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Objectives The aim of this study was to investigate the changes in thiol/disulfide balance, pro-fibrotic mediators (transforming growth factor-beta [TGF-β] and periostin) and a potential biomarker for the prediction of HCV-induced HCC (3β-hydroxysterol Δ24-reductase [DHCR24]) during direct-acting antiviral (DAA) therapy in chronic hepatitis C (CHC) patients. Methods This prospective cohort study included 56 non-cirrhotic, treatment-naive CHC patients who were treated with DAAs between January and June 2020. Laboratory tests, including serum total/native thiol, TGF-β , $\text{,}$ periostin, DHCR24, total bilirubin and albumin levels were measured and disulfide levels were calculated at baseline, then at 1 month and at the end of therapy (EOT). Results Of the 56 patients, all achieved a sustained virological response after DAA therapy. There was a significant decrease in serum levels of disulfide and TGF-β, (p=0.020 and ps=0.470, p=0.001) and negatively with albumin levels (rs=−0.483, ps=0.356, p=0.007). Conclusions The study results suggest that the DAA therapy may help to restore the impaired thiol/disulfide balance and reduce the pro-fibrotic process in CHC patients by markedly decreasing serum levels of TGF-β, a key player in HCV-induced liver fibrosis.

Figen Sarıgül Yıldırım,1 Aslıhan Candevir,2 Sıla Akhan,3 Selçuk Kaya,4 Mehmet Çabalak,5 Gülden Ersöz,6 Dilara Ä°nan,7 Nurgül Ceren,8 Ä°lkay Karaoğlan,9 Tuba Damar Çakırca,10 Şafak Özer Balin,11 Sevil Alkan,12 Özlem Kandemir,6 Ülkü Üser,13 Oğuz Karabay,14 Mustafa Kemal Çelen15 1Antalya Life Hospital, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey; 2Cukurova University, Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Adana, Turkey; 3Kocaeli Üniversity, Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Kocaeli, Turkey; 4Karadeniz Teknik University, Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey; 5Mustafa Kemal University Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Hatay, Turkey; 6Mersin University, Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Mersin, Turkey; 7Akdeniz University Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey; 8Health Science University, Haydarpaşa Numune Education and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ä°stanbul, Turkey; 9Gaziantep University, Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Gaziantep, Turkey; 10Health Science University, Şanlıurfa Numune Education and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Şanlıurfa, Turkey; 11Fırat University Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Elazığ, Turkey; 12Çanakkale 18 Mart University, Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Çanakkale, Turkey; 13Health Science University, Antalya Education and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey; 14Sakarya University Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Hatay, Turkey; 15DicleUniversity, Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Diyarbakır, TurkeyCorrespondence: Figen Sarıgül Yıldırım, Antalya Life Hospital, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey, Tel +90 532 473 44 46, Email drfigensarigul@yahoo.com.trBackground: Rapid initiation of antiretroviral therapy (ART) reduces the transmission of HIV infection in the community. This study aimed to determine whether rapid ART initiation is effective compared to standard ART treatment in our country.Methods: Patients were grouped based on time to treatment initiation. HIV RNA levels, CD+4 T cell count, CD4/CD8 ratio, and ART regimens were recorded at baseline and follow-up visits for 12 months.Results: There were 368-ART naive adults (treatment initiated at the time of HIV diagnosis; 143 on the first day, 48 on the second-seventh day, and 177 after the seventh day). Although virological suppression rates at 12th months were higher in all groups, over 90% on average, there were no statistically significant differences in HIV-1 RNA suppression rates, CD+4 T cell count, and CD4/CD8 ratio normalization in the studied months but in multivariate logistic regression analysis; showed a significant correlation between both virological and immunological response and those with CD4+ T < 350 cells/mL at 12th month in total patients.Conclusion: Our findings support the broader application of recommendations for rapid ART initiation in HIV patients.Keywords: HIV, ART, antiretroviral, rapid start

Background: Glecaprevir/pibrentasvir (G/P) is a pangenotypic direct-acting antiviral (DAA) drug with a high resistance barrier. It has been used in patients with chronic hepatitis C in Turkey since March 2019. This drug's efficacy and safety data in Turkey are very limited, and there are not enough studies on real-life data. Objectives: In this study, we aim to present real-life data, efficacy, and safety for our patients. Methods: In this retrospective, observational, single-center study, 116 patients who were started on G/P (100mg/40mg) oral therapy at the infectious diseases clinic between March 2019 and December 2021 due to HCV were included. Of the 116 patients included in the study, 92 were analyzed. Demographic data of the patients, previous treatment experience, drug use, viral load (HCV RNA levels at the 4th week of treatment and 12th week after treatment), and viral genotype data were obtained retrospectively from the automation system. Statistical analysis IBM SPSS version 21.0 statistical package program was used. Results: Seventy-one (77.2%) of the patients were male, and 21 (22.8%) were female, with a mean age of 47.4 (18 - 89). Genotype distribution of patients 8.7% (n = 8) type 1a, 31.5% (n = 29) type 1b, 26.1% (n = 24) type 2, 22.9% (n = 21) type 3, 10.9% (n = 10) were type 4, 8.7% (n = 8) of the patients were treatment-experienced. In our study, there were no patients with cirrhosis. SVR-12 could not be obtained from a patient infected with only genotype 1a. In addition, this patient was co-infected with Hepatitis B. No side effects were observed in any of the patients that required treatment discontinuation. The SVR-12 rate was 98.6% with patients per protocol analysis (PP), but the SVR-12 rate was 77.2% with intention to treat analysis (ITT). Conclusions: In conclusion, this study suggested that G/P therapy in Turkey is used in real life with very high efficacy and tolerability. In addition, a significant change was observed in the genotype distribution previously reported in Turkey in the patient group we treated.

Parasitic infections are more frequently observed in immunosuppressed cases, such as those infected with human immunodeficiency virus (HIV). Furthermore, compared to immunocompetent cases, a more severe clinical course is observed in the immunosuppressed patient group. HIV-positive individuals have increased pathogenicity of parasites and may exhibit a wide range of clinical symptoms of varying severity that may result in mortality. Visceral leishmaisis (VL) is a vector-borne disease and an important opportunistic infection seen in HIV/AIDS cases, most notably in Southern Europe and Africa, where both infections are endemic. Several parasites namely toxoplasmosis, cryptosporidiosis, isosporiasis, cyclosporiasis, amebiasis, giardiasis, plasmodium, and strongyloidiasis are infections posing significant risk factors for these patient groups. In this study, visceral leishmaniasis was investigated serologically in serum samples and parasitic infections were analyzed by conventional methods in fecal samples from HIV-positive cases. 5 of the 42 cases included in the study were female. The mean age of these cases was 38.7 years (19-66). Blastocystis spp was detected in 5 fecal samples obtained from HIV-positive cases. The rK39 dipstick test with serum samples yielded a very weak band in one case, while none of the other tests yielded a positive band. As a result, the regional prevalence of these latent infections, which can be subclinical in HIV-positive patients, is important to know. However, the literature lacks sufficient data on the situation in Turkey. In this study, the prevalence of enteric parasitic infections in people with HIV infection in our region was found to be low and VL was not detected.

