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Background In this study, we aimed to compare the intensive care unit (ICU) admission rate of hospitalized mild/moderate COVID-19 patients treated with hydroxychloroquine (HCQ), favipiravir, and HCQ plus favipiravir. Methods Single center retrospective designed observational study conducted in Ankara City Hospital. Patients who were hospitalized between March 15, 2020 and June 1, 2020 in COVID-19 inpatient clinics with laboratory confirmed diagnosis of COVID-19 were included in the study. An inverse probability of treatment weighting (IPTW) for multiple treatment groups approach was used to balance the differences in several variables on admission. Results Among 2441 patients hospitalized with diagnosis of COVID-19 during the study period, 824 were eligible for the analysis. Median age of patients was 42 (18−93 years). Among all, 347 (43.2%) of the patients had mild disease, 470 (56.8%) had pneumonia. Propensity scores ranged from 0.1841 to 0.9381 in the HCQ group, from 0.03643 to 0.29885 in the favipiravir group, and from 0.03542 to 0.56184 in the HCQ plus favipiravir group. After IPTW for multiple treatment groups was applied, all the covariates in the planned propensity score had weighted standardized effect sizes below 10% which were ranged from 0.005 to 0.092. Multivariate analysis of treatment effect (adjusted effect of treatment) was indicated that there is no statistically significant difference between HCQ, favipiravir, and HCQ plus favipiravir treatment. After using combination of SMOTE and Bootstrap resampling approach, we found no statistically significant difference between HCQ and HCQ plus favipiravir groups in terms of ICU admission. However, compared with the HCQ group, ICU admission rate was statistically significantly higher in the favipiravir group. We obtained the similar results after the sensitivity analysis. Conclusions HCQ with or without favipiravir treatment is associated with reduced risk of ICU admission compared to favipiravir alone in mild to moderate COVID-19 adult patients.

Özet Bulaşıcı hastalıklar çoğunlukla önlenebilir halk sağlığı problemleri olmakla birlikte dünya genelinde her düzeyde salgınlara, ekonomik kayıplara ve ölümlere yol açmaktadır. Özellikle küreselleşmenin etkisi ile viral salgınların oldukça hızlı bir biçimde hayatın tüm aşamalarını etkileyebildiği COVID-19 pandemisi ile çok daha iyi gözlemlenmiştir. Yaşanan tecrübeler, bulaşıcı hastalıkların kontrolünde sadece ulusal sorumluların değil uluslararası kuruluşların da kritik roller üstlenmesi gerektiğini göstermektedir. Buradan hareketle çalışmamızda uluslararası sağlık politikalarında belirleyici rolü olan Dünya Sağlık Örgütü’nün (DSÖ)COVID-19 pandemisinin ilk üç aylık periyodundasalgının yayılımını önlemeye yönelik faaliyetleri incelenmiştir. Ayrıca Dünya Bankası’na göre farklı gelir gruplarında bulunan Kanada, Türkiye, Pakistan ve Tacikistan’ın pandemi ile mücadelede aldıkları ulusal önlemlerin ve politikaların vaka ve ölüm sayıları üzerine olası etkileri tartışılmıştır. Bu çerçevede söz konusu ülkelerin COVID-19 bazında gösterdikleri performansa DSÖ’nün katkıları veya potansiyel etkileri yorumlanmıştır. Çalışmamızda farklı gelir gruplarındaki ülkelerin COVID-19 salgını ile mücadelede genel olarak kabiliyetlerine göre ülke bazında ve diğer ülkelerden bağımsız politikalar geliştirdikleri anlaşılmıştır. Ülkelerin salgın ile mücadeledeki başarılarının ülke nüfuslarının yaş ortalaması, sağlık alt yapıları ve tıbbi malzeme ve ekipmanlara erişim imkanlarını büyük ölçüde etkileyen gelir düzeyleri gibi farklı parametrelerden etkilendiği değerlendirilmiştir. Bununla beraber DSÖ gibi kurumsal gücü bulunan uluslararası kuruluşlarının pandeminin önlenmesi konusunda beklenen seviyede yeterli öncü rol oynayamadığı ve yerel politikaları yönlendirmede ve uluslararası koordinasyonu sağlamada etkisiz kaldığı söylenebilir. Özellikle COVID-19 gibi hızlı ve sıkı kararlar alınması gereken viral pandemi süreçlerinde bu öncü rolün eksikliği daha da belirgin olarak hissedilmektedir. DSÖ’nün COVID-19 pandemisinin ilk üç aylık dönemindeki kararları ve toplantı bildirimleri incelendiğinde tanı araçlarının hızlı bir biçimde küresel erişime sunulması ve kısmen de sağlık malzemelerinin tedarik süreçlerinin aksatılmaması dışında ulusal sağlık yöneticilerine kesin ve etkin bir yönetim planı sunamadığı anlaşılmaktadır. Sonuç olarak çalışmamızda tespit edilen tüm bu unsurlar bir arada düşünüldüğünde; etkin, hızlı, sürekli güncellenen kapsayıcı politikalar üreten, bütünleştirici, önleyici ve adil bir uluslararası sağlık kurumuna olan ihtiyaç açıkça gözükmektedir. Abstract Infectious diseases are generally preventable public health problems; however, they cause epidemics, economic losses, and deaths at all levels worldwide. Especially with the effect of globalization, it has been observed much better with the COVID-19 pandemic, where viral outbreaks can rapidly affect all stages of life. Experiences show that not only national authorities, but also international organizations should play critical roles in the control of infectious diseases. Based on this perspective, in our study, the responses of the World Health Organization (WHO), which has a decisive role in international health policies, to prevent the spread of the COVID-19 pandemic in the first three-month period were examined.In addition, the possible effects of the national measures and policies taken by Canada, Turkey, Pakistan, and Tajikistan, which are in different income groups according to the World Bank, on the number of cases and deaths were discussed.In this context,the contributions, or potential effects of the WHO on the performance of these countries against the COVID-19 were interpreted.It was understood that the countries in different income groups have developed policies based on their capability at country level independent from other countries in the fight against COVID-19 outbreak. It has been evaluated that the success of countries in the fight against theoutbreaksis affected by different parameters such as average age of the country's populations, health infrastructures and income levels that greatly affect access to medical supplies and equipment.However, it can be said that international organizations with institutional power such as WHO cannot play a leading role at the expected level in the prevention of the pandemic and ineffective in directing local policies and ensuring international coordination. Especially in the COVID-19 viral pandemic environment where fast and precise decisions are required, this leading role is desperately needed. The first quarterly decisions and meeting notifications of the WHO in the COVID-19 pandemic were examined in our study and it was understood that these outcomes cannot provide a definite and effective management plan to national health policy makers, although WHO presented diagnostic tools rapidly and, in some degree maintained the supply chain of medical equipment globally. As a result, when all these elements determined in our study were considered together; the need for an integrative, proactive, and fair international health institution that produces prompt, effective and constantly updated comprehensive policies should be emphasized.

