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Objective: This study describes the relationships of factors related to gut microbiota and skin conditions associated with Demodex, including demodicosis, rosacea, and perioral dermatitis. Methods: A total of 113 patients from Dokuz Eylül University Hospital Dermatology Department answered a cross-sectional questionnaire. They consisted of 42 cases of Demodex-related skin diseases and 71 healthy controls. Demographic data and medical history, dietary and lifestyle habits, and gastrointestinal symptoms were recorded. Statistical analysis included descriptive statistics, chi-square tests, Fisher’s Exact tests, independent samples t-tests, and logistic regression methods. Results: Our findings identified alcohol consumption [odds ratio (OR)=11.13, 95% confidence interval (CI): 4.11-17.22, p

Introduction: Coronavirus diseases-2019 (COVID-19) have been ongoing for more than two years. Despite the scientific research conducted in this process, there is still no widely accepted definitive treatment for the disease. For treating COVID-19, using antiviral agents previously used for the treatment of other RNA-virus infections has been seen as a fast way to a solution, and favipiravir is one of the leading agents. This prospective, multicenter, observational study was designed to investigate the safety of favipiravir in 500 patients treated with favipravir for favipravir. Methods: This study was conducted as a multicenter prospective study. Eight different sites from four cities participated, and 500 patients were included in the study. Follow-up of laboratory parameters, adverse events (AEs), and amelioration of fever, dyspnea, and cough symptoms of the patients was recorded in a case report form. Results: A total of 475 patients from eight centers completed the study. A total of 401 AEs were reported in 206 (51.4%) patients, which were mild-to-moderate in the majority of cases. Serious AEs occurred in 5 patients and death occurred in 4 patients. From the first to the last measurement, serum alanine aminotransferase levels (31.9±27.7 vs. 47.2±49.7 U/L, p37.8 for 6.6% on day 3, 3.2% on day 5, and 0.6% on day 10), dyspnea (for 56.4% on day 5, 62.4% on day 7, and 81.2% on day 10), and cough (46.0% on day 5, 73.0% on day 7, and 87.3% on day 10) were noted in an increasingly higher percentage of patients with continued therapy. Conclusion: The current study provides real-life data of favipiravir, which is a unique option in Turkey for treating COVID-19 patients. The results revealed that favipiravir is a well-tolerated agent with a low side-effect profile. However, it needs to be evaluated with well-designed, dose-compared, randomized controlled studies for the evaluation of efficacy.

Introduction: In December 2019, pneumonia associated with the 2019 novel Coronavirus or Severe acute respiratory syndrome-Coronavirus-2 emerged in Wuhan, China. Its effects on national and global economies have been tremendous. There is limited evidence regarding treatment costs for hospitals and the effects of comorbidities on treatment costs. These factors are crucial inputs for health policymakers. The main objective of this study was to retrospectively determine the direct healthcare costs of hospitalized Coronavirus disease-2019 (COVID-19) patients in Türkiye and estimate the effect of comorbidities on these costs. Materials and Methods: This study was conducted at two prominent research and training hospitals in İzmir, Türkiye, during the first year of the COVID-19 pandemic. General Linear Models were employed for the calculation of cost figures. The hospitalization costs of 2,067 patients with COVID-19 were analyzed, and the effects of comorbidities on the treatment costs of 532 patients with COVID-19 were estimated. Results: Our analysis based on the entire sample of 2,067 patients revealed that the mean hospitalization cost was $1,432.3 [purchasing power parity (PPP) $4,994.7]. The mean treatment cost is higher for male patients and increases with age and intensive care unit admissions. The mean length of hospitalization was 10.6 days [standard deviation (SD) ±8.5] and the mean length of intensive care unit hospitalization was 9.9 (SD ±9.6). The mean daily hospitalization cost was $135.25 (PPP $471.63) for 2,067 patients. Hospitalization costs for COVID-19 patients significantly increased due to factors, such as gender, age, intensive care unit hospitalization, and comorbidities, including myocardial infarction, cerebrovascular and transient ischemic attacks, chronic obstructive pulmonary disease, and chronic kidney disease, according to the analysis. Conclusion: COVID-19 is a novel pandemic that caused morbidity and mortality at considerable levels. A holistic approach to fighting the pandemic requires unraveling not only medical efforts but also financial aspects.