BACKGROUND: Pentraxin-3 (PTX-3) is an important marker that plays a role in suppressing inflammation and tissue repair. The aim of this study is to investigate the diagnostic and prognostic characteristics of PTX-3 in chronic hepatitis B (CHB) patients and the relationship between PTX-3 levels and fibrosis. METHODS: A total of 52 CHB patients and 40 healthy subjects were included in the study. All of the CHB patients underwent liver biopsy and were then scored using an Ishak histologic scoring system. Blood samples were collected to evaluate the PTX-3 levels. RESULTS: Of the subjects who participated in the study, 53% were female. The PTX-3 levels were determined as 5.63 ng/mL in the control group, and as 0.88 ng/mL in the CHB patient group. PTX-3 levels were found to be 1.19 ng/mL in stage 1, 0.89 ng/mL in stage 2, 0.68 ng/mL in stage 3, and 0.55 ng/mL in stage 4. Of the CHB patients, 44.2% had significant fibrosis, while 55.7% were identified as not having significant fibrosis. The PTX-3 values were 0.64 and 1.0 ng/mL in patients with and without significant fibrosis, respectively. The cut-off value for PTX-3 in predicting the absence of significant fibrosis was estimated as 0.9 ng/mL. CONCLUSION: The CHB patients were found to have lower serum PTX-3 levels compared to the control group, and these levels decreased even further as the stage of fibrosis progressed. In addition, the significant decrease in PTX-3 levels in patients with stage 1 fibrosis compared to the control group shows that PTX-3 can be used as a non-invasive marker for the early detection of fibrosis (P < .001).

Objectives The aim of this study was to evaluate the relationship between systemic oxidative balance, and the severity of the disease in patients with COVID 19. Methods Sixty-four patients were divided into three groups according to the severity of the disease: mild (n=28), moderate (n=11) and severe (n=25). Twenty-four healthy controls included to the study. Proinflammatory cytokines (IL-6 and TNF-α), D-dimer, fibrinogen, total oxidative status (TOS), total antioxidant status (TAS) were measured and oxidative stress index (OSI) was calculated. Results The mean age of severe group was significantly higher than the other groups (p=0.001). TAS levels were significantly decreased in all patient groups compared to controls, while serum TOS and OSI levels were significantly different in all three stages of the disease. Serum IL-6 and TNF- α levels were significantly elevated in severe group compared to other groups. TOS and OSI levels were also significantly correlated with IL-6, CRP, ferritin, fibrinogen, LDH and D-dimer. Conclusions TOS and OSI levels are an indicator of systemic oxidative balance in COVID-19 and related to the disease severity. They can be an important marker for evaluating the disease severity and used in the management of patients with COVID-19.

Bu çalışma ile COVID-19 enfeksiyonu olan ve olmayan olgular arasında Hepatit A virüsüne karşı kazanılmış immün yanıt düzeyi açısından fark bulunup bulunmadığının irdelenmesi amaçlanmaktadır. Bu retrospektif, kesitsel, tek merkez çalışmasına kliniğimizde 1 Haziran 2020-1 Eylül 2020 tarihleri arasında COVID-19 hastalığı (PCR pozitifliği ile doğrulanmış) nedeniyle takip edilmiş 50 olgu dahil edildi. Benzer demografik özelliklere sahip olan, salgın öncesindeki son iki yılda (1 Kasım 2017–1 Kasım 2019) kliniğimize başvuruları sırasında Anti HAV IgG düzeyleri belirlenmiş olgular arasından rastlantısal olarak seçilen toplam 150 olgu ise kontrol grubu olarak alındı. Bu iki grup arasında Anti-HAV IgG seropozitiflik oranları ile serum antikor titreleri karşılaştırıldı. Çalışmaya dahil edilen toplam 200 olgunun ortanca yaşı 48.5 (IQR=43.0-59.0) yıl olup, 108’i (%54) erkek, 92’si (%46) kadındı. Olguların 142’si (%71) 60 yaş ve üzerinde idi, ancak hasta grupları içerisindeki 60 yaş ve üzeri olguların oranı benzerdi (p=0.105). COVID-19 olgularındaki Anti-HAV IgG seropozitifliği oranları kontrol grubundaki olgularla benzer olmakla birlikte (p=0.062), COVID-19 olgularındaki anti HAV IgG titrelerinin, kontrol olgularındakine göre anlamlı oranda daha düşük olduğu görüldü (p

Background: The aim of this national, multicenter, cross-sectional, retrospective chart review study was to determine the rate of patients in Turkey who received hepatitis C virus (HCV) treatment after receiving positive anti-HCV results during HCV screening. Methods: Data related to patients’ demographics, laboratory results, the time interval from obtaining a positive anti-HCV result to treatment initiation, the specialty of the physician requesting anti-HCV screening, and type of hospital were collected and analyzed. Results: Among 1000 patients who received a positive anti-HCV result, 50.3% were male and 78.5% were screened for HCV-RNA. Among HCV-RNA screened patients, 54.8% (n = 430) had a positive result. Among patients testing positive for HCV-RNA, 72.8% received HCV treatment in line with their positive anti-HCV results. The median time from obtaining a positive anti-HCV result to initiation of HCV treatment was 91.0 days (interquartile range 42.0 to 178.5). Non-surgical branches requested HCV-RNA testing more frequently than surgical branches (p < 0.001). The rate of access to HCV treatment was higher in patients screened in university hospitals than in patients screened in training and research hospitals (p < 0.001). Conclusions: Our results indicate a higher rate of treatment initiation in patients with HCV infection than is described in the published literature. Furthermore, the time from screening to treatment initiation was considerably shorter compared with other international studies. However, because HCV-RNA testing was not requested in a significant portion of patients with a positive test result for anti-HCV, there might be a large patient population with HCV who do not receive treatment.