Aim: The aim of this study is to develop and explain an easy-to-use severity score calculation tool to predict severe COVID-19 cases that would need intensive care unit (ICU) follow-up.Material method: The study was carried out in patients with laboratory-confirmed COVID-19 hospitalized in Ankara City Hospital between March 15, 2020, and June 15, 2020. The outcome was severe illness that required ICU follow-up. Univariate and binary logistic regression were used to create a prediction model by using potential predictive parameters obtained on the day of hospitalization. Youden’s J index was calculated with receiver-operator characteristic curves analysis in order to evaluate cut-off points, and predicted probability was calculated. The accuracy of the prediction model was tested by calculating the area under curve (AUC). Results: Of the total of 1022 patients, 152 had a severe illness and required ICU follow-up. Among 68 variables, 20 parameters met the potential predictive factor condition for severe illness and were included in the development process for ANKARA CITY HOSPITAL COVID-19 SEVERITY SCORE (ACCSES). The ACCSES calculation tool was created by the final 9 parameters (sex, oxygen saturation, hemoglobin, platelet count, glomerular filtration rate, aspartate transaminase, procalcitonin, ferritin, and D-dimer). AUC was 0.96 (95% CI, 0.95-0.98).Conclusion: We developed a simple, accessible, easy to use calculation tool, ACCSES, with good distinctive power for a severe illness that required ICU follow-up. The clinician can easily predict the course of COVID-19 and decide the procedure and facility of further follow-up simply using available clinical and laboratory values of patients upon admission.

Background Early identification of severe COVID-19 patients who will need intensive care unit (ICU) follow-up and providing rapid, aggressive supportive care may reduce mortality and provide optimal use of medical resources. We aimed to develop and validate a nomogram to predict severe COVID-19 cases that would need ICU follow-up based on available and accessible patient values. Methods Patients hospitalized with laboratory-confirmed COVID-19 between March 15, 2020, and June 15, 2020, were enrolled in this retrospective study with 35 variables obtained upon admission considered. Univariate and multivariable logistic regression models were constructed to select potential predictive parameters using 1000 bootstrap samples. Afterward, a nomogram was developed with 5 variables selected from multivariable analysis. The nomogram model was evaluated by Area Under the Curve (AUC) and bias-corrected Harrell's C-index with 95% confidence interval, Hosmer–Lemeshow Goodness-of-fit test, and calibration curve analysis. Results Out of a total of 1022 patients, 686 cases without missing data were used to construct the nomogram. Of the 686, 104 needed ICU follow-up. The final model includes oxygen saturation, CRP, PCT, LDH, troponin as independent factors for the prediction of need for ICU admission. The model has good predictive power with an AUC of 0.93 (0.902–0.950) and a bias-corrected Harrell's C-index of 0.91 (0.899–0.947). Hosmer–Lemeshow test p-value was 0.826 and the model is well-calibrated (p = 0.1703). Conclusion We developed a simple, accessible, easy-to-use nomogram with good distinctive power for severe illness requiring ICU follow-up. Clinicians can easily predict the course of COVID-19 and decide the procedure and facility of further follow-up by using clinical and laboratory values of patients available upon admission.

