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Objectives: Patients with chronic hepatitis C virus (HCV) infectionand superinfection by hepatitis A or hepatitis B virus have highermorbidity and mortality when compared with those without HCVinfection. The aim of this study was to determine hepatitis A and Bseroprevalence rates and immunity in patients with chronic HCV indifferent regions of TurkeyMaterials and Methods: This multi-center study involving HCVinfected chronic cases was conducted between July 2016 andOctober 2017. Serological tests of Hepatitis B surface antigen, antiHBs, hepatitis B core antibody (anti-HBc) immunoglobulin G (IgG)and anti-HAV IgG were evaluated by ELISA, and the files of HCVinfected patients at the age of 18 or over who applied to 15 hospitalsin 13 different cities of our country were screened.Results: Three hundred sixty-two of the 828 patients were menand 466 were women. The prevalence of HBV/HCV coinfection was2.4%, while the anti-HBs positivity rate was 46.9%. Of the 610patients evaluated in terms of anti-HAV IgG serology, 88.8% wereanti-HAV IgG positive, while 11.1% were anti-HAV IgG negative.Isolated anti-HBc IgG positivity was detected in 5.8% of patients.Conclusion: Revealing the serological status of other hepatitisagents, such as hepatitis A and B, in patients with chronic hepatitisC is important in terms of providing the opportunity to immunize ortreat when required Gereç ve Yöntemler: HCV ile enfekte kronik olguları içeren çok merkezli bu çalışma Temmuz 2016-Ekim 2017 tarihleri arasında yapıldı. Hepatit B yüzey antijeni (HBsAg, antiHBs, antiHBcIgG ve antiHAVIgG’nin serolojik testleri ELISA ve 18 yaşında HCV ile enfekte hastaların dosyaları veya Ülkemizin 13 farklı ilinde 15 hastaneye başvuranlar tarandı. Ülkemizin 13 farklı ilindeki 15 hastanenin HCV ile enfekte hastalarının dosyaları tarandı ve ELISA yöntemi ile değerlendirilen HBsAg, anti-HBs, anti-HBc IgG ve antiHAV IgG bakıldı. Bulgular: Sekiz yüz yirmi sekiz hastanın üç yüz altmış ikisi erkek, 466 kadındı. HBV/HCV koenfeksiyon prevalansı %2,4 iken antiHBs pozitiflik oranı %46,9 idi. Anti-HAV IgG serolojisi açısından değerlendirilen 610 hastanın %88,8’i anti-HAV IgG pozitif, %11,1’i anti-HAV IgG negatif idi. Hastaların %5,8’inde izole anti-HBc IgG pozitifliği saptandı. Sonuç: Kronik hepatit C’li hastalarda hepatit A ve B gibi diğer hepatit ajanlarının serolojik durumunun ortaya konması, gerektiğinde aşılama veya tedavi fırsatı sağlama açısından önemlidir WOS:000605350300005

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

Kentlerin görsel yüzü olan dış duvarlar, cephe oluşturduğu mekan ve yakın çevresi ile iletişim kurmaktadır. Cephe tasarımında kullanılan; biçim, malzeme, renk, doku, doluluk-boşluk (geçirgenlik) görsel iletişim gücünü belirleyen en önemli dış duvar öğeleridir. Yenilenme hareketleri kentsel dönüşüm başlığı altında tanımlanırsa, bu bağlamda başlayan ve devam eden yapı üretimlerinin illere, ilçelere hatta semtlere göre etki değerinin birbirinden farklı özelliklere sahip olduğu görülmektedir. Özellikle yerleşim için daha çok tercih edilen bölgelerdeki değişim, sadece dayanıklı yapı üretimi amacını taşımadığı için ortaya çıkan yeni doku özellikleri, bina üretim yaklaşımları da bunu doğrular niteliktedir. Her yerleşim bölgesi büyüme ve değişme davranışı gösterme eğilimindedir. Değişim, zaman içine yayılarak kendi doğal ihtiyaçları içinde geliştiğinde daha kolay kabul görmesine rağmen, hızlı ve yenilenme gerekliliğinin karşılığını tam olarak ifade etmeyen fiziksel bir değişim oluştuğunda, olumsuz fiziksel sonuçlar doğurabilmektedir. Bu bağlamda İstanbul ili Kadıköy ilçesi Bağdat caddesi yakın çevresinin belirtilen bu hızlı değişim özelliğine yakın olduğu düşünülmektedir. Bu bağlamda değişim hızı ve sonuçlarının daha yoğun görüldüğü Kadıköy ilçesi, Bağdat caddesi yakın çevresi çalışma alanı olarak seçilmiştir The outer walls, which are the visual faces of the cities, communicate with the space formed by the facade and its immediate surroundings. The most important external wall elements Used in facade design that determine the visual communication power are form, material, colour, texture, and occupancy-void (permeability). If the renewal movements are defined under the heading of urban transformation, it is seen that the impact value of the building productions that started and continued in this context have different characteristics than provinces, regions or even districts. Changes especially in the regions which are more preferred for settlement, affirm not only the purpose of durable building production, also the new texture features and building production approaches confirm this. Each residential area tends to show growth and behavioural changes. Although change spreads over time and is more easily accepted when it develops within its natural needs, it may have negative physical consequences when a physical change occurs that does not fully express the need for renewal. In this context, it is thought that the close vicinity of Bağdat Street in Kadıköy district of Istanbul is close to this mentioned rapid change feature. In this context, close vicinity of Bağdat Street, Kadıköy district, where the rate of change and its results are more intense, was chosen as the study area 274

