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2019 yılının son günlerinde, Çin’in Hubei eyaletinden etiyolojisi bilinmeyen ardışık pnömoni vakaları bildirilmeye başlanmış ve daha sonra SARS-CoV2 olarak adlandırılacak olan bu yeni tip Coronavirüs kısa sürede tüm dünyaya hızla yayılarak bir pandemiye dönüşmüştür. Bu süreçte tedavide birçok yeni molekül ile birlikte steroidlerin de kullanım sıklığı artmıştır. Steroidlerin pek çok yan etkisi bulunmaktadır ve femur başı avasküler nekrozu steroidlerin uzun süreli kullanımı sonucu görebildiğimiz önemli yan etkilerinden biridir. Bu yazıda COVID-19 pnömonisi nedeniyle yoğun bakım ünitesi ve ardından serviste izlenen bir hastada kısa süreli steroid kullanımı sonucu gelişen bilateral femur başı avasküler nekrozu olgusu sunulmuştur.

This study aimed to evaluate the influencing variables for outcomes in patients with septic shock having culture-proven carbapenem-resistant Gram-negative pathogens. It included 120 patients (mean age 64.29 ± 1.35 years and 58.3% female). The mean Sequential Organ Failure Assessment score during septic shock diagnosis was found to be 11.22 ± 0.43 and 9 ± 0.79 among the patients with mortality and among the survivors, respectively (P = 0.017). The logistic regression analysis showed that empirical treatment as mono Gram-negative bacteria-oriented antibiotic therapy (P = 0.016, odds ratio (OR) = 17.730, 95% confidence interval (CI): 1.728-182.691), Charlson Comorbidity Index2 (P = 0.032, OR = 7.312, 95% CI: 5.7-18.3), and systemic inflammatory response syndrome score 3 or 4 during septic shock diagnosis (P = 0.014, OR = 5.675, 95% CI: 1.424-22.619) were found as independent risk factors for day 30 mortality. Despite early diagnosis and effective management of patients with septic shock, the mortality rates are quite high in CRGNP-infected patients.

Introduction: Diabetic foot ulcer (DFU), one of the complications of Diabetes Mellitus (DM), is the most common reason for the hospitalization of diabetic patients and leads to extremity amputations and increase in mortality. DFU brings an additional physical and emotional burden to the patients and affects their quality of life (QoL) negatively. This study was organized with the aim of comparing the anxiety, depression and QoL levels of DFU patients with diabetic patients without DFU due to the limited number of the studies investigating the QoL and mental health of DFU patients. Materials and Methods: One hundred and thirty-three patients followed up in the X University Faculty of Medicine Infectious Diseases and Clinical Microbiology Department and volunteered to participate in this cross-sectional study. Besides sociodemographic information, anxiety and depression levels were assessed by Hospital Anxiety Depression (HAD) Scale and QoL was measured by Short Form 36 (SF-36). Results: Among the 133 DM patients with a median age of 60 years, 83 patients were in the DFU group. Mean age (p= 0.006, t= -2.813) and male prevalence (p= 0.0002, χ²= 13.824) were higher in the DFU group. Only physical functioning scores were lower in the DFU group (p= 0.002, Z=-3.04) while comparing SF-36 and HAD scores between the two groups. All SF-36 subscale scores of both diabetic groups were lower than the Turkish normative values (p< 0.0001). Conclusion: Finding worse QoL in the aspect of physical functioning among DFU patients reveals the necessity of interventions that will improve the DFU patients’ QoL by increasing their physical functioning, besides medical and surgical treatments for foot ulcers. In our study, it was found that all diabetic patients had lower QoL than the normal population. This finding emphasizes the need for taking steps to improve the QoL of patients with DM and especially DFU.

Introduction: In this study, it was aimed to determine the risk factors for developing acute kidney injury (AKI) and effects of ascorbic acid on the development of nephrotoxicity in patients receiving systemic colistin sodium therapy. Materials and Methods: We retrospectively reviewed records of cases who were treated with systemic colistin sodium and did not have any known renal disease in our hospital between the years of 2014 and 2019. The demographic characteristics, indications for systemic colistin, other antibiotics applied and nephrotoxic drugs, vasopressor necessity, daily creatinine values, development of acute kidney injury, and ascorbic acid use were evaluated. Acute kidney injury was assessed according to KDIGO 2017. Results: Sixty-six patients were included in the study. In addition to colistin therapy, 33 cases who received at least three grams of ascorbic acid per day and 33 cases who received only colistin therapy were evaluated retrospectively. Acute kidney injury developed in 12 (36.4%) of those receiving ascorbic acid and 15 (45.5%) in those not receiving ascorbic acid (p= 0.617). Acute kidney injury developed in 9.1 ± 5.9 days in ascorbic acid patients and 7.1 ± 4.4 days in non-ascorbic acid patients (p= 0.314). The rate of septic shock development was significantly lower in patients receiving ascorbic acid (30.3% vs 57.6%, p= 0.046). Advanced age (p= 0.005), sepsis (p= 0.046), and underlying cardiac disease (p= 0.01) were found to be statistically significant in terms of the development of nephrotoxicity. Conclusion: Although no statistically significant effect of ascorbic acid using on the development of colistin-related nephrotoxicity was determined in our study, we think that high dose vitamin C may be beneficial in selected patient groups in terms of the fact that AKI is seen less in the group using ascorbic acid, does not have serious side effects and has a positive effect on preventing from septic shock. However further research is needed with more patients.