World Health Organization (WHO) is the specialized agency of the United Nations (UN) which was established in 1948. It has its Headquarters in Geneva, 6 different Regional Offices and149 Country Offices. World Health Organization’s mandate, priority areas and working fields are decided by its Member States. Its primary decision-making body is the World Health Assembly (WHA) with WHO Executive Board (EB). World Health Organization’s work is determined and reviewed at the WHA by instructions and approval of official delegations authorized by Member States. World Health Organization Director General and staff, together constituting Secretariat, are responsible of implementation of decisions. WHO is an organization that is setting standards and norms in the field of global health, therefore WHO has an impact and mandate on particularly as the directing and coordinating authority, norm and standard setting agency, providing support in cases of emergencies and development of health policies health systems countries. Being a legal framework of detection and control of public health risks at its origin before crossing border, The International Health Regulations (IHR imposes some obligations on WHO and assigns some responsibilities on Member States. Some global health problems and lately the COVID-19 pandemic has led to some criticisms on World Health Organization and brought up the future of World Health Organization for discussion in the post-pandemic era.

This study was conducted to assess the health-related quality of life (HRQOL) and perceived health status of the Turkish population. The data came from a nationwide survey, which was conducted by Ministry of Health on prevalence and risk factors for chronic diseases in Turkey, with a representative random sample of 18,477 people aged ≥ 15 years from Turkey. Each family physician invited two individuals selected from their registered population to the Family Health Center, conducted the survey by face to face interviews using an electronic form. HRQOL was determined using EQ-5D-3L scale. In Turkish population, each four women out of 10, two men out of 10 have problems in pain/discomfort and anxiety/depression dimensions of the scale; three women out of 10, one man out of 10 have some or severe problems in mobility. Proportion of people without health problems (health state 11,111) were 64,1% in men, 40,7% in women. The mean VAS score for males was 71.5 ± 0.2 (95% CI 70.9–72.1), 66.4 ± 0.2 (95% CI 65.8–66.9) for females (p

Summary Introduction Brucellosis is the most prevalent bacterial zoonosis worldwide. In this study, we aimed to compare our 1028 brucellosis cases with other big series in the literature in view of epidemiological, clinical, and laboratory findings and therapeutic features. Methods A total of 1028 brucellosis cases admitted to the Department of Infectious Diseases and Clinical Microbiology over a 10-year period were included in the study. A retrospective analysis was undertaken and patient files were reviewed for history, clinical and laboratory findings, and therapeutic features, as well as complications. Results Of the 1028 patients, 539 (52.4%) were female and 489 (47.6%) were male. The mean age of patients was 33.7±16.34 years and 69.6% of cases were aged 13–44 years. Four hundred and thirty-five cases (42.3%) had a history of raising livestock and 55.2% of the cases were found to have no occupational risk for brucellosis. Six hundred and fifty-four of the cases (63.6%) had a history of raw milk and dairy products consumption. The most frequently seen symptoms were arthralgia (73.7%) and fever (72.2%), while the most common clinical findings were fever (28.8%) and hepatomegaly (20.6%). The most frequent laboratory finding was a high C-reactive protein level (58.4%). The standard tube agglutination (STA) test+Coombs STA test was positive in 1016 cases (98.8%). Focal involvement was present in 371 (36.1%) cases. The most frequent involvement was osteoarticular involvement with 260 cases (25.3%). The overall relapse rate for patients with brucellosis was 4.7%. The highest relapse rate, 8.5%, was observed in the group of patients with osteoarticular involvement. Regimens including doxycycline and streptomycin with or without rifampin appeared more effective than other regimens in osteoarticular involvement. Conclusions In humans, brucellosis may lead to serious morbidity, and it continues to be a major health problem in Turkey. There is no recommended treatment protocol for complicated brucellosis. Large multicenter studies are needed to determine the most appropriate treatment choices and durations in complicated brucellosis.

Crimean-Congo hemorrhagic fever virus (CCHFV) is the causative agent of a tick-borne disease with high mortality Fates in humans. The distribution of CCHFV includes over 30 countries in Asia, the Middle East, southeastern Europe, and Africa. It was first recognized in Turkey in 2002, with an increasing number of cases reported between 2002 and 2009. Recent analysis of complete genome sequences of CCHFV isolates has revealed that the genomic plasticity of the virus is surprisingly high for an arthropod-borne virus. We have determined the complete nucleotide and deduced amino acid sequences of strain CCHFV Turkey-Kelkit06 isolated from the blood of a patient in an endemic region of Turkey in 2006. The complete sequence length of the CCHFV Turkey-Kelkit06 strain is 19,186 nt, consisting of a 1673 nt S segment, a 5364 nt M segment, and a 12,149 nt L segment. Based on the analysis of S, M, and L segments, CCHFV Turkey-Kelkit06 clustered in Group V, which represents the Europe/Turkey geographic lineage. Although glycoproteins encoded by the M gene are the most variable part of the CCHFV Turkey-Kelkit06 strain, some functional domains of the glycoproteins are well conserved. Here, we report the complete sequence and genome organization of the CCHFV Turkey-Kelkit06 strain and its phylogenetic relationship to other strains of CCHFV. Collecting data on viral sequences among isolates from CCHF epidemics may provide valuable information regarding the molecular basis of the epidemic potential of the virus. (C) 2009 Elsevier B.V. All rights reserved.

