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ispartof: ACTA MEDICA MEDITERRANEA vol:38 issue:2 pages:985-990 status: published

The incidence rate of tetanus has dramatically decreased following the discovery of the tetanus vaccine. A decennial booster dose is necessary to maintain the protective antibody levels after the primary vaccination schedule. The recommendations for the tetanus booster doses in adult "people living with acquired immune deficiency virus (HIV)" (PLWH) is similar to those for the general population. However, the duration of protective antibodies in PLWH is unknown. The aim of this study was to determine the factors affecting the response of HIV-infected individuals to tetanus vaccine and to evaluate the role of tetanus antitoxin level in determining the timing of the booster dose. PLWH attending the Adult Vaccination Unit of Ege University Faculty of Medicine Infectious Diseases and Clinical Microbiology Department were tested for tetanus antibodies from 30 October to 30 November 2020. Demographic information and the history of primary vaccination and booster doses were derived from medical files. Tetanus antibodies were detected with "enzyme immunoassay (EIA)" method with Clostridium tetani toxin 5S IgG-"enzyme linked immunosorbent assay (ELISA)" kit (Nova Lisa, Novatec Immundiagnostica, Germany). Antibody levels 1.1 IU/ml strong positive. A level >= 0.50 IU/ml was considered as protective. The study included 146 PLWH [men (n= 126) and women (n= 40)]. The mean age was 39.5 +/- 11.20 years (range: 18-65). Protective antibody level was detected in 114 (78.1%) participants. Receiver operating characteristics (ROC) analysis revealed that the ideal lower limit of CD4+ T cell count during booster vaccination for a person to develop protective antibody level was calculated as >= 218 cell/mm(3). In the multivariate analysis, it was found that age < 50 years (OR= 16.4, 95% CI= 4.9-55.2), the absence of AIDS at the time of diagnosis (OR= 6.7, 95% CI= 1.05-17.4) and CD4+ T cell count z 218 cells/mm(3) at the time of vaccination (OR= 4.2, 95% CI= 1.05-17.4) were associated with protective levels of antibody. Protective levels of tetanus antibodies in PLWH are lower than the general population. It should be considered that the booster dose may be required earlier, especially in PLWH who are > 50 years old, with CD4+ T lymphocyte count < 200 cells/mm(3) during previous booster vaccination and who had AIDS at the time of the diagnosis.

While severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) continues to spread rapidly worldwide, some issues such as the uncertainty of the disease progress, whether intensive care will be needed, and risk classification are still important for clinicians. It is notable that in countries where latent tuberculosis infection (LTBI) is common and participating in the national Bacillus Calmette-Guerin (BCG) vaccination program, the case-fatality rates are relatively low throughout the world. In this study, it was aimed to evaluate the effects of the BCG vaccine and LTBI status on the course of the disease in patients diagnosed with coronavirus-19 (COVID-19) infection and to compare the LTBI rate with people with and without COVID-19 infection. The patients diagnosed with COVID-19 infection who were hospitalized during a period of seven months between May 1st to December 1st, 2020 were investigated by the QuantiFERON-TB Gold Plus (QFT-Plus) test in the blood samples for the presence of LTBI. For the comparison of the patients diagnosed with COVID-19 and people without COVID-19 infections in terms of LTBI rate retrospectively; all consecutive patients who were sent blood samples to the mycobacteriology laboratory for the QFT-Plus test between January 2016 and December 2019 were included in the study. Demographic, clinical, radiological, laboratory, and follow-up data of the patients were obtained from the electronic patient file. A total of 170 patients (n= 9 8 male [57.6%], n= 72 female [42.3%], mean age= 53.5 +/- 15.8 years) were enrolled. Twenty-five patients' (25/170 [14.7%]) QFT-plus tests were positive. When the cases with positive QFT-Plus test (n= 25) and the cases with negative QFT-Plus test (n = 145) were compared in terms of disease severity respectively; it was determined that mild/moderate patients were 18/25 (72%) and 108/145 (74.5%), severe patients were 7/25 (28%) and 37/145 (25.5%) (p= 0.988). When these two groups were compared in terms of the clinical course respectively; the need for intensive care was 6/25 (24%) and 34/145 (23.4%) (p= 1.00), oxygen therapy requirement was 13/25 (52%) and 49/145 (33.8%) (p= 0.128), and death was 5/25 (20%) and 18/145 (12.4%) (p= 0.341). QFT-Plus positivity was 25/170 (14.7%) in patients diagnosed with COVID-19, while in control group it was 198/496 (39.9%) (OR= 0.259, 95% CI [0.164-0.411], p< 0.001). When the values were evaluated quantitatively, in the COVID-19 patient group, QFT-Plus T1/T2 (IU/ml) interferon (IFN)-. was 0.87 +/- 1.52/0.62 +/- 1.53, while in the control group it was 1.52 +/- 3.69/1.50 +/- 3.33 (p= 0.032, p= 0.04). There was no significant difference in the parameters investigated between 82 (48.2%) patients with BCG vaccine and those 88 (51.8%) without BCG vaccine. Although it was not statistically significant in our study, increased oxygen therapy requirement and higher mortality rates in the QFT-Plus positive group were remarkable. The detection of statistically significantly lower LTBI rates and T1-T2/IFN-. values in the COVID-19 group supported that SARS-CoV-2 infection may suppress lymphocyte functions in patients and IFN-. response. We believe that the results of our study are remarkably valuable, but more clinical studies are needed to elucidate the relationship between BCG vaccine, LTBI, and COVID-19 infection.