Introduction: Crimean-Congo Hemorrhagic Fever (CCHF) is a zoonotic disease frequently transmitted by tick bite and accompanied by fever and bleeding. It may cause important public health problems. Besides clinical symptoms and epidemiological history, blood count and biochemical test results are the first clues for CCHF. In this study, we aimed to retrospectively evaluate 16 patients who were followed and treated due to CCHF in our hospital. Materials and Methods: The patients who were followed up and treated with CCHF between 2009-2019 in our clinic were evaluated retrospectively in terms of demographic characteristics, presenting complaints, presence of tick history, laboratory parameters, necessity of blood products replacement, hospitalization periods, ribavirin treatment and one-month survival. Results: Sixteen patients [ten females, six males, mean age 50.37 ± 18.01 (min: 18-max: 79)] with the diagnosis of CCHF were included into the study. Presenting complaints were fever (16/16, 100%), fatigue (16/16, 100%), bleeding (9/16, 56.2%), petechial rash (7/16, 43.7%). nausea and vomiting (6/16, 37.5%). There was a history of tick contact in 14 cases (87.5%) but not in two cases. Supportive treatment was applied to all cases, and droplet and contact isolation were applied. Blood product replacement was performed in five patients (31.2%), and ribavirin was administered in nine patients (56.2%). Mortality rate was 6.3% (1/16). Conclusion: Crimean-Congo Hemorrhagic Fever is an endemic disease in our country. Especially in spring and summer months, patients with fever and cytopenia on hemogram should be questioned, and tick contact should be sought.