Objectives: The aims of this study were to evaluate the biopsy methods used in terms of safety, and effectiveness as well as incidence, and severity of complications. Materials and Methods: This study was conducted as a prospective, observational study with the participation of five centers in Turkey. Any patient complaints and/or complications were also recorded. The patients’ pain severity was determined by an established scoring method. Results: This research included 221 chronic hepatitis patients and 12 physicians. With regard to the biopsies, 71.9% were ultrasound-guided and 28.1% were blind biopsies. 71% of patients had complaints (mostly pain) and 19.9% developed complications; however, no mortality occurred. It was observed that patient’s complaints were significantly correlated with the physician’s age, level of biopsy experience, and number of biopsies performed yearly. It was determined that the biopsy method was not affective factor in terms of the development of severe pain after biopsy. The use of a 16G biopsy needle was found to increase the probability of severe pain occurrence by about eight times. Conclusion: Severe pain was not affected by the biopsy method or patient-specific factors, and was a result of the size of the biopsy needle used and the characteristics of the practitioner.

Aim: The aim of this study is to evaluate the attitudes of healthcare workers against seasonal influenza vaccine and the reasons for vaccine avoidance. Materials and Methods: This national survey was conducted from April 1st to June 30th in 2017. The study was carried out among health care workers working in primary, secondary and tertiary care settings. A total of 12 questions were sent to 5046 health care professionals from 55 different cities who agreed to participate in the survey.Results: 7% of the participants stated that they get vaccinated regularly every year. 65.8% of the participants stated that they don’t get vaccinated at all. The most important reason for those who did not receive influenza vaccination was their disbelief in the necessity of the vaccination (51.9%). The most common reason for the seasonal influenza vaccination was the prevention of influenza infection (56.7%).Conclusion: The results of the study showed that HCWs influenza vaccination rates are very low. Doctors have been found to have slightly better rates than other HCWs. The high level of education and the increase in professional experience had a positive effect on the vaccination rate. It is important to know the HCWs attitudes and behaviors towards the vaccination to increase the rates., Amaç: İnfluenza tüm dünyada önemli ölçüde morbidite, mortalite ve maliyet yükünden sorumludur. Sağlık çalışanları (HCP) mesleksel bulaş açısından risk altındadırlar. Bu çalışmada sağlık çalışanlarının mevsimsel influenza aşısına karşı tutumlarının ve aşıdan kaçınma nedenlerinin değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Bu çok merkezli ulusal anket çalışması 1 Nisan-30 Haziran 2017 tarihleri arasında gerçekleştirildi. Ankete katılmayı kabul eden 55 şehirden toplam 5046 HCP uzaktan katılım yoluyla cevaplamaları için toplam 12 sorudan oluşan bir anket gönderildi.Bulgular: Çalışmaya katılanların %7’si her yıl düzenli olarak aşı yaptırdığını belirtti. Hiç yaptırmıyorum diyenlerin oranı %65,8 idi. İnfluenza aşışını yaptırmayanların en önemli nedeni grip aşısının gerekliliğine inanmama idi (%51,9). Mevsimsel grip aşısı yaptıranların en önemli gerekçesi grip infeksiyonundan korunma (%56,7) idi.Sonuç: Sonuçlarımız, tüm HCP influenza aşılama oranlarının çok düşük olduğunu göstermiştir. Doktorların diğer HCP’lerden biraz daha iyi oranlara sahip olduğunu görülmüştür. Eğitim düzeyinin yüksek olması ve mesleki tecrübenin artması aşılama oranını olumlu yönde etkilemiştir. Sağlık çalışanlarının aşılanma oranlarının artırılabilmesi için öncelikle aşı konusundaki tutum ve davranışlarının bilinmesi gerekir.