Background. With the advent of direct-acting antiviral agents, the rate of sustained virological response in the treatment of hepatitis C virus (HCV) infection has reached 100%. However, it has been observed that many patients still do not have access to treatment. Aim. The aim of this study was to identify patients who are anti-HCV and HCV-RNA-positive, to reveal undiagnosed cases, and thus to reveal the necessity of increasing HCV follow-up tests and diagnosis. Methods. The microbiology database of Tepecik Research and Training Hospital was examined for patients who were tested for anti-HCV and HCV-RNA from January 2013 to January 2023. Patients were indexed based on their entry date, and duplicate values were manually removed. The data were then grouped according to the clinics that requested the analysis. Results. Between 2013 and 2023, a total of 334,537 anti-HCV tests were conducted without duplications. The annual average number of tests was 33,454 ± 10,027. During the ten-year period under review, the total number of patients with a positive result for the anti-HCV test was 3,943. The positivity rate among all anti-HCV tests was 1.18%. The annual average number of positive test results was 394 ± 54. Between 2013 and 2022, out of the 3,943 patients who tested positive for anti-HCV, HCV-RNA analysis was conducted on 2,500 of them (63.4%). Among the 2,500 patients who underwent HCV-RNA analysis, 682 were found to be HCV-RNA-positive (27.4%), while 1,818 were HCV-RNA-negative (72.6%). In the ten-year period, when the distribution of the 334,537 anti-HCV tests according to internal and surgical branches was evaluated, it was found that 157,680 tests (47.1%) were requested from internal branches, while 176,857 tests (52.9%) were requested from surgical branches. Of the 2,500 patients who tested positive for anti-HCV and underwent HCV-RNA analysis, 2,273 (90.9%) were requested by internal branches, while surgical branches requested 227 tests (9.1%). Among the 1,443 patients who tested positive for anti-HCV but did not have HCV-RNA tests ordered, 788 (54.6%) were evaluated in internal branches, and 655 (45.4%) were evaluated in surgical branches. Conclusion. In this study, it was observed that multiple anti-HCV tests were requested for the same individual, and HCV-RNA tests were not ordered for those testing positive for anti-HCV. Moreover, patients were not referred to the infection or gastroenterology clinics for HCV-RNA testing. Consequently, it was concluded that sufficient and necessary tests for diagnosis were not conducted, leading to the inability to access treatment. To achieve the World Health Organization’s goals for HCV eradication, it is imperative to increase the rates of HCV-RNA testing, enhance the utilization of reflex testing, and ensure proper referral to the necessary clinics.

Introduction: An irregular systemic inflammatory response in sepsis can induce acute lung injury (ALI), which is characterized by the exaggerated inflammation of the lung tissue. Colchicine inhibits several inflammatory pathways which may prevent sepsis-induced secondary lung injury. We aimed to examine the histopathological effects of colchicine on lung tissue in a lipopolysaccharide (LPS)-induced sepsis model in rats. Materials and Methods: Twenty-eight rats were randomly divided into the following four groups: “sham” (n=6), “colchicine only” (n=6), “sepsis only” (n=8) and “sepsis+colchicine” (n=8). In the “sham” group, 0.9% NaCl was administered intraperitoneally (IP) and intragastrically (IG). In the “Colchicine only” group, 0.9% NaCl was administered IP and colchicine was administered IG. Sepsis was induced in the “sepsis only” and “sepsis+colchicine” groups by administering of 1 mg/kg of LPS IP at the 0-time point. In the “sepsis+colchicine” group, colchicine was additionally given IG at the 90th minute. An observational sepsis scoring system was used to evaluate the signs of sepsis. Subsequently, the rats were sacrificed at the 24th hour. The lung tissues were examined according to the American Thorax Association’s assessment report on ALI in animals. Results: The histopathological lung injury score in the “sepsis+colchicine” group was significantly higher than in the “sham” group (0.23±0.18 vs. 0±0; p

Objective: Hypothalamic-pituitary-adrenal (HPA) axis dysfunction is thought to be found in patients with multiple sclerosis (MS). Copeptin is a serum protein that is indicated as an indirect marker of HPA axis. The aim of this study was to evaluate the relationship between HPA axis and clinically silent MS (CSMS) by evaluating copeptin levels. Materials and Methods: Sixty patients with CSMS which was defined as relapsing-remitting MS without attack and progression, and 60 healthy individuals were included in the study from September 2016 to September 2017. All patients were in the remission period. HPA axis dysfunction was examined by measuring serum copeptin levels in all individuals. Copeptin level was compared with clinical parameters in patients with MS. Results: A total of 120 individuals were composed of 60 patients with CSMS and 60 healthy controls. The average ages of the patients and the control group were 37.1+-8 (20-52) and 35.1+-8.9 (18-54), respectively. The copeptin level was significantly lower in patients compared to the control group (p

Introduction. COVID-19 pandemic has led to an increased rate of intensive care unit (ICU) stays. Intermediate care units (IMCUs) are a useful resource for the management of patients with severe COVID-19 that do not require ICU admission. In this research, we aimed to determine survival outcomes and parameters predicting mortality in patients who have been admitted to IMCU. Materials and Methods. Patients who were admitted to IMCU between April 2019 and January 2021 were analyzed retrospectively. Sociodemographics, clinical characteristics, and blood parameters on admission were compared between the patients who died in IMCU and the others. Blood parameters at discharge were compared between survived and deceased individuals. Survival analysis was performed via Kaplan–Meier analysis. Blood parameters predicting mortality were determined by univariate and multivariate Cox regression analysis. Results. A total of 140 patients were included within the scope of this study. The median age was 72.5 years, and 77 (55%) of them were male and 63 (45%) of them were female. A total of 37 (26.4%) patients deceased in IMCU, and 40 patients (28.5%) were transferred to ICU. Higher platelet count (HR 3.454; 95% CI 1.383–8.625; p=0.008), procalcitonin levels (HR 3.083; 95% CI 1.158–8.206; p=0.024), and lower oxygen saturation (HR 4.121; 95% CI 2.018–8.414; p

