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Introduction: Our knowledge has gaps regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication levels and its association to severity of Coronavirus disease 2019 (COVID-19). The aim of this study was to investigate the association of SARS-CoV-2 viral load with disease severity and serum biomarkers in COVID-19 patients. Methodology: Viral load was determined via cycle threshold (Ct) values of SARS-CoV-2 real-time reverse transcriptase-polymerase chain reaction (RT-PCR) in 214 adult patients. Ct values were compared with clinical severity, biochemical and hematological biomarkers. Results: Clinical course of the disease was mild (49.1%), moderate (40.2%), and severe (10.7%). Median Ct value was 28.2 (IQR: 22.2–33.8) during the first week of the disease. Ct values were lower within five days after symptom onset [lowest Ct value on the third day (median: 24, IQR: 20.6–32.3)], but they increased significantly during the second and third weeks. No association was detected between admission Ct values and disease severity. Gender, age, co-morbidity, and mortality did not differ significantly in patients with low (≤ 25) and high (> 25) Ct values. White blood cell, neutrophil, platelet, and especially lymphocyte counts, were significantly lower in patients with low Ct values. Conclusions: No definitive/clear correlation between SARS-CoV-2 viral load and severity and mortality was found in the studied COVID-19 patients. However, neutrophil, platelet, and especially lymphocyte count were significantly lower in patients with a high viral load.

The potential role of interleukin-6 (IL-6) in coronavirus disease 2019 (COVID-19) pneumonia provides the rationale for investigating IL-6 signaling inhibitors.To evaluate and report treatment responses to tocilizumab (TCZ) in COVID-19 patients and compare mortality outcomes with those of standard care.Patients hospitalized with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, diagnosed with reverse transcription polymerase chain reaction (RT-PCR) between March 2020 and April 2021, were enrolled in this single-center retrospective cohort study. Propensity score matching was performed in order to reduce confounding effects secondary to imbalances in receiving TCZ treatment.A total of 364 patients were included in this study. Two hundred thirty-six patients received standard care, while 128 patients were treated with TCZ in addition to standard care (26 (20.3%) patients received a dose of 400 mg intravenously once, while 102 (79.7%) patients received a total dose of 800 mg intravenously). In the propensity score-matched population, less noninvasive mechanical ventilation (p = 0.041) and mechanical ventilation support (p = 0.015), and fewer deaths (p = 0.008) were observed among the TCZ-treated patients. The multivariate adjusted Cox regression model showed a significantly higher survival rate among TCZ patients compared to controls (hazard ratio (HR): 0.157, 95% confidence interval (95% CI): 0.026-0.951; p = 0.044). The hazard ratio for mortality in the TCZ group was 0.098 (95% CI: 0.030-0.318; p = 0.0001 using log-rank test).This study determined that TCZ treatment in COVID-19 patients was associated with better survival, reduced need for mechanical ventilation and reduced hospital-associated mortality.

Bu çalışma, 14-17 Eylül 2016 tarihleri arasında Lizbon[Portekiz]'de düzenlenen 19. Meeting of the European Society for Clinical Virology'de bildiri olarak sunulmuştur. Background: Because of their similar modes of transmission, the simultaneous infection of viral hepatitis and human immunodeficiency virus are increasingly seen as a big problem related to human health. Aims: To determine the drug mutations in hepatitis B virus and/or hepatitis C virus co-infected human immunodeficiency virus-1 patients in Turkey. Study Design: Retrospective cross-sectional study. Methods: The present study was conducted between 2010 and 2017. HBsAg, anti-hepatitis C virus, and anti-human immunodeficiency vim were tested with ELISA. All anti-human immunodeficiency virus positive results by ELISA were verified for anti-human immunodeficiency virus positivity by a Western blot test, and Antihuman immunodeficiency virus positive patients with HBsAg andior anti-hepatitis C virus positivity were included in the study. Subtyping and genotypic resistance analyses were performed by population sequencing of the viral protease and reverse transcriptase regions of the human immunodeficiency virus-1 pol gene. Results: We detected 3896 human immunodeficiency virus-1 positive patients whose sera were sent from numerous hospitals across the country to our polymerase chain reaction unit for detection of drug resistance mutations and whose molecular laboratory tests were completed. Viral hepatitis co-infections were detected in 4.3% (n=170) of patients. Hepatitis B virus and hepatitis C virus co-infection were observed in 3.2% and 0.5% of all human immunodeficiency virus-I infected patients, respectively. The major human immunodeficiency virus-1 subtype detected was group M, subtype B (62.9%). However, 13.5% of drug resistance mutation motifs were found in human immunodeficiency virus-1 genomes of patients included in the study. Conclusion: Due to similar transmission routes, HIV1 patients are at risk of hepatitis B and C virus co-infection. However, antiretroviral drug resistance mutation model is similar to patients with hepatitis negative. European Society for Clinical Virology

Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific humoral immune persistence has been proposed to be affected by patients' characteristics. Moreover, available conflicting assay results are needed to be settled through comparative research with defined clinical specimens. Methods This prospective study investigated SARS-CoV-2-specific antibodies among 43 adults and 34 children at a mean of 12 weeks after the onset of COVID-19 symptoms using six serological assays and compared their performance. We used two Euroimmun (Euroimmun, Luebeck, Germany), two automated Roche Elecsys (Basel, Switzerland), and two rapid immuno-chromatographic Ecotest (Matrix Diagnostics, Assure Tech. (Hangzhou) Co., L, China) assays to investigate SARS-CoV-2 antibodies. Results The findings showed that the Roche Elecsys anti-S total test yielded the best positivity/sensitivity (children 94.1% and adults 93.0%; p = 0.877) while five immunoglobulin IgG targeting assays had similar positivity/sensitivity between children (88.2% to 94.1%) and adults (88.4% to 93.0%) (p0.05). Although IgM positivity was relatively low (p0.001), it was found in the majority of our pediatric and adult patients (67.6% and 86.0%, respectively; p = 0.098). SARS-CoV-2 S IgG titers were found to be higher among males in pediatric and adult groups compared to females (p = 0.027 and p = 0.041, respectively). Furthermore, we observed significantly higher antibody titers among pneumonia patients (p = 0.001). Conclusion Overall, we concluded SARS-CoV-2 antibody persistence over an average of 12 weeks after the onset of COVID-19 symptoms. While automated Roche Elecsys total antibody assays yielded the best sensitivity (90%) and five assays targeting IgG had acceptable performance. Patients with pneumonia and males have higher antibody titers. The effect of antibody persistence on re-infections should be monitored in longitudinal studies.

