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There are very few reports on the prevalence of multidrug-resistant microorganisms during the COVID-19 pandemic. In addition, these publications usually cover covid-19 patients.Our study aimed to compare the prevalence of multidrug-resistant microorganisms in patients without COVID-19 undergoing treatment in an intensive care unit (ICU) during the COVID-19 pandemic with those in the pre-pandemic period. The study was planned retrospectively. In our country, the prevalence of multi-drug-resistant microorganisms was evaluated in the intensive care unit where internal and surgical patients were hospitalized in a single center in 6-month periods before and after the occurrence of covid-19 cases. The prevalence of multidrug-resistant microorganisms increased in patients being followed up in our ICU during the pandemic period (p

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

ÖZETAmaç: Ondokuz Mayıs Üniversitesi’nde sıtma endemik bölgeden gelen yabancı uyruklu öğrencilerin sıtmadeneyimlerini ve bilgi düzeylerini ölçmekGereç ve Yöntem: Hastalıkları Kontrol ve Koruma Merkezi (CDC) tarafından sıtma endemik olarak kabuledilen ülkelerden gelen öğrencilerin demografik verileri, sıtma deneyimleri ve bilgi düzeylerinin değerlendirildiğianket yüz yüze yapılmıştır.Bulgular: Endemik bölgeden gelen 750 öğrenciden ankete katılmayı kabul eden ve anketi eksiksiz dolduran106’sı değerlendirmeye alınmıştır. Katılımcıların yaş ortalaması 23 (±3,5), 77 (%72.6)‘sı erkekti. Ülkesi endemikkategoride olsa da 13 (%12.3) öğrenci ülkesinde hiç sıtma görülmediğini ifade etmiştir. Katılımcıların48 (%45.3)’ünün yaşamı boyunca ortalama 2.4±4.5) defa sıtma geçirme öyküsü vardı. Yedisinin profilaksialtında sıtma öyküsü bulunmaktaydı. Sıtma geçiren öğrenciler en sık Artemether-lumefantrin (10) ve klorokin(9) tedavilerini kullanmıştır. Kırk yedi (%43.3)’ü profilakside kullanılan en az bir sıtma ilacına aşinaydı.Katılımcıların %16’sı ülkelerinde sıtma ilaçlarına ulaşılabilirliği zor olarak ifade etmiştir. ‘Sıtma ölümcül birhastalık mıdır?’ sorusuna %84.9 oranda evet yanıtı alınmıştır.Öğrencilerin 20’si tıp fakültesinde okumakta olup, 15’inin sıtma geçirme öyküsü vardı. Sıtma ile ilgili bilgidüzeyleri değerlendirilen tıp öğrencilerinin %70 (14)’i Afrika ülkelerinden gelmekteydi. Tıp öğrencileri sıtmanın%95 (19) oranda anofel türü sivrisineklerin ısırması ile, %60 (12) kan nakli, %70 (14) anneden bebeğebulaş ve %15 (3) organ nakli ile bulaştığını belirtmiştirSonuç: Bu sonuçlar tıp öğrencileri de dahil olmak üzere endemik bölgeden gelen öğrencilerin sıtma ile ilgilibilgi düzeylerinin arttırılması gerekliliğine işaret etmektedir.Anahtar kelimeler: Sıtma; Bilgi düzeyi; Yabancı uyruklu öğrencilerABSTRACTAim: The aim of this study was to evaluate experiences and level of knowledge about malaria amongOndokuz Mayis University students from endemic countries.Material and Methods: Face to face questionnaires were conducted asking questions about malariademographic data, basic knowledge of its transmission, treatment, fatality and personal experiencesfrom foreign students coming from countries considered to be malaria endemic by the Center for DiseaseControl and Protection.Results: Of the 750 students from the endemic region, 106 accepted to participate and completed thequestionnaire. The mean age of the participants was 23 (± 3.5) and 77 (72.6%) were male. Thirteen (12.3%)of students from endemic regions stated that malaria was not observed in their countries. Forty nine (45.3%)of the participants had a history of malaria at an average of 2.4 (± 4.5) times during their lifetime. Sevenparticipants had a history of malaria despite the use of chemoprophylaxis. Artemether-lumefantrine (10)and chloroquine (9) were commonly used antimalarials by students. Forty-seven (43.3%) of the participantswere familiar with at least one malaria drug used in prophylaxis. Of them 16% (17) stated that accessibilityto malaria drugs was easy. The question whether malaria is a fatal disease was answered as yes by 84.9% (n= 90) of the participants. Of the twenty medical student participants, 15 had a history of malaria and 70%(14) of them were from Africa. Medical students students stated that malaria was transmitted by; 95%(19) anopheles type mosquito bite, 60% (12) blood transfusion, 70% (14) transmission from mother-toinfantand 15% (3) through organ transplantation.Conclusion: These results indicate that students from endemic areas, including medical students, shouldincrease their knowledge about malaria.Key words: Malaria; Knowledge; Foreign students

