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A prospective, multicentre observational cohort study of carbapenem-resistant Klebsiella spp. (CRK) bloodstream infections was conducted in Turkey from June 2018 to June 2019. One hundred eighty-seven patients were recruited. Single OXA-48-like carbapenemases predominated (75%), followed by OXA-48-like/NDM coproducers (16%). OXA-232 constituted 31% of all OXA-48-like carbapenemases and was mainly carried on ST2096. Thirty-day mortality was 44% overall and 51% for ST2096. In the multivariate cox regression analysis, SOFA score and immunosuppression were significant predictors of 30-day mortality and ST2096 had a non-significant effect. All OXA-48-like producers remained susceptible to ceftazidime-avibactam.

One of the patient groups adversely affected during the COVID19 pandemic is those suffering with cancer. The aim of this study was to evaluate the clinical characteristics and outcomes of lung cancer (LC) patients with COVID-19.Three thousand seven-hundred and fifty hospitalized patients with a presumptive diagnosis of COVID-19 in a tertiary referral hospital between March 2020-February 2021 were retrospectively evaluated. Among them, 36 hospitalized COVID-19 patients with a history of primary LC were included in the study. Univariate and multivariate analyses were carried out to assess the risk factors associated with severe disease.Of the 36 patients included in the study, 28 (77%) were males and 8 (23%) were females. Median age was 67 years (min-max: 53-81 years). Six patients (17%) had a diagnosis of small cell LC, whereas 30 patients (83%) had a diagnosis of non-small cell LC. The most common symptoms were fever (n= 28, 77%), coughing and myalgia (n= 21, 58%) and dyspnea (n= 18, 50%). The most common radiological finding was ground glass opacity (GGO) (n= 30), of which 13 was bilateral and 17 was unilateral in distribution. Nearly 30% (n= 11) of LC patients with COVID-19 developed severe disease, 5% (n= 2) of the 36 patients were admitted to intensive care unit and all of these patients eventually expired. LC patients with COVID-19 and patchy consolidation on computed tomography of thorax (Th CT) on admission had a higher risk of developing severe disease in univariate (HR 2.41, 95%CI: 1.4- 4.4, p= 0.04) and multivariate Cox regression analysis (HR 0.48, 95%CI: 0.24-0.97, p= 0.03).Clinical characteristics, laboratory and radiographic findings were similar in LC patients with COVID-19 when compared with the general population, LC patients have a higher mortality rate than the general population, with a 5% mortality rate in our series. Our findings suggest that LC may be a risk factor associated with the prognosis of COVID-19 patients.

Objective: Appendicitis is a common surgical emergency among children. The coronavirus pandemic affected the system of hospitals more than any other field, and great amount of people were concerned about visiting the hospitals for any reason. In this study, it was aimed to evaluate the profile of appendicitis by emphasizing perforated and acute appendicitis in the pandemic period and to compare the rates with previous three years. Material and Methods: Charts of the children who underwent laparoscopic appendectomy due to appendicitis between March 11-September 30 between 2017-2020 were retrospectively analyzed in terms of demographic data, duration of symptoms, duration between hospital admission and surgery, radiologic imaging and perioperative outcomes. Results: This study includes 467 children who underwent laparoscopic appendectomy. There were 97 procedures in 2020, 111 in 2019, 146 in 2018 and 113 in 2017. Multiple comparison tests revealed that age did not show difference; but onset of symptoms in admission (p= 0.004), hospitalization time before surgery (p< 0.001), total hospitalization time (< 0.001) showed statistically significant difference between years. Pairwise comparisons showed that these parameters were increased in 2020 compared to other years. Perforated appendicitis rate was significantly increased in 2020 when compared to previous years. Conclusion: Although there is no direct relation between appendicitis and COVID-19 infection in the current knowledge, perforated appendicitis was found to be increased in children during the COVID pandemic. Reason of the higher rate of perforated appendicitis may be multifactorial; however, the pandemic appears to have a role in increased morbidity in children with appendicitis indirectly due to delay of hospital admissions.

Introduction. Aminoglycosides are used for the treatment of carbapenemase-producing Klebsiella pneumoniae (CPK) infections. 16S rRNA methyltransferases (RMTs) confer resistance to all aminoglycosides and are often cocarried with NDM. Hypothesis/Gap Statement. There is a dart of studies looking at the aminoglycoside resistance mechanisms for invasive CPK isolates, particularly in OXA-48 endemic settings. Aim. We aimed to determine the prevalence of RMTs and their association with beta lactamases and MLSTs amongst aminoglycoside-resistant CPK bloodstream isolates in an OXA-48 endemic setting. Methodology. CPK isolates (n=181), collected as part of a multicentre cohort study, were tested for amikacin, gentamicin and tobramycin susceptibility using custom-made sensititre plates (GN2XF, Thermo Fisher Scientific). All isolates were previously subjected to whole-genome sequencing. Carbapenemases, RMTs, MLSTs and plasmid incompatibility groups were detected on the assembled genomes. Results. Of the 181 isolates, 109(60 %) were resistant to all three aminoglycosides, and 96 of 109(88 %) aminoglycoside-resistant isolates carried an RMT (85 ArmA, 10 RmtC, 4 RmtF1; three isolates cocarried ArmA and RmtC). Main clonal types associated with ArmA were ST2096 (49/85, 58 %) and ST14 (24/85, 28 %), harbouring mainly OXA-232 and OXA-48 +NDM, respectively. RmtC was cocarried with NDM (5/10) on ST395, and NDM +OXA-48 or NDM +KPC (4/10) on ST14, ST15 and ST16. All RMT producers also carried CTX-M-15, and the majority cocarried SHV-106, TEM-150 and multiple other antibiotic resistance genes. The majority of the isolates harboured a combination of IncFIB, IncH and IncL/M type plasmids. Non-NDM producing isolates remained susceptible to ceftazidime-avibactam. Conclusion. Aminoglycoside resistance amongst CPK bloodstream isolates is extremely common and mainly driven by clonal spread of ArmA carried on ST2096 and ST14, associated with OXA-232 and OXA48 +NDM carriage, respectively.