Introduction Stenotrophomonas maltophilia (SM) is one of the common gram-negative pathogens that cause nosocomial infections. The aim of the present study is to evaluate the treatment and outcome of SM bacteraemia. Materials and Methods We retrospectively evaluated antimicrobial treatment in adult patients with nosocomial SM bacteraemia, with the 14th and 30th-day mortality as the outcome. Results In total, 140 adult patients with SM bacteraemia who were diagnosed between January 1, 2002, and December 31, 2016 were enrolled in the present study. Seventy-one (50.7%) patients were in the intensive care unit (ICU). The 14th and the 30th-day mortality rates were 32.9% (n=46) and 45.7% (n=64), respectively. Female sex (OR, 7.47; 95% CI 1.61-34.47, p

Background: Determination of the prognostic factors which affects the mortality and morbidity in COVID-19 patients, has an importance in terms of planning the treatment and follow-up strategy. Material and Method: Patients who had COVID-19 diagnosis via microbiologically and/or radiologically between March and October 2020 in a tertiary-care university hospital were recorded retrospectively. Only adult patients (≥18 years) with clinical spectrum of moderate, severe and critical illness were included in the study according to National Institutes of Health (NIH) guideline. A p value of less than 0.05 was considered significant. Ethical committee approval was given from the Uludag University with decision number 2020-22/11. Also, the permission from Republic of Turkey, Ministry of Health was given. Results: A total number of 257 patients were included in the study. 30-day mortality rate was recorded as 14.4%. In univariate analysis; age, chronic renal failure, malignancy, cerebrovascular disease, number of comorbidities >2, dyspnea, cough, NIH severe and critical illness, oxygen saturation, respiratory rate, systolic and diastolic blood pressure, qSOFA, GCS, MEWS, SOFA, CURB-65, CCI, CRP, procalcitonin, CK, D-dimer, lymphocyte and thrombocyte levels, neutrophile-to-lymphocyte ratio, AST, albumin, hemoglobin, CK-MB, fibrinogen, LDH and potassium levels were found as statistically significant (p

Gunal, Ozgur/0000-0002-7744-4123; KARABAY, OGUZ/0000-0003-1514-1685 WOS: 000490537600009 PubMed: 31580558 Objective: Treponema pallidum and HIV are transmitted frequently through sexual contact, these agents with epidemiological similarities co-infect the same host. The current number of HIV-infected cases in Turkey is increasing. For this reason, we aimed to reveal the characteristics of syphilis in HIV/AIDS cases. Methods: A retrospective longitudinal cohort study was performed, patients were followed up at 24 clinics in 16 cities from all seven regions of Turkey between January 2010 to April 2018. We examined the socio-demographic characteristics, laboratory parameters and neurosyphilis association in HIV/AIDS-syphilis co-infected cases. Results: Among 3,641 patients with HIV-1 infection, 291 (8%) patients were diagnosed with syphilis co-infection. Most patients were older than 25 years (92%), 96% were males, 74% were working, 23% unemployed, and 3% were students. The three highest prevalence of syphilis were in Black Sea (10.3%), Mediterranean (8.4%) and Marmara Regions (7.4%). As for sexual orientation, 46% were heterosexuals, 42% men who have sex with men (MSM), and no data available for 12%. Patients with the number of CD4+

Background: Because of their similar modes of transmission, thesimultaneous infection of viral hepatitis and human immunodeficiencyvirus are increasingly seen as a big problem related to human health.Aims: To determine the drug mutations in hepatitis B virus and/or hepatitis C virus co-infected human immunodeficiency virus-1patients in Turkey.Study Design: Retrospective cross-sectional study.Methods: The present study was conducted between 2010 and 2017.HBsAg, anti-hepatitis C virus, and anti-human immunodeficiencyvirus were tested with ELISA. All anti-human immunodeficiencyvirus positive results by ELISA were verified for anti-humanimmunodeficiency virus positivity by a Western blot test, and Antihuman immunodeficiency virus positive patients with HBsAg and/oranti-hepatitis C virus positivity were included in the study. Subtypingand genotypic resistance analyses were performed by populationsequencing of the viral protease and reverse transcriptase regions ofthe human immunodeficiency virus-1 pol gene.Results: We detected 3896 human immunodeficiency virus-1 positivepatients whose sera were sent from numerous hospitals across thecountry to our polymerase chain reaction unit for detection of drugresistance mutations and whose molecular laboratory tests werecompleted. Viral hepatitis co-infections were detected in 4.3% (n=170)of patients. Hepatitis B virus and hepatitis C virus co-infection wereobserved in 3.2% and 0.5% of all human immunodeficiency virus-1infected patients, respectively. The major human immunodeficiencyvirus-1 subtype detected was group M, subtype B (62.9%). However,13.5% of drug resistance mutation motifs were found in humanimmunodeficiency virus-1 genomes of patients included in the study.Conclusion: Due to similar transmission routes, HIV1 patients are atrisk of hepatitis B and C virus co-infection. However, antiretroviraldrug resistance mutation model is similar to patients with hepatitisnegative.