Amaç: Anti-tümör nekrozis faktör alfa (anti-TNF) alfa kullanan HBsAg pozitif hastalarda profilaksi önerilmektedir.HbsAg (-), anti-HBcIgG ( /-) ve anti-HBsIgG (-)hastalarda ise hepatit B profilaksisi tartışmalıdır. Bu çalışmada antiTNF alfa kullanan hastalarda HBV tarama oranı ve reaktivasyon sıklığının saptanması amaçlanmıştır.Yönetmler: Çalışma tek merkezde retrospektif olarak yürütülmüştür. Farklı endikasyonlarla anti-TNF alfa kullananhastalarda tedavi öncesi hepatit B göstergeleri (HBsAg, anti-HBcIgG, anti-HBs) ile viral yük tetkik sonuçları elektronikdosya kayıtlarından taranmıştır.Bulgular: Farklı endikasyonlarla anti-TNF alfa kullanan 644 hasta çalışmaya alınmıştır. Bu hastaların 410’u (%63,7)tedavi öncesinde hepatit B açısından taranmıştır. (410 hastanın 17’si HBsAg () (grup 1), 39’u HBsAg (-), anti-HBs()ve anti-HBcIgG () (grup 2), 15’i izole anti-HBcIgG () (grup 3), 339‘u viral göstergeleri negatif (grup 4) olaraksaptanmıştır). Hastalar ortalama 28 ay süreyle takip edilmiştir. Grup 1 hastaların 13’ü (%76), grup 2 ve 3’dekihastaların ise 48’i (%88,9) reaktivasyon açısından takip edilmiştir. Grup 2 ve 3’deki hastaların hiçbirisindetakiplerinde HBV reaktivasyonu gelişmezken, grup 1 hastalarının birinde reaktivasyon gelişmiştir. Anti-TNFöncesinde tarama yapılmayan bir hastada da reaktivasyon tespit edilmiştir.Sonuç: Anti-TNF alfa alan hastaların reaktivasyon açısından tarama ve takibinin doğru zamanda ve uygun testlerleyapılması ve hastaların yakın izlemi gerekmektedir. Objective: Prophylaxis is recommended in HBsAg positive patients receiving anti-TNF alpha. HBV prophylaxis iscontroversial in HbsAg (-), anti-HBc IgG () and anti-HBs IgG (/-) patients. The aim of this study was to determineHBV screening rate and reactivation frequency in patients receiving anti-TNF alpha.Methods: The study was conducted retrospectively in a single center. Hepatitis B markers (HBsAg, anti-HBcIgG, antiHBs) and viral load results were screened from electronic file records in patients who were treated with anti-TNFalpha for different indications.Results: Sixty-four patients using anti-TNF alpha for different indications were included in the study. 410 (63.7%) ofthese patients were screened for hepatitis B before treatment. (Of the 410 patients, 17 were HBsAg () (group 1), 39were HBsAg (-), anti-HBs() and anti-HBc IgG () (group 2), 15 isolated anti-HBc IgG () (group 3), 339 were markernegative (group 4). Patients were followed for a mean of 28 months. 13 (76%) of the patients in group 1 and 48(88.9%) of the patients in group 2 and 3 were followed for reactivation. None of the patients in group 2 and 3developed HBV reactivation during follow-up, while one of the patients from group 1 developed reactivation.Reactivation was also detected in one patient who had not been screened prior to anti-TNF therapy.Conclusion: Screening and follow-up of patients receiving anti-TNF alpha in terms of reactivation should beperformed at the right time with appropriate tests and close monitoring of the patients is required.

Stella G. Muthuri,1 Sudhir Venkatesan,1 Puja R. Myles,1 Jo Leonardi-Bee,1 Wei Shen Lim,2 Abdullah Al Mamun,3 Ashish P. Anovadiya,4 Wildo N. Ara ujo,5 Eduardo Azziz-Baumgartner,6 Clarisa B aez,7 Carlos Bantar,8 Mazen M. Barhoush,9 Matteo Bassetti,10 Bojana Beovic,11 Roland Bingisser,12 Isabelle Bonmarin,13 Victor H. Borja-Aburto,14 Bin Cao,15 Jordi Carratala,16 Mar ıa R. Cuezzo,17 Justin T. Denholm,18 Samuel R. Dominguez,19 Pericles A. D. Duarte,20 Gal Dubnov-Raz,21 Marcela Echavarria,22 Sergio Fanella,23 James Fraser,24 Zhancheng Gao,25 Patrick G erardin,26,27,28,29 Maddalena Giannella,30 Sophie Gubbels,31 Jethro Herberg,32 Anjarath L. Higuera Iglesias,33 Peter H. Hoeger,34 Matthias Hoffmann,35 Xiaoyun Hu,36 Quazi T. Islam,37 Mirela F. Jim enez,38 Amr Kandeel,39 Gerben Keijzers,40 Hossein Khalili,41 Gulam Khandaker,42 Marian Knight,43 Gabriela Kusznierz,44 Ilija Kuzman,45 Arthur M. C. Kwan,46 Idriss Lahlou Amine,47 Eduard Langenegger,48 Kamran B. Lankarani,49 Yee-Sin Leo,50 Rita Linko,51 Pei Liu,52 Faris Madanat,53 Toshie Manabe,54 Elga Mayo-Montero,55 Allison McGeer,56 Ziad A. Memish,57,58 Gokhan Metan,59 Dragan Miki c,60 Kristin G. I. Mohn,61,62 Ahmadreza Moradi,63,64 Pagbajabyn Nymadawa,65 Bulent Ozbay,66 Mehpare Ozkan,67 Dhruv Parekh,68 Mical Paul,69 Wolfgang Poeppl,70 Fernando P. Polack,71,72 Barbara A. Rath,73 Alejandro H. Rodr ıguez,74 Marilda M. Siqueira,75 Joanna Skre zt-Magierło,76 Ewa Talarek,77 Julian W. Tang,78,79,80 Antoni Torres,81 Selda H. T€ or€un,82 Dat Tran,83 Timothy M. Uyeki,84 Annelies van Zwol,85 Wendy Vaudry,86 Daiva Velyvyte,87 Tjasa Vidmar,88 Paul Zarogoulidis,89 PRIDE Consortium Investigators* Jonathan S. Nguyen-Van-Tam1 1Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK. 2Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK. 3International Centre for Diarrhoeal Diseases, Research Bangladesh (ICDDRB), Dhaka, Bangladesh. 