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: Vaccination is the most effective and safe preventive health service after public health services in preventing infectious diseases. Vaccination in adults is therefore as important as childhood vaccinations. The need for immunization is urgent and important in some diseases according to risk groups, except for the tetanus/diphtheria vaccine, which should be given to all adults regardless of their risk group. People with rheumatological diseases are also in the risk group. The most important point regarding vaccination in rheumatic patients is the evaluation of the immune status of the patient at the time of admission. In order for the vaccine to be safe enough and to create an adequate immune response, it is recommended to be administered during the lowest period of rheumatological disease activity before starting immunosuppressive treatments or while being administered at low doses. In this study, it was aimed to review the cases encountering hepatitis B virus (HBV), vaccination, HBV reactivation and prophylaxis in people with rheumatological diseases. Materials and Methods: The prophylaxis applied in terms of exposure to hepatitis B virus (HBV), vaccination and prevention of 118V reactivation in patients who were referred from the rheumatology outpatient clink of our hospital between September 2017 and November 2020 were evaluated retrospectively. Ethics committee approval was obtained from the ethics committee of Ege University with the decision dated 22.07.2020 and numbered 99166796-0500.06.04. Results: A total of 482 patients, 370 (76.8%) of whom were women, were included in the study. Mean age of the patients was .55.31 (22-84) years. Standard deviation of the ages was calculated as 12.88. Of the patients, 44 (9.1%) were diagnosed with spondyloar-thritis, 26 (5.4%) with Behcet's/vasculitis, and the remaining 412 (8.5.5%) patients were followed up with a diagnosis of connective tissue disease. Two hundred and ninety-nine (62%) of the patients had other comorbidities (hypertension, chronic lung disease, hypothyroidism, heart disease, diabetes, osteoporosis, migraine, fibromyalgia, cancer, hyperlipidemia, cerebrovascular diseases). The cases encountering hepatitis B virus were in 385 (79.9%) patients before biologic agent or high-dose steroid treatment and in 97 (20.1%) patients during treatment. Three hundred and forty-two (71%) of the patients have not been exposed to hepatitis B virus before and have not been vaccinated. It was determined that only 63 (13.1%) patients were immunized against hepatitis B virus at the time of admission. There were 63 patients with previous HBV serology and 11 patients with isolated anti-HBc total positivity. HBV reactivation was not observed in any of these patients. Conclusion: Adult immunization is especially vital in high-risk groups such as rheumatologic patients and patients receiving other immunosuppressive therapy. When these patients are diagnosed, hepatitis B virus serology should be evaluated and vaccination or prophylaxis should be started as soon as possible.