Purpose: The aim of this study was to determine the novel arrhythmia markers (Tpe, cTpe, cTpe/cQT) in addition to standard evaluation of 12-derived electrocardiography (ECG) and effects of therapy in patients with COVID-19. Materials and Methods: We evaluated 12-derived ECG in 51 patients with COVID-19 at the pre-treatment stage and on the 2nd and 5th days of the treatment, retrospectively. Patients were treated by either hydroxychloroquine (HCQ) + azithromycin or HCQ alone. Severe COVID-19 patients were defined with the presence of clinical signs and symptoms of pneumonia plus SpO2 30 breathe/minute. Results: While 68.6% of patients received HCQ + azithromycin combination therapy, 31.4% of patients received HCQ monotherapy. On the 2nd day of the treatment, heart rate was the only statistically significant variable either on the treatment of HCQ + azithromycin or HCQ alone. On the 5th day of treatment, in addition to the heart rate, Tpe and cTpe levels were also statistically significant among the whole treatment regimens. Although Tpe statistically significantly increased in both treatment strategies during treatment, increasing relative Tpe ratios were similar between both of the treatment strategies. Conclusion: The results of our study suggests that those off-label drugs (HCQ/azithromycin) have an acceptable cardiac safety profile in COVID-19 disease during short hospitalization.

Leishmaniasis is a protozoan parasitic disease transmitted to humans by infected female sand flies. Turkey has received more than three million immigrants from Syria because of the civil war and political instability. This study reported cases of two patients, who were from Syria and lived in Hatay, with cutaneous leishmaniasis and mucosal involvement. Two patients presented to the infectious diseases clinic with a complaint of facial lesions and were subsequently referred to the parasitology department laboratory. Smears were prepared from the lesions, stained with Giemsa and examined under a microscope. Moreover, aspirates taken from the patients' lesions were inoculated into the modified Novy-MacNeal-Nicolle medium. The diagnosis was made when amastigotes were detected in both smears. Proliferation of promastigotes was observed in one of the clinical specimens inoculated on the medium. By PZR-RFLP, Leishmania tropica were detected in the isolate. Both patients were treated with amphotericin B. One patient was treated again with a pentavalent antimony compound because of the recurrence of the lesion.Leishmaniasis, bir protozoon parazit olan Leishmania türlerinin sebep olduğu ve enfekte dişi kum sinekleri tarafından bulaştırılan bir hastalıklar grubudur. Türkiye, yakın sınır komşumuz olan Suriye’de meydana gelen iç savaş ve siyasi istikrarsızlık nedeniyle üç milyonu aşan sayıda göç almıştır. Bu çalışmada, Suriye’den göç ederek Hatay’da yaşayan, iki yurt dışı kaynaklı mukozal tutulumlu kutanöz leishmaniasis olgusu ve tedavileri sunulmaktadır. Enfeksiyon hastalıkları kliniğine yüzünde lezyon nedeniyle başvuran iki olgu, Parazitoloji Anabilim Dalı laboratuvarına yönlendirilmiştir. Olguların lezyonlarından yayma preparatlar hazırlanmış ve Giemsa ile boyanarak mikroskop altında incelenmiştir. Aynı zamanda olguların lezyonundan, aspirasyon sıvısı alınarak modifiye edilmiş Novy-MacNeal-Nicolle besiyerine inoküle edilmiştir. Üreme gözlenen örnekler, ITS-1 bölgesini hedefleyen LITSR ve L 5.8S primerleri kullanılarak PZR-RFLP yöntemi ile tiplendirilmiştir. Olguların lezyonlarından hazırlanan yayma preparatların ikisinde de amastigotlar görülerek tanı konmuştur. Besiyerine inoküle edilen klinik örneklerin, birinde promastigotların ürediği gözlenmiştir. PZR-RFLP ile izolat Leishmania tropica olarak tiplendirilmiştir. Olguların ikisi de amfoterisin B ile tedavi edilmiştir. Bir olgu lezyonun tekrar etmesi nedeniyle beş değerli Antimon bileşiği ile tekrar tedavi edilmiştir.

Introduction: Objectives: Elderly cases have not been adequately representedin clinical trials with respect to chronic hepatitis C treatment. Extremely limited realworld data is available on new direct-acting antivirals in elderly patients. Herein, weaim to evaluate real-world data on new direct-acting antivirals used in the treatmentof chronic hepatitis C virus.Materials and Method: Medical records of 122 patients who started treatmentwith new direct-acting antivirals between January 2018 and December 2019 owingto chronic hepatitis C virus infection were analyzed retrospectively. Patients weredivided into two age groups: those younger than 65 years and those aged 65 andolder. Sustained virological response at 12 week rates were compared between thetwo groups. Sustained virological response at 12 week treatment efficacy analyseswere performed with both modified intention to tract and per protocol.Results: Sustained virological response in the 12th week post treatment wassimilar in both elderly patients and younger patients. Per protocol analysis was97.6% (42/43) vs. 100% (56/56) and modified intention to tract analysis was 91.3%(43/45) vs. 91.8% (56/61), respectively. The most common genotype of patientsaged 65 years and older were 1b 80%, and the most common genotype of patientsyounger than 65 years was 1b 57%.Conclusion: In the present study, Sustained virological response rates weresimilar in elderly patients compared to younger patients; however, very limitedinformation is available on the effectiveness and safety of new, recently approveddirect-acting antivirals in the elderly population.

