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To evaluate the retinal and choroidal microvascular blood flow in patients with human immunodeficiency virus (HIV) infection using optical coherence tomography angiography (OCTA).Macular OCTA parameters including vessel density (VD) of parafoveal superficial capillary plexus (SCP-VD) and deep capillary plexus (DCP-VD), foveal vessel density (FD), foveal avascular zone area, and flow area of choriocapillaris were analyzed in 42 HIV-positive patients, and compared with 42 healthy controls.The mean SCP-VD, DCP-VD and FD were significantly lower in HIV-positive group compared with controls (p .001, p = .014, p = .026; respectively). Reduced SCP-VD was associated with higher HIV RNA plasma level (r = -0.400, p = .021) and lower CD4 + T cell count (r = 0.314, p = .046) in HIV-positive patients.Macular microvascular blood flow is affected by HIV infection. OCTA can detect microvascular flow abnormalities in retinal capillary plexus in HIV-positive patients.

Background: In chronic hepatitis B patients with or exposed to the risk of osteoporosis or renal dysfunction, switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide fumarate (TAF) or entecavir (ETV) may be the right choice. Objectives: This study aimed to present real-life data in terms of the efficacy and safety of a TAF/ETV treatment change while receiving TDF. Methods: This retrospective study was conducted on 344 adult patients from 10 centers. The data of patients who had changed to ETV (n = 107) and TAF (n = 237) while receiving TDF were analyzed. The data collected at 0 and 6 months of treatment were analyzed. The virological response was assessed based on undetected hepatitis B virus (HBV) DNA. Serum alanine aminotransferase (ALT) values were used to evaluate the biochemical response. For renal function, serum creatinine and phosphorus, as well as estimated glomerular filtration rate (eGFR), were recorded. Moreover, lumbar spine and hip T-scores along with the serum lipid profile were evaluated. Results: The mean age of patients was 41.14 ± 13.46 years, and 224 (65.1%) of the participants were male. The treatment arms were not significantly different in terms of demographic characteristics, comorbid diseases, infection duration, family history of HBV infection, blood platelet count, serum biomarkers, such as ALT, phosphorus, creatinine, total bilirubin, albumin, lipid profile, and HBV DNA levels at the beginning. No statistically significant difference was found between the proportion of undetectable HBV DNA of the two treatment groups after 6 months (P = 0.221). The ALT normalization in the ETV and TAF groups at the sixth month compared to the baseline levels was not significantly different (P = 0.853, P = 0.330, respectively). There was no statistically significant difference between the two treatment arms regarding changes in eGFR, creatinine, phosphorus, hip, and spine T-scores from baseline to 6 months (P = 0.296, P = 0.78, P = 0.141, P = 0.832, P = 0.947, respectively). In those who switched to TAF or ETV, low-density lipoproteins cholesterol were observed to be significantly higher after 6 months compared to baseline values (P = 0.002, P = 0.049, respectively). The TC increased significantly in the TAF group (P = 0.035). Conclusions: Our study showed that switching to ETV and TAF sustained the viral suppression and biochemical response achieved by TDF therapy. The treatment switch to TAF of ETV can control renal dysfunction and reduce bone mineral density caused by TDF.

This study aimed to identify the agents causing community-acquired urinary tract infections (CAUTIs) and their resistance patterns and to investigate risk factors for ESBL production.Patients diagnosed at the Department of Infectious Diseases in the Cukurova University School of Medicine Hospital with CAUTI between January 2006 and April 2007 were included prospectively. Patient data were recorded and the microorganisms and their sensitivity patterns were evaluated by the university's central microbiology laboratory.A total 146 patients with CAUTIs, 109 women and 37 men (mean age: 50.9+/-18.44 years), were included in the study. The most common infectious agents were Escherichia coli (76.9%), Klebsiella pneumoniae (9.2%), Proteus mirabilis (4.1%), and Enterococcus spp. (1.6%). The ciprofloxacin resistance rate for E. coli was 35% and resistance to TMP-SMZ 43%, whereas amikacin resistance was substantially low (3%). Four of 12 K. pneumoniae strains were resistant to ciprofloxacin and 2 to TMP-SMZ. Resistance to amikacin was not found in the K. pneumoniae strains. ESBL production was identified in 25 of the 112 E. coli and K. pneumoniae strains. A history of a UTI within the last 6 months (p=0.029) and a history of frequent UTI (p=0.028) were found to be significant risk factors for ESBL production by univariate analysis. The only independent risk factor was a history of urinary system infection in the past 6 months (p=0.025) according to multivariate regression analysis.These high resistance rates to antimicrobials and particularly the extremely high rate of ESBL production in CAUTI should be carefully considered.