INTRODUCTION: The prevelance of HCV in Turkey is 0.5–1.0%. According to Turkish Society of Nephrology registry, anti-HCV positivity rate was 6.94% in chronic hemodialysis patients in 2013. Beyond the liver-related mortality, HCV infection increases all kind of mortality in hemodialysis patients. In order to decrease the mortality and to eliminate the source of infection, hepatitis C must be treated in patients undergoing hemodialysis. Interferon based therapies were cumbersome and less effective in these patients, however DAAs seem highly effective and safe in patients with chronic renal failure. In this study we presented our experiences with Paritaprevir+Ritonavir+Ombitasvir+Dasabuvir (PrOD) regime in patients undergoing hemodialysis. METHODS: Since July 2016, 25 patients on chronic hemodialysis have been treated with PrOD±ribavirin. Their demographic data, HCV genotypes, and HCV RNA and ALT levels at the beginning and week 4, 12, 24 were recorded. Data of adverse effects were collected. FINDINGS: Thirteen females, 12 males with a mean age of 55±12 (34–71) were treated. Two patients had compensated liver cirrhosis, 6 had previous renal transplantation. Basal ALT was 24.6±12.6 U/l, HCV RNA level was 5.71±5.82 logIU/ml. Genotype 1b was found in 18, 1a in 5, 1a+1b mixed infection in 2 patients. All 1a patients were given ribavirin 200 mg/day. Among 22 tested patients, 19 were HCV RNA negative at week-4, the other 3 patients’ HCV RNA levels were 13, 63 and 16 IU/ml. Twenty three patients who had completed week-12 became HCV RNA negative. All 22 patients reaching posttreatment week-12 had sustained response, 1 had SVR-8. G1a patients tolerated 200 mg/day ribavirin except 1 patient who needed blood transfusion and dose reduction to every other day of 200 mg. Three patients complained pruritus, 1 had anemia. There were two patients who could not finish the treatment one of them was due to pruritus, the other one died due to heart failure. CONCLUSIONS: In this ongoing study, there has been no treatment failure in PrOD±ribavirin treatment in hemodialysis patients. PrOD±ribavirin is highly effective and safe regime in patients undergoing hemodialysis.

WOS:000493372200013, PubMed: 31709958, [No Abstract Available]

WOS: 000511368300023, [No abstract available]

WOS: 000434852700512 …

Introduction: Management of candiduria remains controversial, mainly due to uncertainties of clinicians about diagnosis and treatment. In this study, we aimed to investigate diagnostic and therapeutic approaches of different specialists for candiduria. Materials and Methods: An interview survey composed of 10 questions on candiduria was applied interactively to 429 randomly selected clinicians in six different tertiary care hospitals. We compared the answers of infectious diseases (ID) specialists with the others. Data were evaluated by Statistical package for Social Sciences version 11. In Independent samples, t-test and chi square test were performed for data analysis. Results: Out of the 429 participants, 91 (21.2%) were ID and 338 (78.8%) were specialists from other fi elds. For asymptomatic patients with candiduria, 213 (49.6%) participants stated that a second culture was required. Compared to others, a higher number of ID specialists [76 (83.5%)] asked for a second culture. It was determined that ID specialists joining this study, whose mean length of experience after specialization was longer than the others, encountered a signifi cantly higher number of candiduria cases and referred current guidelines to use frequently compared to others. Conclusion: Clinicians can treat candiduria largely, but have diffi culty in diagnosing. The fact that only 49.6% of all specialists included into the study order a second urine culture test shows that without differentiating colonization and contamination, half of them start therapies, which are likely to be unnecessary.