Objective: We aimed to retrospectively evaluate our cases followed up in department of Infectious Diseases, Medical Faculty of Yuzuncu Yil University with the diagnosis of bacterial meningitis between January 1995 and August 2008 in view of their clinical and laboratory findings. Material and Methods: Demographic features, history, physical examination and laboratory findings were achieved by screening the files. The diagnosis of bacterial meningitis in cases clinically consistent with suspected meningitis was done by microbiological, biochemical and serological tests performed on cerebrospinal fluid (CSF) samples, by radiological examinations of central nervous system (CNS) and the answers of the patients to antibacterial treatment. Results: Of 204 patients, 96 were females and 108 were males with an average age of 30.8 +/- 13.9 years. Thirty three percent of cases had acute bacterial meningitis (ABM), 44% had tuberculous meningitis (TM) and 23% brucella meningitis (BrM). Headache was the most frequent symptom in all cases with 80%, being 89.5% in ABM cases, 71% in TM cases and 74.5% in BrM cases. In CSF cultures of the patients with ABM, S. pneumonia was isolated in 13.4% of the cases, N.meningitides in 7.5% and S.aures in 3%. In patients with TM, acid-fast bacilli was seen in 20% of the cases. B. melitensis was grown from CSF in 10.6% of the patients with BrM and from blood in 17.2% of the patients. Mortality rate was 13.4% in ABM cases, 14.4% in TM cases and 2.1% in BrM cases. Conclusion: TM seems to be more frequent in our region when compared to other causes of bacterial meningitis and its high morbidity and mortality rates attract the attention. Clinical and laboratory findings of BrM are vaguer than other forms of bacterial meningitis.

In the winter of 2006-2007, several parotitis cases were reported in different provinces of Turkey. Serological and virological studies were undertaken to investigate these cases with the aim of determining the genotype of the mumps virus (MuV) circulating in Turkey. Samples from 23 cases-Ankara (n:5), Kirklareli (n:4), Mugla (n:10), Isparta (n:3), Trabzon (n:1)-with a diagnosis of clinical parotitis were investigated. Serum samples were tested against mumps IgM and IgG, nested PCR amplification of a 639-bp fragment encompassing the entire SH gene was performed using buccal swabs, and PCR products were sequenced. Of 18 serum samples, 16 (88.9%) were positive for mumps IgM. Seven (30.4%) of 23 buccal swab samples were positive by PCR. In five PCR-positive cases, the sample was also positive for mumps IgM, and serum samples were not available from two of the PCR-positive cases. There was 98% identity between the different sequences, and all were identified as genotype H. The sequences were most similar to sequences identified in Spain, Japan, Switzerland and the UK, and less closely related to the H strains identified in Belarus, Korea and Russia. This is the first report of the mumps virus genotypes circulating in Turkey. Turkey is, geographically, a bridge between Europe and Asia, and therefore, a better understanding of the molecular epidemiology of MuV in Turkey may led to improved tracking of the circulation of strains between the two continents. Moreover, there is a need to further investigate the existence of other genotypes in Turkey.

Introduction: Crimean-Congo haemorrhagic fever (CCHF) has been encountered in Turkey since 2002. Education of health-care personnel is very important to control CCHF. The aim of this study was to determine the knowledge of health-care personnel who are working in endemic area and working in a secondary or tertiary hospital caring the patients regarding CCHF. Materials and Methods: A questionnaire including 12 questions was prepared and it was applied to health-care personnel working in seven provinces. Eighty-nine doctors, 310 nurses and 112 laboratory technicians were included in the study. Results: 94.3% of doctors’, 80.4% of nurses’ and 77.6% of laboratory technicians’ knowledge level about CCHF were good or very good according to theirself. Tick-bite, contact with blood or body fluid of infected animals and contact with blood or body fluid of CCHF patients were known as transmission routes by 85.7%, 77.1% and 69.1% of health-care personnel respectively. Ribavirin treatment was required according to the 30.3% of doctors while 63.3 of them offered only supportive therapy. 83.6% of personnel described that tick has been removed completely with pleat or tweezers. But 11.9% and 3.3% of personnel told that alcohol or olive-oil can be applied before removing tick, respectively. Conclusion: It is very important to perform continuous education of health-care personnel especially in the epidemic region for early diagnosis of the patient, appropriate management and to reduce nosocomial infection risk.

An 18- year old female patient was admitted to the Emergency Department with complaints of fever and fatigue beginning 15 days ago associated with headache, weakness, palpitation, abdominal pain, and diarrhea a week later. The patient who apathic confused and discordant was transferred to the Department of Infectious Diseases. There was also hypocalcemia, hypopotassemia, pancytopenia, intestinal hemorrhage, and hepatic involvement. S. typhi was grown in the blood culture. The patient was discharged with full recovery after ciprofloxacin treatment in addition to electrolyte replacement. Typhoid fever is a widespread infectious disease in our country and should be taken into consideration in differential diagnosis of many diseases because it may involve a number of systems and may present with a variety of complications

The clinical utility of two complementary tests for brucellosis, the Brucella IgM and IgG flow assays, was evaluated in a hospital in eastern Turkey. The results show that the flow assays are convenient diagnostic tests for use in endemic areas. A positive result in the flow assays was obtained in 91% and 97% of the admission sera from adult and pediatric patients with brucellosis, respectively, and the sensitivity at admission was 100% for culture-confirmed brucellosis. The assay system performed equally well in diagnosing patients at different stages of illness including patients with acute, subacute, or chronic disease and with relapse. The results of the flow assays correlated well with those of a serum agglutination test at a cut-off greater than or equal to1:160. The agreement was 92%. Application of the flow assays on serum samples collected during a village survey for brucellosis after an outbreak demonstrated their diagnostic potential as field tests.