Ventilator-associated pneumonia (VAP) due to Acinetobacter spp. is one of the most common infections in the intensive care unit. Hence, we performed this prospective-observational multicenter study, and described the course and outcome of the disease. This study was performed in 24 centers between January 06, 2014, and December 02, 2016. The patients were evaluated at time of pneumonia diagnosis, when culture results were available, and at 72 h, at the 7th day, and finally at the 28th day of follow-up. Patients with coexistent infections were excluded and only those with a first VAP episode were enrolled. Logistic regression analysis was performed. A total of 177 patients were included; empiric antimicrobial therapy was appropriate (when the patient received at least one antibiotic that the infecting strain was ultimately shown to be susceptible) in only 69 (39%) patients. During the 28-day period, antibiotics were modified for side effects in 27 (15.2%) patients and renal dose adjustment was made in 38 (21.5%). Ultimately, 89 (50.3%) patients died. Predictors of mortality were creatinine level (OR, 1.84 (95% CI 1.279–2.657); p = 0.001), fever (OR, 0.663 (95% CI 0.454–0.967); p = 0.033), malignancy (OR, 7.095 (95% CI 2.142–23.500); p = 0.001), congestive heart failure (OR, 2.341 (95% CI 1.046–5.239); p = 0.038), appropriate empiric antimicrobial treatment (OR, 0.445 (95% CI 0.216–0.914); p = 0.027), and surgery in the last month (OR, 0.137 (95% CI 0.037–0.499); p = 0.003). Appropriate empiric antimicrobial treatment in VAP due to Acinetobacter spp. was associated with survival while renal injury and comorbid conditions increased mortality. Hence, early diagnosis and appropriate antibiotic therapy remain crucial to improve outcomes. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.

WOS: 000463053800027, Introduction: Hand hygiene is one of the most cost-effective infection control measures. In this multicenter Study we analysed the hand hygiene compliance observation results of 15 hospitals in Turkey. Materials and Methods: This study was performed in intensive care units (ICUs) of 15 hospitals (Eight terriary-care educational hospitals, six state hospitals and one private hospital) from 11 cities from six regions of Turkey The observations were made by infection control practitioners according to the World Health Organization - Five Moments for Hand Hygiene (WHO-5) indications rule for hand hygiene and overall compliance rates were calculated. Observations were unblinded (healthcare professionals knew that they were observed). The study period included 2015 and 2016 calendar years. Results: There was a statistically significant increase in hand hygiene compliance rates in 2016 versus 2015. The overall number of hand hygiene indications and compliance in 2015 and 2016 were 60071/78116-76,9% and 66551/83607-79,6% (p=0.0001), respectively. Nurses were the most compliant group in both years. The highest compliance was in after body fluid exposure indication (88.2%-2015 and 91.4%-2016) while the lowest compliance was in before patient contact indication (61.3%-2015 and 65%-2016). Conclusion: The presented data suggest that under unblinded observations, hand hygiene compliance seems to be in relatively acceptable rates in Turkey. Centers with compliance rates below 50 percentile rates in any of the 5 moments should increase efforts to enhance compliance in that indication.

Objectives: In this study, we aimed to evaluate the clinical course of treatment-naive patients infected with hepatitis C virus (HCV) who were followed up in various centers in Turkey. Materials and Methods: This was a retrospective study performed with the participation of 15 centers. Patients aged 18 years and older with HCV infection were included. Results: A total of 391 treatment-naive patients infected with HCV were included in this study. During the follow-up period, the final values of alanine aminotransferase, aspartate transaminase, and total protein were significantly decreased when compared to the initial values (p

We aimed to develop a scoring system for predicting in-hospital mortality of community-acquired (CA) sepsis patients. This was a prospective, observational multicenter study performed to analyze CA sepsis among adult patients through ID-IRI (Infectious Diseases International Research Initiative) at 32 centers in 10 countries between December 1, 2015, and May 15, 2016. After baseline evaluation, we used univariate analysis at the second and logistic regression analysis at the third phase. In this prospective observational study, data of 373 cases with CA sepsis or septic shock were submitted from 32 referral centers in 10 countries. The median age was 68 (51-77) years, and 174 (46,6%) of the patients were females. The median hospitalization time of the patients was 15 (10-21) days. Overall mortality rate due to CA sepsis was 17.7% (n = 66). The possible predictors which have strong correlation and the variables that cause collinearity are acute oliguria, altered consciousness, persistent hypotension, fever, serum creatinine, age, and serum total protein. CAS (%) is a new scoring system and works in accordance with the parameters in third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). The system has yielded successful results in terms of predicting mortality in CA sepsis patients.