4Department of Pharmacology, Government Medical College and Sir Takhtsinhji General Hospital, Bhavnagar, Gujarat, India. 5University of Bras ılia, Bras ılia, DF, Brazil. 6Centers for Disease Control and Prevention, Atlanta, GA, USA. 7Ministerio de Salud de la Provincia de Buenos Aires, Buenos Aires, Argentina. 8Department of Infection Control, Hospital San Mart ın de Paran a, Entre R ıos, Argentina. 9Department of Medicine, King Saud Medical City, Riyadh, Saudi Arabia. 10Santa Maria Misericordia Hospital, Udine, Italy. 11Department of Infectious Diseases, University Medical Centre, Ljubljana, Slovenia. 12Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland. 13Institut de Veille Sanitaire, Saint-Maurice, France. 14Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico. 15Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China. 16Department of Infectious Diseases, Hospital Universitari de Bellvitge, Bellvitge Institute for Biomedical Research, L’Hospitalet de Llobregat, Red Espa~nola de Investigaci on en Patolog ıa Infecciosa, University of Barcelona, Barcelona, Spain. 17Ministerio de Salud de Tucum an, Tucum an, Argentina. 18Victorian Infectious Diseases Service and Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, Parkville, Vic., Australia. 19Department of Pediatric Infectious Diseases, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA. 20Universidade Estadual do Oeste do Parana ´, UNIOESTE, Cascavel, PR, Brazil. 21The Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel. 22Clinical Virology Laboratory, CEMIC University Hospital, Buenos Aires, Argentina. 23Section of Pediatric Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada. 24Paediatric Intensive Care Unit, Bristol Children’s Hospital, Bristol, UK. 25Department of Respiratory & Critical Care Medicine, Peking University People’s Hospital, Beijing, China. 26NICU/PICU, PFME, CHU Saint Pierre, Saint Pierre, La R eunion, France. 27CIC 1410 (CHU/Inserm/University of La Re ´union/URML-OI), CHU Saint Pierre, Saint Pierre, La Réunion, France. 28UMR PIMIT (CHU/Inserm/University of La Re ´union/IRD/CNRS), CYROI, Saint Denis – Reunion Island, Saint Denis, France. 29NICU/PICU CHU of La Re ´union, Groupe Hospitalier Sud Re ´union, Saint Pierre, La Re ´union, France. 30Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Maran ˜o ´n, Madrid, Spain. 31Department of Infectious Disease Epidemiology, Sector for National Health Documentation and Research, Statens Serum Institut, Copenhagen, Denmark. 32Section of Paediatrics, Division of Infectious Disease, Imperial College, London, UK. 33Epidemiology Research Unit, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosı ´o Villegas, Mexico City, Mexico. 34Cath. Children’s Hospital Wilhelmstift, Hamburg, Germany. 35Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital St. Gallen, St. Gallen, Switzerland. 36Peking Union Medical College Hospital, Beijing, China. 37Dhaka Medical College Hospital, Dhaka, Bangladesh. 38Departamento de Ginecologia e Obstetrı ´cia – UFCSPA, Preceptora da Reside ˆncia Me ´dica do Hospital Fe ˆmina, Porto Alegre, Brazil. 39Ministry of Health in Egypt, Cairo, Egypt. 40Gold Coast Hospital, Gold Coast, Qld, Australia. 41Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. 42National Centre for Immunisation Research and Surveillance (NCIRS), The Children’s Hospital at Westmead, University of Sydney, Sydney, NSW, Australia. 43National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK. 44National Institute of Respiratory Diseases ‘Emilio Coni’ ANLIS “C. Malbran”, Santa Fe, Argentina. 45School of Medicine, University Hospital for Infectious Diseases, University of Zagreb, Zagreb, Croatia. 46Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong. 47Faculty of Medicine and Pharmacy, Mohammed V Military Teaching Hospital, Biosafety Level 3 and Research Laboratory, University Mohammed V-Souissi, Rabat, Morocco. 48Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg, Stellenbosch, South Africa. 49Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. 50Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore. 51Helsinki University Hospital, Helsinki, Finland. 52Department of Infectious Diseases, The First Affiliated Hospital, China Medical University, Shenyang, China. 53Department of Pediatrics, King Hussein Cancer Center, Amman, Jordan. 54Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan. 55Instituto de Medicina Preventiva de la Defensa, Capitan Medico Ramon y Cajal (IMPDEF), Ministerio de Defensa, Madrid, Spain. 56Toronto Invasive Bacterial Diseases Network, University of Toronto, Toronto, ON, Canada. 57Ministry of Health, Riyadh, Saudi Arabia. 