Introduction: We evaluated neutralizing antibody and anti-spike antibody (anti-S) response against omicron variant in solid organ (SOT) or hematopoietic stem cell (HSTC) receivers after third dose of BNT162b2 (BNT) or CoronaVac (CV) following two doses of CV. Methods: In total, 95 participants who underwent SOT (n=62; 44 liver, 18 kidney) or HSCT (n=27; 5 allogeneic, 22 autologous) were included from five centers in Turkey. The median time between third doses and serum sampling was 154 days. The vaccine-induced antibody responses of both neutralizing antibodies and Anti-Spike antibodies were assessed by plaque neutralizing assay and immunoassay. Results: Neutralizing antibody and anti-spike IgG levels were significantly higher in transplant patients receiving BNT compared to those receiving CV (GMT:26.76 vs 10.89; p=0.03 and 2116 Au/ml vs 172.1 Au/ml; pConclusion: This study highlights the superiority of BNT responses against omicron as a third dose among transplant recipients after two doses of CV. Lack of neutralizing antibody against omicron after CV in liver transplant recipients should be taken into consideration particularly in countries where inactivated vaccines are available in addition to mRNA vaccines.

Graphical abstract Associations between inherited Killer Immunoglobulin-like Receptor (KIR) genotypes and the severity of multiple RNA virus infections have been reported. This prospective study was initiated to investigate if such an association exists for COVID-19. In this cohort study performed at Ankara University, 132 COVID-19 patients (56 asymptomatic, 51 mild-intermediate, and 25 patients with severe disease) were genotyped for KIR and ligands. Ankara University Donor Registry (n:449) KIR data was used for comparison. Clinical parameters (age, gender, comorbidities, blood group antigens, inflammation biomarkers) and KIR genotypes across cohorts of asymptomatic, mild-intermediate, or severe disease were compared to construct a risk prediction model based on multivariate binary logistic regression analysis with backward elimination method. Age, blood group, number of comorbidities, CRP, D-dimer, and telomeric and centromeric KIR genotypes (tAA, tAB1, and cAB1) along with their cognate ligands were found to differ between cohorts. Two prediction models were constructed; both included age, number of comorbidities, and blood group. Inclusion of the KIR genotypes in the second prediction model exp (-3.52 + 1.56 age group - 2.74 blood group (type A vs others) + 1.26 number of comorbidities - 2.46 tAB1 with ligand + 3.17 tAA with ligand) increased the predictive performance with a 92.9% correct classification for asymptomatic and 76% for severe cases (AUC: 0.93; P

Cytomegalovirus infection is an important complication in immunocompromised patients. As few studies have shown that cyclophosphamide treatment is a risk factor for cytomegalovirus infection in patients with glomerulonephritis, we aimed to describe the frequency and risk factors of cytomegalovirus infection in glomerulonephritis patients treated with cyclophosphamide. We prospectively recruited 43 cytomegalovirus seropositive patients with glomerulonephritis treated with cyclophosphamide. We screened all patients for viral DNA monthly during treatment. Patients were compared for age, sex, glomerular pathology, renal function and clinical status regarding development of cytomegalovirus infection before and after the treatment. Cytomegalovirus infection was detected in 10 (23.3%) patients, most commonly within the first 2 months of cyclophosphamide treatment. All patients recovered without any cytomegalovirus-related complications. Patients with cytomegalovirus infection had higher serum creatinine (4.2 ± 3.2 vs. 1.9 ± 1.8 mg/dl, p = 0.006) and lower estimated glomerular filtration rate (29 ± 11 vs. 65 ± 8 ml/min/1.73 m2, p = 0.016) at diagnosis compared with cytomegalovirus infection non-occurred patients. In addition, number of patients presented with rapidly progressive glomerulonephritis were higher in cytomegalovirus infection group (80.0% vs. 27.3%, p = 0.007). Moreover, cytomegalovirus infection was associated with prolonged hospital stay (54 ± 7 vs. 29 ± 6 days, p = 0.027). Cytomegalovirus infection is a common complication in glomerulonephritis patients treated with cyclophosphamide in this prospective study. Routine monitoring and prophylaxis should be considered for these high-risk patients.

Background CoronaVac, an inactivated whole-virion SARS-CoV-2 vaccine, has been shown to be well tolerated with a good safety profile in individuals aged 18 years and older in phase 1/2 trials, and provided a good humoral response against SARS-CoV-2. We present the interim efficacy and safety results of a phase 3 clinical trial of CoronaVac in Turkey. Methods This was a double-blind, randomised, placebo-controlled phase 3 trial. Volunteers aged 18-59 years with no history of COVID-19 and with negative PCR and antibody test results for SARS-CoV-2 were enrolled at 24 centres in Turkey. Exclusion criteria included (but were not limited to) immunosuppressive therapy (including steroids) within the past 6 months, bleeding disorders, asplenia, and receipt of any blood products or immunoglobulins within the past 3 months. The K1 cohort consisted of health-care workers (randomised in a 1:1 ratio), and individuals other than health-care workers were also recruited into the K2 cohort (randomised in a 2:1 ratio) using an interactive web response system. The study vaccine was 3 mu g inactivated SARS-CoV-2 virion adsorbed to aluminium hydroxide in a 0.5 mL aqueous suspension. Participants received either vaccine or placebo (consisting of all vaccine components except inactivated virus) intramuscularly on days 0 and 14. The primary efficacy outcome was the prevention of PCR-confirmed symptomatic COVID-19 at least 14 days after the second dose in the per protocol population. Safety analyses were done in the intention-to-treat population. This study is registered with ClinicalTrials.gov (NCT04582344) and is active but no longer recruiting. Findings Among 11 303 volunteers screened between Sept 14, 2020, and Jan 5, 2021, 10 218 were randomly allocated. After exclusion of four participants from the vaccine group because of protocol deviations, the intention-to-treat group consisted of 10 214 participants (6646 [65.1%] in the vaccine group and 3568 [34.9%] in the placebo group) and the per protocol group consisted of 10 029 participants (6559 [65.4%] and 3470 [34.6%]) who received two doses of vaccine or placebo. During a median follow-up period of 43 days (IQR 36-48), nine cases of PCR-confirmed symptomatic COVID-19 were reported in the vaccine group (31.7 cases [14.6-59.3] per 1000 person-years) and 32 cases were reported in the placebo group (192.3 cases [135.7-261.1] per 1000 person-years) 14 days or more after the second dose, yielding a vaccine efficacy of 83.5% (95% CI 65.4-92.1; p, TUSEB, We are grateful to all participants who volunteered to be part of this study and to all members of the clinical research teams of the participating sites. We thank TUSEB for funding the study and Omega-CRO for the statistical analyses and production of figures, and providing the study protocol. We also thank the members of the data and safety monitoring board for their contributions in the safe execution of this study.