Introduction: Hand hygiene is one of the most effective infection control measures to prevent the spread of healthcare-associated infections (HCAI). Water, soap, paper towel and hand disinfectant must be available and adequate in terms of effective hand hygiene. The adequacy of hand hygiene products or keeping water-soap and paper towel is still a problem for many developing countries like Turkey. In this multicenter study, we analyzed the adequacy in number and availability of hand hygiene products., Materials and Methods: This study was performed in all intensive care units (ICUs) of 41 hospitals (27 tertiary-care educational, 10 state and four private hospitals) from 22 cities located in seven geographical regions of Turkey. We analyzed water, soap, paper towel and alcohol-based hand disinfectant adequacy on four different days, two of which were in summer during the vacation time (August, 27th and 31st 2016) and two in autumn (October, 12th and 15th 2016)., Results: The total number of ICUs and intensive care beds in 41 participating centers were 214 and 2357, respectively. Overall, there was no soap in 3-11% of sinks and no paper towel in 10-18% of sinks while there was no alcohol-based hand disinfectant in 1-4.7% of hand disinfectant units on the observation days. When we compared the number of sinks with soap and/or paper towel on weekdays vs. weekends, there was no significant difference in summer. However, on autumn weekdays, the number of sinks with soap and paper towel was significantly lower on weekend days (p, Conclusion: There should be adequate and accessible hand hygiene materials for effective hand hygiene. In this study, we found that soap and paper towels were inadequate on the observation days in 3-11% and 10-18% of units, respectively. Attention should be paid on soap and paper towel supply at weekends as well.

WOS: 000446000200057, PubMed ID: 30256855, Sepsis is a severe clinical syndrome owing to its high mortality. Quick Sequential Organ Failure Assessment (qSOFA) score has been proposed for the prediction of fatal outcomes in sepsis syndrome in emergency departments. Due to the low predictive performance of the qSOFA score, we propose a modification to the score by adding age. We conducted a multicenter, retrospective cohort study among regional referral centers from various regions of the country. Participants recruited data of patients admitted to emergency departments and obtained a diagnosis of sepsis syndrome. Crude in-hospital mortality was the primary endpoint. A generalized mixed-effects model with random intercepts produced estimates for adverse outcomes. Model-based recursive partitioning demonstrated the effects and thresholds of significant covariates. Scores were internally validated. The H measure compared performances of scores. A total of 580 patients from 22 centers were included for further analysis. Stages of sepsis, age, time to antibiotics, and administration of carbapenem for empirical treatment were entered the final model. Among these, severe sepsis (OR, 4.40; CIs, 2.35-8.21), septic shock (OR, 8.78; CIs, 4.37-17.66), age (OR, 1.03; CIs, 1.02-1.05) and time to antibiotics (OR, 1.05; CIs, 1.01-1.10) were significantly associated with fatal outcomes. A decision tree demonstrated the thresholds for age. We modified the quick Sequential Organ Failure Assessment (mod-qSOFA) score by adding age (> 50 years old = one point) and compared this to the conventional score. H-measures for qSOFA and mod-qSOFA were found to be 0.11 and 0.14, respectively, whereas AUCs of both scores were 0.64. We propose the use of the modified qSOFA score for early risk assessment among sepsis patients for improved triage and management of this fatal syndrome.

Sepsis is a major healthcare problem worldwide. Its mortality and morbidity is still high. Early diagnosis of sepsis and appropriate management in the initial hours improve outcomes. The Surviving Sepsis Campaign published new definitions for sepsis in 2016. In Sepsis-3 definitions, sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Organ dysfunction can be identified as an acute change in total SOFA score of at least two points consequent to the infection. However, this definition is endorsed by two international societies and there is much discussion regarding new definitions. Prospective validation of this definition on different levels is needed. The infectious source in sepsis depends on patients' underlying diseases and origin of the infection (community-acquired or healthcare-associated). In the literature, urinary tract and skin-soft tissue infection are the common sites in community-acquired sepsis, whereas respiratory system and intraabdominal infections are more common in nosocomial sepsis. Another challenge in sepsis management is the increasing incidence of sepsis due to multidrug-resistant bacteria and limited treatment options. New antibiotics may be treatment options in the future. In this review, current definitions of sepsis, physiopathology of sepsis, foci of sepsis and causative microorganisms, microbiological diagnosis and rapid diagnosis methods, biomarkers used in the diagnosis of sepsis, antimicrobial treatment and resistance, new antibiotics and non-antibiotic therapy are discussed.

PubMedID: 28419820 Objectives Data on the impact of refugees on Intensive Care Units (ICUs) are lacking in the literature, in particular for community-acquired (CA) infectious diseases, for which they are known to be at higher risk. We did a descriptive, multicenter study to analyze CA infections among refugee patients requiring ICU admission. Methods Inclusion criteria were adult refugee patients admitted to an ICU due to CA infections. Anonymized data were collected between January 1, 2010 and December 30, 2015 across 10 referral centers. Results 29.885 patients were admitted to the ICUs in the study period. 37 patients were included the study, the majority were from Syria (n = 31, 83.8%). Mean (SD) age of the patients was 45.92 ± 20.16 years. The 5-year prevalence rate was 123.8 per 100.000 patients in the ICUs. All patients had at least one comorbid condition. Forty-nine CA infections were diagnosed. The most common CA infection was pneumonia (49%) followed by urinary-tract infections (16.3%). 21 patients (56.7%) hospitalized in the ICU had trauma history. Mortality rate was high at 22 patients (59.5%) with 5 (22.7%) deaths directly attributed to CA infections. Conclusions Refugees presented to ICUs with CA infections similar to the host populations (pneumonia and urinary-tract infections) but had high mortality rates (59.5%). It seems that Turkish ICUs were not congested with the refugee patients’ influx for CA infections. More research needs to be done to better understand how to deliver preventative and timely health care services to this group of patients. © 2017 International Society for Infectious Diseases