Phlebotomy causes pain and discomfort to adults. The objective of this study was to investigate the effect of the use of Buzzy on phlebotomy satisfaction and pain relating to the phlebotomy process in healthy adult blood donors voluntarily donating blood. This was a prospective, randomised, controlled experimental study. The research sample was made up of 90 healthy adult men. These individuals were randomly assigned to an experimental group (Buzzy group), a placebo control group, and a nonintervention control group. For the individuals in the experimental group, the ice wings of the Buzzy device, frozen solid in the refrigerator, were placed approximately 5 centimeters above the intervention site from 1 minute before the procedure until the end of the needle location process. When the device was operated, it applied vibration and cold to the site: For individuals in the placebo control group, the Buzzy device was also located approximately 5 centimeters above the intervention site from 1 minute before the procedure until the end of the needle location process, but with the ice wings at room temperature (unfrozen) and with the vibration switch remaining off. For the nonintervention control group, no intervention was implemented before the procedure. Immediately after entry to the vein, pain levels and levels of phlebotomy satisfaction were assessed in individuals in all groups. A statistically significant difference was determined between the mean pain and phlebotomy satisfaction scores of individuals in the experimental and control groups (p < .05). Results indicate that use of the Buzzy device was an effective method of reducing the pain of phlebotomy and increasing phlebotomy satisfaction in healthy adult male blood donors.

Phlebotomy causes pain and discomfort to adults. The objective of this study was to investigate the effect of the use of Buzzy

Introduction Brucellosis is a public health problem that is prevalent in several developing countries. Methods The clinical and laboratory characteristics of 164 cases of brucellosis in Bursa, Turkey, were retrospectively evaluated. Results The ages of the 164 patients ranged from 15-85 years. All of the patients underwent the Rose Bengal test and 163 (99.4%) patients tested positive. 122 (74.4%) patients were diagnosed with acute brucellosis, 31 (18.9%) with subacute brucellosis and 11 (6.7%) with chronic brucellosis. Focal involvement was found in 101 (61.6%) patients. Although patients with focal involvement had a higher white blood cell count (p = 0.002), those without focal involvement had higher aspartate transaminase and alanine transaminase values, and lower platelet values (p = 0.005, 0.007 and 0.039, respectively). Spondylodiscitis was observed on imaging in 58 (66.7%) of the 87 patients who presented with back pain. Among the 118 patients who were examined within the first month of treatment, 79 (66.9%) responded to treatment. The relapse rate was 11.6% among all 164 patients. Conclusion Brucellosis should be considered as a differential diagnosis among patients who present with fever, and joint or back pain. Focal involvement should be investigated in the presence of leucocytosis, and subacute or chronic forms of brucellosis. To identify cases of spondylodiscitis, radiography should be performed in patients who present with back pain.

The aim of this study was to investigate the immunological alterations that occur during the storage of erythrocyte suspensions which may lead to transfusion-related immunomodulation following allogeneic blood transfusion.One part of the erythrocyte suspensions obtained from donors was leucoreduced while the other part was not. The leucoreduced (LR) and non-leucoreduced (NL) erythrocyte suspensions were then further divided into three equal amounts which were stored for 0, 21 or 42 days prior to measurements, by enzyme-linked immunosorbent assays, of cytokine levels in their supernatants. T-helper (Th) lymphocyte subgroups and gene expression were analysed in the NL erythrocyte suspensions by flow cytometry and real-time polymerase chain reaction, respectively. Results were compared to those of storage day 0.By day 21, the number of Th2 cells had increased significantly and the numbers of Th1, Th22 and Treg cells had decreased significantly in the NL erythrocyte suspensions. On day 42 the numbers of Th2 and Treg cells in the NL suspensions were significantly increased while the number of Th1 cells was significantly decreased. The levels of transcription factors (TBX21, GATA3, and SPI.1) were significantly decreased on days 21 and 42, and AHR, FOXP3 and RORC2 levels were significantly increased on day 42 in NL erythrocyte suspensions. The decrease in interleukin-22 and increase in transforming growth factor-β levels found in NL erythrocyte suspensions on day 21 were statistically significant. Elevated levels of interleukin-17A were found in both LR and NL erythrocyte suspensions on day 42.Our results suggest that allogeneic leucocytes and cytokines may play significant roles in the development of transfusion-related immunomodulation.

Introduction: There are only a few studies regarding community-acquired sepsis and its epidemiology. We aimed to evaluate the cases diagnosed as community-acquired sepsis and followed in our clinic. Patients and Methods: In this study, epidemiological and clinical features of 125 adult patients with community-acquired sepsis followed in our clinic during the period 1989-2005 were retrospectively evaluated. Results: The mean age was 52.7 years; 58 patients (46.4%) were male and 67 (53.6%) were female. Anatomic site of infections included urinary tract in 56 patients (45%), respiratory system in 23 (18%), intraabdominal in 12 (9.6%), and skin and soft tissue in 6 (5%). No anatomic site of infection was found in 28 (22.4%) patients. Of the blood culture isolates, 64% were gram-negative bacteria. In-hospital mortality was 30% in patients with sepsis. The mortality rate was found to be 4.25% in 47 patients with sepsis, while it was 35.9% in 78 patients with severe sepsis on admission (p< 0.001). Conclusion: New and large studies are needed to understand the epidemiology of community-acquired sepsis.

SUMMARYThe incidence of nosocomial candidaemia was evaluated in a retrospective study in a Turkish tertiary-care hospital. Over a 12-year period (1996–2007), a total of 743 episodes of candidaemia occurred in 743 patients, accounting for an average incidence of 1·9 episodes/1000 admissions and 2·9 episodes/10 000 patient-days per year. The annual incidence was almost constant during the study period except for 1996 when it was significantly higher in comparison with other years (PCandida albicans (45%), followed by C. parapsilosis (26%), C. tropicalis (7%), C. krusei (7%), and C. glabrata (3·5%). A significant increase in C. albicans isolates causing candidaemia linked to a decrease in C. parapsilosis isolates in adult patients and C. krusei isolates in children was found between the two 6-year study periods. This trend reflects improved infection control at Uludağ University Hospital. Ninety percent of isolates were susceptible to fluconazole (⩽8 μg/ml) and resistance was found only in C. glabrata and C. parapsilosis isolates. Regular local surveillance of Candida spp. is important in order to develop empirical treatment protocols to reduce the incidence and mortality of candidaemia.

We present a case of multiple intracranial abscesses caused by Cryptococcus neoformans in a patient who presented with no symptoms of immunodeficiency.