58College of Medicine, Alfaisal University, Riyadh, Saudi Arabia. 59Department of Infectious Diseases and Clinical Microbiology, Erciyes University Faculty of Medicine, Kayseri, Turkey. 60Military Medical Academy, Clinic for Infectious and Tropical Diseases, Belgrade, Serbia. 61Section for Infectious Diseases, Medical Department, and Department of Research and Development, Haukeland University Hospital, Bergen, Norway. 62Department of Clinical Science, The Influenza Centre, University of Bergen, Bergen, Norway. 63The Division of Ocular Immunology, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 64National Research Institute for Tuberculosis and Lung Disease, Massih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 65National Influenza Center, National Center of Communicable Diseases, Ministry of Health, Ulaanbaatar, Mongolia. 66Department of Pulmonary and Critical Care, Yuzuncu Yil University Medical Faculty, Van, Turkey. 67Clinic of Pediatric Neurology, Dr. Sami Ulus Research and Training Hospital of Women’s and Children’s Health and Diseases, Ankara, Turkey. 68Critical Care and Pain Perioperative, Critical Care and Trauma Trials Group, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK. 69Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel. 70Medical University of Vienna, Vienna, Austria. 71Department of Pediatrics, Vanderbilt Vaccine Center, Vanderbilt University, Nashville, TN, USA. 72Fundacion INFANT, Buenos Aires, Argentina. 73Division of Pneumonology-Immunology, Department of Pediatrics, Charite ´ University Medical Center, Berlin, Germany. 74Critical Care Department, Hospital Joan XXIII, IISPV, URV, CIBERES, Tarragona, Spain. 75Laboratory of Respiratory Viruses, Oswaldo Cruz Institute/Fiocruz, Rio de Janeiro, Brazil. 76Uniwersytet Rzeszowski, Rzeszo ´w, Poland. 77Department of Children’s Infectious Diseases, Medical University of Warsaw, Warsaw, Poland. 78Division of Microbiology/Molecular Diagnostic Centre, Department of Laboratory Medicine, National University Hospital, Singapore, Singapore. 79Alberta Provincial Laboratory for Public Health, University of Alberta Hospital, Edmonton, Canada. 80Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada. 81Hospital Clinic, University of Barcelona, IDIBAPS, CIBERES, Barcelona, Spain. 82Department of Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul, Turkey. 83Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada. 84Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. 85Department of Pediatric Intensive Care, VU University Medical Center, Amsterdam, The Netherlands. 86Division of Infectious Diseases, Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada. 87Lithuanian University of Health Sciences, Kaunas, Lithuania. 88General Hospital, Slovenj Gradec, Slovenia. 89Unit of Infectious Diseases, University General Hospital of Alexandroupolis, Democritus University Thrace, Dragana, Greece. Correspondence: Jonathan S. Nguyen-Van-Tam, University of Nottingham, City Hospital, DM, Room A28b, Clinical Sciences Building, Nottingham NG5 1PB, UK. E-mail: jvt@nottingham.ac.uk *List of PRIDE Consortium Investigators are in Appendix 1. For affiliations, please see Table S1. Múltipla - ver em notas Background The impact of neuraminidase inhibitors (NAIs) on influenza-related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1) pdm09 virus infection. Methods A worldwide meta-analysis of individual participant data from 20 634 hospitalised patients with laboratory-confirmed A (H1N1)pdm09 (n = 20 021) or clinically diagnosed (n = 613) ‘pandemic influenza’. The primary outcome was radiologically confirmed IRP. Odds ratios (OR) were estimated using generalised linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids. Results Of 20 634 included participants, 5978 (29 0%) had IRP; conversely, 3349 (16 2%) had confirmed the absence of radiographic pneumonia (the comparator). Early NAI treatment (within 2 days of symptom onset) versus no NAI was not significantly associated with IRP [adj. OR 0 83 (95% CI 0 64–1 06; P = 0 136)]. Among the 5978 patients with IRP, early NAI treatment versus none did not impact on mortality [adj. OR = 0 72 (0 44–1 17; P = 0 180)] or likelihood of requiring ventilatory support [adj. OR = 1 17 (0 71– 1 92; P = 0 537)], but early treatment versus later significantly reduced mortality [adj. OR = 0 70 (0 55–0 88; P = 0 003)] and likelihood of requiring ventilatory support [adj. OR = 0 68 (0 54– 0 85; P = 0 001)]. Conclusions Early NAI treatment of patients hospitalised with A (H1N1)pdm09 virus infection versus no treatment did not reduce the likelihood of IRP. However, in patients who developed IRP, early NAI treatment versus later reduced the likelihood of mortality and needing ventilatory support.