Introduction: In this multicenter study, we analysed the magnitude of healthcare worker (HCW) [infection control practitioner (ICP), nurses and others] workforce in hospitals participated in the study., Materials and Methods: This study was performed in 41 hospitals (with intensive care units-ICU) located in 22 cities from seven regions of Turkey. We analysed the ICP workforce, nursing and auxiliary HCW (AHCW) workforce in ICUs, number of ICU beds and occupied beds in four different days [two of which were in summer during the vacation time (August 27 and 31, 2016) and two others in autumn (October 12 and 15, 2016)]. The Turkish Ministry of Health (TMOH) requires two patients per nurse in level 3 ICUs, three patients per nurse in level 2 ICUs and five patients per nurse in level 1 ICUs. There is no standardization for the number of AHCW in ICUs. Finally, one ICP per 150 hospital beds is required by TMOH., Results: The total number of ICUs, ICU beds and ICPs were 214, 2377 and 111, respectively in he 41 participated centers. The number ICPs was adequate only in 12 hospitals. The percentage of nurses whose working experience was 2. The number of patients per other HCW was minimum 3.75 and maximum 4.89 on weekdays and on day shift while it was minimum 5.02 and maximum 7.7 on weekends or on night shift. When we compared the number of level 1, 2 and 3 ICUs with adequate nursing workforce vs inadequate nursing workforce, the p value was, Conclusion: Our data suggest that ICP workforce is inadequate in Turkey. Besides, HCW workforce is inadequate and almost 1/4 of nurses are relatively inexperienced especially in level 3 ICUs. Turkish healthcare system should promptly make necessary arrangements for adequate HCW staffing.

Enürezis nokturnası (EN) olan çocuklarda aile öyküsüne çok sık rastlanmakta ama bu olguların klinik özellikleri, aile öyküsünün tedavi etkinliğine etkisi bilinmemektedir. Ailesel EN olgularının demografik, klinik özelliklerini incelemek ve aile hikâyesinin tedavi etkinliğine olan etkisini değerlendirmek için prospektif bir çalışma planlanmıştır.Bu çalışma prospektif, tanımlayıcı ve anket bazlı bir çalışmadır. Çalışmaya EN nedeniyle kliniğimizde takip edilen 117 olgu ve EN şikâyeti olmayan 150 sağlıklı çocuk dâhil edilmiştir. Çalışmaya alınan tüm olguların demografik özellikleri, aile eğitim düzeyleri, tuvalet eğitimi zamanı, idrar yolu enfeksiyonu öyküsü, ailede EN öyküsünü ölçmeyi amaçlayan anket yapılmıştır. EN’li olgular içinde aile hikâyesi olan ve olmayan hastalar tedavi açısından karşılaştırılmıştır. Olguların yaş ortancası EN’li (n:117) ve sağlıklı çocuklarda (n:150) 8 yaştır (7-9 yaş) (p>0.05). Kız/erkek oranı EN grubunda 52/65, sağlıklı çocuklarda 63/87’dir. Aile eğitim düzeyleri karşılaştırıldığında, yüksek eğitim gören anne, baba oranlarının sağlıklı çocuklarda EN’si olan olgulara oranla daha fazla olduğu izlenmiştir (p0.05). EN’li olgularda aile öyküsü sağlıklı çocuklara oranla daha sık gözlenmektedir. EN öyküsü olan çocukların aile eğitim düzeyi sağlıklı çocukların ailelerine göre daha düşük, tuvalet eğitim zamanları ise daha geçtir. Aile öyküsü olan ve olmayan çocuklar arasında fark bulunmamaktadır. Aileler tarafından değerlendirilen tedavi etkinliği aile öyküsü olan ve olmayan hastalar arasında fark göstermemektedir.

WOS: 000386954300001, PubMed: 27809934, Background: The aim of this study was to assess health-related quality of life (HRQOL) among chronic hepatitis B (CHB) patients in Turkey and to study related factors. Methods: This multicenter study was carried out between January 01 and April 15, 2015 in Turkey in 57 centers. Adults were enrolled and studied in three groups. Group 1: Inactive HBsAg carriers, Group 2: CHB patients receiving antiviral therapy, Group 3: CHB patients who were neither receiving antiviral therapy nor were inactive HBsAg carriers. Study data was collected by face-to-face interviews using a standardized questionnaire, Short Form-36 (SF-36) and Hepatitis B Quality of Life (HBQOL). Values equivalent to p < 0.05 in analyses were accepted as statistically significant. Results: Four thousand two hundred fifty-seven patients with CHB were included in the study. Two thousand five hundred fifty-nine (60.1 %) of the patients were males. Groups 1, 2 and 3, consisted of 1529 (35.9 %), 1721 (40.4 %) and 1007 (23.7 %) patients, respectively. The highest value of HRQOL was found in inactive HBsAg carriers. We found that total HBQOL score increased when antiviral treatment was used. However, HRQOL of CHB patients varied according to their socio-demographic properties. Regarding total HBQOL score, a higher significant level of HRQOL was determined in inactive HBV patients when matched controls with the associated factors were provided. Conclusions: The HRQOL score of CHB patients was higher than expected and it can be worsen when the disease becomes active. Use of an antiviral therapy can contribute to increasing HRQOL of patients.