Objectives: Chronic hepatitis C (CHC) infection considered to be associated with an increased risk of coronary artery disease (CAD). However, there is not enough data concerning this association in diabetics. Thus, this study investigated the effect of chronic HCV infection and its clearance on the CAD risk in diabetics. Materials and Methods: This was a retrospective case-control study conducted at the Mustafa Kemal University, Department of Infectious Diseases and Clinical Microbiology, Hatay, between January 2010 and January 2015. The presence of CAD and its main risk factors such as age, sex, hypertension (HT), hyperlipidaemia (HL), chronic obstructive pulmonary disease and chronic renal failure were compared between 100 HCV infected diabetic patients and 100 uninfected diabetic controls. The HCV-infected patients were further divided into a viral clearance group and a persistence group, and the CAD prevalence was also compared between these two groups. Results: Patients with CHC were predominantly male (55% vs 39%) and predominantly older than 60 years of age (68% vs 51%) in comparison with controls. The HCV-infected group had a significantly lower prevalence of CAD, HT and HL compared with controls (p, Amaç: Kronik hepatit C (KHC) enfeksiyonunun artmış koroner arter hastalığı (KAH) riski ile ilişkili olduğu kabul edilmektedir. Bununla birlikte diyabetik hastalarda bu ilişki ile ilgili yeterli veri bulunmamaktadır. Bu nedenle bu çalışma ile kronik HCV enfeksiyonunun ve klirensinin, diyabetik hastalardaki KAH riski üzerine etkisi araştırılmıştır. Gereç ve Yöntemler: Bu çalışma; Mustafa Kemal Üniversitesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilimdalı, Hatay’da, Ocak 2010-2015 tarihleri arasında yapılan retrospektif bir olgu kontrol çalışmasıdır. HCV ile enfekte diyabetik olgular (n=100) ile HCV ile enfekte olmamış diyabetik kontrol grubu (n=100) arasında KAH varlığı ve yaş, cinsiyet, hipertansiyon (HT), hiperlipidemi (HL), kronik obstrüktif akciğer hastalığı ve kronik böbrek yetmezliği gibi KAH için risk faktörleri açısından karşılaştırıldı. Buna ek olarak, HCV ile enfekte diyabetik olgular viral klirens gelişen ve persistan viremisi olan olgular olarak iki alt gruba ayrıldı ve bu iki grup arasında da KAH prevalansı karşılaştırıldı. Bulgular: CHC olguları kontrol grubuna göre çoğunluğu erkekti (%55’e karşı %39) ve ağırlıklı olarak 60 yaşından büyüktü (%68’e karşı %51). HCV ile enfekte olan grupta, kontrol grubuna kıyasla KAH, HT, HL prevalansı anlamlı olarak daha düşüktü (p

Objectives We aimed to evaluate the ability of lymphocyte-C-reactive protein ratio (LCR) to discriminate between different levels of severity of COVID-19 disease. Methods This retrospective observational single-center study was performed on 61 confirmed (PCR positive) COVID-19 patients between March and June 2020. The study population was separated into three groups: mild/moderate (n=24), severe (n=25) and critically ill (n=12). The optimal cut-off values of the LCR and neutrophil-to-lymphocyte ratio (NLR) in discriminating between patients with different severity levels were calculated by applying the receiver operating curve (ROC) analysis. Results At baseline, the LCR decreased significantly across the three severity groups (mild/moderate > severe > critically ill). ROC analysis showed that a mean LCR of 43.21 was the cut-off value which best discriminated patients with the critically ill disease from severe patients (sensitivity: 84% and specificity: 69%). The discriminative performance of LCR (ROC AUC 0.820) was better than that of NLR (0.751) in this regard. LCR, unlike NLR was able to distinguish severe patients from mild/moderate patients, with a cut off value of 458.19 (sensitivity: 80% and specificity: 45%). Conclusion LCR was observed to be able to distinguish COVID-19 infected patients of different severity (mild/moderate, severe and critically ill) and was superior to NLR in this regard.

Introduction: The importance of sexually transmitted infections such as viral hepatitis and syphilis has increased relatively with prolonged life expectancy in HIV-positive cases. The aim of this study was to investigate the seroprevalence of viral hepatitis and syphilis coinfection in HIV-positive cases followed in our clinic. Materials and Methods: This retrospective, cross-sectional, single center study included 98 HIV-infected cases who were followed up in our clinic between January 2018 and November 2019. Demographics, physical examination findings, CD4 T lymphocyte count, HCV RNA, HBsAg, anti-HBcIgG, anti-HBs, anti-HCV, anti-HAVIgG, RPR and TPHA test results were obtained retrospectively from the patients’ files. Results: Median age of the patients was 33.5 (24-44) years, 73 (74.5%) were males, 13 (13.3%) were foreign nationals, 69 (70.4%) were treatment naive, 20 (20.4%) were male sex with male (MSM) and 5 (5.1%) had a history of intravenous drug addiction. The most common transmission route was heterosexual intercourse, and median CD4 T lymphocyte count was 249.5 cells/mm3 (145-358). Overall, 15 (15.3%) of the cases had at least one co-infection. The most common co-infections were HIV/syphilis and HIV/HBV coinfections (13.3% (n= 13) and 4.0% (n= 4), respectively). Only one case had HIV/HBV/syphilis coinfection while HIV/HCV coinfection was not found in this population. The rate of effective HBV vaccination was 26.5%, previous HBV infection was 14.3% and the prevalence of isolated anti-HBc was 3.9%. Cases coinfected with viral hepatitis or syphilis were older than those infected with HIV alone, but there were no significant differences between the groups in terms of sex, antiretroviral therapy (ART) experience, and CD4 T lymphocyte count (p= 0.013, p= 0.106, p=0.542 and p=0.421, respectively. TPHA and anti-HAV IgG seropositivity were significantly higher in MSM cases than in non-MSM cases (p< 0.001 and p= 0.035, respectively). Conclusion: Seroprevalence of HBV, HCV and HAV in HIV-positive cases followed in our clinic were similar to those in the general population. On the other hand, HIV-infected MSM patients had higher anti-HAV IgG and TPHA seropositivity than non-MSM cases.

Objectives: Chronic hepatitis C (CHC) is now a more curable disease with new direct acting antivirals (DAA). Although high sustained virologic response rates, failures still occur in DAA regimens. Our objective in this study was to characterize the real-life presence of clinically relevant resistance - associated substitutions (RASs) in the HCV NS5A gene in CHC patients whose DAA regimen has failed. Methods: The study enrolled 53 CHC patients who experienced failure with DAA regimen as the prospective longitudinal cohort between 2017-2019. Genotypic resistance testing was performed via the viral population sequencing method and The Geno2pheno HCV tool was used for RAS analysis. Results: The most frequent failure category was relapse (88%) followed by non-responder (12%). For a total of 36% of patients, RASs was detected in NS5A, Y93H was the most detected RAS in GT1b infected patients (89%). Conclusions: This study establishes an HCV failure registry for Turkey in which samples were combined with clinical, virologic and molecular data of adult patients whose DAA therapy failed. RASs can occur in CHC patients with DAA treatment failures. Evaluation of RAS after DAA failure is very important before retreatment is initiated to prevent virologic failure. (C) 2020 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. WOS:000540737100014 32302766 Q2