Objective: Measles, rubella, mumps (MRM) and chickenpox are diseases that can be prevented by vaccination. Knowledge of healthworkers’ immunity to infectious diseases and vaccination status, the identification of susceptible individuals, and subsequentappropriate vaccination programs are essential to the prevention and control of infections.Aim: The purpose of this nationwide multi-center study was to investigate the infection, testing, and vaccination status of healthworkers, individuals at greater risk of encountering exanthematous diseases such as MRM and chickenpox.Method: A questionnaire intended for eliciting health workers’ demographic characteristics, MRM and chickenpox infection, andvaccination status was produced, and participants were asked to respond with the form being dispatched through a link availableonline via the web page.Results: A total of 12,475 health workers from the seven regions of Turkey participated, 8099 participants (64.9%) women and 4376(35.1%) men, with a mean age of 35.4±9.4 years. Infection rates for measles, rubella, mumps, and chickenpox ranged between 22.4%and 34.9%. Health workers’ MRM and chickenpox vaccination status was investigated, with 22.3% (n=2784) not answering thatquestion for MRM vaccination, and 22% (n=2748) not responding for chickenpox vaccination. Numbers of participants vaccinatedagainst MRM and chickenpox performed were 2048 (21.1%) and 4451 (45.8%), respectively. Numbers of health workers not havingmeasles, rubella, mumps or chickenpox serological tests performed were 8953 (79%), 9010 (80.1%), 9363 (83.5%), and 9591 (85.4%).Of the 2383 individuals having measles IgG serological tests performed, 77.6% were measles IgG positive, 81.5% of 2233 individualswere rubella IgG positive, 81.6% of 1854 participants were rubella IgG positive, and 83.6% of 1644 participants were chickenpox IgGpositive. No statistically significant associations were determined between participants’ age, sex, or occupational group and MRM andchickenpox vaccination status (p>0.05).Conclusion: The high rates of health workers not having serological tests performed in this study indicates a weakness in this area inTurkey as a whole. Serological examinations should be performed before health workers commence employment, and they must beenrolled in the appropriate vaccination programs., Giriş: Kızamık, kızamıkçık, kabakulak (KKK) ve suçiçeği hastalıkları aşı ile önlenebilir hastalıklar arasında yer almaktadır. Sağlık çalışanlarının enfeksiyon hastalıklarına karşı bağışıklık ve aşılanma durumlarının bilinmesi, duyarlı personelin belirlenmesi ve ardından uygun aşılama programlarının geliştirilmesi enfeksiyonların önlenmesi ve kontrolü için önemlidir.Amaç: Ülke genelini kapsayan çok merkezli olarak gerçekleştirilen bu çalışmada, KKK ve suçiçeği gibi döküntülü hastalıklarla karşılaşma riski fazla olan sağlık çalışanlarının hastalık geçirme, test yaptırma ve aşılanma durumlarının belirlenmesi amaçlanmıştır.Yöntemler: Sağlık çalışanlarının demografik özelliklerini, KKK ve suçiçeği hastalığını geçirme ve aşılanma durumlarını öğrenmeye yönelik bir anket formu oluşturulmuş ve bu form web sayfası üzerinden online ulaşılabilen bir link aracılığıyla sağlık çalışanlarına iletilerek katılımcıların anketteki soruları yanıtlamaları istenmiştir.Bulgular: Çalışmaya Türkiye’de toplam yedi bölgeden 12.475 sağlık çalışanı katıldı. Katılımcıların 8099 (%64,9)’u kadın, 4376 (%35,1)’i erkek ve yaş ortalaması 35.4±9.4 yıl idi. KKK ve suçiçeği geçirmeme durumları %22,4-34,9 arasında idi. Sağlık çalışanlarının KKK ve suçiçeği aşılanma durumları sorgulandı. KKK için katılımcıların %22,3’ü (n=2784), suçiçeği aşısı için katılımcıların %22’si (n=2748) bu soruya cevap vermedi. KKK ve suçiçeği aşısı yaptıranlar sırasıyla 2048 (%21,1) ve 4451 (%45,8) idi. KKK ve suçiçeği serolojisi baktırmayan sağlık çalışanlarının sayısı sırasıyla 8953 (%79), 9010 (%80,1), 9363 (%83,5) ve 9591 (%85,4) idi. Kızamık IgG serolojisi baktıran 2383 kişiden %77,6’sı kızamık IgG pozitif, 2233 kişinin %81,5’i kızamıkçık IgG pozitif, 1854 kişinin %81.6’sı kabakulak IgG pozitif ve 1644 kişinin %83,6’sı suçiçeği IgG sonucu pozitifdi. Katılımcıların cinsiyet, yaş ve meslek gruplarına göre KKK ve suçiçeği aşısı yaptırma durumları değerlendirildiğinde istatiksel anlamlılık yoktu (p>0.05).Sonuç: Çalışmamızda serolojik sonuçlarına baktırmayan sağlık çalışanlarının oranının fazla olması ülke genelinde bu konudaki eksiklikleri ön plana çıkarmaktadır. Sağlık çalışanlarının serolojik değerlendirmeleri işe başlamadan önce kontrol edilmeli ve gerekli aşı programına alınmalıdır.

Amaç: Bu çalışmanın amacı, 2014 ve 2018 yılları arasında yoğun bakım ünitelerinde (YBÜ) sağlık çalışanlarının el hijyeni uyum oranını saptamaktır.Gereç ve Yöntem: Bu araştırma yedi YBÜ’de (Çocuk Sağlığı ve Hastalıkları, Yenidoğan, İç Hastalıkları, Anestezi ve Reanimasyon, Göğüs Hastalıkları, Nöroloji ve Kalp Damar Cerrahisi) çalışan doktor, hemşire ve yardımcı sağlık personelinin el hijyeni uyumunu değerlendiren prospektif, gözlemsel bir çalışmadır. El hijyeni uyumu enfeksiyon kontrol hemşireleri tarafından Dünya Sağlık Örgütü (DSÖ) beş endikasyonuna göre Ocak 2014 ile Aralık 2018 arasında haberli gözlem şeklinde yapılmıştır. Ayrıca, yüksek ve düşük el hijyeni uyumluluğuna sahip bireylere kişisel geri bildirimler verilmiştir.Bulgular: Toplam 24153 el hijyeni fırsat gözlemi (2014: 5695, 2015: 5307, 2016: 4563, 2017: 4821, 2018: 3767) yapıldı. Çalışmamızda 2014'ün ilk döneminde el hijyeni uyum oranı %25,6 idi. Tüm çalışanların el hijyeni uyum oranı sırasıyla; 2014: %32,0, 2015: %55,7, 2016: %61,0, 2017: %55,6 ve 2018: %68,1 olmuştur. Mesleklere göre; el hijyeni uyum oranları hemşirelerde %37 ile %70, yardımcı sağlık personelinde %20 ile %51, doktorlarda %28 ile %49 arasındaydı.Sonuç: Hastanemizde el hijyeni kurallarına uyum, sürekli çabalarla nispeten zayıf seviyelerden ortalama seviyelere yükselmiştir. El hijyeni uyum oranlarını %70'lerin üstüne çıkarmak için daha fazla destekleyici çalışmaya ihtiyaç vardır., Aim: The aim of this study was to determine the hand hygiene (HH) compliance of the health workers in the intensive care units (ICUs) between the years 2014 and 2018. Materials and Methods: A prospective, observational study assessed the hospital care HH compliance among doctors and nurses and auxiliary staff in seven ICUs (Pediatrics, Neonatal, Internal Medicine, Anesthesia and Reanimation, Chest Diseases, Neurology and Cardiovascular Surgery) of our setting.Unblinded observations were conducted by infection control nurses between January 2014 and December 2018 according to the five indications based on World Health Organization (WHO) guidelines. Practical HH training was continued during the HH observations of employees at ICUs in our hospital. In addition, personal feedback was given to individuals with high and low HH compliance.Results: A total of 24153 HH opportunity (2014: 5695, 2015: 5307, 2016: 4563, 2017: 4821, 2018: 3767) observations were made. In the first period of 2014, the rate of HH compliance was 25.6%. The HH compliance rates of all employees were as follows: 2014: 34%, 2015: 55.7%, 2016: 61.0%, 2017: 55.6% and 2018: 68.1%. According to occupations; HH compliance rates were found to range between 37% and 70% in nurses, 20% and 51% in auxiliary healthcare personnel, 28% and 49% in doctors.Conclusion: In our hospital compliance with HH rules increased from relatively poor levels to relatively average levels via continuous efforts. Further supportive studies are needed to increase HH compliance rates above 70%.