COVID-19, caused by severe acute respiratory syndrome coronavirus-2, typically presents with respiratory symptoms and fever, but still a variety of clinical presentations have been reported. In this study, it was aimed to report a case of COVID-19 with an atypical presentation and an atypical course. As well, the recovery phase was complicated with GBS and consequently cytomegalovirus infection. It should be kept in mind that patients with COVID-19 severe disease need to be followed for neurological and other complications which may arise during the course of critical illness.

Background/aim Most of the hospitalized patients are on a number of drugs for comorbidities and/or to prevent nosocomial infections. This necessitates a careful consideration of drug interactions not only to avoid possible toxicities but also to reach the highest efficiency with drug treatment. We aimed to investigate drug interactions related to systemic antibiotic use and compare three different databases to check for drug interactions while characterizing the main differences between medical and surgical departments. Materials and methods This point prevalence study covered data on 927 orders for patients hospitalized between June 3 and 10, 2018 in Ankara University Hospitals. Systemic antibiotic use and related drug interactions were documented using UptoDate, Drugs, and Medscape and comparisons between the departments of medical and surgical sciences were made. Results The number of orders, or the number of drugs or antibiotics per order were not different between the medical and surgical sciences departments. A total of 1335 antibiotic-related drug interactions of all levels were reported by one, two, or all three databases. UptoDate reported all common and major interactions. Pantoprazole was the most commonly prescribed drug and appeared in 63% of all orders. Among 75 different molecules, ceftriaxone and meropenem were the two most prescribed antibiotics by the surgical and medical departments, respectively. Conclusion A dramatic variance existed amongst antibiotics prescribed by different departments. This indicated the requirement for a centralized role of an infectious diseases specialist. Especially for the hospitalized patient, prophylactic coverage with at least one antibiotic brought about a number of drug interactions. A precise evaluation of orders in terms of drug interactions by a clinical pharmacist (currently none on duty) will reduce possible drug-related hazards.

WOS:000605350300001 Objectives: Hepatitis B virus (HBV) affects a significant part of society and is characterized by high mortality and morbidity. Hepatitis B affects approximately 350 million people worldwide, many of whom are chronic patients. Especially being under immunosuppressive therapy is a risk factor for the reactivation of the disease. The aim of this study was to investigate the seroprevalence of HB in oncology patients. Materials and Methods: In this study, the seroprevalences of hepatitis B surface antigen (HBsAg), anti-hepatitis C virus, anti-HBs, and anti-hepatitis B core antibody (anti-HBc) immunoglobulin G (IgG) were retrospectively evaluated from the medical records of 84 patients who were diagnosed of cancer, and were admitted to the outpatient clinic of medical oncology in the Batman State Hospital within a period of one year (between January and December 2017). Results: Anti-HBc IgG was positive in 44 patients (52.2%),16 (36.4%) have received treatment for the prevention of HBV reactivation six of these patients were HBsAg positive No reactivation and no side effects occur in patients who received prophylactic antiretroviral treatment. Conclusion: In our study, both the proportion of patients with HBsAg positivity and the proportion of patients with natural immunity were found to be slightly higher than those in Turkey and worldwide. No patients with HB reactivation is important evidence of necessity effectiveness of prophylactic antiviral treatment Amaç: Hepatit B virüsü (HBV) toplumun önemli bir bölümünü etkiler ve yüksek mortalite ve morbidite ile karakterizedir. HB, çoğu kronik hasta olan dünya çapında yaklaşık 350 milyon kişiyi etkilemektedir. Özellikle immünosüpresif tedavi altında olmak, hastalığın yeniden aktivasyonu için bir risk faktörüdür. Bu çalışmanın amacı, onkoloji hastalarında HB seroprevalansını araştırmaktır. Gereç ve Yöntemler: Bu çalışma retrospektif nitelikte tanımlayıcı bir çalışma olarak gerçekleştirilmiştir. 1 Ocak-2017 ila 31 Aralık 2017 dönemi boyunca Batman Bölge Devlet Hastanesi, Onkoloji Bölümü’ne başvuran 84 hasta çalışmaya dahil edilmiştir. Bu hastaların hepatit serolojileri kayıt altına alınarak hastalar aktif HBV enfeksiyonu, geçirilmiş HBV enfeksiyonu, almış oldukları profilaksiler ve reaktivasyon açısından değerlendirmiştir. Bulgular: Hastaların 6’sı hepatit B yüzey antijeni (HBsAg) pozitif olarak saptanmış olup, 44 hasta (%52,2) ise anti-HBc immünoglobulin G (IgG) pozitif olarak saptanmıştır. Bu 44 hastadan 28 hasta (63.6%) düşük riskli bir kemoterapotik ajan almaları nedeniyle profilaksi almamıştır, diğer hastalar ise profilaksi almıştır. HBsAg poztif olan hastalardan bir hasta dışında tüm hastalar tedavi almıştır. Tüm pozitif hastalar değerlendirdiğinde takipte hiçbir hastada reaktivasyon gelişmemiştir. Sonuç: Kapsamlı HB serolojisi onkolojik tedavi planı olan tüm hastalara bilinmeli ve eğer endikasyonu varsa hastalar tedavi veya profilaksi için değerlendirmelidir. Bu değerlendirmelerde kılavuz önerileri esas alınması reaktivasyon gelişme ihtimalini en aza indirecektir.