Amaç: Bu çalışmanın amacı, üçüncü basamak bir nöroloji yoğun bakım ünitesinde hastane enfeksiyonlarına (HE) yol açan risk etkenlerinin belirlenmesi, klinik ve direkt hastane maliyetlerinin hesaplanmasıdır. Gereç ve Yöntem: Retrospektif olgu-kontrol çalışması olarak planlanmıştır. Örnek büyüklüğü grup başına en az 51 olarak hesaplanmıştır. Hastane enfeksiyon kontrol komitesinden, nöroloji yoğun bakım ünitesinde hastane enfeksiyonu tanısı alan en son 55 hastanın listesi elde edilmiştir. Bu hastalar yaş, cinsiyet, tanı açısından hastane enfeksiyonu gelişmemiş hastalar ile eşleştirilmiştir. Veriler hasta dosyaları ve muhasebe kayıtlarından alınmıştır. Bulgular: Olgu grubundaki 55 hastada toplam 79 HE saptanmıştır. Pnömoni (% 48) ve kateter ile ilgili üriner sistem enfeksiyonu (% 39) en yaygın görülen HE'dir. Acinetobacter baumannii (% 25)en sık üreyen etmen olarak saptanmıştır. HE, bilinci açık, entübe edilmemiş, kan transfüzyonu yapılmamış, trakeostomisi, üriner kateteri olmayan ya da mekanik ventilasyon bağlı olmayan hastalarda daha az görülmüştür. Ölüm oranı olgularda % 53.1 ve kontrollerde% 30.8 bulunmuştur. HE'ye ait ek maliyet 7.121,15 $ ve uzamış yatış günü hasta başına 26,9 gün olarak saptanmıştır. Sosyal Güvenlik Kurumu, geri ödeme süresi altı ayı aşmakla beraber tüm toplam fatura tutarını geri ödemiştir. Sonuç: Hastane enfeksiyonlarının sağlık ve parasal maliyetleri göz önüne alındığında, hasta güvenliği ve hastane itibarı için HE önlemek öncelenmelidir. Üçüncü basamak hastanelerinde yoğun bakım üniteleri hastane bütçesine yük getirmemekte, aksine bütçeyi dengelemek için bir fırsat sağlamaktadır., Aim: The purpose of this study is to overview nosocomial infections (NI), to determine risk factors and to evaluate the clinical and financial impact of NI on direct hospital cost among neurology intensive care unit (NICU) patients in a tertiary-care referral hospital. Material and Methods: A retrospective case control study was performed. The sample size was calculated to be at least 51 per group. A list of the last 55 patients who acquired an infection in NICU was obtained from infection control committee. These patients were matched with uninfected patients according to age, sex, diagnosis. The data were collected from patient files, accounting records. Results: A total of 79 NI occurred in 55 cases. The most common NI were pneumonia (48%), catheter related urinary tract infection (39%). Acinetobacter baumannii (25%) is most commonly responsible for NI. NI were detected less in patients who were conscious, non- intubated, without blood transfusion, tracheostomy, urinary catheter or mechanical ventilation. The mortality ratio was 53.1% in cases and 30.8% in controls. The excess costs of NI were $7121.15 and extra length of stay was 26.9 days. Although reimbursement took longer than six months, the Social Security Institution paid back the total billing amount. Conclusion: Given the impact on monetary and health costs of NI, measures to prevent NI in the hospital are strongly recommended for patient safety and for hospital reputation. NICUs in tertiary care referral facilities do not cause financial burden; on the contrary, they provide an opportunity to balance the budget.

WOS: 000219732100007, Solid organ transplantation (SOT) is a treatment method that improves quality of life and survival of patients with end-stage organ failure. Immunosuppressive treatments given to these patients may predispose to the development of invasive fungal infections (IFI). The incidence of IFI in SOT recipients, which is between 5% and 42%, depends on the organ to be transplanted. Although Candida spp., followed by Aspergillus spp. are the most common microorganisms, among fungal pathogens, this situation varies according to transplant type. The mortality rate associated with these IFI can be high. Therefore, antifungal prophylaxis may be necessary for SOT recipients. Many transplantation centers employ antifungal strategies according to their own experience because of the lack of randomized controlled studies. If the antifungal prophylaxis is given to all patients, antimicrobial resistance and drug-drug interactions may occur. Therefore, it is important to identify patients at a high risk of developing IFI. In this paper, epidemiology, risk factors, literature data and antifungal prophylaxis associated with IFI in liver, kidney, small intestine, pancreas, heart, and lung transplant recipients are reviewed.

s / Journal of Clinical Virology 70 (2015) S1–S126 S37 tion. The difference between viral load of other respiratory viruses detected in single and co-infections was not significant statistically. http://dx.doi.org/10.1016/j.jcv.2015.07.089