patients with a median ICU stay of 12 days were selected for the study. 236 infectious episodes (33.8/1,000 ICU-days) were diagnosed among 134 patients (42.8/100 patients) in this group. Multivariate analysis revealed that exposure to a cephalosporin antibiotic (hazard ratio [95% confidence interval] 1.55 [1.10-2.19]) was an independent risk factor, whereas having a tracheostomy cannula (0.53 [0.36-0.81]) or nasogastric tube (0.48 [0.33-0.70]) was protective. Patients admitted to the ICUs from surgical wards were significantly more exposed to cephalosporins.ICU-associated infections, which are quite high in Turkey, are largely due to inadequate infrastructure and facilities and understaffing. Abuse of antibiotics, particularly in patients who have undergone surgery, and prolonged ICU stays are significant risk factors for such infections.

Since it was first defined, human immunodeficiency virus / acquired immunodeficiency syndrome (HIV / AIDS) has become one of the most studied infectious disease. Syphilis is a sexually transmitted chronic infection, which can affect all systems and organs with different clinical stages, and Treponema pallidum, a member of the spirochete family, is the agent. Syphilis has led to numerous epidemics throughout the world, which started in the 1990s and still ongoing with the increase of HIV-infected patients. Despite the decline in the United States and Europe, it has increased since 2000. It is noteworthy that syphilis shows high rates of co-infection with HIV and HIV infection may alter the clinical signs of syphilis. Since these two infections can be frequently seen together, all HIV-infected patients should be tested for syphilis. In this report, a case with HIV co-infection with secondary syphilitic skin lesions is presented. [Dis Mol Med 2016; 4(2.000): 21-23]

Summary Ophthalmomyiasis externa is mainly caused by the sheep botfly Oestrus ovis; therefore, it is usually seen in rural areas. We report here a case of ophthalmomyiasis externa in a young man from Istanbul. The patient had no known history of exposure to farm animals or rural areas.

Dear Sir, Hepatitis C virus (HCV) infection is common in hemodialysis patients and the relatively lower alanine aminotransferase (ALT) values in acute [1] and chronic hepatitis C infections [2, 3] of these patients make the diagnosis more difficult. Acute hepatitis C in hemodialysis patients can be treated by interferon (IFN) therapy [4], although the response rates are lower than in patients with normal renal function [5]. Lampe et al. [6] emphasized the role of recognizing acute HCV infection in hemodialysis patients by comparing the ALT level to the patient’s ALT baseline values. A 53-year-old male was under hemodialysis for 10 years due to hypertensive nephropathy. Hemodialysis was applied 3 times weekly and the serology of HCV and hepatitis B virus (HBV) and biochemistry were checked monthly. When his ALT level was measured as 29 U/l, which seemed significantly higher than his previous measurements (4, 5, 7, 4, and 6 IU/l, respectively), HCV and HBV serology was repeated. Although antiHCV remained negative and anti-HBs was positive, his ALT level was serially checked. Within 1 month, his ALT level increased to 114 U/l and anti-HCV was detected as positive. He remained symptomless. HCV ribonucleic acid (RNA) by polymerase chain reaction (PCR) was measured as 7,130 IU/l and the genotype study remained an indeterminate result. HCV RNA studies obtained 2 weeks apart gave comparable results of 5,150 and 6,120 IU/l. His ALT level increased to a maximum level of 155 U/l and then tended to decrease (Fig. 1). He was initiated with pegylated IFN alpha-2a 135 lg weekly. The study of Lemos et al. [7] emphasized the role of monitoring ALT for recognizing acute HCV infection, since the patients are almost always asymptomatic, as in our case. They observed ALT elevation in all patients and the median peak ALT was 4.79 the upper limit of normal (range: 1.1–47.4). The median interval between ALT elevation and anti-HCV seroconversion was 1 month. What is the upper limit of normal of ALT in hemodialysis patients? Espinosa et al. [1] reported the upper limit for ALT in hepatitis-free hemodialysis patients as 27 IU/l. The sensitivity of a mean ALT value C27 IU/l in the diagnosis of HCV viremia was 50% and the specificity was 100%. They reported the positive predictive value of this test in the diagnosis of hepatitis C viremia as 100% and concluded that a high ALT level can constitute an excellent tool in predicting viremia in hemodialysis patients, once other causes of liver disease have been excluded. In two studies including 19 and 32 patients with acute hepatitis C under hemodialysis, the peak median ALT levels of the patients were 345 IU/l (range: 24–1,473) [8] and 169 IU/l (range: 22–325), respectively. Another study used the definition of acute HCV infection as ‘‘a rise of twice the normal or more of serum ALT level compared to baseline in addition to a positive serum anti-HCV antibody’’ [4]. To conclude, recognizing acute HCV infection is critical, since treatment can prevent progressive liver damage by a considerable part. The ALT levels are not expected to increase by several times, so any increase compared to his/ her ‘‘normal’’ values should be considered as a warning. R. Ozaras (&) M. Yilmaz B. Mete A. Demirel Department of Infectious Diseases, Cerrahpasa Medical Faculty, University of Istanbul, Aksaray, Istanbul 34303, Turkey e-mail: rozaras@yahoo.com

To our knowledge, there have been only six S. warneri endocarditis cases reported in the English-language literature (Medline: 1966 to April 2011). We report a case of recurrent S. warneri endocarditis in a patient with prosthetic valve and silicon mammoplasty and we also review the relevant literature.