Levamisole is an immunopotenciator drug which is used as an antihelmintic drug as well as very effective remedy on cellular immunity compared with humoral immunity. A total 71 patients (37 men, 34 women) who referred to our department between March 1997 and December 2001, with a history of the disease for about I year, were diagnosed as having chronic brucellosis through those tests brucella serum agglutination test (SAT), SAT with Coombs and SAT with 2-mercaptoethanol. The patients were randomly divided into levamisole group (36 patients) and control group (35 patients). All patients were given rifampicin 600 mg/day + doxycycline 200 mg/day for 6 weeks as a standard classical combined therapy for brucellosis. In the levamisole group, oral levamisole 80 mg every other day for 6 weeks was added to the treatment. There was a statistically significant difference between two groups, in complaints of arthralgia, fatigue and sweats before and 6 months after treatment, as well as in erythrocyte sedimentation rate and C-reactive protein elevations and lymphomonocytosis finding. While it was provided both clinical and serological improvement in all patients in the levamisole group; 11 patients in the control group did not improve both clinically and in view of specific and nonspecific laboratory findings and a recurrence occurred in one case, in this group. In conclusion, levamisole added to classical antibiotic therapy in treatment of chronic brucellosis was found quite efficient in all patients in providing adequate clinical and laboratory response in comparison to classical antibiotic therapy alone. -chronic brucellosis; levamisole; treatment (C) 2003 Tohoku University Medical Press.

Background Appropriate antimicrobial therapy and sometimes urgent surgery are life-saving in intra-abdominal infections (IAI). Methods We performed a retrospective case control study to evaluate the efficacy of ceftriaxone, ceftriaxone plus metronidazole, tigecycline, and ertapenem regimens in IAI. Patients aged >18 years and diagnosed with IAI between 2015 and 2017 are included in the study. Definitions are based on IDSA IAI guideline. Significant resolution of all signs and symptoms of IAI with no further need for antimicrobial therapy or surgical intervention for infection is accepted as clinical response (CR). Microbiological response (MR) is assessed among patients with positive culture and defined as documented or presumptive microbiological eradication of pathogen. Results 659 patients are included in the study. Mean age was 56 years. Source control was maintained in 45.5% of patients. Among 54 patients with available culture specimen, E.coli was the most isolated pathogen (81% ESBL +). Comparisons of antibiotics in all patients and in complicated IAI are shown in Table 1 and 2, respectively. Conclusion Ertapenem, and especially tigecycline are good options in IAI in the era of high antimicrobial resistance. Table 1. Comparison of antibiotic regimens in all patients (n (%), n ± SD) Ceftriaxone (343) Ceftriaxone/ Metronidazole (230) Tigecycline (27) Ertapenem (59) P APACHE II ≥15, 5 (1.5) 14 (6) 2 (7.4) 10 (16.9)

Background It is important to determine which anthropometric measurements are better predictor of coronary heart disease risk in local settings. The aim of this study is to compare the predictive power of anthropometric indices including recent ones such as body shape index (ABSI) and waist to height ratio(WHtR) for risk of developing CHD and history of CHD. Methods We used cross-sectional data from nationally representative Chronic Diseases and Risk factors Survey conducted by Ministry of Health in 2011. Body mass index …

Background In 2011, Turkish Ministry of Health (MoH) initiated a nation-wide “Smoking Cessation Treatment Support Program” (SCTSP), to provide smoking cessation drugs free of charge. Methods SCTSP was conducted in all 81 cities of Turkey, at 228 smoking cessation clinics, and by over 400 physicians. In total, 164,733 participants took advantage of the program between January and November 2011. Varenicline (Champix ® , Pfizer) and Bupropion (Zyban ® , GlaxoSmithKline) were used in the program at a ratio of 0.7 and 0.3 respectively. Post-program data were obtained by phone interviews from randomly selected participants, who had completed a 1-year follow-up after enrollment in the program. Findings Quit rates were 29.6% for those given Varenicline and 25.1% for those given Bupropion. The quit rates for participants with hypertension (35.0%), diabetes mellitus (36.9%), coronary artery disease (32.1%) and cerebrovascular events (34.0%) were higher than those without. Increased age, female gender, longer duration of cessation drug use, low Fagerstrom score, the presence of hypertension, the absence of chronic obstructive pulmonary disease, and the absence of cancer were found to be associated with higher success rates. Interpretation SCTSP is the first successful report of a nation-wide community-based smoking cessation intervention. The real-life quit rates obtained herein are comparable to those of clinical evidence to date. The centralization of smoking cessation clinics, standardization of treatment guidelines, application of a specific drug assignment algoritm, and provision of primary care support and follow-ups by trained physicians, appeared to be key elements for success.