Introduction: The fever of unknown origin (FUO) cases are one of the main patient group of infectious diseases departments. The reason of FUO followed in our department were evaluated in this study. Patients and Methods: Thirty-eight cases (18 male, 20 female) of FUO seen in the Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Uludag University between January 2007 and January 2009 were analyzed retrospectively. The cases within a classic definition of FUO as established by Petersdorf and Beeson were included. Results: The average age of the patients was 51 ± 19 years (20-82). The mean duration of hospitalization was 20 ± 12 (7-63) days. In 32 (84.2%) patients, the diagnosis was established, while in 6 (15.8%) patients, the cause of fever could not be explained. The etiology was infectious in 19 (50%) patients, collagen vascular diseases in 6 (15.8%), and neoplasm in 6 (15.8%), and pulmonary embolism was diagnosed in 1 (2.6%) patient. The most common infectious diseases were brucellosis, infective endocarditis and atypical pneumonia. The most frequently performed invasive procedure was the aspiration and biopsy of bone marrow. Of the 38 patients, 8 (21%) died. Conclusion: Infectious diseases were the most common causes of FUO in our study as in other studies in our country; however, it is striking that there was no tuberculosis among our cases, which is in contrast to other studies.

Several genes encoding for different cytokines may play crucial roles in host susceptibility to Brucellosis, since the cytokine production capacity varies among individuals and depends on the cytokine gene polymorphism. The association of the cytokine gene polymorphisms with the development of Brucellosis was investigated in this study. DNA samples were obtained from a Turkish population of 40 patients with Brucellosis, and 50 healthy control subjects. All genotyping (IL-6, IL10, IFN-gamma, TGF-beta and TNF-alpha) experiments were performed using sequence-specific primers PCR (PCR-SSP). When compared to the healthy controls, the frequencies of high/intermediate producing genotypes of IL-10 and high producing genotype of IL-6 were significantly more common in the patient group. These results suggest that IL-10 and IL-6 gene polymorphisms may affect susceptibility to Brucellosis and increase risk of developing the disease. In order to confirm the biological significance of our results, further studies should be performed in larger population groups. (c) 2007 Published by Elsevier Ltd.

The diagnostic value of procalcitonin, C-reactive protein, tumor necrosis factor-alpha, and interleukin-10 levels in differentiating sepsis from severe sepsis and the prognostic value of these levels in predicting outcome were evaluated and compared in patients with community-acquired sepsis, severe sepsis, and septic shock in the first 72 h of admission to the hospital. Thirty-nine patients were included in the study. The severe sepsis and septic shock cases were combined in a single "severe sepsis" group, and all comparisons were made between the sepsis (n=21 patients) and the severe sepsis (n=18 patients) groups. Procalcitonin levels in the severe sepsis group were found to be significantly higher at all times of measurements within the first 72 h and were significantly higher at the 72nd hour in patients who died. Procalcitonin levels that remain elevated at the 72nd hour indicated a poor prognosis. C-reactive protein levels were not significantly different between the groups, nor were they indicative of prognosis. No significant differences in the levels of tumor necrosis factor-alpha were found between the sepsis and severe sepsis groups; however, levels were higher at the early stages (at admission and the 24th hour) in patients who died. Interleukin-10 levels were also higher in the severe sepsis group and significantly higher at all times of measurement in patients who died. When the diagnostic and prognostic values at admission were evaluated, procalcitonin and interleukin-10 levels were useful in discriminating between sepsis and severe sepsis, whereas tumor necrosis factor-alpha and interleukin-10 levels were useful in predicting which cases were likely to have a fatal outcome.

Antibiotic associated diarrhea may develop due to several causes. Here, we report the cases with diarrhea syndrome developed during the use of oral antibiotics for the treatment of community-acquired infections. Thirty hospitalized patients (15 male, 15 female) with bloody diarrhea were included in this study. The mean age was 40.8 years (range 16-85). Twenty-six of the cases had history of ampicillin/sulbactam usage before the onset of diarrhea, whereas remaning four cases mentioned use of amoxycilline/clavunate (2), azitromycine (1) or ampicillin/sulbactam + ornidazole (1). The time from onset of antibiotic use before the appearance of symptoms varied from 1 day to 8 days (median ± SEM, 3.73 ± 0.34 days). The frequencies of defecation were 3-9 times/day in six cases, 10-20 times/day in 15 cases and ≥ 20 times in nine cases. The presence of Clostridium difficile toxin in feces was assessed in 10 patients, and was weak positive in one patient. No enteric pathogen was isolated from feces culture. The diarrhea was regressed within two to six days (median ± SEM, 3.96 ± 0.18 days) after starting metronidazole (4 x 250 mg/day, oral, 10 days) treatment. In conclusion, cephalosporins and clindamycine, which are the most common causes of antibioticassociated colitis worldwide, were not responsible for the diarrheas observed in our cases. This may be due to the fact that ampicillin/sulbactam is commonly used for the treatment of community-acquired infections in our country.

The aim of this study was to determine and discuss the significance of fungemias developed at a tertiarycare university hospital in which almost all types of patients are followed up. Fungemia episodes, during five years period from January 1996 to December 2000 were emphasized. Approximately 24.000 patients per one year admitted to our hospital during the study period and fungemias developed among 285 of them. Candida species were responsible for 96% of episodes (275/285) and Trichosporon, Fusarium, Rhodotorula species were the other isolated fungi. There wasn’t any trend of increase or decrease with respect to the incidence of candidemia between the years but the highest ratio was significantly found at 1996 (p< 0.05). The mean value of ratio was 2.2 per 1000 admissions. Although Candida albicans was the species predominantly isolated, the total number of nonalbicans strains constituted 66% of all cases.