Any highly infectious and rapidly spreading disease is a primary concern for immunocompromised solid organ transplant recipients. The number of data about the spectrum of clinical illness, the treatment modalities, and the outcomes of COVID-19 in this vulnerable population is scant and still remains empirical. Herein, we report the first COVID-19 case of a heart transplant recipient in Turkey who presented with fever, postnasal discharge, and myalgias for two days. The possibility of lung involvement was ruled out by thoracic computed tomography. Despite stable vital signs, we reduced the intensity of immunosuppressive therapy and maintained home self-isolation promptly. We also commenced a five-day course of hydroxychloroquine 200 mg q12h initially. After confirmation of real-time reverse-transcriptase-polymerase-chain-reaction testing of the nasopharyngeal swab positive for COVID-19, the patient was hospitalized. After a loading dose of favipiravir 1,600 mg b.i.d., the patient received a five-day course of favipiravir 600 mg q12h. He was discharged with cure after 23 days of hospital isolation and treatment. In conclusion, treatment process can be affected by the daily electrocardiography, hand-held portable echocardiography, myocardial injury markers, and pulse oximeter for self-monitoring in the follow-up of previous heart transplant recipients suffering from COVID-19. The lack of treatment protocols in the solid organ transplant recipients with COVID-19 infection and the controversies about the protective effect of immunosuppression invite a global and update discussion.

Objective: Influenza is a systemic infectious disease. It is recommended that all pregnant women receive the influenza vaccine because the mortality of the disease is high during pregnancy. However, the rates of influenza vaccination in pregnant women are low. This study aims to estimate the rate at which Turkish gynecologists and obstetricians (GOs) recommend the influenza vaccine to their pregnant patients.. Materials and Methods: This study was designed as a cross-sectional survey. The sample size was calculated to be 364 based on 95% confidence interval and 5% margin of error. The data were collected through a questionnaire consisting of 17 questions, which was distributed through social media. The final study group included in the research consisted of 384 GOs. Results:The mean age of the GOs that participated in the study was 39.7 years (SD = 10.2). 43.5% of the GOs reported that they recommended the influenza vaccine to pregnant women who had consulted with them, while 62.8% reported that at least 50% of the pregnant women they had recommended the vaccine rejected it. According to multivariate logistic regression analysis, three factors increased the rate of GOs’ not to recommend influenza vaccination: the GOs’ age, not receiving influenza vaccination themselves, and not knowing the social insurance reimbursement for the vaccine. Conclusion: Vaccination of pregnant women is necessary because of the increased mortality risk of influenza during pregnancy. Even though GOs are not in charge of vaccinating their patients during their routine pregnancy follow-up, they can contribute to vaccination rates by recommending the vaccine. Physicians’ application of scientific knowledge and transferring it to their patients can contribute to increased adult immunization rates. Conclusion: Influenza, Influenza Vaccine, Pregnancy, Vaccination, Viral Infections

It is known that there is an increase in the frequency of psychiatric disturbances in the acute and post-illness phase of coronavirus disease (COVID-19). Comorbid psychiatric symptoms complicate the management of patients and negatively affect the prognosis, but there is no clear evidence of their progress. We aimed to determine psychiatric comorbidity in inpatients and outpatients with COVID-19 and recognize the factors that predict psychiatric comorbidity. For this purpose, we evaluated patients on the first admission and after 4 weeks. We investigated psychiatric symptoms in outpatients (n = 106) and inpatients (n = 128) diagnosed with COVID-19. In the first 7 days after diagnosis (first phase), sociodemographic and clinic data were collected, a symptom checklist was constructed, and the Hospital Anxiety and Depression Scale (HADS) and the Severity of Acute Stress Symptoms Scale (SASSS) were applied. After 30-35 days following the diagnosis, the SASSS and the HADS were repeated. In the first phase, the frequency of depression and anxiety were 55% and 20% in inpatients, and 39% and 18% in outpatients, respectively. In the second phase, depression scores are significantly decreased in both groups whereas anxiety scores were decreased only in inpatients. The frequencies of patients reporting sleep and attention problems, irritability, and suicide ideas decreased after 1 month. Patients with loss of smell and taste exhibit higher anxiety and depression scores in both stages. Our results revealed that the rate of psychiatric symptoms in COVID-19 patients improves within 1 month. Inpatients have a more significant decrease in both depression and anxiety frequency than do outpatients. The main factor affecting anxiety and depression was the treatment modality. Considering that all patients who were hospitalized were discharged at the end of the first month, this difference may be due to the elimination of the stress caused by hospitalization.

Ceftazidime-avibactam exhibits good in vitro activity against carbapenem resistant Klebsiella carrying OXA-48-like enzymes. We tested two hundred unique carbapenem resistant Klebsiella blood stream isolates (71% with single OXA-48-like carbapenemases, including OXA-48, n = 62; OXA-232, n = 57; OXA-244, n = 17; OXA-181, n = 5) that were collected as part of a multicentre study against ceftazidime-avibactam using Etest (bioMérieux, Marcyl'Étoile, France), 10/4 μg disc (Thermo Fisher) and Sensititre Gram Negative EURGNCOL Plates (Lyophilized panels, Sensititre, Thermo Fisher) with the aim of comparing the performances of the Etest and disc to that of Sensititre. Ceftazidime-avibactam MIC