Background: Screening aimed at hepatitis B reactivation risk is recommended in patients using immunosuppressive drugs. The aim of this study was to investigate the results of hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis A virus (HAV) retrospectively in patients referred to the infectious diseases clinic before immunosuppressive treatment.Materials and Methods: In our study, 148 patients who were referred to our infectious disease clinic before immunosuppressive therapeutic usage between January 2018-December 2018. Patients files and hospital automation sysytem were analyzed for Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (Anti-HBs), hepatitis B core protein antibody (Anti -HBc IgG), anti-hepatitis C virus antibody (Anti-HCV) and anti-hepatitis A virus antibody (anti -HAV) retrospectively.Results: HbsAg positivity rate was 4.1%, Anti-HBs positivity rate was 31.8%, Isolated Anti-HBc IgG positivity rate was 1.4% and Anti-HBs was not detected in two patients. Anti-HCV positivity was detected as 1.4%. Anti-HAV was not examined in 79.7% of the patients, 12.2% was determined to have positive Anti-HAV and 8.1% negative Anti-HAV. Conclusions: Since some screenings are incomplete despite screening performed for the patients, we recommend that physicians who follow patients receiving immunosuppressive therapy should be trained and raise awareness of HBV infection., Amaç: İmmünsupresif ilaç kullananlarda, hepatit B reaktivasyon riskine yönelik tarama yapılması önerilmektedir. Bu çalışmada immünsüpresif tedavi öncesi, Enfeksiyon hastalıkları kliniğine yönlendirilen hastalarda hepatit B virüsü (HBV), hepatit C virüsü (HCV) ve hepatit A virüsü (HAV) sonuçları retrospektif olarak irdelenmesi amaçlandı.Materyal ve Metod: Çalışmamızda Ocak 2018 - Aralık 2018 tarihleri arasında immünsüpresif tedavi öncesi, Enfeksiyon hastalıkları kliniğine yönlendirilen 148 hastanın hepatit B yüzey antijeni (HBsAg), hepatit B yüzey antikoru (Anti-HBs), hepatit B core protein antikoru (Anti-HBc IgG), anti hepatit C virüs antikoru (Anti-HCV) ve anti hepatit A virüs antikoru (Anti-HAV) hasta dosyalarından ve hastane otomasyon sisteminden retrospektif olarak incelendi.Bulgular: HBsAg pozitiflik oranı %4.1, Anti-HBs pozitiflik oranı %31.8, İzole Anti-HBc IgG pozitiflik oranı %1.4 ve iki hastada ise Anti-HBs bakılmamıştı. Anti-HCV pozitifliği %1.4 tespit edildi. Hastaların %79.7 Anti-HAV bakılmamış, Anti-HAV pozitifliği %12.2 ve Anti-HAV negatifliği %8.1 olarak saptandı. Sonuç: İmmünsüpresif tedavi öncesi tarama yapılmasına rağmen bazı taramaların eksik yapıldığı tespit edildi. Bu nedenle bu hastaları takip eden hekimlere eğitim verilmesi ve özellikle HBV enfeksiyonu konusunda farkındalık oluşturulmasını önermekteyiz.

Evaluation of the incidence and predictors of failure of direct-acting antiviral treatment for hepatitis C virus genotype 1b patients is important. Our retrospective cohort study assessed 172 Turkish patients who had received a full course of such treatment and could be checked for sustained virologic response. The overall treatment failure rate was 2.9% (5/172), all of whom relapsed. In three of these cases with sequencing data available, all had NS5A resistance-associated substitution. Multivariate analysis revealed that a 1 mg/dL increase in pre-treatment total bilirubin level was associated with a sevenfold increased likelihood of treatment failure. The baseline level of total bilirubin was the only significant independent predictor of direct-acting antiviral treatment failure.

Nötropenik enterokolit çoğunlukla akut lösemili hastalar gibi mukozal hasarı indükleme potansiyeli yüksek hastalığı olanları ve yoğun kemoterapötik rejimleri alan hastaları etkilemektedir. Burada kemoterapi devamında ateş, karın ağrısı, bulantı, kusma, karında şişkinlik, ishal, ağız içinde yara şikayetleri ile başvuran, batın BT’ de diffüz duodenum duvar kalınlaşması saptanan 34 yaşında akut lenfoblastik lösemi tanılı nötropenik enterokolit olgusu sunulmuştur. Olgumuzu sunmaya değer kılan duodenal bölge tutulumu ile seyreden nötropenik enterokolit olmasıdır., Neutropenic enterocolitis mostly affects patients with disease with a high potential to induce mucosal injury, such as patients with acute leukemia, and patients receiving intensive chemotherapeutic regimens. Here, we present a 34-year-old neutropenic enterocolitis case diagnosed with acute lymphoblastic leukemia and diffuse duodenal wall thickening on abdominal CT, who presented with fever, abdominal pain, nausea, vomiting, abdominal distention, diarrhea, and mouth sores following chemotherapy. What makes our case worth presenting is neutropenic enterocolitis with duodenal involvement.

Objectives: Severe disease characterized by interstitial pneumonia may develop in some cases of coronavirus disease (COVID-19). Periostin has been associated with many respiratory diseases. In this study, we aimed to investigate whether periostin could be a useful new biomarker in the follow-up and severity assessment of the disease in patients with COVID-19 pneumonia. Methods: In the study, 32 patients followed up during May–July 2020 due to COVID-19 and 24 healthy controls were included. The patients were divided into two groups, namely, mild/moderate and severe, according to the severity of the disease. Serum periostin and transforming growth factor beta (TGF-β) levels were tested using an enzyme-linked immunosorbent assay (ELISA) method using commercially available ELISA kits. Results: It was observed that the periostin level was significantly higher in both mild/moderate cases and severe cases compared to the control group at first presentation. However, TGF-β levels at first presentation were similar between the groups. Conclusions: Our study is the first study to investigate periostin levels in patients with COVID-19, and we believe that periostin can be used as a new biomarker. Keywords: COVID-19, Periostin, TGF-β, Pneumonia, New Biomarker Coronaviruses are among the main pathogens that mainly target the human respiratory system. Severe disease characterized by interstitial pneumonia develops in 10-20% of patients. Periostin has recently been shown to be an indicator of disease progression in idiopathic pulmonary fibrosis and asthma. In this study, we aimed to investigate whether periostin could be a useful new biomarker in the follow-up and severity assessment of the disease in patients with COVID-19 pneumonia. This article demonstrated that periostin is a useful new biomarker for disease follow-up and severity in patients with COVID-19 pneumonia. It is also the first study on periostin levels in patients with COVID-19

Purpose This paper aims to determine the knowledge and attitudes of the physicians regarding human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), to emphasize that these patients exist and they will exist in the future and to raise awareness so as to prevent that their rights to treatment are revoked. Design/methodology/approach The survey was conducted via a link sent through an online system. Random physicians from 81 cities of the country were invited to the survey. The survey has 41 questions regarding knowledge and attitudes in total, including epidemiological information such as age, gender and title. Findings A total of 3,107 physicians has voluntarily participated in the study. In total, 2,195 (70.7%) are internal physicians and 912 (29.3%) are surgical physicians among the participant physicians. In total, 1,452 (46.7%) of the participants are specialist physicians, 608 (19.6%) of the participants are practising physician and the rest of it is physician assistants, academicians and dentists, respectively. Originality/value In this study, it has been found out that the physicians have a lack of knowledge on HIV/AIDS and they adopt a discriminatory attitude towards HIV-positive persons. HIV-positive patients who are exposed to discrimination and scared of being uncovered refrain from applying to hospitals for treatment, which puts public health into jeopardy due to the high viral load and these patients are faced with difficulties in coping with both medical and emotional load of the disease.