Aim: Occupational exposure to blood and other potentially infectious body fluids, and sharp injuries, poses a significant risk to blood-borne infections for healthcare workers. The aim of this study is to evaluate the serology of Hepatitis A, Hepatitis B, Hepatitis C and HIV infection and determine the knowledge level of healthcare workers about the risk of occupational exposure.Materials and Methods: 89 healthcare workers who applied to Ege University Medical Faculty Hospital Infectious Diseases outpatient clinic were evaluated with a questionnaire about knowledge levels of occupational injury and attitudes though screening their status by serological test along with Hepatitis A, Hepatitis B, Hepatitis C and HIV infection.Results: 66 of the participants (74%) were female and 23 (26%) were male. The mean age was 39.94 ± 12.54 years (min-max; 24-66 years). 41 people (46%) who defined occupational injuries were identified with a history of 56 injuries. Of these, 19 (34%) had needlestick injury, 22 (39%) had penetrating stab wounds, and 15 (27%) had blood/patient excretion on the eye. As a result of injuries, hepatitis B, hepatitis C and HIV transmission were not observed.Conclusion: Due to the possibility of mucosal contact with blood or body fluids, we think that it is important to inform healthcare workers in terms of hepatitis B, hepatitis C and HIV transmission and raise awareness through practices aimed at reducing these injuries., Amaç: Kesici delici alet yaralanmaları yanında kan ve diğer potansiyel enfekte vücut sıvılarıyla her türlü mesleki maruziyet sağlık çalışanları için kan yoluyla bulaşan enfeksiyonlar açısından önemli bir risk teşkil etmektedir. Bu çalışmada sağlık çalışanlarının bilgi düzeyleri ve mesleki maruziyet riski nedeniyle Hepatit A, Hepatit B, Hepatit C ve HIV enfeksiyonu yönünden serolojik değerlendirilmesi amaçlandı.Gereç ve Yöntem: Ege Üniversitesi Tıp Fakültesi Hastanesi Enfeksiyon Hastalıkları polikliniğine başvuran 89 sağlık çalışanının 10 soruluk bir anket ile mesleki yaralanma, bilgi düzeyleri ve tutumları ile birlikte Hepatit A, Hepatit B, Hepatit C ve HIV enfeksiyonu yönünden durumları serolojik testle değerlendirildi.Bulgular: Çalışanların 66’sı (%74) kadın, 23’ü (%26) erkek olup, yaş ortalaması 39.94± 12.54 yıl (min-maks;24-66) idi. Mesleki yaralanma tanımlayan 41 kişi (%46) 56 yaralanma öyküsü tanımlandı. Bunların 19’u (%34) iğne batması, 22’si (%39) kesici delici alet yaralanması, 15’i (%27) göze kan/ hasta çıkartısı sıçraması şeklindeydi. Bu yaralanmalar sonucu hepatit B, hepatit C ve HIV bulaşı olmadığı test sonuçları ile görüldü.Sonuç: Kan ya da vücut sıvılarıyla mukozal temas ihtimali olması nedeniyle hepatit B, hepatit C ve HIV bulaşı açısından sağlık çalışanlarının bilgilendirilmesi ve bu yaralanmaları azaltmaya yönelik uygulamalarla farkındalık yaratılmasının önemli olduğunu düşünmekteyiz.