Background Achieving a good glycemic control is essential for the prevention of complications of diabetes mellitius (DM). Different studies showed that good glycemic control is achieved in less than 50% of diabetic patients. The reasons for this failure are complex and multifactorial. In Turkey, diabetes prevalence had increased by 90% between 1998-2010. In addition to this rapid increase of the disease, poor management of the patients has also been an important …

During the second year of the "Iron-like Turkey" Project, in which all children aged 4-6 months in Turkey receive iron supplementation for 5 months, we aimed to assess the utilization of iron supplementation in the field, as well as the prevalence of anemia in healthy infants aged 12-23 months, while determining a variety of sociodemographic and nutritional factors for anemia in three of the 12 NUTS (Nomenclature of Territorial Units for Statistics) regions (regions with the highest, lowest and middle under-5 malnutrition levels). In a community-based, cross-sectional survey using a multi-staged, weighted, cluster-selected sample, children aged 12-23 months with birthweight ≥2500 g, no chronic illness, no history of blood disease, and from term and singleton pregnancy were enrolled; 1589 children met the criteria. The mean±SD age of children surveyed was 17.8±3.6 months. Of the parents, 72.4% claimed that their physician had recommended iron supplementation, and 68.8% had given supplementation to their children. Overall prevalence of anemia was 7.3%. Multivariate analysis revealed that the frequency of anemia decreased significantly in older infants, when supplementation was recommended by health providers, when an infant was breastfed longer than 6 months, and when the mother received iron supplementation during pregnancy. However, anemia prevalence increased when the infant received iron supplementation at a later age (³9 months), lived in a crowded family (³6 persons), and when the mother had a history of iron deficiency anemia. Anemic infants had significantly lower z scores of weight for age than non-anemic ones. This survey suggests that iron supplementation during pregnancy, initiation of iron supplementation in infants at 4-6 months of age, effective counseling on supplementation, subsequent compliance, support of breastfeeding, and effective training of health care personnel are effective strategies for prevention of anemia in the community.

Crimean-Congo haemorrhagic fever (CCHF) is a disease caused by a virus belonging to Bunyaviridae family. CCHF virus isolation and/or disease have been reported from more than 30 countries in Africa, Asia, south-eastern Europe, and the Middle East [1]. The main transmission routes of the virus are tick-bite and contact with tissues, body fluids and blood of infected animals [1-4]. Nosocomial transmission is another important route of infection [1]. The incubation period is generally described as 1-3 days after tick-bite and 5-6 days after exposure to infected animal or human blood or body fluid, but it can be longer. Fever, chills, headache, fatigue and myalgia are the most common symptoms in the pre-haemorrhagic period. The disease progresses to haemorrhagic form in severe cases [1]. The fatality rate of disease is reported between 7.5-50% in hospitalised patients [4-7]. This wide range may due to phylogenetic variation of the virus, transmission route and different treatment facilities [4-7].

We report here a 70-year-old female patient who was diagnosed with brucellosis and presented with mass formation resembling a tumor. The mass was protuberant, 10 cut from the skin surface with a diameter of 15 cm, located at the inferior-lateral region of the left scapula. Brucella melitensis was yielded from culture of mass fluid. The patient responded to ceftriaxone, rifampin and doxycycline therapy and recovered without any sequela at the end of surgery and 3 months of medical treatment.

Cases of botulism in a family in eastern Anatolia were studied. In late September 2005, an outbreak of botulism developed in our region, first in 2 patients, a teenage boy and his mother, in whom the disease culminated in respiratory insufficiency and death. An additional 8 cases of botulism were identified later; most of them presented to our medical centre the next d. These patients with milder symptoms recovered gradually. All the patients received anti-botulinum toxin. The investigation of the source of the outbreak showed an unexpected vehicle for botulism infection in the these patients, suzme (condensed) yoghurt buried under soil. Type A botulinal toxin was detected in the yoghurt sample. The clinical diagnosis was also confirmed by a mouse bioassay performed with the serum samples of the patients. The most common symptoms were dry mouth, difficulty in speaking and swallowing, and change in voice quality. The 10 identified patients with botulism constitutes the largest-ever outbreak of botulism reported in Turkey to date. The present study shows the importance of considering a diagnosis of botulism soon after patients present with acute cranial nerve dysfunction and of promptly treating suspected cases with antitoxin.

This study compared the application of intramuscular recombinant hepatitis B vaccine in hemodialysis patients with the application of accelerated intradermal recombinant hepatitis B vaccine, which can be applied with one-tenth of the standard dose. Sixty seronegative patients for hepatitis B were randomly separated into two groups. Twenty mug of the recombinant hepatitis B vaccine was intramuscularly applied at 0-, 1-, 2-, and 6-month intervals to the first group (32 cases). One more dose was applied at month 12 to those whose anti-HBs titers remained below 100 mIU/mL at month 7. The same vaccine was intradermally applied at 2 microg dose six times with one-month intervals to the second group (28 cases). Vaccine applications were continued in those whose anti-HBs titers remained below 100 mIU/mL at month 7 until antibody titers reached above this value or until the dose number became 12. Measurements of antibody titers were repeated at month 13 in both groups. As a result, in the vaccination of hemodialysis patients against hepatitis B, the accelerated ID application of hepatitis B vaccine with a dose reduced to one-tenth is more cost-effective than the standard dose vaccination schedules. Especially for hemodialysis patients, the time has come for routine application of ID hepatitis B vaccine as an alternative vaccination method.

