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Objective: Skull base osteomyelitis (SBO) is a rare, life-threatening infection and frequently followed and treated by otolaryngologists previously. In this study, we analyzed the diagnosis, treatment and long-term outcomes of SBO from the perspective of infectious diseases and clinical microbiology (IDCM). Methods: Hospitalized patients with SBO between 2012-2019 were evaluated retrospectively. Epidemiological, clinical, laboratory data of the patients were recorded. The patients who recovered with and without sequelae were compared. Results: The mean age of 16 SBO cases was 66 years, 75% of them were male and 87.5% had diabetes mellitus (DM). Cranial nerve and vascular/dural involvement were present in 75% and 56.3% of them, respectively. The most common isolated microorganism were P. aeruginosa, staphylococci and Candida spp. 81.2%, 43.7%, and 56% of the patients received anti-pseudomonal antibiotics, additional glycopeptide and additional antifungal drugs, respectively. The sequelae rate was 46.7% in a 24-month follow-up. Hypertension (p=0.041), duration of complaints (p=0.003), bilateral involvement of skull base (p=0.001), vascular thrombosis/inflammation or dural involvement (p=0.007), previous surgical intervention (p=0.041) and elevated ESR at the end of treatment (p=0.014) were defined as risk factors for permanent sequelae. There was no in-hospital mortality. Conclusions: SBO mainly affects older male patients with DM and causes significant sequelae in half of them. In the cases unresponsive to anti-pseudomonal agents, the addition of antifungal therapy empirically may provide a clinical response. Permanent sequelae are more common in cases with delayed diagnosis/treatment, bilateral, vascular or dural involvement, and elevated ESR at the end of treatment. ESR can be used to determine the treatment response and duration. The follow-up and treatment of SBO cases by IDCM with the support of experienced surgeons may contribute to the positive clinical results. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the comorbidities, antiretroviral therapy (ART) switches, and drug side-effects in HIV-infected patients who were followed in the Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University. Methods: This study was designed as a retrospective cohort study. Files of HIV-infected patients admitted to the outpatient clinic between years 2002 and 2018 were evaluated. Among them, 210 patients over 18 years of age, whose HIV/AIDS diagnosis was confirmed with ELISA and Western Blot test, without loss to follow up longer than six months, and using ART for at least 6 months were included in the study. Their demographic and clinical features, laboratory results, initial ART regimen, and its side-effects, reasons for ART switches, and subsequent ART regimen were recorded. Results: 165 (78.5%) out of 210 patients were men, and 45 (21.4%) patients were women. Mean age of the patients was 40.4±12.373. 152 (72.4%) patients identified themselves as heterosexual, and 39 (18.6%) were men who had sex with men. Comorbidities of patients during their follow-up were hyperlipidemia in 42 (20%), hypertension in 22 (10.4%), cardiovascular disease in 13 (6.1%), type 2 diabetes mellitus in 12 (5.7%), renal dysfunction in 9 (3.8%), osteopenia/osteoporosis in 8 (3.8%) patients. Although two most common regimens in the first step therapy were tenofovir disoproxil fumarate/emtricitabine + lopinavir/ritonavir, and tenofovir disoproxil fumarate/ emtricitabine + elvitegravir/cobisistate, the second step therapy was detected as an interchange in the order of these two regimens. ART switch was detected in 71 (33.8%) patients. Leading reasons of ART switch were intolerance/toxicity in 22 (30.9%) patients, and simplification of regimen in 19 (26.7%) patients. Frequency of disorders developed after ART were 5 (2.3%) diabetes mellitus, 4 (1.9%) renal diseases, 5 (2.3%) cardiovascular events, 4 (1.9%) osteopenia, and 4 (1.9%) osteoporosis. Conclusions: HIV infection is controlled with ART and life expectancy is prolonged. Patients must be evaluated carefully for metabolic risk factors in the beginning of the treatment and treatment regimen should be selected by considering these situations. The side-effects such as hyperlipidemia, diabetes mellitus, cardiovascular diseases, bone metabolic disorders, osteopenia ve osteoporosis may also develop during the treatment. Therefore, patients must be closely monitored for the possible side-effects, and physicians must work in cooperation with the related specialties, and ART switch must be performed when required. Klimik Dergisi 2020; 33(3): 241-7. [ABSTRACT FROM AUTHOR]