Amaç: Endemik olmayan ülkelerde görülen importe sıtma olguları gecikmiş tanı ve tedaviye sekonder artmış komplikasyon oranı ve mortalite riski taşımaktadır. Bu çalışma ile kliniğimizde son 10 yılda takip edilen importe sıtma olgularının insidansının ve klinik özelliklerinin irdelenmesi amaçlanmıştır. Yöntemler: Bu retrospektif çalışmaya Ocak 2008 - Aralık 2017 tarihleri arasında kliniğimizde importe sıtma tanısı ile takip edilmiş 75 olgu dahil edilmiştir. Olgulara ait epidemiyolojik, laboratuvar, tedavi ve klinik seyre ilişkin verilere sistem kayıtlarından ulaşılmıştır. Bulgular: Olguların 74’ü erkek, 1’i kadın olup ortanca yaş 51(23-64) olarak saptanmıştır. Olguların tamamı Sahra altı Afrika ülkelerine seyahat etmiş ve hiçbiri seyahat öncesinde kemoprofilaksi almamıştır. Tüm olgularda etkenin Plasmodium falciparum olduğu görülmüştür. İmporte sıtma olgu sayısı 2015 sonrasında düşme eğilimindeydi. En sık görülen bulgular sırasıyla ateş (%100), trombositopeni (%84) ve anemi (%72) olarak saptanmıştır. Olguların %8’i ciddi seyirli sıtma olgusu olmakla birlikte ölümle sonuçlanan olgu görülmemiştir. Sonuç: Son yıllarda ülkemizden bildirilen importe sıtma olgu sayısındaki artışa rağmen bölgemizde bu sayıda düşüş olduğu görülmektedir. Ülkemiz importe sıtma olgularının en sık görüldüğü ülkeler arasında yer aldığından, ateş yüksekliği ve trombositopeni ile başvuran olgularda sıtmanın endemik olduğu bir bölgeye seyahat öyküsü olup olmadığı sorgulanmalıdır., Objective: Cases with imported malaria have increased complication and mortality rates because of delayed diagnosis and treatment in non-endemic countries. This study aimed to investigate the incidence and clinical features of imported malaria in our clinic during the past 10 years. Methods: This retrospective study included 75 cases diagnosed as having imported malaria in our clinic between January 2008 and December 2017. The epidemiological data, laboratory findings, treatment data and clinical course of the cases were obtained from system records. Results: Patients were predominantly male (%98.6) with a median age of 51 (23-64) years. All cases were infected with Plasmodium falciparum, had a recent travel history to Sub-Saharan African countries and none had received chemoprophylaxis before travel. The incidence of imported malaria showed a declining trend after 2015. The most common findings were fever (100%), thrombocytopenia (84%) and anemia (72%). Although 8% of patients had presented with severe malaria, none of them died. Conclusion: Despite increasing incidence of imported malaria in our country in recent years, there is a decrease in this number in our region. Since Turkey is one of the countries with the highest prevalence of imported malaria in the world, patients with fever and thrombocytopenia should be questioned whether or not they had a history of travel to malaria-endemic area.

WOS:000654928300001 PMID: 33977603 Objective Occult hepatitis B infection (OHBI) appears to have a higher prevalence in populations at high risk for hepatitis B virus (HBV) infection with concomitant liver disease. The aim was to assess the prevalence of OHBI in a sample of human immunodeficiency virus -1 positive and HBV surface antigen-negative (HIV-1+/HBsAg-) Turkish patients. Methods Ten centres in Turkey were included in the study. Patients were selected on the basis of a power calculation with a known population size of HIV-positive patients and a reported prevalence of OHBI. Gender, age, occupation, place of residence, treatment and clinical status, and laboratory results, including immunodeficiency panel, antibody tests, hemogram, biochemistry, and coagulation studies were evaluated retrospectively. Results The number of HIV-infected patients followed in these centres was 3172 and the sample population numbered 278. All 278 were HBsAg negative. The mean age of the sample was 37.2 +/- 13.1 years and 235 (84.5%) were male. All but one patient (99.6%) had been treated with antiretroviral therapy. Of the 278 patients, 169 (60.6%) were positive for Anti-HBs and 125 (44.8%) were positive for Anti-HBc IgG. HIV RNA was detected in 203/278 (73%) of the patients. Four HBV DNA (1.4%) were diagnosed with OHBI. There was no significant difference in hemogram, hemoglobin or bilirubin concentrations in those with OHBI compared with the other patients. Conclusion In a representative sample of HIV+ patients from 10 Turkish centres, the prevalence of OHBI was found to be 1.4%. In HIV positive patients, it is important to identify those with OHBI for optimal clinical management and prognosis.