Hepatitis delta virus infection is an important cause of liver morbidity and mortality worldwide. In Eastern Turkey, hepatitis B virus infection is the major cause of chronic liver diseases. We aimed to research the role of hepatitis delta virus infection in chronic liver diseases related to hepatitis B virus infection in the Van region of Eastern Turkey.Serological markers of hepatitis B virus and hepatitis delta virus infection [HBsAg, HbeAg, Anti-HBe and Anti- hepatitis delta virus total (IgM+IgG)] were determined by ELISA test in patients with chronic hepatitis and cirrhosis. Serum hepatitis B virus DNA was determined by polymerase chain reaction (PCR) method in chronic hepatitis B patients.Hepatitis delta virus infection was detected in 5% (7/138) of asymptomatic hepatitis B virus carriers, in 16% (24/148) of chronic hepatitis B patients and in 45% (34/75) of cirrhotic hepatitis B virus patients. hepatitis delta virus infection showed a three-fold increase in chronic hepatitis (p0.01) and nine-fold increase in cirrhosis (p0.001) compared to hepatitis delta virus carriers. Also, it was three times more frequent in cirrhosis (p0.001) compared to chronic hepatitis. Chronic hepatitis delta virus infection was equally distributed between sexes in patients with chronic hepatitis B virus infection, whereas chronic hepatitis B virus infection alone was three times more frequent in males (p0.001). Mean ages of hepatitis delta virus carriers, chronic hepatitis D and hepatitis delta virus cirrhosis patients were 30.7+/-8 (14-65), 36+/-13 (19-70) and 44 +/-16 (25-55), respectively.The higher prevalence of hepatitis delta virus infection in more severe form of hepatitis B virus infection suggests that hepatitis delta virus infection increases the severity of chronic hepatitis B virus infection in the Van region. hepatitis delta virus infection remains a second major cause of chronic liver diseases in Eastern Turkey in spite of its decreasing prevalence in Western countries and in Western Turkey.

The clinical utility of two complementary tests for brucellosis, the Brucella IgM and IgG flow assays, was evaluated in a hospital in eastern Turkey. The results show that the flow assays are convenient diagnostic tests for use in endemic areas. A positive result in the flow assays was obtained in 91% and 97% of the admission sera from adult and pediatric patients with brucellosis, respectively, and the sensitivity at admission was 100% for culture-confirmed brucellosis. The assay system performed equally well in diagnosing patients at different stages of illness including patients with acute, subacute, or chronic disease and with relapse. The results of the flow assays correlated well with those of a serum agglutination test at a cut-offor =1:160. The agreement was 92%. Application of the flow assays on serum samples collected during a village survey for brucellosis after an outbreak demonstrated their diagnostic potential as field tests.

Anthrax is essentially a disease of grazing herbivorous animals. The most common form of the disease is cutaneous anthrax, which accounts for 95% of all cases. We report here 39 cutaneous anthrax cases in humans that were seen in Eastern Anatolia over a six-year period. The clinical presentation was malignant edema in 16 of the cases (41%) and malignant pustule in 23 (59%). A secondary bacterial infection was present in 13 patients (33.3%) in the vicinity of the lesions. The agent was observed using Gram-stained smears in 25 patients (64%), and Bacillus anthracis was isolated from 15 patients (38.5%). All of the patients were treated with penicillin G or penicillin procaine, except one patient who had a penicillin allergy. One patient with cervical edema (2.5%) died as a result of laryngeal edema and sepsis syndrome. In conclusion, we found that the appearance of the skin lesion of cutaneous anthrax may vary, and this fact, combined with the rarity of this disease, which contributes to a general lack of experience among medical personnel, may make diagnosis difficult in nonagricultural settings

Background Human brucellosis is an infectious disease produced by Brucella species: small, coccoid or rod-like, aerobic, Gram-negative bacteria. The infection is common in developing countries, and can also affect the skin. Its prevalence is high in our region of Turkey, where stockbreeding is one of the main economic sources, compared with the industrially developed areas of Turkey, and dermatologic complaints due to brucellosis are fairly common. Materials and methods One hundred and three patients with serologically and clinically confirmed brucellosis were studied in order to investigate the prevalence of cutaneous findings and their variability in brucellosis. Fifty-two (50.49%) were males and 51 (49.51%) were females with an age range of 4–70 years (mean, 30.45 ± 15.08 years). Results Of these patients, 14 (13.59%) had cutaneous findings probably related to brucellosis. These findings were more frequent in females (11 cases) than males, and most of the females (eight cases) were housewives; three were students. Urticaria-like papules and plaques were the most common findings; they were seen in six (35.3%) patients. One case had livedo reticularis and another palmar erythema, which have not been reported previously. No relationship was observed between the serologic values and the cutaneous findings. Conclusions Cutaneous findings in our cases were more prevalent than in other reported studies. It is important to emphasize that cutaneous lesions are not specific to brucellosis and may be seen in a variety of other dermatologic diseases caused by many agents; therefore, these agents should be kept in mind in the differential diagnosis.