Introduction: Human papillomavirus (HPV) is a DNA virus belonging to the Papillomaviridae family and infects only humans. HPV virus has an important role in the development of cervical cancer and anogenital warts, and it is also responsible for oropharyngeal cancers and penile cancers. The aim of this study was to evaluate the knowledge, awareness, and attitudes about HPV and HPV vaccines in medical students with HPV vaccine. Materials and Methods: A questionnaire consisting of 30 close-ended questions was applied to the medical students with HPV vaccine between February 1- May 31, 2019 in the Faculty of Medicine. Data were analyzed with descriptive statistical methods. Results: Eighty-five medical students enrolled in the study, 5% (n= 5) were males and 95% (n= 80) were females. The number of participants who responded correctly to the questions about HPV transmission pathways, symptoms, diseases, HPV vaccine protection, and screening methods was 4% (n= 3). The average number of correct answers was 14.3 (min: 8, max: 18). 96% (n= 82) of the participants responded to the question related to condom use in people who have been vaccinated with HPV as “required to use” or “use condoms”, and 4% (n= 3) stated that this information was wrong. For the question about genital herpes and HPV, 45 % (n= 38) of the participants stated that they might be related, and 9% (n= 8) did not know. Conclusion: The rates of HPV vaccine application in our country are still low. Vaccination of health workers is very important. Firstly, acquiring the right information and completing their own vaccines will increase immunization rates.

Negative pressure wound therapy (NPWT) is a popular treatment option in wound care. Main principle of treatment is to apply pressure that is below atmospheric pressure on wound, continuously or intermittently. NPWT helps reducing tissue edema and it accelerates wound healing by increasing blood flow locally. We think that this method, which was initially used as an adjunctive treatment option, may be an alternative to surgical procedures such as wound debride-ment and abscess drainage in selected patient groups in current practice. In this paper, a 55-year-old female patient with a rapid clinical response to NPWT treatment after spontaneous thigh abscess that drained spon-taneously. NPWT treatment should be kept in mind as the primary treatment option, especially in uncomplicated wounds. © 2022 by Türkiye Klinikleri.

A systematic review was conducted with the aim of describing the demographical data, features and outcomes of patients with Lyme disease (LD), reported from Turkey. Three international database (electronic PubMed, Web of Science and Scopus) and two national database (Ulakbim and Turkmedline) searches were performed using the following keywords ([‘Lyme’ or ‘Borrelia burgdorferi’ or ‘Borrelia’ or ‘Borreliosis’] and ‘Turkey [and/country]’). National Notifiable Diseases Surveillance System (NNNDS) of Centers for Disease Control and Prevention (CDC) criteria were used for classification. A PRISMA-based algorithm was used for systematic review. There were a total of 75 LD cases in 36 different reports. Studies related to LD are confined to case reports. We believe that LD is an important healthcare problem in Turkey and to our knowledge this is the first systematic review from this country.

The frequency of colonization and infections with resistant microorganisms in urinary tract infections is increasing day by day. Treatment difficulties are encountered in infections due to carbapenem-resistant Gram negative bacteria. Despite its nephrotoxic and neurotoxic side effects, colistin may remain the only option in these infections. Myroides spp. is a Gram negative and non-fermentative bacillus belonging to the Flavobacteriaceae family. It is an opportunistic pathogen that can rarely cause infection in humans. This agent can be resistant to many antibiotic groups, so it can be difficult to treat. Colistin, an old antibiotic, is used not only intravenously in infections with resistant Gram negative agents, but also intrathecally in the treatment of meningitis and inhaled in the treatment of pneumonia. There are also case reports about its intravesical application. In this study, a successful intravesical colistin treatment application was presented in a patient with asymptomatic bacteriuria who had Myroides spp. growth in urine culture and who had a urinary intervention plan., Üriner sistem enfeksiyonlarında dirençli mikroorganizmalarla kolonizasyon ve enfeksiyonların sıklığı gün geçtikçe artmaktadır. Karbapeneme dirençli Gram negatif bakterilere bağlı enfeksiyonlarda tedavide zorluklarla karşılaşılmaktadır. Bu enfeksiyonlarda nefrotoksik ve nörotoksik yan etkilerine rağmen kolistin tek seçenek olarak kalabilmektedir. Myroides spp. Gram negatif ve nonfermentatif bir basil olup Flavobacteriaceae ailesindendir. İnsanlarda nadiren enfeksiyona neden olabilen fırsatçı bir patojendir. Bu etken çok sayıda antibiyotik grubuna direnç gösterebilir, bu nedenle tedavisi zor olabilmektedir. Eski bir antibiyotik olan kolistin, dirençli Gram negatif etkenlerle olan enfeksiyonlarda parenteral tedavi yanında menenjit tedavisinde intratekal ve pnömoni tedavisinde ise inhaler yolla da kullanılmaktadır. İntravezikal uygulaması ile ilgili de olgu düzeyinde bildiriler mevcuttur. Bu çalışmada, idrar kültüründe Myroides spp. üremesi görülen asemptomatik bakteriürisi olan ve üriner girişim planı olan bir olguda başarı ile sonuçlanan bir intravezikal kolistin tedavi uygulaması sunulmuştur.