Background and objective: Acinetobacter baumannii and A. baumannii/calcoaceticus complex are commonly encountered pathogens in nosocomial infections. This study aimed to evaluate the treatment and prognostic risk factors in nosocomial pneumonia caused by these microorganisms. Methods: The study was conducted retrospectively in Uludag University Hospital and included 356 adult non-neutropenic patients with nosocomial pneumonia. Results: Of the subjects, 94.9% (n = 338) had ventilator-associated pneumonia. The clinical response rate was 57.2%, the 14-day mortality 39.6% and the 30-day mortality 53.1%. The significant independent risk factors for the 30-day mortality were severe sepsis (OR, 2.60; 95% CI: 1.49-4.56; P = 0.001), septic shock (OR, 6.12; 95% CI: 2.75-13.64; P < 0.001), APACHE II score >= 20 (OR, 2.12; 95% CI: 1.28-3.50; P = 0.003) and empiric monotherapy (OR, 1.63; 95% CI: 1.00-2.64; P = 0.048). Multi-trauma (OR, 2.50; 95% CI: 1.11-5.68; P = 0.028) was found to be a protective factor. In patients with a clinical pulmonary infection score (CPIS) > 6 on the third day of treatment, both the 14- and 30-day mortality rates were high (P < 0.001, P < 0.001). Also, the 14- and 30-day mortality rates were significantly higher in the patients treated with empiric monotherapy compared with combination therapy (48/93 (51.6%)-46/123 (37.4%), P = 0.037 and 62/93 (66.7%)-65/123 (52.8%), P = 0.041, respectively) in pneumonia caused by imipenem-resistant strains. Conclusion: Mortality rates were high in pneumonia caused by imipenem-resistant A. baumannii or A. baumannii/calcoaceticus complex. In the units with a high level of carbapenem resistance, antibiotic combinations should be considered for empiric therapy.

Pancytopenia associated with EBV is a rare complication. In this study, a case of infectious mononucleosis with pancytopenia that is resolved spontaneously was reported.

WOS: 000340538700017, PubMed ID: 24789652, The aim of this study was to assess the infectious diseases (ID) wards of tertiary hospitals in France and Turkey for technical capacity, infection control, characteristics of patients, infections, infecting organisms, and therapeutic approaches. This cross-sectional study was carried out on a single day on one of the weekdays of June 17-21, 2013. Overall, 36 ID departments from Turkey (n = 21) and France (n = 15) were involved. On the study day, 273 patients were hospitalized in Turkish and 324 patients were followed in French ID departments. The numbers of patients and beds in the hospitals, and presence of an intensive care unit (ICU) room in the ID ward was not different in both France and Turkey. Bed occupancy in the ID ward, single rooms, and negative pressure rooms were significantly higher in France. The presence of a laboratory inside the ID ward was more common in Turkish ID wards. The configuration of infection control committees, and their qualifications and surveillance types were quite similar in both countries. Although differences existed based on epidemiology, the distribution of infections were uniform on both sides. In Turkey, anti-Gram-positive agents, carbapenems, and tigecycline, and in France, cephalosporins, penicillins, aminoglycosides, and metronidazole were more frequently preferred. Enteric Gram-negatives and hepatitis B and C were more frequent in Turkey, while human immunodeficiency virus (HIV) and streptococci were more common in France (p < 0.05 for all significances). Various differences and similarities existed in France and Turkey in the ID wards. However, the current scene is that ID are managed with high standards in both countries.

BACKGROUND In this study, our aim was to identify the validity of the prophylaxis indications for patients who received tetanus prophylaxis, determine the ratio of high-risk wounds to the number of patients with immunity, and to evaluate the tetanus immunity of specific age groups. METHODS Patients who applied to the Emergency Department (ED) between September 2009 and May 2010 and who were considered for tetanus prophylaxis by his/her primary care physician were included in the study. RESULTS A total of 320 patients were evaluated. The average age of the patients was 40.87 +/- 15.83 years. A total of 73.1% of the patients were male and 26.8% were female. A total of 40.3% of the patients knew their vaccination history, while 59.7% had no recollection of their vaccination history. 14.7% of the patients had received their last dose within 5 years and 48.1% within 5-10 years; 37.2% of the patients declared that more 10 years had passed since their last vaccination. In 75% of the patients, the tetanus immunoglobulin (Ig)G level was identified as >= 0.1 IU/ml, while 25% of the patients had levels

This study was designed to determine the prevalence of intestinal parasites in relation to personal and environmental risk factors in Bursa province of Turkey and to compare wet mount + Lugol's iodine, formalin ethyl acetate concentration, trichrome staining and enzyme-linked immunosorbent assays (ELISA) methods used inEntamoeba histolytica/ Entamoeba dispar diagnosis. For this purpose a total of 176 faecal samples from people were randomly collected from regions of the Bursa City Centre, where crowded families of low socio-economic levels reside. All faecal samples were examined by wet mount + Lugol's iodine formalin ethyl acetate concentration, trichrome staining methods and ELISA. 66 faecal samples were infected with one or more parasite species and the overall prevalence rate was 37.5%. Nine species of intestinal parasites, including six protozoon and three helminth species were found. The most prevalent species was Blastocystis hominis (17.04%) and others were found with the following frequencies: 9.09% Enterobius vermicularis, 7.38% Giardia intestinalis, 5.68% Entamoeba coli, 2.27% E. histolytica/E.dispar, 1.13 % Entamoeba hartmani, 1.13% Taenia spp., 0.56% Hymenolepis nana. 6.2% of examined samples had mixed infections. Overall prevalence of the detected parasites did not differ significantly in different demographic groups. Except for B. hominis andG. intestinalis, there was no evidence for sex, age and other demographic-related differences in the prevalence of these parasites. Statistically, B. hominis and G. intestinalis were higher in 20 to 49 and in 1 to 19 year age groups, respectively than in any other age group. Microscopical examination and ELISA revealed that one sample (0.5%) was found to be positive using all 4 methods, and 162 samples (92%) were found to be negative with all 4 methods applied. E. histolytica/E. dispar complex was detected in 0.56% (1); in 0.56% (1), in 0.56% (1) and in 2.27% (4) of the fecal samples examined by wet mount + Lugol's iodine, formalin ethyl acetate concentration, with trichrome staining, and ELISA respectively. The wet mount + Lugol's iodine, formalin ethyl acetate and trichrome staining methods had a sensitivity of 25% each, a specificity of 94.1, 99.4 and 98.2%, compared to the results of the E. histolytica/E. dispar ELISA, respectively. Key words: Entamoeba histolytica/ Entamoeba dispar, enzyme-linked immunosorbent assays (ELISA), intestinal parasites, microscopy, prevalence.