Objective: Allergic rhinitis (AR) is an inflammatory disease of the nasal mucosa mediated by IgE after exposure to an allergen. The most well known related comorbidity of AR is asthma. This study was planned due to the need for an animal model for studies on AR-asthma coexistence. In this study, the frequency of AR accompanying in the asthma model created in mice,and the usability of the related model in AR studies will be investigated. Methods: In our study, 6-8 week-old, 18-20 g BALB/c mice were used. Chicken egg ovalbumin (OVA Grade V, Sigma) was administered through intraperitoneal (IP) route at doses of 10 μg on days 0 and 14. Mice were exposed to aerosolized 2.5% ovalbumin solution in sterile saline for 30 minutes 3 days a week for 8 weeks, starting 7 days after the last IP administration (21st day). After exposure to OVA, mice were observed for typical signs of AR including sneezing, runny nose, and nasal itching. The final diagnosis of AR was made by histopathological examination of the rhinotracheal tissues of mice. Results: In our study, all mice exposed to ovalbumin received histopathologic diagnosis of AR. Increased number of capillaries lymphocytes, polymorphonuclear leukocytes and eosinophilsper square millimetre of rhinotracheal tissues were calculated in the murine model of AR compared to the the control group. Conclusion: This study introduced a new AR model, not cited in the literature, and induced with the longest-term ovalbumin exposure in the literature. It was concluded that this model, known as the asthma model, can also be used to induce an AR model and can be used in studies investigating coexistence of allergic rhinitis and asthma.

Background: To end the COVID-19 pandemic, a large part of the world must be immune to the virus by vaccination. Therefore, this study aimed to gauge intent to be vaccinated against COVID-19 among ordinary people and to identify attitudes towards vaccines and barriers for vaccine acceptance. Methods: The study population comprises 1880 people residing in different countries that answer a prepared questionnaire. The questionnaire topics are demographics, historical issues, participants’ attitudes and beliefs regarding vaccines, concerns, and vaccine hesitancy. Results: Attitudes and beliefs relating to vaccines in general, and the COVID-19 vaccine, were ascertained. Overall, 66.81% of the contributors would like to be vaccinated against COVID-19, while %33.19 did not intend to be vaccinated. Reasons for COVID-19 vaccine hesitancy included concern regarding vaccine side effects, fear of getting sick from the uptake of the vaccine, and the absence of accurate vaccine promotion news. Individuals with higher education believe that India (68.6%) produces the best vaccine (P

Coronavirus disease 2019 (COVID-19) dissemination occurred from December 2019 and quickly spread to all countries. Infected patients with COVID-19 have had a wide range of symptoms, ranging from mild to severe illness. The most mortality was observed in patients with underlying disease and over 45 years. World statistics have shown that the COVID-19 outbreak is most expanded in Middle Eastern, West Asian, European, North, and South American countries, and is least expanded in African countries. Therefore, the aim of the paper was the evaluation of six African countries including Mali, Mauritania, Niger, Guinea, Togo, and Djibouti to find why this disease is least expanded in African countries. Study was conducted by Questioner for countries health organizers to define their different aspect exposure and fight with COVID-19 including epidemiology, clinical aspects of the disease, case definitions, diagnosis laboratory confirmation, and referral of cases by the portal of entry, case management, and disease prevention in these countries. According to this opinion review, due to the low international flights and low domestic travel, the spread, and prevalence of COVID-19 was low and the return of the immigrants of these countries has caused the spread of COVID-19 among these countries. Experience, preparation, and impact of previous infections epidemic such as the Ebola virus epidemic would have beneficial, which have promoted certain reflexes among people that cause low dissemination in these countries.

Objective:To determine the clinical characteristics of patients with cystic echinococcosis and the diagnostic and therapeutic approaches used.Methods:This is a multicentre, retrospective study. Patients from six centres who were diagnosed with hydatid cysts in the last five years were evaluated.Results:The mean age was 45.4±17.4 years, and 54.7% were female. The most common complaints were abdominal pain, nausea and vomiting, and the most common physical examination finding was abdominal tenderness. Most patients were diagnosed within 2-6 months. Anaemia and eosinophilia were the most common laboratory findings. The liver was the most commonly involved organ (n=153, 90%). One hundred twenty-five (73.5%) patients underwent ultrasonography. The largest cyst was present in the liver at stage four, and its diameter was 160x170 mm. The rates of the negative, grey zone and positive results were 9.4%, 8.8% and 81.8%. Surgery was more common (n=72, 42.4%) than puncture, aspiration, injection, and re-aspiration treatments (n=14, 8.2%). Of the 47 patients who had a recurrence, 22 (46.8%) had a history of hydatid cyst treatment.Conclusion:Hydatid disease, which is endemic in our country, is diagnosed at a late stage. In terms of disease diagnosis, serological tests may be misleading. It was not possible to compare the success rates according to the treatment choices because of the lack of randomisation of stages and sizes of the lesions.

Enterococcus faecalis is one of the important causative agents of nosocomial and life-threatening infections in human. Several studies have demonstrated that the presence of CRISPR-cas is associated with antibiotic susceptibility and lack of virulence traits. In this study, we aimed to assess the phenotypic and genotypic virulence determinants in relation to CRISPR elements from the dental-root canals and hospital-acquired isolates of E. faecalis. Eighty-eight hospital-acquired and 73 dental-root canal isolates of E. faecalis were assessed in this study. Phenotypic screening of the isolates included biofilm formation, and gelatinase and hemolysis activities. Genotypical screening using PCR was further used to evaluate the presence of CRISPR elements and different virulence-associated genes such as efaA, esp, cylA, hyl, gelE, ace, ebpR, and asa1. Biofilm formation, gelatinase, and hemolysis activities were detected in 93.8%, 29.2%, and 19.2% of the isolates, respectively. The most prevalent virulence-associated gene was ace, which was followed by efaA, whereas cylA was the least identified. The presence of CRISPR1-cas, orphan CRISPR2, and CRISPR3-cas was determined in 13%, 55.3%, and 17.4% of the isolates, respectively. CRISPR elements were significantly more prevalent in the dental-root canal isolates. An inverse significant correlation was found between CRISPR-cas loci, esp, and gelE, while direct correlations were observed in the case of cylA, hyl, gelE (among CRISPR-loci 1 and 3), asa1, ace, biofilm formation, and hemolysis activity. Findings, therefore, indicate that CRISPR-cas might prevent the acquisition of some respective pathogenicity factors in some isolates, though not all; so selective forces could not influence pathogenic traits. Abbreviations: BHI: brain-heart infusion agar; CRISPRs: Clustered regularly interspaced short palindromic repeats; Esp: Cell wall-associated protein; ENT: ear-nose-throat; ICU: intensive care units; OD: optical densities; PCR: polymerase chain reaction; SDS: sodium dodecyl sulfate; UTI: urinary tract infection