Highlights • CCHF in pregnancy is rare but has high rates of maternal (34%) and fetal mortality (59%). • Maternal hemorrhage is associated with maternal and fetal/neonatal death. • Nosocomial transmission of CCHF from 6/37 index pregnant cases resulted in 38 cases. • Early recognition and risk-assessment allows appropriate IP & C precautions and supportive care provision., Background Crimean-Congo hemorrhagic fever (CCHF) is acute viral infection and a major emerging infectious diseases threat, affecting a large geographical area. There is no proven antiviral therapy and it has a case fatality rate of 4–30%. The natural history of disease and outcomes of CCHF in pregnant women is poorly understood. Objectives To systematically review the characteristics of CCHF in pregnancy, and report a case series of 8 CCHF cases in pregnant women from Russia, Kazakhstan and Turkey. Methods A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement protocol. PubMed, SCOPUS, Science Citation Index (SCI) were searched for reports published between January 1960 and June 2016. Two independent reviewers selected and reviewed studies and extracted data. Results Thirty-four cases of CCHF in pregnancy were identified, and combined with the case series data, 42 cases were analyzed. The majority of cases originated in Turkey (14), Iran (10) and Russia (6). There was a maternal mortality of 14/41(34%) and fetal/neonatal mortality of in 24/41 cases (58.5%). Hemorrhage was associated with maternal (p = 0.009) and fetal/neonatal death (p

Cataract is one of the most common causes of visual impairment [1]. It is estimated that there are approximately 30 million blind people in the world and 50 percent of them are blind due to cataracts [2]. The only treatment for cataract is surgery and modern surgical techniques are extremely safe with few major complications [3]. Endophthalmitis is a severe intraocular inflammation which may occur as a serious complication of cataract surgery [4].In our hospital cataract surgery has been performed since 2003. Over one thousand five hundred cataract operation was performed in our hospital by the same ophthalmologist. This was the first case and also outbreak by this time. Endophthalmitis was occurred in four cases following cataract surgery. The surgery was consecutively performed on the same day. All the patients were over 65 years old. Their past medical history included hypertension, heart failure, Parkinson disease and chronic obstructive pulmonary disease. All four patients were admitted to the hospital on the day of surgery. Implantation of a foldable intraocular lens through clear corneal incision was performed under local and topical anesthesia. Prophylactic antibiotics were not administered in the preoperative and perioperative period. There was no complication occurred during surgery and patients were discharged following the surgery. But on the second day after the surgery all four patients complaining about eye pain and decreasing vision. On physical examination slightly swollen eyelids, decreased visual acuity and hypopyon was revealed. The view of the retina was hazy on ophthalmological examination. The time between cataract surgery and the diagnosis of endophthalmitis was twenty four hours. Multiple cultures were obtained from all parts of phacoemulsifier on the same day of the outbreak by infection control team. All the patients received prednisolone sodium phosphate, moxifloxacin hydrochloride, cyclopentolate hydrochloride and vancomycin drops by topical route, vancomycin and gentamicin by subkonjunctival route vancomycin and ciprofloxacin by intravenous route. On the second day of initial treatment signs and symptoms of the patients started to recover dramatically. After follow up of seven days all patients hypopyon have resolved with improved vitritis and inflammation decreased and eventually visual activity corrected.During the outbreak we focused on the surgical devices because nosocomial surgical infections were considered to be the result of contaminated surgical sites with inadequately sterilized surgical instruments. We obtained cultures from recent sterilized hydrodissection cannula, capsulorhexis forceps, phaco tip, phaco handpiece, and aspiration and irrigation hose. They were all inoculated into blood, chocolate and eosin methylene blue agar. Koagulase negative staphylococcus was isolated from an aseptically obtained culture of phaco tip. Other culture results were reported negative. We did not able to sample vitreous and aqueous humor. Most cases of endophthalmitis present acutely with hours to a few days of symptoms. Coagulase negative staphylococci (70% of patients) are the most common causes of postcataract endophthalmitis [5]. Bacterilogical diagnostic similarities among samples from patients with endophthalmitis and surveillance species have not been shown. This was the crucial limitation of the report. In this outbreak when we investigate the cause of the infections we realized that all phaco tips have disappeared except one that was used during the cataract surgery of four cases and operating staff was keeping it in a tube. This tube presumably didn’t allow adequate decontamination and sterilization.We aimed to share an outbreak experience. This report demonstrates the importance of well organization and close collaboration between sterile service providers, operating staff, infection control team and operator for reducing the risk of surgical infections.