EASL International Liver Congress -- APR 13-17, 2016 -- -- Barcelona, SPAIN, WOS: 000398711700582, …, EASL

Background/aims The present study aimed to determine the changes in the epidemiology of hepatitis in recent years in an adult Turkish population. Materials and methods Overall, 852 patients with acute viral hepatitis from 17 centers were included in this study. Their sociodemographic characteristics, clinical courses, treatments, and laboratory findings were retrospectively analyzed. Results The most commonly found microorganisms were the hepatitis B virus (55.2%) and hepatitis A virus (37.6%), and the types of acute viral hepatitis differed significantly according to the age group (p≤0.001). The most frequently reported symptom was fatigue (73.7%), and the most common complications were cholecystitis (0.4%) and fulminant hepatitis (0.4%). The median hospital stay was 9 days (range 1-373). In total, 40.8% patients with acute hepatitis B virus developed immunity. Conclusion In Turkey, there are significantly large adolescent and adult populations susceptible to acute viral hepatitis. Therefore, larger vaccination programs covering these age groups should be implemented.

Durmuş G, Boybeyi-Türer Ö, Gharibzadeh-Hizal M, Ekinci S, Kiper N. Meconium periorchitis: An incidentally diagnosed rare entity during inguinal herniorraphy. Turk J Pediatr 2018; 60: 612-614. Meconium periorchitis (MPO) is a rare disorder caused by meconium peritonitis with the leakage of meconium into the scrotal sac through the patent processus vaginalis. MPO may be rarely detected during inguinal hernia repair. The association of MPO with cystic fibrosis is rarely seen. We present a male infant with the complaint of left groin swelling, compatible with reducible inguinal hernia. An herniotomy was carried out and the greenish nodules with calcifications were detected. Histopathological examination was compatible with MPO. Two months later the patient was diagnosed with atypical cystic fibrosis. Clinicians should be aware of MPO presentations and its appearance on the hernia sac to prevent unnecessary orchiectomy.

Soyer, Tutku/0000-0003-1505-6042 WOS: 000344155900027 PubMed: 25552166 Background/aim: To compare dysfunctional voiding symptom scores (DVSSs) between enuretic children and nonenuretic controls and to investigate associated factors that may affect DVSS. Materials and methods: A questionnaire including demographic features, educational status of parents, DVSS questions, and urinary tract infection (UTI) history was designed. A total of 269 patients were included; Group 1 comprised 161 patients with no voiding symptoms and Group 2 comprised 108 patients with nocturnal enuresis (NE). Children with DVSS of greater than 8.5 were suspected to have dysfunctional voiding. The results were evaluated using SPSS 15.0 with Kruskal-Wallis and multivariate logistic regression tests. Results: The median DVSS was 2 (interquartile range [IQR]: 1-3) in Group 1 and 8 (IQR: 5-12) in Group 2. The percentage of children with DVSS greater than 8.5 was 0.6% in Group 1 and 53.1% in Group 2 (P = 0.01). The percentage of children with UTI history was significantly higher in Group 2 (34.3%) than Group 1 (15.9%) (P = 0.03). An increase in the educational level of the father decreased DVSS by 0.5-fold. Presence of UTI history increased DVSS 2.5-fold. Conclusion: The DVSS is a rapid, easy tool for determining abnormal voiding parameters in children. Children with NE had higher DVSSs, which was significantly affected by the father's educational status and the child's UTI history.