Background Coronavirus Disease‐19 (COVID‐19) has high mortality in kidney transplant recipients (KTR), and vaccination against severe acute respiratory syndrome‐coronavirus‐2 (SARS‐CoV‐2) is vital for this population. Although the humoral response to messenger RNA vaccines was shown to be impaired in KTR, there is a lack of data regarding the antibody response to inactivated vaccines. We investigated the antibody response to two consequent doses of the inactivated SARS‐CoV‐2 vaccine (CoronaVac; Sinovac Biotech, China). Methods A total of 118 patients from two centers were included. The levels of anti‐SARS‐CoV‐2 immunoglobulin‐G antibodies against the nucleocapsid and spike antigens were determined with enzyme immunoassay (DIA.PRO; Milano, Italy) before the vaccine and one month after the second dose of the vaccine. Thirty‐three patients were excluded due to antibody positivity in the serum samples obtained before vaccination. Results Eighty‐five patients, 47 of whom were female, with a mean age of 46 ± 12, were included in the statistical analysis. The maintenance immunosuppressive therapy comprised tacrolimus (88.2%), mycophenolate (63.6%), and low‐dose steroids (95.3%) in the majority of the patients. After a median of 31 days following the second dose of the vaccine, only 16 (18.8%) patients developed an antibody response. The median (IQR) antibody level was 52.5 IU/ml (21.5–96). Age (48 vs. 38, p = .005) and serum creatinine levels (1.14 vs. 0.91, p = .04) were higher in non‐responders and were also found to be independently associated with the antibody response (odds ratio (OR): 0.93, p = 0.012 and 0.15, p = 0.045, respectively) in multivariate analysis. Conclusion In this study, we found the antibody response to the inactivated vaccine to be considerably low (18.8%) in KTR. Increased age and impaired renal function were associated with worse antibody response. Based on the knowledge that mRNA vaccines yield better humoral responses, this special population might be considered for additional doses of mRNA vaccination.

Amaç: Aşı ile önlenebilir hastalıklardan korunmanın sağlanması toplum sağlığı açısından oldukça önemlidir. Fakat ülkemizde erişkin bağışıklama konusunda uygulamada önemli eksiklikler mevcuttur. Bu çalışmada ikinci basamak bir devlet hastanesi olan Batman Bölge Devlet Hastanesinde kurulan ‘Erişkin Bağışıklama Ünitesi’nin deneyimleri aktarılmıştır. Yöntem: Kasım 2017-Şubat 2018 tarihleri arasındaki 3 aylık süreçte ünitede yapılan Hepatit A, Hepatit B ve konjuge pnömokok aşıları aşı yapılan kişilerin epidemiyolojik özellikleri, aşı endikasyonları ve yönlendirildikleri klinikler açısından analiz edilmiştir. Bulgular: Kayıtlarının retrospektif incelemesinde toplamda 85 hastaya aşı yapıldığı saptandı. Bu hastaların %35.3’ü (n=30) kadın olarak saptandı. Hastaların tümü 16 yaş üzeri idi. Yaş ortalaması 57.6 olarak saptandı. Yapılan aşıların dağılımına bakıldığında %80 (n=68) hastanın konjuge pnömokok aşısı ile aşılandığı, %17.6 (n=15) hastaya Hepatit B, %2.4 (n=2) hastaya ise hepatit A aşısı uygulandığı görüldü.Aşılama endikasyonlarına bakıldığında %5.9 (n=5) hasta 65 yaş üstü olması nedeni ile, %36.5 (n=31)hasta böbrek yetmezliği nedeni ile, %1.2 (n=1) hasta romatolojik tedavi adayı olması nedeni ile, %8.2 (n=7) birey evde riskli temaslı birey-tümü Hepatit B açısından- olması nedeni ile, %4.7 (n=4) birey ise sağlık personeli olduğu için aşılanırken, %42.4 (n=36) birey ise başta KOAH olmak üzere altta yatan akciğer hastalıkları nedeni ile aşılanmış olarak tesbit edilmiştir. Sonuç: Erişkin Bağışıklama Merkezleri’ ikinci ve üçüncü basamak sağlık hizmeti veren tüm kurumlar için gereklidir. Özellikle başvuran hasta sayısının çok ve hasta grubunun da çeşitli olduğu hastaneler aslında aşı gereksinimi olan hasta popülasyonun da fazla olduğu hastanelerdir. Aşılanma oranlarını gerekli seviyeye ulaştırabilmek için hastaneler bünyesinde bu merkezlerin aktif olarak çalışmalıdır.

Introduction: Tuberculous meningitis is an important central nervous system infection, and it is the most severe clinical form of tuberculosis. Mycobacterium tuberculosis is the frequently isolated microorganism, and it is associated with high morbidity and mortality among central nervous system infections. Despite all the advances in medicine, diagnosis of tuberculous meningitis is still a significant problem. In our study, we aimed to evaluate clinical, microbiological and radiological features of the patients with tuberculous meningitis in detail. Materials and Methods: The study was designed as a retrospective study. A total of 32 patients diagnosed on the basis of clinical, microbiological and radiological criteria with tuberculous meningitis were included into the study. Patients were exposed to computed tomography scan and magnetic resonance imaging with the exception of two patients. Computed tomography scans were performed at the time of admission to the emergency department while magnetic resonance imagings were performed within the 48 hours after computed tomography scans. The data were analyzed with SPSS 24. Results: Eleven of the patients were diagnosed with gold standard methods. The pathogen microorganism was M. tuberculosis in all cases. The diagnoses of other patients were determined by clinical; microbiologic and radiologic estimations. Demographic findings-symptoms of the patients, laboratory findings-symptoms and the contribution of radiology to the diagnosis were evaluated. Particularly, when the contribution of radiology to the diagnosis was studied, it was found that especially magnetic resonance imaging was more useful than computed tomography. Conclusion: Central nervous system infections due to M. tuberculosis are frequently related to high morbidity and mortality. The gold diagnosis methods of the disease are; isolation of M. tuberculosis from the cerebrospinal fluid or seeing the microorganism in the fluid with EZN stain. Because of the low positivity rates in gold standard methods, radiologic methods such as magnetic resonance imaging can be used in tuberculous meningitis diagnosis. Giriş: Tüberküloz menenjit önemli bir santral sinir sistemi infeksiyonudur ve tüberkülozun en ağır klinik formudur. Mycobacterium tuberculosis en sık izole edilen mikroorganizmadır ve santral sinir sistemi infeksiyonları içinde önemli bir mortalite ve morbidite nedenidir. Tıptaki tüm gelişmelere rağmen tüberküloz menenjit tanısı koymak hala ciddi bir problemdir. Bu çalışmada tüberküloz menenjit tanısı alan hastaların klinik, laboratuvar ve radyolojik özelliklerini detaylıca incelemeyi amaçladık. Materyal ve Metod: Çalışma retrospektif olarak tasarlandı. Klinik, mikrobiyolojik ve de radyolojik olarak tüberküloz menenjit tanısı alan toplam 32 hasta çalışmaya dahil edildi. İki hasta dışındaki tüm hastalara hem bilgisayarlı tomografi (BT) hem de manyetik rezonans görüntüleme (MRG) ile kraniyal görüntüleme yapıldı. Bilgisayarlı tomografi incelemeleri acil serviste, MRG incelemeleri ise BT’den sonraki 48 saat içinde yapıldı. Data analizi SPSS.24 ile gerçekleştirildi. Bulgular: Hastaların 11’i altın standart yöntemler ile tanı almıştır. Üretilen tüm etkenler M. tuberculosis’dir. Diğer hastaların tanısı ise klinik, laboratuvar ve radyoloji desteği ile konulmuştur. Hastalara ait demografik veriler, semptomlar, laboratuvar bulguları ve radyolojinin tanıya katkısı değerlendirilmiştir. Radyolojinin tanıya katkısı incelendiğinde MRG BT’ye göre tanıya daha fazla katkı sağlayıcı olarak bulunmuştur. Sonuç: M. tuberculosis’e bağlı santral sinir sistemi infeksiyonları yüksek mortalite ve morbidite nedenidir. Tanı için altın standart, basilin EZN boyası ile gösterilmesi ve kültürde üretilmesidir. Bu yöntemlerle düşük pozitiflik oranlarının olması nedeniyle radyolojik yöntemler özellikle de MRG tanıya yardımcı yöntem olarak kullanılabilir.