Aim Coronavirus Disease 2019 (COVID‐19) changed the delivery of medical education in Turkey by moving to an emergency remote teaching system and led to many challenges for future doctors. In this study, we aimed to explore the impact of the COVID‐19 pandemic on medical students, to assess their anxiety level and their main anxiety sources related to this pandemic. Methods A Google Form was distributed to medical students using the virtual snowball sampling method. The form included the Beck Anxiety Inventory and additional 19 questions on sociodemographic characteristics, perceived level of knowledge about the epidemic, self‐risk perceptions of COVID‐19 and their anxiety levels about some other topics related to COVID‐19. Results Overall, 3105 medical students with a mean age of 22.37 ± 2.46, took the survey. Amongst the participants, only 32% of the students defined their knowledge about the precautions that should be taken during an epidemic disease as acceptable. Students reported highest anxiety level for the continuing spread of COVID‐19 in Turkey and transmitting coronavirus to another person. Clinically significant anxiety prevalence was 23.2%. Regression analysis revealed that factors that increased the risk of being anxious included being female, being other than a 5th‐year student, thinking that being a medical student would increase the risk of coronavirus transmission or being uncertain about it, being exposed to a patient with COVID‐19 or being uncertain about it, being anxious about the continuing spread of COVID‐19 in Turkey, being anxious about acquiring COVID‐19, being anxious for graduating and being on active duty, being anxious about a medical training interruption. Conclusion Our results suggest that anxiety is prevalent amongst Turkish medical students during the COVID‐19 pandemic and they have a weak preparedness for a pandemic such as COVID‐19. Based on our results, new strategies should be implemented for medical education and for alleviating students’ anxiety levels.

Background/aim: The aim of this descriptive article is to share the experience in Ege University, Turkey with favipiravir in the treatment of severe SARS-CoV-2 pneumonia. Materials and methods: This retrospective descriptive study included patients diagnosed with COVID-19 who presented with or developed severe pneumonia. Results: Forty patients who completed a full course (at least 5 days) of favipiravir were included in the study. At baseline, 30 (75%) patients required treatment for respiratory distress. Thirty-three patients (82.5%) were discharged from the hospital with full recovery, 6 patients (15%) died and 1 case (2.5%) was still at the intensive care unit (ICU) when this paper was written. Conclusion: This study provides relevant information for the treatment of COVID-19, suggesting that favipiravir was associated with significant clinical and laboratory improvements in the majority of the patients, is a safe drug with no serious side effects and would merit further investigation.

Objectives Daptomycin is highly effective against Gram-positive multidrug-resistant bacteria. Publications on daptomycin in osteomyelitis treatment are limited. Patients and methods In this multicenter retrospective cohort study, the aim was to evaluate the outcomes of osteomyelitis cases having received daptomycin or teicoplanin. This multicenter retrospective cohort study gathered data from seven centers located in five cities of Turkey. Study inclusion criteria were as follows: (a) magnetic resonance imaging and/or direct X-ray revealed osteomyelitis or biopsy pathologic examination results concomitant with osteomyelitis. Chi-squareand Student t-tests were used for statistical comparison. Results A total of 72 patients, 38 cases in the daptomycin group and 34 cases in the teicoplanin group diagnosed with osteomyelitis fulfilling the study inclusion criteria, were included in the study. Clinical success at the end of induction therapy was achieved in 32/38 cases in the daptomycin cohort vs. 30/34 cases in the teicoplanin cohort (p: 0.73). Conclusion Although this is a limited experience in a small but well-defined cohort, our data suggest that daptomycin may be a safe alternative to glycopeptides in osteomyelitis treatment. A randomized controlled clinical study involving larger cohorts may increase the available evidence.

Uysal, Serhat (Balikesir Author), Aim Influenza vaccination is the most effective method in prevention of influenza disease and its complications. Our study aimed to investigate the rates of vaccination and the behaviours and attitudes against the vaccine in healthcare workers in Turkey. Methods This multicentre national survey is a descriptive study in which 12 475 healthcare workers. Healthcare workers were asked to answer the questionnaire consisting of 12 questions via the survey. Results It was found that 6.7% of the healthcare workers regularly got vaccinated each year and that 55% had never had the influenza vaccine before. The biggest obstacle against getting vaccinated was determined as not believing in the necessity of the vaccine (53.1%). Conclusion The rates of influenza vaccination in healthcare workers in Turkey are quite low. False knowledge and attitudes on the vaccine and disease are seen as the most important reasons to decline vaccination. It is important to detect reasons for anti-vaccination and set a course in order to increase the rates of vaccination.