AIMS: Coronavirus disease 2019 (COVID-19), which is a highly contagious disease, is an ongoing outbreak worldwide with high morbidity and mortality. The approaches targeting the autophagy processes might have promising diagnostic and therapeutic values against Coronavirus infection. Here, we aimed to investigate the relationship of Beclin-1 (BECN1), an autophagy-related protein, with blood parameters and the clinical severity in patients with COVID-19. MATERIALS AND METHODS: We enrolled 108 patients with COVID-19 and 21 healthy controls in this study, from September 2020 to January 2021 and divided all patients into two groups according to the severity of the disease: The non-severe group and the severe group. BECN1 levels and blood parameters were measured with Enzyme-Linked Absorbent Assay and routine techniques, respectively. KEY FINDINGS: Serum BECN1 levels were increased in patients with COVID-19 compared to the healthy controls, and its concentrations were significantly higher in the severe group than in the non-severe group (p

Introduction: Immunosuppressive drug use is common in the treatment of systemic lupus erythematosus (SLE). In cases receiving immunosuppressive therapy, screening for hepatitis B reactivation risk is also recommended. In this study, we aimed to investigate the frequency of hepatitis B screening in cases diagnosed as having SLE, who were followed up in the Rheumatology Clinic of Hatay Mustafa Kemal University. Materials and Methods: We included 93 patients who were followed-up in the Rheumatology Clinic of Hatay Mustafa Kemal University with the diagnosis of SLE between July 2017-December 2019 in our study. The screening rates of hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and hepatitis B core protein antibody (anti-HBc IgG) of the cases and the immunosuppressive drugs used by them were analyzed retrospectively. Results: The mean age of the cases was 38 years (minimum-maximum: 18-79), and 91.4% were women. Of the cases, 43 (46.2%) were determined to be never screened for hepatitis B, 34 (36.6%) screened inadequately, and only 16 (17.2%) screened fully. In 22 cases receiving high-risk immunosuppressive therapy, the rate of full screening of hepatitis B was 27.3%. Conclusion: In patients with SLE, even those who used high-risk immunosuppressive therapy, screening rates were found low. We think that awareness should be increased in this regard by performing joint training with clinics that start immunosuppressive therapy, a periodic repetition of these trainings should be done, and also multi-center studies should be conducted.

Intravenous drug use (IVDU) is more common inprisoner patients, and this is a global problem. Hepatitis C virus(HCV) infection is higher in prisoners than general population. Inour study, we aimed to examine the IVDU rates and direct-actingantiviral (DAA) treatment results of the prisoners who applied toHatay Mustafa Kemal University Clinic of Infectious Diseases.Materials and Methods: In our study, IVDU rates and HCVtreatment results of 85 prisoners who applied to Hatay MustafaKemal University Faculty of Medicine Clinic of Infectious Diseasesbetween January 2017 and December 2019 were retrospectivelyanalyzed. Treatment results were evaluated by performing modifiedintention to tract (mITT) and per protocol (PP) efficacy analysis,respectively.Results: The rate of IVDU was 37.7% in prisoners who werepositive for HCV. Although sustained virological response (SVR) ratewas 100% in PP analysis, SVR rate was determined as 80.5% inmITT analysis. Viral genotype 3 (41.6%) and genotype 4 (39%) werethe most common.Conclusion: However, data on HCV screening and treatment inprisons in Turkey is inadequate or too low. We think that with theuse of DAAs, patients’ compliance to treatment will increase, it is animportant step for HCV eradication and multicenter studies shouldbe conducted., Mahkum hastalarda intravenöz ilaç kullanımı (IVDU) sıklığı ve hepatit C virüs (HCV) enfeksiyonu prevelansı küresel olarak genel popülasyona göre daha yüksektir. Bu çalışmada Hatay Mustafa Kemal Üniversitesi Enfeksiyon Hastalıkları Kliniği’ne başvurup sağlık hizmeti alan mahkum hastalardaki IVDU oranlarının ve direkt etkili antiviral (DEA) tedavi sonuçlarının incelenmesi amaçlandı. Gereç ve Yöntemler: Çalışmamızda Ocak 2017- Aralık 2019 yılları arasında Hatay Mustafa Kemal Üniversitesi Tıp Fakültesi Hastanesi Enfeksiyon Hastalıkları Kliniği’ne başvurup sağlık hizmeti alan toplam 85 mahkum hastanın IVDU oranları ve DEA tedavi sonuçları retrospektif olarak incelendi. Sırasıyla modifiye intention to tract (mITT) ve per protocol (PP) ile etkinlik analizi yapılarak tedavi sonuçları değerlendirildi. Bulgular: HCV pozitif mahkum hastalarda intravenöz ilaç kullanım oranı %37,7 idi. PP analizinde kalıcı virolojik yanıt (KVY) %100 iken mITT analizinde bu oran %80,5 olarak saptandı. En sık viral genotip 3 (%41,6) ve genotip 4 (%39,0) saptandı. Sonuç: Cezaevlerinde HCV taranması ve tedavisi açısından Türkiye’de yeterli veri yok veya çok azdır. DEA’ların kullanılması ile hastaların tedaviye uyumunun artacağını, HCV eradikasyonu için önemli bir adım olduğunu ve çok merkezli çalışmalar yapılması gerektiğini düşünmekteyiz.

OZ Objective: Women of childbearing potential treated for chronic hepatitis B virus (HBV) infection may experience exacerbations during or after pregnancy. Infants may also acquire HBV infection through perinatal route. Currently, there is no antiviral agent approved for use in pregnancy. This makes it difficult to decide whether treatment should be withdrawn immediately or continued in women who become pregnant while on HBV antiviral therapy. The present study aims to establish the safety and, as a second measure, the efficacy of telbivudine in patients who became pregnant while they were on telbivudine treatment for chronic HBV infections and were maintained on the treatment throughout pregnancy. Materials and Methods: Between 2010 and 2013, twentyone patients, who became pregnant while receiving telbivudine treatment for chronic HBV infection and continued the treatment, were evaluated retrospectively. Results: The mean age of the patients was 28.9±6.3 years (range: 18-41 years). All patients were hepatitis B envelope antigen-negative. The mean pre-treatment hepatic activity index was 9.4±1.6 (range: 7-13), and fibrosis and serum HBV, DNA measurements were 3.2±0.8 (range: 2-5) and 3.5x105±2.8x105 IU/mL, respectively. No drug-related side effects were seen in any of the patients. All infants had normal birth weights and no abnormalities were observed in any of them. At the end of week 28, none of the infants was hepatitis B surface antigen-positive. Conclusion: The use of telbivudine from the first trimester of pregnancy appears to be safe both for the mother and fetus and Amac: Kronik hepatit B virusu (HBV) nedeni ile takip edilen dogurganlik cagindaki kadin hastalarda kronik karaciger hastaligi gelisebilir, gebelik doneminde veya sonrasinda alevlenmelere neden olabilir, bununla birlikte perinatal donemde HBV bulasi ile bebek infekte olabilir. Gebelik doneminde HBV enfeksiyonu icin kullanimi onaylanmis bir antiviral ilac yoktur. Bu nedenle, antiviral ilac kullanirken gebe kalan kadinlarda tedaviyi sonlandirma ya da devam etme kararini vermek zordur. Bu calismada kronik HBV enfeksiyonu nedeniyle telbivudin tedavisi almakta iken gebe kalan ve tum gebelik donemi boyunca tedavi alan hastalarda telbivudinin ilk etapta guvenilirligini daha sonra ise etkinligini degerlendirmeyi amacladik. Gerec ve Yontemler: 2010-2013 yillari arasinda kronik HBV enfeksiyonu nedeniyle telbivudine tedavisi kullanirken gebe kalan ve tedaviye devam karari verilen 21 hasta retrospektif olarak degerlendirildi. Tum hastalarin tedavi baslandigi andaki serum hepatit B yuzey antijeni, hepatit B zarf antijen, anti-HBe, HBV DNA, alanin aminotransferaz (ALT), aspartat aminotransferaz (AST) seviyeleri, hepatik aktivite indeksi ve fibrozis degerleri kaydedildi. Daha sonra hastalarin gebelik baslangici, gebelik donemi boyunca ve dogum sonrasi 6. aya kadar 3’er ay ara ile serum hepatit B yuzey antijeni, hepatit B zarf antijen, anti-HBe, HBV, DNA, ALT, AST seviyeleri olculdu. Bulgular: Hastalarin yas ortalamasi 28,9±6,3 (yas araligi: 18-41) idi. Tum hastalar hepatit B zarf antijen negatif idi. Tedavi oncesi hepatik aktivite indeksi ortalama 9,4±1,6 (yas araligi: 7-13), fibrozis 3,2±0,8 (yas araligi: 2-5), serum HBV DNA duzeyi 3,5x105±2,8x105 IU/mL idi.