Escherichia coli is the most common microorganisms isolated from community-acquired urinary tract infections (UTIs). Furthermore increasing frequency of extended spectrum β-lactamase (ESBL) positive E. coli strains in community-acquired UTIs has led to increasing rates of resistance to antibiotics that used in empirical treatment. The aim of this study was to determine the antimicrobial resistance patterns and epidemiological characteristics of community-acquired E.coli strains in our geographical region. The 3887 (2146 women and 1741 men) urine culture samples examined between September 2011 - September 2013 which were sent to microbiology laboratory from outpatient clinics of our hospital with a preliminary diagnosis of UTIs. 697 (18%) of urine culture samples were find positive; 423 (61%) were female, 274 (39%) were male. By using conventional methods, 352(51%) of the isolated strains were identified as E.coli. Antimicrobial susceptibilities of E.coli strains determined by Clinical Laboratory Standards Institute criteria. Extended spectrum β-lactamase was investigated by double-disk synergy test. The 352 isolated strains of E.coli belong to 47% of urology, 28% of internal medicine and 25% of pediatric patients urine cultures. The highest resistance ratio was observed against to ampicillin according to 68% treatments. There was no resistance found against imipenem and amikacin and 2% of resistance determined to fosfomycin trometamol. The 53 (15%) of isolated strains had extended spectrum β-lactamase. Determination of the antimicrobial resistance rates and selection of the empirical treatment according to these results will prevent the ESBL production and development of resistance to antimicrobials in our region. Also, we hope this study will help to determine the differences between similar geographical regional studies and comparing the results, Escherichia coli is the most common microorganisms isolated from community-acquired urinary tract infections (UTIs). Furthermore increasing frequency of extended spectrum β-lactamase (ESBL) positive E. coli strains in community-acquired UTIs has led to increasing rates of resistance to antibiotics that used in empirical treatment. The aim of this study was to determine the antimicrobial resistance patterns and epidemiological characteristics of community-acquired E.coli strains in our geographical region. The 3887 (2146 women and 1741 men) urine culture samples examined between September 2011 - September 2013 which were sent to microbiology laboratory from outpatient clinics of our hospital with a preliminary diagnosis of UTIs. 697 (18%) of urine culture samples were find positive; 423 (61%) were female, 274 (39%) were male. By using conventional methods, 352(51%) of the isolated strains were identified as E.coli. Antimicrobial susceptibilities of E.coli strains determined by Clinical Laboratory Standards Institute criteria. Extended spectrum β-lactamase was investigated by double-disk synergy test. The 352 isolated strains of E.coli belong to 47% of urology, 28% of internal medicine and 25% of pediatric patients urine cultures. The highest resistance ratio was observed against to ampicillin according to 68% treatments. There was no resistance found against imipenem and amikacin and 2% of resistance determined to fosfomycin trometamol. The 53 (15%) of isolated strains had extended spectrum β-lactamase. Determination of the antimicrobial resistance rates and selection of the empirical treatment according to these results will prevent the ESBL production and development of resistance to antimicrobials in our region. Also, we hope this study will help to determine the differences between similar geographical regional studies and comparing the results. Key Words: E.coli, ESBL, community-acquired UTI, antimicrobial resistanceÖzetEscherichia coli toplum kaynaklı üriner sistem enfeksiyonlarından (ÜSE) etken olarak en sık izole edilen mikroorganizmadır. Genişlemiş spektrumlu β-laktamaz (GSBL) pozitif E.coli suşlarının toplum kaynaklı ÜSE’lerde sıklığının artması ile beraber ampirik tedavide kullanılan antibiyotiklere karşı direnç oranlarının artmasına neden olmaktadır. Bu çalışmanın amacı toplum kaynaklı ÜSE etkenlerinden olan E.coli suşlarının antimikrobiyal paternleri belirlenerek, bölgemizdeki direnç oranlarının ve epidemiyolojik özelliklerinin araştırılmasıdır. Eylül 2011- Eylül 2013 tarihleri arasında hastanemiz polikliniklerinden toplum kökenli ÜSE ön tanısıyla mikrobiyoloji laboratuvarımıza gönderilen 3887(2146 kadın, 1741 erkek) idrar kültür örneği incelendi. İdrar kültür örneklerinin 697’sinde(%18) üreme oldu. İdrar kültür örneklerinde üreme saptanan hastaların 423’ü(%61) bayan, 274’ü(%39) erkekti. İzole edilen bakterilerin 352’si(%51) konvansiyonel yöntemlerle E.coli olarak tanımlandı. Tanımlanan E.coli suşlarının antimikrobiyal direnç durumu Clinical Laboratory Standards Institute kriterleri ile belirlendi. GSBL oranları ise çift disk sinerji testi ile araştırıldı. İzole edilen 352 E.coli suşu’nun, %47’si üroloji, %28’i dahiliye ve %25’i pediatri polikliniklerine ayaktan