Objective: The aim of this study to evaluate histopathological improvement and virological, serological and biochemical response rates in patients with chronic hepatitis B (CHB) who were treated with tenofovir disoproxil fumarate (TDF). Material and Method: A total of 91 nucleosid(t)e-naive CHB patients who received TDF were evaluated. Virological, serological and biochemical test results were assessed at baseline and every 12 weeks. Liver biopsy specimens were assessed according to the modified Ishak scoring. Results: The study was conducted on 52 patients. The mean age was 40±10 years and 40.4% were female. The mean follow-up period was 33±11 months. HBsAg seroclearance occurred in none of the patients. The serum level of HBV-DNA became undetectable in 94.2% of the patients. Mean histological activity index at baseline and on-treatment were 8.2±2.3 and 6.2±2.0 and the mean fibrosis scores were 2.65±1.3 and 2.33±1.1, respectively. Conclusion: We determined that TDF therapy provided remarkably good HBV DNA suppression and biochemical response rates, but low seroconversion. Improvement of liver necroinflammation was detected, but no significant change observed in fibrosis.

Aim: We aimed to investigate the use of serum quantitative hepatitis B surface antigen (qHBsAg) and cytokeratin 18 (CK18) levels as noninvasive markers to differentiate inactive HBsAg carriers from hepatitis B e-antigen (HBeAg) negative chronic hepatitis B (CHB) patients. Methods: Sixty randomly selected treatment-naive patients with CHB and 25 healthy volunteers as control group were included in the study. Virological, serological and biochemical test results were assessed. Levels of M30 antigen which is the active form of CK18 were measured by M30-Apoptosense enzyme linked immunosorbent assays (ELISA). Liver biopsy specimens were assessed according to the modified Ishak scoring. Results: Forty-eight (56.5%) participants were female. There was no significant difference between three groups in terms of age, gender, alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), total bilirubin (T.Bil), direct bilirubin (D.Bil), prothrombin time (PT), international normalized ratio (INR), alfa-fetoprotein (AFP) and CK18 values. HBVDNA and qHBsAg levels were found to be significantly lower in inactive carriers compared with HbeAg-negative chronic HBV patients. The diagnostic efficacy of CK18 in differentiating inactive carriers from HbeAg-negative CHB patients was not statistically significant. Conclusion: In conclusion, when used along with HBVDNA, qHBsAg may be an important parameter to differentiate inactive HBsAg carriers from HbeAg-negative chronic HBV patients. However, as one of the parameters targeted in this study, serum CK18 levels can not be used as a noninvasive marker.

Aim: Urinary tract infections (UTIs) are frequently seen and also empirically treated in the emergency department (ED). It is known that the antimicrobial resistance of uropathogens is increasing worldwide. Because geographical location plays an important role in antimicrobial resistance and can be used as a guide for treatment, regional studies are particularly important. The aim of this study is to analyze the urine cultures performed at our ED.Materials and Methods: We investigated the medical records of 4,493 patients who were requested to give urine samples for culture at the ED of the Tepecik Training and Research Hospital between 2010 and 2014.Results: In our study, 47.3% cultures were positive, and the most frequent microorganism was found to be Escherichia coli (E. coli) (66.7%). Trimethoprim/sulfamethoxazole (TMP-SMX) and ciprofloxacin resistance rates were detected as 44.8% and 36.8%, respectively; further, nitrofurantoin and fosfomycin resistance rates were detected as 13.3% and 7.6%, respectively. The relationship of nitrite positivity with the reproduction of pathogens was found to be stronger than that of leukocyte esterase (LE).Conclusion: For our region, for the empirical treatment of uncomplicated UTIs, fosfomycin and nitrofurantoin must be considered as the first-line agents. Because of the increasing ratio of antibiotic resistance, urinary culture samples must be arranged for in the ED itself where administering first-line treatment has mostly been initiated.