Owing to impaired immune function, surgical procedures, and multiple hospitalizations, patients with end-stage liver disease are at risk for numerous infectious complications while waiting for transplantation. Infection in transplant recipients remains the main cause of mortality and morbidity, despite advances in surgical techniques and the development of new repressive agents. The purpose of this study is to examine the infections that develop during the pretransplantion period in live donor liver transplant recipients and their effect on post-transplant clinical outcomes. The retrospective analysis of adult live donor liver transplant recipients in the last 4 years was conducted at Ankara University Hospital, a 1900-bed tertiary-care university hospital, in Ankara, Turkey. Demographic characteristics, preoperative infections, and clinical outcomes were analyzed. Patients were divided into 2 groups according to whether they had developed an infection before transplantation. The diagnoses were based on clinical, laboratory, and microbiological findings. Statistical analyses were performed using Stata version 9.0 (StataCorp, College Station, Tex., United States), and P In univariate analyses, having diabetes mellitus or a pretransplant infection, the number of pretransplant infection attacks, the need for a reoperation, and developing a post-transplant infection were the statistically significant factors associated with 1-year mortality (P Our study showed the effect of pretransplantation infections on post-transplant morbidity but not on rejection or mortality. According to the situation of patients, manageable pretransplantation infection is not an absolute contraindication for liver transplantation. Awareness of the increased risk for post-transplant infections and fast-acting antimicrobial coverage are the most important facts for patient survival.

Introduction: Guidelines recommend using a pulse oximeter rather than arterial blood gas (ABG) for COVID-19 patients. However, significant differences can be observed between oxygen saturation measured by pulse oximetry (SpO2) and arterial oxygen saturation (SaO2) in some clinical conditions. We aimed to assess the reliability of pulse oximeter in patients with COVID-19 Methods: We retrospectively reviewed ABG analyses and SpO2 levels measured simultaneously with ABG in patients hospitalized in COVID-19 wards. Results: We categorized total 117 patients into two groups; in whom the difference between SpO2 and SaO2 was 4% (acceptable difference) and >4% (large difference). Large difference group exhibited higher neutrophil count, C-reactive protein, ferritin, fibrinogen, D-dimer and lower lymphocyte count. Multivariate analyses revealed that increased fibrinogen, increased ferritin and decreased lymphocyte count were independent risk factors for large difference between SpO2 and SaO2. The total study group demonstrated the negative bias of 4.02% with the limits of agreement of −9.22% to 1.17%. The bias became significantly higher in patients with higher ferritin, fibrinogen levels and lower lymphocyte count. Conclusion: Pulse oximeters may not be sufficient to assess actual oxygen saturation especially in COVID-19 patients with high ferritin and fibrinogen levels and low lymphocyte count low SpO2 measurements.

Background/aim: The aim of this study is to evaluate the distribution, sources, clinical features, and mortality rates of bacteremia due to evaluation of extensively drug-resistant (XDR) gram negative among solid-organ transplant (SOT) recipients. Materials and methods: A retrospective study of SOT recipients with bacteremia due to XDR gram-negative pathogens in 11 centers between 2016 and 2018 was conducted. Patients' records were evaluated. Results: Of 171 bacteremia that occurred in 164 SOT recipients, 93 (56.7%) were liver, 46 (28%) kidney, 14 (8.5%) heart, and 11 (6.7%) lung recipients. Bacteremia episodes were recorded in the first year in 63.7% of the patients (n = 109), early-onset bacteremia was recorded in 45% (n = 77) of the episodes. In multivariate analysis, catheter-associated bacteremia was an independent risk factor for 7-day mortality (p = 0.037), and early-onset bacteremia was found as an independent risk factor for 30-day mortality (p = 0.017). Conclusion: Difficult-to-treat infections due to XDR bacteria in SOT recipients shadow the success of transplantation. Central venous catheters seem to be the main risk factor. Judicious use of medical devices is of pivotal importance.