başvuran hastaların idrar kültür örneklerine aitti. E.coli suşlarında %62 ile en yüksek direnç oranı ampisiline karşı görüldü. İmipenem ve amikasine karşı ise direnç saptanmazken fosfomisin trometamole %2 oranında direnç belirlendi. İzole edilen suşların 53’ünde(%15) GSBL varlığı saptandı. Bölgemizdeki antimikrobiyal direnç oranlarının belirlenmesi, ampirik tedavide akılıcı ilaç kullanımına katkıda bulunarak, GSBL üretimi ve direnç gelişimini önleyecek, antibiyotiklerin etkin kullanılmasına katkıda bulunacağı inancındayız. Ayrıca çalışmamızın benzer bölgesel çalışmalara ışık tutarak farklılıkların gösterilebilmesi ve sonuçların karşılaştırılabilmesi açısından yararlı olacağı kanısındayız. Anahtar Kelimeler: E.coli, GSBL, toplum kaynaklı üriner enfeksiyon, antimikrobiyal direnç

Giriş ve Amaç: Hepatit C virusu (HCV) hemodiyalize giren hasta popülasyonunda sık görülen bir enfeksiyon etkenidir. Bu çalışmada bölgemizdeki hemodiyaliz hastalarında HCV enfeksiyonunun epidemiyolojik özellikleri ve periferik kandaki mononükleer hücreler (PKMNH)'de viral RNA saptanması temeline dayanan ?real time? polimeraz zincir reaksiyonu (PZR) yöntemiyle okkült C hepatiti (OCH) sıklığının araştırılması amaçlanmıştır.Hastalar ve Yöntem: Çalışmaya rutin olarak hemodiyalize giren 16 yaşın üzerindeki kronik böbrek yetmezliği olan 100 hasta alındı. Hastaların demografik verileri, HCV için olası bulaş yolları, böbrek yetmezliği nedenleri, hemodiyalize giriş yolu, hemodiyaliz süresi, karaciğer fonksiyon testleri, hepatit göstergeleri ile plazmada ve PKMNH'de HCV RNA araştırıldı. Hepatit göstergeleri ?enzyme immunoassay? (EIA) (Architect, Abbott) ile test edildi. Plazma ve PKMNH'de HCV RNA ?real time? PZR yöntemi (TaqMan 48, Roche) ile araştırıldı. PZR testinin ölçüm aralığı 25-3.91x108 IU/mL, testin hassasiyeti ise 25 IU/mL idi. OCH karaciğer enzimleri yüksek veya normal olan, serumda anti-HCV ve plazmada HCV RNA negatif saptanan hastalarda PKMNH'de HCV RNA'nın pozitif bulunması olarak tanımlandı.Bulgular: Hastaların yaş ortalaması 58.6 ±13.9 yıl idi ve %56'sı erkekti. Hastaların 81 (%81)'i fistülden diyalize girmekteydi. Ortalama diyaliz süresi 4.8 (1-19) yıl idi. ALT ve AST değerleri ortalaması sırasıyla 17±1.1 IU/L ve 16.1±7.2 IU/L idi. Yetmiş üç hastanın kronik böbrek yetmezliğine eşlik eden en az bir alt hastalığı vardı ve en sık alt hastalık hipertansiyon (HT) olarak belirlendi. En sık bulaş yolu cerrahi girişim, ikinci sıklıkla kan transfüzyonu olarak saptandı. Çalışmaya dahil edilen 100 hastanın 19'unda HCV tanısal testleri olarak kullanılan anti-HCV, plazma HCV RNA ve PKMNH'de RNA testlerinden en az biri pozitifti. Hastalardan 10'unda anti-HCV pozitifliği, 11'inde plazma HCV RNA pozitifliği ve yedisinde PKMNH'de RNA pozitifliği belirlendi. Anti-HCV'si pozitif olan 10 hastadan 5'inin hem plazma hem PKMNH'de HCV RNA'sı negatifti. Serum anti-HCV'si negatif olan 90 hastanın 6 (%6.7)'sında plazma HCV RNA, 3 (%3.3)'ünde PKMNH'de HCV RNA değerleri pozitifti. Bu hastaların plazma HCV RNA değerleri 75-338 IU/L arasındaydı. Plazma HCV RNA düzeyleri düşük pozitif olan bu hastaların tümünde PKMNH'de çalışılan HCV RNA değerleri negatif olarak belirlendi. Hem anti-HCV'si hem de plazmada çalışılan HCV RNA'sı negatif olan 84 hastanın 3 (%3.6)'ünde PKMNH'de HCV RNA pozitif bulundu. Plazma HCV RNA'sı 500 IU/mL olan dört hastanın PKMNH'de HCV RNA sonuçları pozitif bulunmuştur.Sonuç: Hemodiyaliz hastalarında HCV enfeksiyonunun sessiz seyretmesi hastalığın ilerlemesi ve virusun bulaşı açısından önemli bir risk oluşturur. PKMNH'de HCV RNA tespiti okkült enfeksiyonu saptamaya yardımcı olacak noninvaziv bir yöntemdir.Anahtar kelimeler: Hepatit C virusu, hemodiyaliz, okkült C hepatiti, periferik kan mononükleer hücreleri Introduction and Aim: HCV is common cause of infection in patients receiving hemodialysis. In this study we aimed to determine epidemiological characteristics of hepatitis C virus (HCV) infection and detection of HCV RNA status in peripheral blood mononuclear cells (PBMCs) of the patients who require hemodialysis and the prevelance of occult HCV infection by real-time polimerase chain rection (PCR) in our region.Patients and Methods: One hundred end-stage renal disease patients, over 16 years old, receiving hemodialysis treatment were enrolled in this study. Participants demographic data, possible routes of transmission for HCV, causes of renal failure, type of vascular access in hemodialysis patients, duration of hemodialysis were all evaluated. Serum samples were tested for liver function tests and serological markers for hepatitis with EIA (Architect, Abbott). HCV RNA was extracted from the serum samples and PBMCs by using real-time PCR (TaqMan 48, Roche). Measurement range of the PCR test was 25-3.91x108 IU/mL and the sensitivity of the test was 25 IU/mL. Occult HCV infection was described in patients with or without high liver function tests of unknown etiology and it is characterized by the presence of HCV RNA in the PBMCs despite negative results for anti-HCV and for serum HCV RNA as tested by conventional assays.Results: The mean age of the