Background: Before the introduction of direct-acting antivirals in the treatment of chronic hepatitis C patients, the combination of peginterferon alpha and ribavirin was the standard therapy. Observational studies that investigated sustained virological response (SVR) rates by these drugs yielded different outcomes. Aims: The goal of the study was to demonstrate real life data concerning SVR rate achieved by peginterferon alpha plus ribavirin in patients who were treatment-naïve. Study Design: A multicenter, retrospective observational study. Methods: The study was conducted retrospectively on 1214 treatment naïve-patients, being treated with peginterferon alpha-2a or 2b plus ribavirin in respect of the current guidelines between 2005 and 2013. The patients’ data were collected from 22 centers via a standard form, which has been prepared for this study. The data included demographic and clinical characteristics (gender, age, body weight, initial Hepatitis C virus RNA (HCV RNA) level, disease staging) as well as course of treatment (duration of treatment, outcomes, discontinuations and adverse events). Renal insufficiency, decompensated liver disease, history of transplantation, immunosuppressive therapy or autoimmune liver disease were exclusion criteria for the study. Treatment efficacy was assessed according to the patient’s demographic characteristics, baseline viral load, genotype, and fibrosis scores. Results: The mean age of the patients was 50.74 (±0.64) years. Most of them were infected with genotype 1 (91.8%). SVR was achieved in 761 (62.7%) patients. SVR rate was 59.1% in genotype 1, 89.4% in genotype 2, 93.8% in genotype 3, and 33.3% in genotype 4 patients. Patients with lower viral load yielded higher SVR (65.8% vs. 58.4%, p=0.09). SVR rates according to histologic severity were found to be 69.3%, 66.3%, 59.9%, 47.3%, and 45.5% in patients with fibrosis stage 0, 1, 2, 3 and 4, respectively. The predictors of SVR were male gender, genotype 2/3, age less than 45 years, low fibrosis stage, low baseline viral load and presence of early virological response. SVR rates to each peginterferon were found to be similar in genotype 1/4 although SVR rates were found to be higher for peginterferon alpha-2b in patients with genotype 2/3. The number of patients who failed to complete treatment due to adverse effects was 33 (2.7%). The number of patients failed to complete treatment due to adverse effects was 33 (2.7%). Conclusion: Our findings showed that the rate of SVR to dual therapy was higher in treatment-naïve Turkish patients than that reported in randomized controlled trials. Also peginterferon alpha-2a and alpha-2b were found to be similar in terms of SVR in genotype 1 patients.

Introduction: After introduction of highly active anti-retroviral treatment (HAART), the mortality and morbidity rates among HIV/AIDS patients have been reduced. CD4+ T cell and HIV RNA measurement is important in the follow-up during the treatment. The aim of this study was to evaluate three different ART regimens in terms of immunological and virological response. Materials and Methods: The study was designed as a retrospective cohort study. Treatment-naive adult HIV/AIDS patients who applied to our outpatient clinic between 2011 and 2017 were included in this study. Treatment regimens included two nucleoside reverse transcriptase inhibitors (NRTI) with either one of a non-nucleoside reverse transcriptase inhibitor (NNRTI) or integrase inhibitor (INI) or protease inhibitor (PI). CD4+ T cell counts and HIV RNA levels were analysed at 1st month, 3rd month, 6th month and 12th month. Results: Sixty-three patients (87% were male) aged 43±13 (min 19, max 66 ) years were included in this study. Fourteen (22.2%) received NRTI and INI treatment (INI group), 18 (28.6%) received NRTI and PI (PI group) and 31 (49.2%) received NRTI and NNRTI (NNRTI group). Immunologically, the PI group was the most successful while NNRTI group was the least successful. INI group had significantly higher immunological response rate than NNRTI group in the first three months. The treatment was more successful in INI group in terms of virological response than in PI and NNRTI groups in the first three months. However, at the end of 6 and 12 months, no statistically significant difference was observed between the groups, neither immunologically nor virologically. Conclusion: Our results have shown that all regimens were effective at the end of 12 months. Among the combinations available, the most appropriate one should be selected individually.

Background: The use of pegylated interferon alpha and ribavirin (PegIFN/RBV) for the retreatment of chronic hepatitis C virus (HCV) infection without a sustained virological response (SVR) prior to PegIFN/RBV treatment has resulted in low success rates. Aims: To investigate the efficacy and safety of telaprevir (TVR) in combination with PegIFN/RBV in patients infected with HCV genotypes 1 and 4 who were previously treated with PegIFN/RBV and failed to achieve SVR. Study Design: Multi-center, retrospective, cross-sectional study. Methods: The study included 111 patients: 80 prior relapsers, 25 prior null responders, and six prior partial responders to PegIFN/RBV treatment. The patients were given TVR/PegIFN/RBV for 12 weeks, followed by a 12-week PegIFN/RBV treatment; virological response results were assessed at weeks 4, 12, and 24. Treatment was discontinued in patients with HCV RNA >1000 IU/mL at week 4 or with negative RNA results at week 4 but >1000 IU/mL at week 12. Rapid virological response (RVR), early virological response (EVR), extended rapid virological response (eRVR), and virological response at 24th week of treatment were evaluated. The side effects of combination therapy and the rates of treatment discontinuation were investigated. Results: The mean age of the patients was 56.02±9.96 years and 45.9% were male. Ninety-one percent of the patients were infected with viral genotype 1, 69.6% with the interleukin (IL) 28B genotype CT and 20.2% were cirrhotic. The RVR rate was 86.3% in prior relapsers, 56% in prior null responders, and 50% in prior partial responders (p=0.002). EVR rates in those groups were 91.3%, 56%, and 83.3%, respectively (p