Introduction: Crimean-Congo Hemorrhagic Fever (CCHF) is a zoonotic disease frequently transmitted by tick bite and accompanied by fever and bleeding. It may cause important public health problems. Besides clinical symptoms and epidemiological history, blood count and biochemical test results are the first clues for CCHF. In this study, we aimed to retrospectively evaluate 16 patients who were followed and treated due to CCHF in our hospital. Materials and Methods: The patients who were followed up and treated with CCHF between 2009-2019 in our clinic were evaluated retrospectively in terms of demographic characteristics, presenting complaints, presence of tick history, laboratory parameters, necessity of blood products replacement, hospitalization periods, ribavirin treatment and one-month survival. Results: Sixteen patients [ten females, six males, mean age 50.37 ± 18.01 (min: 18-max: 79)] with the diagnosis of CCHF were included into the study. Presenting complaints were fever (16/16, 100%), fatigue (16/16, 100%), bleeding (9/16, 56.2%), petechial rash (7/16, 43.7%). nausea and vomiting (6/16, 37.5%). There was a history of tick contact in 14 cases (87.5%) but not in two cases. Supportive treatment was applied to all cases, and droplet and contact isolation were applied. Blood product replacement was performed in five patients (31.2%), and ribavirin was administered in nine patients (56.2%). Mortality rate was 6.3% (1/16). Conclusion: Crimean-Congo Hemorrhagic Fever is an endemic disease in our country. Especially in spring and summer months, patients with fever and cytopenia on hemogram should be questioned, and tick contact should be sought.

Coronavirus disease 2019, which emerged in Wuhan in China in early December 2019, gradually spread across the world and was declared a pandemic by the World Health Organization on March, 12 2020. the disease shows a wide spectrum, ranging from asymptomatic course to severe acute respiratory syndrome. Although data on SARS-CoV-2 infection in HIV-infected cases are still limited, it is thought that the presence of comorbidities is important for mortality and morbidity in infected cases. in this report, it was aimed to evaluate SARS-CoV-2 infection in a patient diagnosed with HIV for six years with negative HIV-1 viral load and a CD4 lymphocyte count of 240 cells/mm(3).

Background/aim The emergence of the coronavirus disease 2019 (COVID-19) outbreak has had an enormous emotional impact on some vulnerable groups, such as people living with human immunodeficiency virus (HIV) (PLHIV). This study was planned with the aim of assessing the anxiety levels of PLHIV and the sources of their anxiety. Materials and methods A web-based questionnaire was sent to PLHIV using the virtual snowball sampling method. The questionnaire included questions about sociodemographic status, information about HIV infection, and the Beck Anxiety Inventory (BAI). Additionally, some opinions of the participants about COVID-19 were asked. Results A total of 307 respondents, with a median age of 33 years, from 32 different cities, participated in the study. More than half of the respondents reported the belief that COVID-19 was not sufficiently well-known by the medical community and nearly 45% believed that they would have more complications if they contracted COVID-19. One-fourth of the participants had anxiety. Having a preexisting psychiatric disorder, perceiving that they were practicing insufficient preventive measures, not being sure about the presence of any individuals with COVID-19 in their environment, and living with a household member with a chronic disease were found to be the risk factors of PLHIV for having anxiety during this pandemic. The BAI scores were correlated with the patient-reported anxiety levels about the spread of COVID-19 in Turkey, acquiring COVID-19, transmitting COVID-19 to another person, and transmitting HIV to another person. Among the stated conditions, the most common concern was the spread of COVID-19 all over the country, while the least common was transmitting HIV to someone else. Conclusion The results revealed that a significant proportion of the sample had anxiety, and the findings were essential for developing evidence-based strategies for decreasing the anxiety of PLHIV, especially for those who had risk factors and to provide them with better health care during this pandemic or other pandemic-like crises.