Aim: Candidemia is a life-threatening infection that has been reported to be associated with poorer outcomes in trauma patients. The present study aimed to investigate the epidemiology of candidemia in non-burn patients with polytrauma. Material and Methods: We conducted a retrospective, single-center, observational study of polytrauma patients with candidemia admitted to the surgical intensive care units of a university hospital in Turkey between 2013 and 2017 on. Results: The incidence of candidemia was 127 episodes per 1000 intensive care unit admissions in polytrauma patients. Nonalbicans Candida species accounted for 75.5% of all candidemia episodes. C. parapsilosis (51.05%) was the predominant species, followed by C. albicans (24.52%) and C. tropicalis (12.21%). The highest crude mortality rate (72%) was observed in patients with C. parapsilosis candidemia. In multivariate analyses, who had undergone prior gastrointestinal surgery were 7.1 times more likely to have C. parapsilosis candidemia than those with other strains. Conclusion: Our study, remarkable, demonstrated a high incidence of Candidemia had in polytrauma patients, and non-albicans Candida species were the most frequently isolated candida species. According to our study findings, a prior history of gastrointestinal surgery may help predict C. parapsilosis, as the causative agent of candidemia in polytrauma patients. However, since our study was observational and limited to such a small number of patients, the results obtained should be applied with caution.

Objective: Nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA) among the healthcare workers (HCWs), hospitalized patients, and healthy individuals was investigated by pulsed field gel electrophoresis (PFGE) for defining of clonally distribution of them. Methods: Totally 403 healthcare personnel, 744 patients, and 204 healthy individuals from the population were enrolled. Microbiological procedures were performed in the Bacteriological Laboratory at the Clinical Microbiology and Infectious Diseases Department of Firat University, and PFGE procedures were performed in the Microbiology Department of Inonu University. Results: Staphylococcus aureus was isolated in 296 (21.9%) of 1351 nasal swabs, and 69 out of 296 (23.3%) were defined as MRSA. Nasal S.aureus carrier state was identical between the patients and HCWs carrier state (p=0.14). It was significantly lower in healthy subjects than the other groups (p=0.02). Seventeen (25.8%) of 66 MRSA strains were defined to be in the cluster. These strains were in 7 different clusters. Among the typed strains, 21 had close relationship, 2 had possible relationship, and 26 had no relation. PFGE pattern was defined in 33 (50%) out of 66 strains and it was inconclusive in 3 strains. Conclusion: MRSA strains can be transferred commonly in the same hospital, among the hospitals located in the same region and the population. The results might be the indicators of increasing frequencies in population based MRSA infections. Multi-center studies are required to define clonally distribution of MRSA and the explanation of epidemiology may be helpful for preventing and controlling of MRSA related infections., Amaç: Sağlık çalışanları, hospitalize hastalar ve sağlıklı gönüllülerde nazal metisilin-dirençli Staphylococcus aureus (MRSA) kolonizasyonu ve klonal dağılımı pulsed field gel electrophoresis (PFGE) ile araştırıldı.Yöntemler: Çalışmaya 403 hastane çalışanı, 744 hasta ve 204 sağlıklı toplum bireyi alındı. Mikrobiyolojik işlemler Fırat Üniversitesi Klinik Mikrobiyoloji ve Enfeksiyon Hastalıkları Anabilim Dalı Bakteriyoloji Laboratuarı’nda, PFGE işlemi ise İnönü Üniversitesi Mikrobiyoloji Anabilim Dalı’nda çalışıldı.Bulgular: Toplam 1351 nazal sürüntü kültüründen 296 Staphylococcus aureus suşu izole edildi ve bunların 69 (% 23,3)’u MRSA idi. Nazal S. aureus taşıyıcılığı sağlık çalışanları ve hastalar arasında benzer idi (p=0,14). Sağlıklı gönüllü gurupta ise diğer guruplara göre anlamlı derecede az olarak bulundu (p=0,02). PFGE yöntemiyle 66 MRSA suşunun 17 (% 25,8)’sinin küme içinde olduğu saptandı. Bu suşlar 7 küme içinde yer almaktaydı. Tiplendirilen suşların 21 tanesi yakın ilişkili, ikisi ise muhtemel ilişkili olarak saptandı. Yirmi altı suş klonal olarak ilişkisiz bulundu. Toplam 66 suş içinde 33 (% 50) PFGE paterni belirlendi.Sonuç: Çalışmamız sonucunda MRSA suşlarının aynı hastane içinde daha fazla olmakla birlikte bölgedeki hastaneler arasında ve hastane-toplum arasında taşınabileceğini gördük. Çalışmadan elde edilen sonuçlar toplumda artan MRSA enfeksiyon sıklığı için bir indikatör olabilir. MRSA’nın klonal dağılımının saptanması ve epidemiyolojisinin belirlenmesi için çok merkezli çalışmalara ihtiyaç olduğunu ve MRSA epidemiyolojisinin aydınlatılmasının MRSA’ya bağlı enfeksiyonların önlenmesi ve kontrolünde yardımcı olacağını düşünüyoruz