Introduction: BK virus (BKV) and cytomegalovirus (CMV) infections are common in renal transplant patients. In this retrospective study, we investigated the frequency of BKV and CMV infections and their effects on graft. Materials and Methods: The data of 118 renal transplant recipients who were transplanted and followed-up between January 2010 and January 2011 were reviewed. Demographic characteristics, biochemical data, BKV and CMV DNA levels by polymerase chain reaction (QIAGEN, Hilden, Germany) were investigated. The patients were followed-up monthly in the first six months and then every three months. Results: A total of 118 patients were included in the study. BK viraemia was detected in 12 (10.2%) patients and the DNA level of BKV was >104 copies/mL in five cases. Three patients with elevated creatinine and compatible renal biopsy findings were considered to have BKV-associated nephropathy (BKVAN). With the reduction of immunosuppressive treatment, viraemia was reduced and creatinine levels decreased within normal levels. Cytomegalovirus DNA was found to be positive in 23 (19.5%) patients, and was >500 copies/mL in 4 (3.4%) patients. The viraemia in these four patients has decreased after antiviral therapy. No CMV related disease were found in any of the patients. Cytomegalovirus DNA positivity at low levels were also detected in three patients who were diagnosed with BKVAN. None of the patients developed rejection. Conclusion: BK and CMV infections in kidney transplant patients are common and can be seen together. However, graft dysfunction and rejection rates are low with close monitoring, early diagnosis and treatment. Randomized, controlled studies with larger patient groups are necessary in order to determine the viral threshold levels associated with graft dysfunction or rejection, to decide the optimal management and to explain the role of concomitant infection.

Introduction: Chronic hepatitis C induces hepatosteatosis, causes insulin resistance increasing tumor necrosis factor-alfa (TNF- α), and leads to the development of type 2 diabetes. This study aimed to evaluate the prevalence of hepatitis C virus (HCV) and its risk factors in the diabetic patients. Materials and Methods: Four hundred and twenty patients over 18 years of age diagnosed with diabetes in internal medicine services of our hospital were evaluated, retrospectively. Anti-HCV was evaluated by ELISA (Liaison, Diasorin, Italy) and HCVRNA was evaluated by real-time polymerase chain reaction (Ampliprep/Cobas Taqman HCV Quantitive Test, v2.0 Roche, Germany) in patients seropositive for Anti-HCV. Results: The mean age of 420 patients was 64.7 (29-86) years and 54% (229 patient) were male. Among the patients, 92.8% (390) had type 2 diabetes and 7.2% (30) had type 1 diabetes, the mean time period for diabetes was 10.1 years (ranged between 1-43). Only one patient (0.2%) in the study having a history of surgery and transfusion was found to be seropositive for anti-HCV and confirmed by HCV-RNA test. Conclusion: In this study, HCV was investigated in diabetic cases but no association was found between the increasing prevalance of HCV and diabetes mellitus. However, it is considered that the prevalence of HCV may increase due to the complications of HCV and some genotypes of HCV that leads to diabetes, and invasive operations such as transfusion, catheterization and hemodialysis.

This study- a secondary analysis of data from a randomized, observer-blinded, non-inferiority study among volunteers between 18–55 y old in Türkiye- evaluated the impact of previous SARS-CoV-2 infection before the first dose of inactive TURKOVAC on post-vaccine local and systemic adverse events (AEs) comparing with CoronaVac. Of 1266 participants analyzed, 27.7% had a previous COVID-19 history. Local and systemic AEs were observed in 37.3% and 39% of the participants. The frequency of AEs was slightly higher in the first 30 minutes and 24 hours among participants with a COVID-19 history; none were severe. 1203 participants had a second dose vaccination, and 27.3% had a history of COVID-19. The frequencies of local and systemic AEs after the second dose were similar between those with and without a COVID-19 history. The TURKOVAC and CoronaVac showed similar frequencies of local and systemic AEs in the first 30 minutes after vaccination.

Background: Blood culture-negative endocarditis (BCNE) is a diagnostic challenge, therefore our objective was to pinpoint high-risk cohorts for BCNE. Methods: The study included adult patients with definite endocarditis. Data were collected via the Infectious Diseases International Research Initiative (ID-IRI). The study analysing one of the largest case series ever reported was conducted across 41 centers in 13 countries. We analysed the database to determine the predictors of BCNE using univariate and logistic regression analyses. Results: Blood cultures were negative in 101 (11.65 %) of 867 patients. We disclosed that as patients age, the likelihood of a negative blood culture significantly decreases (OR 0.975, 95 % CI 0.963–0.987, p

ABSTRACT In the present study, the importance of laboratory parameters and CT findings in the early diagnosis of COVID-19 was investigated. To this end, 245 patients admitted between April 1st, and May 30th, 2020 with suspected COVID-19 were enrolled. The patients were divided into three groups according to chest CT findings and RT-PCR results. The non-COVID-19 group consisted of 71 patients with negative RT-PCR results and no chest CT findings. Ninety-five patients with positive RT-PCR results and negativechest CT findings were included in the COVID-19 group; 79 patients with positive RT-PCR results and chest CT findings consistent with COVID-19 manifestations were included in COVID-19 pneumonia group. Chest CT findings were positive in 45% of all COVID-19 patients. Patients with positive chest CT findings had mild (n=30), moderate (n=21) andor severe (n=28) lung involvement. In the COVID-19 group, CRP levels and the percentage of monocytes increased significantly. As disease progressed from mild to severe, CRP, LDH and ferritin levels gradually increased. In the ROC analysis, the area under the curve corresponding to the percentage value of monocytes (AUC=0.887) had a very good accuracy in predicting COVID-19 cases. The multinomial logistic regression analysis showed that CRP, LYM and % MONO were independent factors for COVID-19. Furthermore, the chest CT evaluation is a relevant tool in patients with clinical suspicion of COVID-19 pneumonia and negative RT-PCR results. In addition to decreased lymphocyte count, the increased percentage of monocytes may also guide the diagnosis.