Because of high morbidity of the brucellosis in humans and the potential use of the microorganism as an agent of biologic warfare, protection of effective vaccines and specific diagnostic reagents become necessary to eradicate brucellosis.In this study we aimed to investigate the cytokine responses and changes in peripheral blood lymphocyte subgroups of acute brucellosis patients in response to L7/L12 and glyceraldehyde 3-phosphate dehydrogenase (GAPDH) recombinant proteins derived from Brucella abortus.levels of IFN-γ, IL-4 and IL-10 secreted from PBMCs of 25 acute brucellosis patients and 15 healthy controls, stimulated with Phytohemagglutinin (PHA), L7/L12 or GAPDH were measured by ELISA. Furthermore alterations in lymphocyte subgroups in response to these Brucella antigens were determined by flow cytometry.Extracellular IFN-γ levels were found to be elevated after stimulation with L7/L12 in patients with acute brucellosis, whereas no significant changes were found in IL-4 and IL-10 levels. Similar data was also obtained with GAPDH, but the stimulation of IFN-γ production was not observed in all patients and was not as strong as that observed for L7/L12. Moreover, when the distribution of lymphocytes subgroups (CD3+, CD3+ CD4+, CD3+ CD8+, CD4+ CD25+, CD3+ CD69+ and CD3+ CD152+) was evaluated, it was found that the stimulation with L7/L12 and GAPDH only led to an increase in the percentage of CD3+ CD69+ lymphocytes.These data indicate that Brucella abortus L7/L12 or GAPDH induce a Th1 type immune response in acute brucellosis patients. Additionally, these recombinant proteins, especially L7/L12, may be used in new vaccine preparations and diagnostic tests.

Despite the decrease in transfusion-transmitted hepatitis B virus (HBV), it is still one of the main problems in transfusion medicine. Recent studies have shown that HBV is transmissible to recipients from HBsAg negative donations. This study was aimed to detect anti-HBc, anti-HBs and HBV-DNA positivity in HBsAg negative cases and to determine whether a reconsideration is required for HBV screening policies in blood banking. In this study, anti-HBs and anti-HBc total was investigated in 9282 HBsAg negative donor samples by commercial ELISA (Orto-Clinical Diagnostics, Vitros, Brazil) system and HBV-DNA by real-time PCR method (QIAGEN, Artus 3000, Germany). In 9282 HBsAg negative samples, anti-HBc positivity rate was 18% (1679/9282). Anti-HBs negativity was detected in 15% (n=225) of these anti-HBc positive sera. Among the isolated anti-HBc positive (HBsAg negative, anti-HBc positive, anti-HBs negative) 225 serum samples 218 were investigated for HBV-DNA presence and one sample was found to be positive (0.45%). When the samples not tested due to insufficient serum amount were excluded, the total rate of isolated anti-HBc positivity in the study region was 2.5% (225/9107) and HBV-DNA positivity in the HBsAg negative group was 0.011% (1/9100). The annual number of blood donations in our center was about 21.000, thus the rate of HBV transmission from HBsAg negative donors could be estimated as 2.3 patients/year. Although the rate of HBV transmission due to HBV-DNA positivity among HBsAg negative blood donors is low, this risk should always be kept in mind in transfusion medicine.

Background Clostridium difficile (C. difficile) is a well-established cause of nosocomial diarrhea. The aim of our study was to define the incidence of nosocomial diarrhea in our hospital and to determine the role of C. difficile. Additionally, the risk factors for nosocomial diarrhea and Clostridium difficile associated diarrhea (CDAD) were investigated. Methods We included all patients, 18 years of age or more, who were admitted to the Uludag Teaching Hospital between October 1, 2004 and February 1, 2005, and developed diarrhea at least three days after hospital admission. A case-control study was performed. Results The total incidence of nosocomial diarrhea was 0.6 per 1,000 hospitalization-days and 5 per 1,000 patients’ admissions. Previous use of chemotherapy was found to be an important predisposing factor for nosocomial diarrhea. The incidence of CDAD was 0.26 per 1,000 hospitalization-days and 2.1 per 1,000 admissions, comparable with incidence rates in Europe. CDAD was diagnosed in 43% of patients with nosocomial diarrhea. No severe cases of CDAD were diagnosed. A correlation was found between CDAD and antibiotic use before admission and during admission in univariate analysis. PCR ribotyping revealed four strains of PCR ribotype 002 and 1 strain of ribotype 012 out of 5 C. difficile strains available for extensive identification. Conclusion The incidence rates of nosocomial diarrhea and CDAD are not different than the usual incidence rates in Europe. C. difficile was the causative agent in 43% of patients with nosocomial diarrhea.