To report the incidence of healthcare-associated infections (HAIs), site of infection and bacterial epidemiology in the Neonatal Intensive Care Unit in a university hospital in Adana, Turkey, between 2001 and 2006.During these years, HAIs were collected by an active surveillance system.Five hundred one of 2832 infants hospitalised more than 72 h had 1124 HAI. The HAI incidence and incidence density ranged between 14.1 and 29.7 infections/100 patients, and 10.9-17.3 infections/1000 patient days within the study period; 61.5% of HAIs were ventilator-associated infections; 26.2% were bloodstream infections; 3.5% were urinary tract infections; 3.5% were necrotising enterocolitis (Stages II and III) and 1.4% was meningitis. The most frequent pathogens were gram-negative pathogens (75.6% of all infections) followed by gram-positive micro-organisms (21.4%) and Candida species (3.0%). Birthweight, gestational age and Apgar scores were lower and overall mortality rate (32.9% vs. 19.7%) and number of inpatient days were higher in patients with HAIs (for all P0.001) when compared with those who did not have HAIs. Furthermore, HAI rate was inversely related to birthweight (P0.001).In this study, the overall infection rate is high compared with developed countries and predominant micro-organisms are gram-negative enteric rods. These results strongly suggest the need for improving measures for prevention and control of HAIs in this hospital.

The aim of this study is to determine the resistance patterns of bacteria causing nosocomial infections. The outcome of this resistance was followed for 3 years.This study was carried out during 2000 to 2002 at a university hospital in Turkey. The resistance patterns of 570 bacteria (390 Gram-negative, 180 Gram-positive) against meropenem, imipenem, ceftazidime, cefotaxime, cefepime, piperacillin/tazobactam, ciprofloxacin and tobramycin were investigated using the E-test. Extended-spectrum beta-lactamase (ESBL) production was determined using ceftazidime and ceftazidime/clavulanic acid E-test strips.Meropenem was the most effective antibiotic against Gram-negative organisms (89.0%); this was followed by imipenem (87.2%) and piperacillin/tazobactam (66.4%). The most active antibiotic against Gram-positive bacteria was imipenem (87.2%) and this was followed by piperacillin/tazobactam (81.7%) and meropenem (77.8%). The rates of production of ESBL by Escherichia coli were 20.9%, Klebsiella pneumoniae 50% and Serratia marcescens were 46.7%. Extended-spectrum beta-lactamase production increased each year (21.7%, 22.1% and 45.5%). All of the ESBL producing isolates were sensitive to meropenem and 98.5% sensitive to imipenem. AmpC beta-lactamase was produced by 20.9% of the Enterobacter species spp, Citrobacter spp. and Serratia marcescens. All of these were sensitive to meropenem and 77.8% to imipenem and ciprofloxacin. Multi-drug resistance rates in Acinetobacter spp were 45.4% and 37.7% in Pseudomonas aeruginosa isolates.As in the entire world, resistance to antibiotics is a serious problem in our country. Solving of this problem depends primarily on prevention of the development of resistance.

The aim of this study was to compare the efficacy, tolerability and side effects of 2 treatment regimens for brucellosis.Fifty-seven patients with brucellosis were followed up in our clinic. The patients were given rifampicin plus doxycycline or rifampicin plus quinolone. Thirty patients (group one) received rifampicin 600mg/daily plus doxycycline 100mg twice daily and 27 patients (group 2) received quinolones (ofloxacin 200mg twice daily peroral) plus rifampicin 600mg/daily. Both regimens were administered for 45-days. During the course of treatment, patients were followed for the disappearance of physical signs and symptoms. All patients were followed up at least 6-months after cessation of therapy. Diagnosis of brucellosis was established by utilizing the following criteria; Isolation of brucella species in blood, body fluids (Sceptor, Becton-Dickinson, United States of America), compatible clinical picture supported by the detection of specific antibodies at significant titers or demonstration, or both, of an at least 4 fold rise in antibody titer in serum specimens taken after 2-weeks. Significant titer was determined to beone/160 in the standart tube agglutination test (Brucella abortus Cromatest, Linear Chemicals, Spain).Of patients 14 (24.5%) were male and 43 (75.5%) were female. Mean age was 36.8 11.3 years (range 15-65). Sacroiliitis was the most common involvement in both groups 9 (30%) versus 6 (22%), followed by peripheral arthritis 6 (20%) versus 6 (22%). In this study, relapse rate was found 7.2% and 6.7% for ofloxacin plus rifampicin and doxycycline plus rifampicin for a 6-week therapy (p0.05). No significant adverse effects were associated with either combination.These results indicated that a 45-day course of doxycycline plus ofloxacin combination was as effective as the doxycycline plus rifampicin combination in patients with brucellosis.