We present the interim results of the efficacy, immunogenicity, and safety of the two-dose schedules of TURKOVAC versus CoronaVac. This was a randomized, observer-blinded, non-inferiority trial (NCT04942405). Volunteers were 18–55 years old and randomized at a 1:1 ratio to receive either TURKOVAC or CoronaVac at Day 0 and Day 28, both of which are 3 μg/0.5 mL of inactivated severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) adsorbed to aluminum hydroxide. The primary efficacy outcome was the prevention of polymerase chain reaction (PCR)-confirmed symptomatic coronavirus disease 2019 (COVID-19) at least 14 days after the second dose in the modified per-protocol (mPP) group. Safety analyses were performed in the modified intention-to-treat (mITT) group. Between 22 June 2021 and 7 January 2022, 1290 participants were randomized. The mITT group consisted of 915 participants, and the mPP group consisted of 732 participants. During a median follow-up of 90 (IQR 86–90) days, the relative risk reduction with TURKOVAC compared to CoronaVac was 41.03% (95% CI 12.95–60.06) for preventing PCR-confirmed symptomatic COVID-19. The incidences of adverse events (AEs) overall were 58.8% in TURKOVAC and 49.7% in CoronaVac arms (p = 0.006), with no fatalities or grade four AEs. TURKOVAC was non-inferior to CoronaVac in terms of efficacy and demonstrated a good safety and tolerability profile.

Abstract Background HBsAg immune-escape mutations can favor HBV-transmission also in vaccinated individuals, promote immunosuppression-driven HBV-reactivation, and increase fitness of drug-resistant strains. Stop-codons can enhance HBV oncogenic-properties. Furthermore, as a consequence of the overlapping structure of HBV genome, some immune-escape mutations or stop-codons in HBsAg can derive from drug-resistance mutations in RT. This study is aimed at gaining insight in prevalence and characteristics of immune-associated escape mutations, and stop-codons in HBsAg in chronically HBV-infected patients experiencing nucleos(t)ide analogues (NA) in Europe. Methods This study analyzed 828 chronically HBV-infected European patients exposed to ≥ 1 NA, with detectable HBV-DNA and with an available HBsAg-sequence. The immune-associated escape mutations and the NA-induced immune-escape mutations sI195M, sI196S, and sE164D (resulting from drug-resistance mutation rtM204 V, rtM204I, and rtV173L) were retrieved from literature and examined. Mutations were defined as an aminoacid substitution with respect to a genotype A or D reference sequence. Results At least one immune-associated escape mutation was detected in 22.1% of patients with rising temporal-trend. By multivariable-analysis, genotype-D correlated with higher selection of ≥ 1 immune-associated escape mutation (OR[95%CI]:2.20[1.32–3.67], P = 0.002). In genotype-D, the presence of ≥ 1 immune-associated escape mutations was significantly higher in drug-exposed patients with drug-resistant strains than with wild-type virus (29.5% vs 20.3% P = 0.012). Result confirmed by analysing drug-naïve patients (29.5% vs 21.2%, P = 0.032). Strong correlation was observed between sP120T and rtM204I/V (P

Background: The aim of this study is to investigate the association between hepatic activity index (HAI) and fibrosis score (FS) with inflammation biomarkers in non-uremic and uremic hepatitis C positive patients. Methods: Fifty chronic hepatitis C (cHepC) positive patients, having a liver biopsy were included in this study. Liver biopsies were scored according to modified ISHAC scoring system. 25 healthy controls of similar age and gender were also enrolled as control group. Serum YKL-40, neutrophil/lymphocyte ratio (NLR), thrombocyte/lymphocyte ratio (PLR), CRP and Immunoglobulin (IgG, A and M) levels were used to determine inflammation. AST to Platelet Ratio Index (APRI) score was also evaluated. According to biopsy findings patients were divided into 2 groups: low (0–2) and severe (3–6) FS. Results: Patients with cHepC had increased inflammation compared to the healthy controls. End-stage renal disease (ESRD) patients had higher levels of inflammation markers (NLR, IgG, CRP and YKL-40) and lower HCV RNA levels, HAI and FS compared to non-uremic patients. When patients were grouped into 2 according to FS as mild and severe, IgG (p < 0.001), YKL-40 (p = 0.02) levels and APRI score (p = 0.002) were significantly higher compared to mild FS (p = 0.002). YKL-40 levels (t value: 3.48; p = 0.001) and APRI score (t value: 4.57, p < 0.001) were found as independent associated with FS in non-uremic patients. However, in adjusted models, only APRI score (t value: 3.98, p = 0.002) was an independent associated with FS in ESRD patients. Conclusion: In non-uremic cHepC patients, YKL-40 levels and APRI score may be valuable markers of FS. In ESRD patients, there is not sufficient data for prediction of HAI and FS. In these patients, APRI score may provide better information.