Objectives: Mediterranean spotted fever (MSF) is an acute febrile, zoonotic disease caused by Rickettsia conorii and endemic infectious disease in Mediterranean countries. Patients and Methods: In this study, a retrospective examination of 16 cases (4 females, 12 males; mean age 38.9±13.0; range 18 to 64 years) that were diagnosed with rickettsioses between 1987-2007 was performed. Diagnosis of MSF was based upon epidemiological and clinical features, indirect immunofluorescence antibody (IFA), as well as response to doxycycline therapy. Results: High fever and maculopapular rash were present in all cases. Palmar and plantar rash were evident in 13 (81.3%) and eschar in eight (50%) cases. All cases responded to treatment within 2±0.9 days, and no death was observed. Conclusion: Mediterranean spotted fever should be considered in the differential diagnosis of all patients admitting with fever, maculopapular rash, headache and/or musclejoint pain during spring, summer and autumn. Amaç: Rickettsia conorii'nin neden olduğu Akdeniz benekli ateşi (ABA), Akdeniz ülkelerinde akut, endemik, zoonotik bir enfeksiyon hastalığıdır. Bu hastalık ülkemiz için endemik olduğundan sunmayı amaçladık. Hastalar ve Yöntemler: Bu çalışmada, 1987-2007 yılları arasında riketsiyoz tanısı alan 16 olgu (4 kadın, 12 erkek; ort. yaş 38.9±13.0; dağılım 18-64) retrospektif olarak incelendi. Akdeniz benekli ateşi tanısı epidemiyolojik özellikleri, indirekt floresan antikor testi (IFA), hastaların klinik bulguları ve doksisiklin tedavisine verdikleri yanıta göre kondu. Bulgular: Olguların tümünde ateş yüksekliği, makülopapüler döküntü tespit edildi. On üç (%81.3) olguda avuç içi ve ayak tabanında döküntü; sekiz olguda (%50) eskar tespit edildi. Tedaviye yanıt 2±0.9 günde gelişti ve tüm olgularda tedaviye yanıt alındı. Sonuç: İlkbahar, yaz ve sonbahar aylarında, ateş, makülopapüler döküntü, baş ağrısı ve/ veya kas-eklem ağrısı yakınmalarıyla başvuran olgularda ayırıcı tanıda mutlaka ABA düşünülmelidir., Amaç: Rickettsia conorii’nin neden olduğu Akdeniz benekli ateşi (ABA), Akdeniz ülkelerinde akut, endemik, zoonotik bir enfeksiyon hastalığıdır. Bu hastalık ülkemiz için endemik olduğundan sunmayı amaçladık. Hastalar ve Yöntemler: Bu çalışmada, 1987-2007 yılları arasında riketsiyoz tanısı alan 16 olgu (4 kadın, 12 erkek; ort. yaş 38.9±13.0; dağılım 18-64) retrospektif olarak incelendi. Akdeniz benekli ateşi tanısı epidemiyolojik özellikleri, indirekt floresan antikor testi (IFA), hastaların klinik bulguları ve doksisiklin tedavisine verdikleri yanıta göre kondu. Bulgular: Olguların tümünde ateş yüksekliği, makülopapüler döküntü tespit edildi. On üç (%81.3) olguda avuç içi ve ayak tabanında döküntü; sekiz olguda (%50) eskar tespit edildi. Tedaviye yanıt 2±0.9 günde gelişti ve tüm olgularda tedaviye yanıt alındı. Sonuç: İlkbahar, yaz ve sonbahar aylarında, ateş, makülopapüler döküntü, baş ağrısı ve/ veya kas-eklem ağrısı yakınmalarıyla başvuran olgularda ayırıcı tanıda mutlaka ABA düşünülmelidir.

We investigated the risk factors for community acquired/onset urinary tract infections due to extended spectrum beta-lactamase (ESBL)-positive Escherichia coli or Klebsiella pneumoniae in 62 patients who were followed-up from August 1, 2003 to September 1, 2006. Sixty patients with community-acquired urinary tract infections caused by ESBL-negative E. coli or K. pneumoniae who were followed-up during the same dates were included as a control group. Age (or =65 or65 years old), sex, bladder cancer, benign prostate hypertrophy (BPH), prostate cancer, urolithiasis, urethral catheter, previous urological operation, diabetes mellitus, use of antibiotics during the last 3 months and hospitalization during the last 3 months were investigated as risk factors. The presence of previous urological operation and quinolone or cephalosporin use for any infection during the last 3 months were found to be independent risk factors. Knowing the risk factors for community acquired/onset urinary tract infections caused by ESBL-positive E. coli or K. pneumoniae is of great importance in planning empirical antibiotic therapy.

In this study, the clinical and laboratory features of 26 infectious mononucleosis (IMN) cases who have been diagnosed between the years of 1984-2005 were evaluated retrospectively. The mean age of the patients was 26+/-11 years, the rate of being hospitalized was 65%, and mean hospitalization period was 9.2+/-6 days. Fever (81%), weakness (50%), sore throat (50%), headache (50%) and swollen neck (35%) were the most common symptoms, while in the physical examination cervical lymphadenopathy (81%), splenomegaly (69%), hyperemic pharynx (65%), hepatomegaly (54%) and tonsillitis (50%) were observed. Laboratory results yielded leukocytosis in 21%, leucopenia in 12%, anemia in 44%, thrombocytopenia in 5% and elevated transaminase levels in 84% of the patients. Of the patients 15 (57.7%) had the history of using antibiotics before the diagnosis. Serological diagnosis was performed by Paul-Bunnel test and/or IgM positivity against Epstein-Barr virus (EBV) viral capsid antigen (VCA). Tonsillo-pharyngitis secondary to edema and respiratory distress due to lymphadenopathy pressure were detected in four patients, whereas pancytopenia was established only in one patient, as complications. This study emphasized that, although IMN is a self-limited infection, the diagnostic difficulties may arise when the clinical course is atypical, and rarely seen life-threatening complications may also develop during IMN course.

In this study, 21 HIV/AIDS cases (18 male, 3 female; age range 17-64 years), followed up in the Department of Infectious Diseases of Uludag University Medical Faculty between 1997-2003 have been analyzed retrospectively, by means of epidemiological, clinical and laboratory aspects. Nineteen (90%) of them were heterosexual, and in 9 cases the diagnosis was coincidental during the blood donations or routine testing. The non-compliance rate of patients to antiretroviral treatment was found as 76%, and the most important factor for non-compliance was the difficulty in providing antiretroviral drugs. The most frequently encountered opportunistic infections were oropharyngeal candidiasis (n:5), herpes zoster (n:4) and community acquired pneumonia (n:4).

Lipid lowering therapy with statins is beneficial because of improvement in lipoprotein concentrations and additional pleiotropic effects. However, less is known about the pleotropic effect of fibrates.To investigate the effects of fenofibrate therapy on inflammatory markers and serum paraoxonase activity in patients with combined hyperlipidemia in addition to their lipid lowering effects.Fifty patients (18 women, 32 men, mean age 50+/-8.7 years) with a history of combined hyperlipidemia and coronary artery disease were enrolled into the study. Serum lipids, inflammatory markers (high sensitivity C-reactive protein (hs-CRP) and fibrinogen levels) and paraoxonase levels were determined before and after two months of 250 mg per day of fenofibrate treatment.Fenofibrate decreased plasma fibrinogen level by 41% (from 3.9+/-0.9 mg/dl to 2.3+/-0.48 mg/dl, p0.0001) and hs-CRP level by 71% (from 1.28 mg/dl to 0.36 mg/dl; p0.0001). Changes in hs-CRP levels were not correlated with the changes in lipid levels. Compared with baseline, serum paraoxonase level was significantly increased after fenofibrate treatment (from 200+/-77U/L to 232+/-82U/L; p0.001). We found a significant correlation between changes in HDL cholesterol and paraoxonase activity after two months of treatment (r=0.46, p=0.018).This study demonstrates that beyond improving lipids and lipoprotein levels, fenofibrate treatment increases paraoxonase activity and decreases inflammatory markers in patients with combined hyperlipidemia.