WOS: 000511368300009, Introduction: Necrotizing fasciitis (NF) is a complicated and rapidly spreading soft tissue infection that affects the superficial fascia, skin, and subcutaneous tissue. in this study, we evaluated patients who were diagnosed with NF and treated in two tertiary-care educational university hospitals. Materials and Methods: Patients diagnosed with NF in three centers (Ege University Department of Orthopedics and Traumatology and Department of Infectious Diseases and Clinical Microbiology and Celal Bayar University Department of Infectious Diseases and Clinical Microbiology) between November 2016 and December 2018 were retrospectively analyzed. the patients' demographic characteristics, significant risk factors for infection, sites of infection, models of surgical treatment, department(s) that performed the surgery, causative infectious agents, empirical and agent-specific treatment regimens and their duration, length of hospital stay, need for intensive care, and one month survival were evaluated. Results: Eighteen patients (10 females, mean age 53.7 [19-86 years]) who were diagnosed with NF were included in the study. Diabetes mellitus, trauma/surgery history, and decubitus wound were the most common predisposing factors. the most common anatomic site was lower extremity (n=10, 55.5%). All patients underwent surgical debridement. the most commonly isolated microorganisms were Escherichio coli (n=4), Klebsiella pneumoniae, Proteus mirabilis, and Acinetobacter boumannii (each n=3). Empirical treatment was initiated with meropenem in eight patients (32%) and tigecycline in four patients (12.5%), and the antibiotic was changed in five patients based on culture results. the mean duration of antibiotic therapy was 35.5 (9-68) days. the average hospital stay was 55 (11-186) days. Six patients (33.3%) required intensive care during follow-up. the mortality rate was 16.6%. Conclusion: NF is a fulminant disease, and early diagnosis and effective multidisciplinary treatment are crucial for reducing mortality rates. When the diagnosis is suspected, early surgical debridement should be performed and empirical antibiotherapy should be started immediately.

PubMedID: 30498901 Purpose: In this multicentre, retrospective, matched cohort study we aimed to evaluate the outcomes of neutropenic fever cases that were treated with daptomycin or a glycopeptide (vancomycin or teicoplanin). Methods: Data and outcomes of adult (aged > 18-years old) patients with neutropenic fever [(1) without clinical and radiological evidence of pneumonia, (2) who were treated with daptomycin or a glycopeptide (teicoplanin or vancomycin) for any reason and for at least 72 h] were extracted from the hospital databases. Matching was performed with all of the three following criteria: (1) underlying disease, (2) reason for starting daptomycin or glycopeptide (microbiologic evidence vs. microbiologic evidence, clinical infection vs. clinical infection and empirical therapy vs. empirical therapy) and (3) neutropenic status. Results: Overall 128 patients [(69/123) (56.1%) in the daptomycin cohort (D) and 59/123 (48%) in the glycopeptide cohort (G)] had a resolution of fever at the end of 72 h antibiotic treatment (p = 0.25). There was no significant difference in cured, improved and (cured + improved) rates between (D) and (G) cohorts as well as fever of unknown origin cases or microbiologically confirmed infections or clinically defined infections subgroups (p > 0.05). There was also no significant difference (p > 0.05), in terms of persistent response in the (D) versus (G) cohorts, Conclusions: These findings suggest that although not better, daptomycin efficacy is comparable to vancomycin if used as empiric therapy in the treatment of adult febrile neutropenia. We conclude that daptomycin may be used at least as a salvage therapy alternative to glycopeptides in the treatment of adult febrile neutropenia cases. A large, randomized-controlled trial may further consolidate the evidence related to this question. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature.

WOS: 000419992100006, Introduction: Transrectal prostate biopsy (TPB) is currently a commonly used invasive procedure for the diagnosis of prostatic diseases. Due to increasing infectious complications after TPBs in our institute, it was decided to change antimicrobial prophylaxis regimens and pre-intervention measures. The aim of this study was to evaluate the effects of shorter antimicrobial prophylaxis, intestinal cleansing and single use sterile gels on infections developing after TPBs in our tertiary-care educational hospital. Materials and Methods: Infections developing in the last six months after TPB were evaluated retrospectively by using records of microbiology, radiology and urology departments. Sterilization and disinfection, antimicrobial prophylaxis regimens, intestinal decontamination procedures and routine biopsy procedures were reevaluated in cooperation with the corresponding clinics. Afterwards, it was decided to implement three changes in the TPB practice: 1) Shortening the antimicrobial prophylaxis, 2) Intestinal cleansing one day before the intervention by using enema, and 3) Using sterile gel (single patient use only) during biopsy. Patients were diagnosed as clinical or microbiologically confirmed healthcare-associated infection according to the 'Centers for Disease Control and Prevention' criteria. The preintervention period was 2007 July-December and the intervention period was 2008 January-July. Results: Overall infection/infectious complication rate (10.5% vs. 3.8%; p=0.007), overall clinically defined infection rate (4.8% vs. 1.1%; p=0.028) and overall microbiologically defined infection rate (5.8% vs. 2.7%; p=0.002) decreased significantly in the post intervention period. Conclusions: Our findings suggest that shorter antimicrobial prophylaxis regimens, using sterile gels and intestinal cleansing may be useful in the control of infections developing after TPB.