patients was 58.5+13.9 years and 56% were male. Arteriovenous fistulas were the most common type of vascular access of hemodialysis patients (81%) and the avarage duration of dialysis was 4.8 (1-19) years. The mean levels of ALT and AST were 17 ± 1.1 IU / L and 16.1 ± 7.2 IU / L, respectively. Seventy-three patients with chronic renal failure had at least one chronic disease and the most common disease was hypertension. Surgical procedures and blood transfusion were the most common route of transmission of HCV. We found that 19 out of the 100 patients testing positive for at least one of these tests; anti-HCV, plasma HCV RNA and PBMCs RNA. Out of 100 patients, 10 were positive for anti-HCV, 11 were positive for plasma HCV RNA and 7 positive for PBMCs HCV RNA. Five of the 10 patients whose anti-HCV positive were both negative for RNA in plasma and PBMCs. Six (6.7%) out of 90 patients whose anti-HCV were negative, HCV RNA in plasma were positive and also HCV RNA in PBMCs positive in 3 (3.3%) patients whose RNA levels were between 75-338 IU/mL. All the patients with low levels of HCV RNA in plasma were negative in PBMCs. Three (%3.6) out of 84 patients in both anti-HCV and plasma HCV RNA negative group, HCV RNA in PBMCs were positive. HCV RNA in PBMCs were all negative in seven patients with the level of plasma HCV RNA were under 500 IU/Ml. We found four patients with HCV RNA positive in PBMCs, their HCV RNA results were over 500 IU/mL.Conclusion: Silent progression of HCV infection may cause progression of the disease and could be potential risk for the transmission of the virus. Detection of HCV RNA status in PBMCs of the patients, is noninvasive method that will help to determine occult infection.Keywords: Hepatitis C virus, hemodialysis, occult hepatitis C infection, peripheral blood mononuclear cells 132

HIV/AIDS is still an important health problem worldwide and the number of people living with HIV worldwide continued to grow in the last years. The first HIV/AIDS cases had been reported in 1985 from Turkey and with an increasing trend during the following years, the number of cases reached to 3898 with 528 new cases in 2009. The aim of this retrospective study was to share the 18 years experience with the patients who were followed-up in Erciyes University Hospital Infectious Diseases Clinics in Cappadocia region. The records of 55 (81%) HIV/AIDS patients out of 68 who were admitted to our clinic between 19922009 have been attained and the demographic and clinical characteristics, administered therapy regimens and adverse effects of antiretroviral therapy of those cases have been evaluated. Forty-three (78%) of the patients were male and 12 (22%) were female of which 11(92%) of their spouses had HIV/AIDS. The median age of the patients was 45 and 20 (36%) of them were over 54 years old. Fifty (91%) of patients lived in Cappadocia region, and 24 (44%) had lived in foreign countries. Fifty (91%) patients had risky heterosexual contact as a risk factor. Of these patients, 47 (85%) were in full-blown AIDS stage at admission. Twenty-seven (49%) of the patients diagnosed occasionally during routine anti-HIV testing, did not have any symptoms. Fever, weakness and weight loss were the most frequently detected symptoms in the rest of the patients. Ten (18%) patients had underlying diseases such as hypertension, chronic hepatitis B or C, coronary artery disease, diabetes mellitus and chronic renal disfunction. Opportunistic infections were determined in 25 (45.5%) patients and 20 (40%) of these infections were determined at admission. The most frequent opportunistic infection was oral candidiasis, followed by Pneumocystis (carinii) jiroveci pneumonia and tuberculosis. Malignancy was diagnosed in three patients; two had Kaposi's sarcoma and one had multiorgan adenocarcinoma. Antiretroviral therapy was started in 37 (67%) of the patients and lamivudin/zidovudin + lopinavir/ritonavir was the most commonly used combination. Antiretroviral therapy was changed in 13 (35%) patients most frequently due to the development of side effects of the drugs. Nausea, vomiting and hyperlipidemia were the most frequent side effects, while diarrhea, skin rashes, anemia, leucopenia and lipoatrophy have also been detected. One patient discontinued therapy by his own will. Sixteen (27.6%) of 58 patients, whose records could be achieved, died. The mortality rates detected in 19921999 and 2000-2009 periods were 78.6% (11/14) and 11.4% (5/44), respectively. The mean exitus time of the patients was six months after the diagnosis. The reasons of mortality were opportunistic infections in six patients, and adenocarcinoma in one patient. Autopsy had been performed in seven cases, however three patients' records could be attained. One had disseminated candidiasis and miliary tuberculosis, one had multiorgan carcinoma, and one had pneumonia, kidney and colon necrosis and condyloma acuminata. In conclusion, increasing awareness of physicians about HIV/AIDS epidemiology in Turkey provides early diagnosis and prevents the dissemination of illness in community.