Background and Aims Cytomegalovirus (CMV) infection is an important complication in immunocompomised patients. Although approach to CMV infection is well-defined in stem cell and solid organ transplant recipients, less is known about the frequency and risk factors of CMV disease in patients with glomerulonephritis (GN). As few studies have shown that cyclophosphamide (CYC) treatment is a risk factor for CMV infection in GN patients, we aimed to describe the frequency and risk factors of CMV infection in GN patients treated with CYC. Method 268 patients diagnosed GN between January 2017 and November 2019 in Ankara University İbni Sina Hospital, Nephrology Department. We recruited 43 GN patients who were treated with CYC and screened all patients for viral DNA monthly. CMV infection defined by CMV DNA detected >500 copies/µl. Patients developed CMV and no-CMV infection were compared for age, sex, glomerular pathology, renal function and clinical status before and after treatment. Results CMV infection was detected in 10 (23,3%) patients at 2±1 (min:1 max:3) months of CYC treatment (Table-1). 7 patients were treated for CMV infection with parenteral ganciclovir, while the other 3 patients with low CMV DNA level (509, 538 and 540 copies/ml) and no disease symptoms were monitored without antiviral treatment. Patients with CMV infection had higher serum creatinine (4,2±3,2 vs. 1,9±1,8 mg/dl, p=0,006), lower estimated glomerular filtration rate (29±11 vs. 65±8 (ml/min/1.73 m2, p=0.016), lower low-density lipoprotein (144±71 vs. 221±83 mg/dl, p=0,012) at diagnosis compared with no-CMV infection patients (Table-2). Also more patients were diagnosed with rapidly proggressive GN (80,0% vs. 27.3%, p=0,007), and secondary GN was the most common GN diagnosis (80,0% vs. 27.3%, p=0.007) in CMV infection group. Conclusion CMV infection is a common complication in GN patients treated with CYC. Routine monitoring and prophylaxis should be considered for the patients who have risk factors for CMV infection.

Imaging modalities play a crucial role in the management of suspected COVID-19 patients. Before reverse transcription polymerase chain reaction (RT-PCR) test results are positive, 60-93% of patients have positive chest computed tomographic (CT) findings consistent with COVID-19. We report a case of positive lung ultrasound findings consistent with COVID-19 in a woman with an initially negative RT-PCR result. The lung ultrasound-imaging findings were present between the negative and subsequent positive RT-PCR tests and correlated with CT findings. The point-of-care lung-ultrasound examination was easy to perform and, as such, could play an important role in the triage of women with suspected COVID-19. The neonatal swabs, cord blood and placental swab RT-PCR tests were negative for SARS-CoV-2, a finding consistent with the published literature suggesting no vertical transmission of this virus in pregnant women. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Background: The hepatitis B virus (HBV) is one of the major causes of chronic liver disease. From the perspective of hospital workers (HWs), employees are at risk of hepatitis B infection because of occupational exposure. Apart from this occupational risk, health professionals may still be affected by HBV, depending on the epidemiological characteristics of the country and geographical region they live in. Objectives: This study aimed to determine HBV, HCV, and HIV seroprevalence among HWs using data obtained from 21 hospitals located in six geographical regions in Turkey and the Turkish Republic of Northern Cyprus. Methods: The study was designed as a retrospective, multicentre, descriptive study. Twenty hospitals from Turkey and one hospital from the Turkish Republic of Northern Cyprus were involved in the study. The variables of the study were vaccination status against HBV and hepatitis A and HBsAg, anti-HBs, anti-HBcIgG, anti-HAVIgG, anti-HCV, anti-HDV, and anti-HIV serology results belonging to the previous year. Results: Women constituted 58.9% (n = 5,622) of the HWs included in the study. The mean age was 36.3 +/- 9.09 years (min =18, max = 72). In terms of occupation, 42.5% (n = 4, 064) were nurses/health officers, and 24.8% (n = 2365) were physicians. HBsAg seroprevalence was found to be 1.8% (n =169; 95% CI = 1.5% - 2.0%), while anti-HBs seropositivity was 75.7% (n = 7,234). About 7.3% (n = 701) had natural immunity to hepatitis B. About 21.6% (n = 2,066) of the HWs did not receive hepatitis B vaccine. Conclusions: This study is the first study involving a large sample size from different locations of Turkey. According to the results, hepatitis B and hepatitis A vaccines should be administered to susceptible individuals and HWs. WOS:000534475500002 2-s2.0-85085751514

According to the Center for Disease Control and Prevention (CDC), there were 2.1 million new human immunodeficiency virus (HIV) cases reported worldwide in 2015, which shows that siginificant work needs to be done to prevent the transmission of HIV. Research to date has focused mainly on high-risk men who have sex with men, but many women around the world are also at a high risk for HIV transmissions. In studies conducted, the incidence of HIV infection in high-risk individuals decreases over 90% when high-risk individuals use pre-exposure prophylaxis (PreP) HIV, tenofovir disoproxil fumarate-emtricitabine (TDF-FTC) safely. Current data and studies on pre-exposure prophylaxis were discussed in this review.

Both nosocomial and community acquired gram-negative bacterial infections cause serious morbidity and mortality. However, old antibiotics, which have toxic side effects, should be re-used because of the lack of newly developed antibiotics. One of these is colistin which has both nephrotoxic and neurotoxic side effects. Especially due to nephrotoxicity side effec, serious problems can be experienced in the use of colistin. In this article, a case of reversible nephrotoxicity after colistin usage is presented.

This study aimed to describe the effect of initial antifungal therapy on patient mortality and to detail the current distribution and resistance patterns of Candida spp. among patients with candidaemia. A prospective observational study was performed among consecutive patients with candidaemia from 10 Turkish medical centres between January 2015 and November 2018. The primary outcome was 10-day mortality. Species were identified using MALDI-TOF/MS. A total of 342 patients with candidaemia were included, of which 175 (51.2%) were male and 68 (19.9%) were aged, NA

“Direct acting antivirals” cure over 99% in the course of the disease as a recent breakthrough treatment method in hepatitis C treatment. Possible drug-drug interactions should not be overlooked. In this case report we aimed to share how we managed the interaction in a patient who was planned to use sofosbuvir-ledipasvir. The use of direct antiviral drugs is a very important point in Hepatitis C treatment. A good patient history and a multidisciplinary approach are necessary for the interaction of drugs. These are necessary for successful and safe treatment of hepatitis C.