Anthrax is a zoonotic infection caused by Bacillus anthracis. Although the incidence of disease has been decreasing in Turkey, it is still endemic in some regions of the country. The cutaneous form of disease is the most common clinical form, usually benign and rarely causes bacteriemia and sepsis. In this report, a case of cutaneous anthrax complicated with sepsis where B.anthracis was isolated from blood and wound cultures, was presented. A 53-years-old male living in Bursa province (northwestern Turkey), admitted to the emergency ward with high fever and a lesion on the right arm. His history indicated that he is dealing with livestock breeding and injured his arm during slaughtering of a sick lamb. The infection started as a black colored painless ulcer with 2 cm in diameter on his right elbow. The case was hospitalized and penicillin G therapy was started with the preliminary diagnosis of anthrax. Bullous lesions occurred around the wound, got necrosis and integrated with the first lesion. Gram stained slides from the bullous lesions revealed capsulated gram-positive bacilli under light microscope. Gram-positive bacilli were also isolated from bullous lesions and the blood cultures. The isolates were identified and confirmed as B.anthracis by conventional and molecular methods. Antibiotic susceptibility tests were performed by E-test method and the isolates were found to be susceptible to ampicillin, tetracyclin, tigecyclin, ciprofloxacin, levofloxacin, gentamycin, chloramphenicol, erythromycin, clarithromycin, vancomycin, linezolid, daptomycin and rifampicin. The lesion became surrounded by an extensive erythema and edema and expanded to the whole arm. Moxifloxacin was initiated due to the fact that clinical progress. During the second week of the therapy, a black colored scar was observed on the wound while hyperemia and edema regressed. The necrotic tissue debridated to accelerate healing and rest of the skin defect was planned for reconstruction. The patient who had septicaemia and disseminated cellulitis was discharged after his treatment continued for 14 days. Multiple-locus variable-number tandem repeat analysis method was used for molecular epidemiological investigation. The strains isolated from the patient were identified as genotype (GK) 43 classified in A3.a major cluster, and found to be identical to those strains isolated from animals in different provinces located at central and eastern Anatolia of Turkey. In conclusion, the risk of sepsis must be considered in patients with cutaneous anthrax with appropriate follow-up and treatment plan.

Objective: A cross-sectional study was performed to evaluate the prevalence of enuresis nocturna (EN) among 6-10 year-old primary school children in Kırıkkale. Material and Method: Children (n:1500) aged between 6-10 years were included in the study. Questionnaires were answered by the parents to evaluate the demographic and voiding characteristics, time of toilet training, dysfunctional voiding (DV) symptoms, prevalence of EN, methods and results of EN treatment. DV score (DVS) validated for Turkish children were surveyed and scores greater than 8.5 were considered significant. Results: Children (n:1372) who completed the questionnaire were included in the study. The mean age of students was 8.27 years (M: F: 707:659). EN was noted in 11.4 % (n:157, group 1) of children. EN history was noted in 37.5 % (n:515, group 2) of children, and 51.1 % (n:700, group 3) of them had never EN. Toilet training was completed after 5 years of age in 5.2 % of the students with EN and 1.3 % of the children without EN (p

INTRODUCTION: Nosocomial infections are acquired during hospital care which were not present or incubating at the time of the patients admission to the hospital. They occur more than 48 to 72 hours after admission and up to 10 days after hospital discharge. The aim of the present study was to determine Neurosurgery Clinics nosocomial infection rates, infecting microorganisms, and their resistance patterns to achieve standardization and make comparisons among other Turkish and developed country hospitals. METHODS: In this study risk factors for nosocomial infection development in neurosurgery patients were analyzed by reviewing patient cards retrospectively, and recording microbiological culture results. RESULTS: Seventy eight nosocomial infection attacks were defined in 57 patients and the incidence of nosocomial infection attacks were 10.34. Of the nosocomial infection attacks 53.8 was pneumonia, 15.4 was urinary tract infection, 12.8 was surgical site infection, 11.5 was central nervous system infection and 6.4 was catheter related blood stream infection. Acinetobacter baumanii, Pseudomonas aeruginosa and Methicillin sensitive Staphylococcus aureus remained the most common pathogens isolated from nosocomial infections. Factors significantly associated with hospital acquired infection were as follows: age 65 years , smoking cigarette, faecal incontinence, malignity and recurrent operation.DISCUSSION AND CONCLUSION: Its important to determine the risk factors for nosocomial infection development and to identify the causative microorganisms to improve infection control and preventive programs., GİRİŞ ve AMAÇ: Hastane enfeksiyonları hastanın hastaneye başvurusu esnasında bulunmayan veya inkübasyon döneminde olmayan, hastaneye başvurduktan 48-72 saat sonra veya hastaneden taburcu olduktan sonraki 10 gün içinde gelişen enfeksiyonlardır. Standardizasyonu sağlamak, Türkiye ve gelişmiş ülkelerin hastaneleri ile karşılaştırma yapabilmek için Beyin Cerrahisi Kliniğindeki hastane enfeksiyonu oranlarını, enfeksiyon etkeni mikroorganizmaları ve direnç kalıplarını belirlemek amaçlanmıştır. YÖNTEM ve GEREÇLER: Bu çalışmada beyin cerrahisi hastalarında hastane enfeksiyonu gelişimindeki risk faktörleri hasta kayıtları gözden geçirilerek ve hasta bilgileri ile mikrobiyoloji kültür sonuçları kaydedilerek analiz edilmiştir. BULGULAR: alışmada 57 hastada 78 hastane enfeksiyonu atağı belirlendi ve hastane enfeksiyonu hızı 10,34 olarak tespit edildi. Hastane enfeksiyon ataklarının 53,8i pnömoni, 15.4ü üriner sistem enfeksiyonu, 12,8i cerrahi alan enfeksiyonu, 11.5i merkezi sinir sistemi enfeksiyonu, 6.4ü kateter ilişkili kan dolaşım enfeksiyonuydu. Hastane enfeksiyonlarından en sık izole edilen etkenler Acinetobacter baumanii 16,4 , Pseudomonas aeruginosa 16,4 ve Metisilin duyarlı Staphylococcus aureus 16,4 idi. Yaşın 65 üzerinde olması, sigara kullanımı, fekal inkontinans, malignite, birden fazla cerrahi girişim varlığının hastane enfeksiyonu gelişiminde risk faktörü olduğu saptanmıştır. TARTIŞMA ve SONUÇ: Hastane enfeksiyonu gelişiminde rol oynayan risk faktörlerinin tanımlanması, etken mikroorganizmaların belirlenmesi enfeksiyon kontrol ve önleme programlarını geliştirilmesi, beyin cerrahisi hastasının değerlendirilmesi, tanı ve tedavisine yaklaşımda önemlidir.