Background: Drug resistance development is an expected problem during treatment with protease inhibitors (PIs), this is largely due to the fact that Pls are low-genetic barrier drugs. Resistance-associated variants (RAVs) however may also occur naturally, and prior to treatment with Pls, the clinical impact of this basal resistance remains unknown. In Turkey, there is yet to be an investigation into the hepatitis C (HCV) drug associated resistance to oral antivirals. Materials and methods: 178 antiviral-naïve patients infected with HCV genotype 1 were selected from 27 clinical centers of various geographical regions in Turkey and included in the current study. The basal NS3 Pls resistance mutations of these patients were analyzed. Results: In 33 (18.5%) of the patients included in the study, at least one mutation pattern that can cause drug resistance was identified. The most frequently detected mutation pattern was T54S while R109K was the second most frequently detected. Following a more general examination of the patients studied, telaprevir (TVR) resistance in 27 patients (15.2%), boceprevir (BOC) resistance in 26 (14.6%) patients, simeprevir (SMV) resistance in 11 (6.2%) patients and faldaprevir resistance in 13 (7.3%) patients were detected. Our investigation also revealed that rebound developed in the presence of a Q80K mutation and amongst two V55A mutations following treatment with TVR, while no response to treatment was detected in a patient with a R55K mutation. Conclusion: We are of the opinion that drug resistance analyses can be beneficial and necessary in revealing which variants are responsible for pre-treatment natural resistance and which mutations are responsible for the viral breakthrough that may develop during the treatment.

Long non-coding RNAs (lncRNAs) have been implicated in numerous biological processes, including epigenetic regulation, cell-cycle control, and transcriptional/translational regulation of gene expression. Differential expression of lncRNAs and disruption of the regulatory processes are recognized as critical steps in cancer development. The role of lncRNAs in hepatitis B virus (HBV) infection is not well understood. Here we analyzed the expression of 135 lncRNAs in plasma samples of 82 HBV patients (classified as chronic patients, inactive carriers, or resolved patients) at diagnosis and at 12 months of treatment in relation to control group (81 healthy volunteers). We also investigated the effect of small interfering RNA (siRNA)-mediated silencing of lincRNA-SFMBT2 on HBV-positive human liver cancer cell line. lncRNA expression was analyzed by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Chemically synthesized siRNAs were transfected into the cell lines using Lipofectamine 2000 Reagent (Thermo Fisher Scientific). HBV DNA and HBsAg and HBeAg were detected in transfected cultures by real-time PCR and ELISA, respectively, using commercial kits. We observed changes in lncRNA expression in all three HBV groups, compared to control group. Most notably, the expression of anti-NOS2A, lincRNA-SFMBT2, and Zfhx2as was significantly increased and expression of Y5 lncRNA was decreased in chronic HBV patients. A decreased Y5 expression and increased lincRNA-SFMBT2 expression were observed in inactive HBsAg carriers. The expression of HOTTIP, MEG9, and PCAT-32 was increased in resolved HBV patients, and no significant change in the expression of Y5 was observed, compared to control group. siRNA-mediated inhibition of lincRNA-SFMBT2 decreased the level of HBV DNA in human liver cancer cells. Further research is needed to confirm the prognostic as well as therapeutic role of these lncRNAs in HBV patients.

Background: Leptospirosis is a zoonotic disease caused by spirochetes of the genus Leptospira. While the majority of leptospirosis cases occur in the tropics, some cases are also observed in temperate regions of developing countries. The disease has various clinical presentations ranging from a mild influenza-like form to a severe potentially fatal illness accompanied by multi-organ failure. However, atypical presentations of leptospirosis have occasionally been described. Here, a case of leptospirosis presenting as thrombotic thrombocytopenic purpura (TTP) is reported. Case Report: A 58-years-old male presented with fever, oliguria, darkening of urine, and visual hallucinations. Laboratory investigations revealed anaemia, severe thrombocytopaenia, elevated total bilirubin with indirect predominance, high lactate dehydrogenase, and increased urea (293 mg/dL) and creatinine (7.6 mg/dL) levels. He was diagnosed with TTP. Patient was thought leptospirosis due to atypical clinical manifestations. Leptospirosis was confirmed by strongly positive Microscopic Agglutination Test. Patient recovered completely with antibiotics and plasmapheresis. Conclusion: Leptospirosis may be accompanied by thrombotic thrombocytopenic purpura in particular subtropic regions. [ABSTRACT FROM AUTHOR]

Summary: Purpose: To determine the population-based seroprevalence of varicella zoster virus (VZV) and related risk factors in Izmir. Materials and methods: A population-based household survey was conducted. A representative sample of the population older than 15 years of age was selected using multistage random sampling. A total of 2136 healthy persons participated in this cross-sectional study. The participants completed a questionnaire designed to collect data related to socio-demographic characteristics and risk factors. Blood samples were collected, and VZV-specific IgG was measured using an ELISA. Results: In total, 94.3% of individuals were seropositive for VZV. The difference between VZV seroprevalence in urban and rural populations was significant (OR: 2.6 (95% CI, 1.7–3.8)). No statistically significant differences in seropositivity were observed with respect to other sociodemographic characteristics. Conclusion: A large proportion of the participants were found to be immune to VZV. Keywords: IgG-specific test, Varicella zoster infection, Prevalence

Objective: The aim of this study was to describe how AIDS, as well as the stigma associated with it, affects the lives of HIV positive patients and their family members. Materials and Methods: Three large state hospitals in the metropolitan area of Izmir participated in the study. Six focus groups were conducted with people infected with HIV (n=32) and their family members (n=11). Participants were asked to fill out a questionnaire to assess their HIV/AIDS knowledge and to convey how the stigma had affected them. Results: The most important problems identified were society and work-related social problems and access to health services. The patients and their family members stated that education was needed to correct misconceptions about HIV and to help them cope with related problems. We found that patients and their family members were sensitive about disclosure.Conclusion: We determined the education, counseling and support needs of HIV-infected patients and their families. Additionally, we found that health personnel who monitor the patients should make more efforts on patients’ education and counselling.