Since wound infection rates in patients with delayed admission seemed to be significantly higher, a retrospective study of bacteriology in 320 burn patients, over a 5-year period was carried out in order to analyze the relation between delayed admission and wound infection rates in our Burn unit of Uludağ University, Faculty of Medicine.The patients were separated into moderate or major burn groups according to burn severity. Wound infection and contamination frequencies were analyzed according to time-delay between burn injury and hospitalization time.Delayed admission was found to be an important factor that causes an increase in wound infection and contamination frequency. This increase was significant especially among patients with moderate burn wounds. In patients with severe burns, wound infection and contamination frequencies were found to be higher for all admission time points.Systemic antibiotic prophylaxis should be discussed in patients with moderate burns whose admission-delay is more than 78 hours. Wound infection and contamination rates were high in patients with major burns independent of the admission time. Therefore, systemic antibiotic prophylaxis should also be discussed in this group of patients, although it results in elimination of the normal skin flora.

Sir, The main route of human trichinosis is eating raw or undercooked pork, but there are also reports of some cases and outbreaks caused by wild boar, horse, dog, cougar, walrus, badger meat, etc., in the literature. Trichinosis is extremely rare in Turkey, because eating pork is prohibited in Islam and consumption of wild game meat is uncommon. Not to be considered in differential diagnosis may cause delays in the diagnosis and the treatment. Here we present an index case and a number of related cases which could only be diagnosed after the patient’s friends had similar complaints and explained that they had eaten wild boar meat all together. CASE REPORT

Objective - Inflammation plays a major role in the pathogenesis of atherosclerosis. Obesity is an independent risk factor for cardiovascular disease, which may be mediated by increased secretion of proinflammatory cytokines by adipose tissue. The aim of this study is to investigate changes in the inflammatory markers interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) during weight reduction with orlistat treatment in obese patients. Methods and results - Thirty-six obese (BMI: 36.1 +/- 3.4 kg/m(2)) and II non-obese (BMI: 22.9 +/- 1.7 kg/m(2)) subjects were studied. IL-6 and hs-CRP levels were evaluated at baseline. In obese subjects after treatment of orlistat 120 mg three times daily for 6 months, IL-6 and hs-CRP levels were repeated. Levels of circulating IL-6 (p < 0.05) and hs-CRP (p < 0.01) were significantly higher in the obese group than in the non-obese group. Plasma IL-6 (r = 0.29 and p < 0.05) and CRP (r = 0.35 and p < 0.05) concentrations correlated positively with the level of obesity assessed by BMI at baseline. After 6 months of orlistat treatment in obese subjects, the mean weight of the patients decreased by 6.8 kg, the BMI by 3.2 kg/m(2). Compared with baseline, weight loss was associated with significant reductions of IL-6 (p < 0.001) and hs-CRP (p < 0.001) levels. Conclusion - In summary plasma IL-6 and hs-CRP levels were increased in obese patients. Orlistat-induced weight reduction was associated with decreasing levels of both IL-6 and hs-CRP in obese subjects. Because inflammatory mediators may be directly involved in atherogenesis, this would suggest that interventions to reduce IL-6 and CRP levels could be cardioprotective.

Objective: Brucellar spondylitis is one of the most serious complications of brucellosis. It should be considered in patients who have back pain and neurologic disorders as well as systemic symptoms and findings in or from endemic areas such as Turkey. This report describes important features of the disease. Methods: Twenty-five patients with brucellar spordylitis were retrospectively evaluated in terms of their clinical, laboratory, and radiologic features and their response to different treatment regimens. Results: The most common symptoms of brucellar spondylitis were back pain, fever, and sweating. Rose Bengal tests were positive in all of these patients. Brucella species was isolated from blood cultures of 8 (32%) patients. Magnetic resonance imaging (MRI) showed that the lumbar segment was the most frequently involved region. Different combination regimens including 2 or 3 antibiotics were used. Combination of tetracycline (especially doxycycline) and streptomycin was the most widely used therapy regimen. Trimethoprim-sulfamethoxazole, ciprofloxacin, ofloxacin, and rifampin were also included in some combination therapies. In this series, the mean duration of antimicrobial therapy was 130 +/- 45.6 days (range, 77-281 days), and 92% of patients received therapy for greater than or equal to 90 days. There were no mortalities in this study. Conclusions: Brucellar spondylitis should be considered in patients with back pain and neurologic disorders as well as systemic symptoms and findings in endemic areas. MR imaging is recommended in suspected cases. The patients can be treated effectively treated with appropriate antibiotic combinations. Follow up is important because relapses can occur.

PURPOSE. To evaluate the effect of anterior chamber continuous infusion maintainer system on the contamination of anterior chamber in phacoemulsification surgery. METHODS. Clear corneal phacoemulsification surgery was performed in 132 eyes of 132 randomly selected patients with cataract who were divided into two groups of 66 eyes according to the use of an anterior chamber maintainer (ACM) system. The fluid specimens were taken from anterior chamber in the beginning and at the end of the surgery. They were transferred under anaerobic conditions and investigated by culturing onto blood agar and thiogluconate broth media. Differences between the two groups with respect to contamination of the specimens were investigated. RESULTS. The mean age of the group undergoing surgery without a maintainer system (Group A) was 63 +/- 10 years (min = 41, max = 80) versus 59 +/- 10 years (min = 33, max = 80) in the other group (Group B) in which the maintainer was used during surgery. In the postoperative specimen, Micrococcus species were isolated from one eye (1.5%) in Group A and S. pyogenes in one eye (1.5%) from Group B. Mean follow-up interval was 12 +/- 6 (min = 4, max 28) months. CONCLUSIONS. The use of ACM system in clear corneal phacoemulsification surgery carries no additional risks as far as contamination is concerned.