Tez (doktora) - Anadolu Üniversitesi, Anadolu Üniversitesi, Eğitim Bilimleri Enstitüsü, Yabancı Diller Eğitimi Anabilim Dalı, Kayıt no: 173388, Türkiye'de, Milli Eğitim Bakanlığı tarafından 2001 yılında Avrupa Dil Gelişim Dosyası Özel İhtisas Komisyonu kuruldu. Bu komisyon, on beş yaşını aşmış öğrenciler için bir Avrupa Dil Gelişim Dosyası geliştirdi ve bu Avrupa Dil Gelişim Dosyası pilot liselerde halen uygulanmaktadır. Önemi ve gerekliliği sadece bilim alanında değil, milletimizin hemen her kesiminde biliniyor olmasına rağmen, ülkemizdeki "yabancı dil öğrenimi" konusu hala sonmludur. Sadece mevcut yabancı dil öğretiminin değil, yabancı dil öğretimine yönelik yeni projelerin de alt sınıflara çekilmesi ve bir an önce uygulamaya geçirilmesi gerekliliği derinden hissedilmektedir. Durum böyle İken, "Pilot liselerde uygulanmaya başlanan Avrupa Dil Gelişim Dosyası daha alt sınıflarda da uygulanamaz mıydı?" sorusundan yola çıkarak ve pedagoji biliminin, "Dil eğitimine erken yaşlarda başlanmalı" ilkesini ele alarak böylesi bir çalışmaya adım atıldı. Bu çalışmanın amacı Türk ilköğretim okulu öğrencilerine yönelik Avrupa Dil Gelişim Dosyası geliştirmek ve bu dosyanın ilköğretim okullarındaki İngilizce derslerinde uygulanması sonucu Avrupa Dil Gelişim Dosyası'nın öğrenen özerkliğine etkisini araştırmaktır. Çalışmaya iki okul seçerek başlandı. Okullar arasındaki yabancı dil eğitim farklılıklarının doğurabileceği bilimsel veri yanılgılarının önüne geçebilrnek için okul seçiminde hem özel okullara hem de devlet okullarına yer vermenin uygun olacağı düşünüldü. Bu düşünceden hareketle devlet okullarından Dilek Özer İlköğretim Okulu ile özelokullardan Özel İlkbahar İlköğretim Okulu belirlendi. Belirlenen okulların 4. ve 5. sınıflarından biri deney, diğeri ise kontrol grubu olmak üzere ikişer grup oluşturuldu. Bu gruplar için Fransa'da çocuklarda uygulanan bir Avrupa Dil Gelişim Dosyası esas alındı ve Türk çocuklarına uygun bir Avrupa Dil Gelişim Dosyası hazırlandı. On iki hafta süren uygulama çalışmasının öncesinde ve sonrasında gruplan oluşturan denekler üzerinde Ögrenen Özerkliği Anketi uygulandı. Uygulama sonunda, Avrupa Dil Gelişim Dosyası'nın devlet okulunda öğrenen özerkliğine ulaşmada daha etkin olduğu görüldü. Ayrıca, Avrupa Dil Gelişim Dosyası uygulamasının başlarında, ortasında ve sonunda olmak üzere Avrupa Konseyi'nin "Learner Anchor Questions" (Standart Öğrenen Anketi) uygulandı. Bu anketlerde çoğunluğun Avrupa Dil Gelişim Dosyası'nın kullanımını olumlu karşıladığı tespit edildi. Bu çalışmanın bulguları, Avrupa Dil Gelişim Dosyası'nın yabancı dil öğrenimi için önemli bir yenilik olduğunu göstermektedir çünkü Avrupa Dil Gelişim Dosyası ilköğretim öğrencilerinin öğrenen özerkliğini geliştirmeye etkisi olan bir araçtır. Ögrenen özerkliği ise yaşam boyu öğrenmenin anahtarıdır.