The aim of this study was to indicate the presence of tick-borne encephalitis (TBE) in an endemic area for Crimean-Congo haemorrhagic fever (CCHF) in Turkey. Of 39 CCHF suspected cases, one was found to be TBE virus Immunoglobulin M positive and seven were TBE virus immunoglobulin G positive. It is important to report this first appearance of the TBE virus in Turkey since 1967.

Aim: The aim of this study was the evaluation of the surveillance activities for seasonal influenza in one of a sentinel city of Diyarbakir-Turkey between the years 2006 to 2009. Methods: In Diyarbakir 10 primary health centre and 2 voluntary physician were involved to surveillance. Weekly Influenza Like Illness (ILI) were reported through Health Administration of city and each week unique nasopharyngeal swap sample were collected from one randomly selected ILI case. Nasopharyngeal swap samples were transported to Virology Laboratory of Ankara Refik Saydam Hifzissiha Institute and virologic investigations were performed in this centre. Monthly distribution, person, place and time properties of ILI cases were shown by graphics and tabulates. Beside this forms filled for surveillance were evaluated according to their sufficiency. Results: Five thousand five hundred thirty four ILI cases were reported during 2006-2007 season and 4541 cases during 2007-2008 season, 10350 cases during 208-2009 season were reported. According to monthly distribution it was determined that ILI cases apparent by the fall, increase during winter and decrease during spring. For all three seasons most of the ILI cases were aged between 1 to 4 years old. Results of virologic investigation of samples collected at 2006-2007 season were 16 Influenza B, 10 Influenza A H3, 6 adenovirus, 4 Influenza A H1, 2 Parainfluenza, and 1 RSV. At 2007-2008 season virologic results were 17 Influenza B, 3 Influenza A, 7 Influenza AH1, 10 Influenza AH3, 3 Parainfluenza. At 2008-2009 season 26 Inf B, 1 InfAH3ve 1 RSV were the viruses found from ILI cases’ samples. Conclusion: The contribution of surveillance conducted in Diyarbakir city which is one of a sentinel region of Turkey was found very prior and important for National Surveillance of Influenza. [TAF Prev Med Bull 2012; 11(2.000): 131-138]

Summary Background Crimean-Congo hemorrhagic fever (CCHF) is a serious disease caused by the CCHF virus of the Bunyaviridae family. The disease has been reported in 30 countries in Africa, Asia, Eastern Europe, and the Middle East. It has been present in Turkey since 2002. In this study we present and discuss the epidemiological features, clinical and laboratory findings, treatment, and outcome of cases diagnosed with CCHF between 2002 and 2007 from the surveillance results of the Turkish Ministry of Health (MoH). Methods According to the surveillance system of the MoH, data for patients with clinical, laboratory, and epidemiological findings compatible with CCHF are recorded on case reporting forms. These forms are submitted to the General Directorate of Primary Health Care of the MoH by the city health directorates. All the surveillance data regarding CCHF were recorded on a database (SSPS 11.0) established in the Communicable Diseases Department of the MoH. Results According to the surveillance reports of the Turkish MoH, between 2002 and 2007, 1820 CCHF cases occurred (150 in 2002–2003, 249 in 2004, 266 in 2005, 438 in 2006, and 717 in 2007). The crude fatality rate was calculated to be 5% (92/1820). Two thirds of the CCHF cases were reported from five cities located in the Mid-Eastern Anatolia region; 69.4% of the cases were from rural areas. The male to female ratio was 1.13:1. Of all the reported cases, 68.9% had a history of tick-bite or tick contact and 84.1% were seen in the months of May, June, and July. Of 1820 CCHF cases, three (0.16%) were nosocomial infections. Conclusions CCHF appears to be a seasonal problem in the Mid-Eastern Anatolia region of Turkey. The possible risk factors for transmission and the clinical and laboratory findings of patients with a diagnosis of CCHF were found to be similar to those reported in the literature. The mean fatality rate for Turkey is lower than the rate reported for other series from other parts of the world.

In the last few years, Crimean-Congo haemorrhagic fever (CCHF) has been reported as an emerging tickborne disease in Turkey. This paper deals with the preparation of an early warning system, aimed to predict the beginning of the CCHF season in Turkey based on a clear, simple and repeatable remotely-sensed signal. Decadal (mean of 10 days) values of the normalized difference vegetation index (NDVI) at 1 km resolution were used on a set of 952 confirmed, accurately geo-referenced, clinical cases between 2003 and 2006. A prerequisite is that the signal should be observable between 2 and 3 decadals before a given moment of the season to be of value as early warning. Decadals marking the 10th percentile or the 25th quartile in the frequency distribution of case reporting were selected as markers for the beginning of season of risk. Neither raw nor accumulated decadal NDVI signals were able to predict the onset of this season. However, when we defined the NDVI anomaly (NDVIa) as the positive difference between decadal NDVI values and the average for the previous year, this standardized measure gave a homogeneous overview of the changes in the NDVI signal producing a NDVIa slope for the decadals 10 to 13 that was always greater than 0. We conclude that observing this slope over time can be used as an early-warning system as it would predict the build-up of the number of cases 20 days in advance with an accuracy of 82% (10th percentile) or 98% (25th quartile).