Ramsay Hunt Syndrome (RHS) is a syndrome with facial nerve involvement which is accompa-nied by auricular rash and ear pain. Facial paralysis recovers late and with a sequelae. In this article, we reported a case who was first treated with oral valacyclovir and developed RHS at the third day of treatment, and whose facial paralysis fully recovered with early initiation of intrave-nous acyclovir and steroid. As it is in this case; it is important to keep in mind that RHS may develop despite oral antiviral treatment in elderly patients with chronic diseases (patients with chronic, elderly). Steroid and antiinflammatory treatments as well as intravenous antiviral the-rapy should be begun in the first 72 hours of this disease.

Infective endocarditis (IE) is rare, but associated with significant morbidity and mortality rates. Estimates of the incidence of IE in Turkey are compromised by the absence of population-based prospective studies. Due to the frequent presence of predisposing cardiac conditions and higher rates of nosocomial bacteremia in high-risk groups, the incidence of IE is expected to be higher in Turkey. Additionally, while IE generally affects older people in developed countries, it still affects young people in Turkey. In order to reduce the mortality and morbidity, it is critical to diagnose the IE to determine the causative agent and to start treatment rapidly. However, most of the patients cannot be diagnosed in their first visits, about half of them can be diagnosed after three months, and the disease often goes unnoticed. In patients diagnosed with IE, the rate of identification of causative organisms is significantly lower in Turkey than in developed countries. Furthermore, most of the centers do not perform some essential microbiological diagnostic tests as a routine practice. Some antimicrobials that are recommended as the first-line of treatment for IE, particularly antistaphylococcal penicillins, are not available in Turkey. These problems necessitate reviewing the epidemiological, laboratory, and clinical characteristics of IE in our country, as well as the current information about its diagnosis, treatment, and prevention together with local data. Physicians can follow patients with IE in many specialties. Diagnosis and treatment processes of IE should be standardized at every stage so that management of IE, a setting in which many physicians are involved, can always be in line with current recommendations. Study Group for Infective Endocarditis and Other Cardiovascular Infections of the Turkish Society of Clinical Microbiology and Infectious Diseases has called for collaboration of the relevant specialist organizations to establish a consensus report on the diagnosis, treatment, and prevention of IE in the light of current information and local data in Turkey.

Toka, Onur/0000-0002-4025-4537; Yoruk, Gulsen/0000-0002-0357-5884; Cinar, Gule/0000-0002-7635-8848; Hakyemez, Ismail Necati/0000-0001-6133-9604; Tulek, Necla/0000-0002-3952-4982 WOS:000511173500009 Objective: Both chronic hepatitis B (CHB) and hepatosteatosis may lead to necroinflammation in liver. Therefore, the presence of hepatosteatosis might negatively affect the efficacy of antiviral therapy. We aimed to determine the effect of hepatosteatosis on virological response in patients with CHB receiving entecavir (ETV) and tenofovir (TDF) treatment. Methods: The study was designed retrospectively. All patients receiving antiviral therapy due to CHB in the departments of Infectious Diseases and Clinical Microbiology of 29 different hospitals between January 2012 and June 2017 were searched by examining medical records. Results: A total of 1069 patients were included. Six hundred and fifty of the patients had been receiving TDF and 419 of them had been receiving ETV. The rate of virological response obtained at the 48'h week of TDF was higher in patients with steatosis (p=0.029). Virological response at the 24th week and 48th week of ETV were higher in the patients without steatosis (p=0.001). TDF and ETV therapies were compared in the patients with hepatosteatosis and it was found that the virological response at 48th week was higher in the TDF group. Conclusion: Although steatosis has an effect on virological response in the short-term results of nucleos(t)ide therapy, it does not have any effect on virological response in the long-term results.

Carbapenemase-producing Enterobacteriacea (CPE) cause serious and life-threatening infections. They are resistant to carbapenems and many other classes of commonly used antimicrobial agents; therefore, managing infections caused by them poses a substantial challenge in clinical practice. They can also cause morbidity and mortality in patients with liver transplant. A retrospective analysis of CPE culture-positive patients with a history of liver transplant can help to examine the epidemiology and microbiology of these bacteria, as well as gain information on the possible infection sources, susceptibility patterns, and expected mortality in infected populations. In addition, study of these bacteria could help formulate a consensus on the appropriate use of empirical and directed antibiotic therapy, which can effectively reduce infections in these patients. We reviewed the medical records of 142 subjects who underwent liver transplantation at Ankara University Hospital, a 1900-bed tertiary care university hospital, in Ankara, Turkey, between January 2014 and August 2018. Patients showing signs of infection with culture positivity for CPE-producing organisms were included from the study. Statistical analysis was performed and a value of P .05 is considered statistically significant. In most cases, the source of infection was the abdomen. Klebsiella species was also predominant in these cases. Model for End-Stage Liver Disease scores and length of hospital stay were higher and statistically significant when compared to patients who were CPE negative. Mortality was highest in the CPE-positive group. Infection is the most important cause of mortality and morbidity after liver transplantation and increases the cost of treatment. Regarding the culture sensitivity patterns and resistance mode, empirical therapy with carbapenems does not produce a solid result. The high mortality observed with these infections reflects very limited therapeutic options.

Aim: Infective endocarditis (IE) is a serious heart disease with high mortality and morbidity. Antibiotic prophylaxis is recommended for patients at risk of infective endocarditis before dental procedures. This Turkish online descriptive survey aimed to evaluate the knowledge and awareness levels of dentists and dental students regarding antibiotic prophylaxis for patients at risk of infective endocarditis. Method: Data on participants’ demographics and responses regarding dental treatments and heart diseases requiring prophylaxis as well as antibiotic dosage, duration, and administration time were collected between February 1 and June 30, 2016 in Turkey. For each correct answer one point was given. A score of >4 was considered successful. Results: In total, 584 dentists and 199 dental students participated in the questionnaire survey. The rate of ad- ministration of antibiotic prophylaxis against infective endocarditis was found as 92.59%. Overall success rates of dental procedures requiring prophylaxis and knowledge regarding heart diseases were 90.3% and 72.6%, respectively. Knowledge levels regarding the use of antibiotic prophylaxis for heart diseases and antibiotic do- sage and duration were greater in women, those with ?5 years of professional experience, dentists, and those working at dental faculties (p5 years of experience (p