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[No abstract available]

Aim: Echinococcosis, caused by Echinococcus species, is an important zoonotic disease causing major health problems in humans and animals. Herein, we aimed to evaluate the epidemiology, clinical and laboratory parameters, radiological, serological, pathological, and treatment protocols of followed-up cases of hydatidosis. Methods: A total of 550 patients diagnosed with hydatid cyst disease were included in this study. Patients who were positive for one or more of the enzyme-linked immunosorbent assay or indirect hemagglutination test, pathological results, or radiological findings were examined. The data analyzed were collected from nine centers between 2008 and 2020. Records were examined retrospectively. Results: Among the patients, 292 (53.1%) were women and 258 (46.9%) were men. The patients' mean age was 44.4 +/- 17.4 years. A history of living in rural areas was recorded in 57.4% of the patients. A total of 435 (79.1%) patients were symptomatic. The most common symptoms were abdominal pain in 277 (50.4%), listlessness in 244 (44.4%), and cough in 140 (25.5%) patients. Hepatomegaly was found in 147 (26.7%), and decreased breath sounds were observed in 124 (22.5%) patients. Radiological examination was performed in all cases and serological methods were also applied to 428 (77.8%) patients. The most frequently applied serological test was IHA (37.8%). A single cyst has been found in 66% patients. Hepatic involvement occurred in 327 (59.4%), pulmonary involvement was found in 128 (23.3%), whereas both of them were recorded in 43 (7.8%) patients. Splenic involvement was only detected in nine (1.6%) patients. Echinococcus granulosus (72.5%) was most frequently detected. Cyst diameters of 56.9% of the patients were in the range of 5-10 cm. A total of 414 (75.2%) patients received albendazole as an antiparasitic. Mortality was noted in nine (1.6%) patients. Conclusion: Echinococcosis is an important public health problem in Turkey. It can affect the social, economic, and political structures of the community. Public education and awareness are extremely important.

OZTURK, ANIL MURAT/0000-0001-8674-8877; Tasbakan, meltem/0000-0002-4689-720X, WOS:000512305000020, The rate of opportunistic infections has decreased with highly active antiretroviral therapy in HIV infected patients. HIV can be diagnosed concurrently with opportunistic infections. in this paper, it was aimed to present a 39-year-old male patient who was diagnosed with HIV while being followed-up for necrotizing skin soft tissue infection and necrotizing pneumonia. Acinetobacter baumannii was isolated from deep wound culture, but no agent was isolated from blood cultures and lower respiratory tract samples of the patient. Considering his clinical condition, anti-HIV was requested from the patient for possible immunodeficiency. The test result was positive. CDC recommends that everyone between the ages of 13-64 get tested for HIV as part of routine health care. For those with specific risk factors such as patients presenting with frequent recurrent infections, testing for HIV should come to mind.

Background. Common variable immunodeficiency (CVID) is a rare disease characterized by humoral immunodeficiency, often causing sinopulmonary and gastrointestinal infections, and may cause enteropathy in some patients, which leads to severe malnutrition and electrolyte deficiencies. Although many autoimmune diseases are seen with increased frequency in CVID patients, primary hypoparathyroidism is extremely rare. Case presentation. A 50-year-old man with CVID presented with diarrhea. The patient had complaints for 2 years and was cachectic. He had severe electrolyte and vitamin deficiencies that did not respond to oral treatment. The diarrhea causes such as celiac, inflammatory bowel diseases, and gastrointestinal infections were excluded and the endoscopy showed enteropathic changes in the duodenum and colon. Concomitant hypoparathyroidism was also detected in the patient with hypocalcemia despite adequate replacement. Conclusion. Parenteral therapy should be considered in the management of CVID enteropathy cases that do not respond to oral replacement. Although very rare, hypoparathyroidism should be considered in the differential diagnosis of CVID patients with treatment-resistant hypocalcemia.

In solid organ transplant recipients, it is recommended that the necessary vaccinations be completed at least 4 weeks before transplant. Chickenpox infection in adulthood can lead to serious clinical conditions such as pneumonia, hepatitis, and central nervous system infections. Herein, the case of chickenpox in a 36-year-old female patient with renal transplantation for end-stage renal disease due to vesicoureteral reflux 11 years previously and without a history of chickenpox or its vaccination before and after transplantation is reported. In this case, because of the development of thrombocytopenia associated with intravenous acyclovir, treatment was successfully concluded with oral valacyclovir.

Coronavirus disease 2019, which emerged in Wuhan in China in early December 2019, gradually spread across the world and was declared a pandemic by the World Health Organization on March, 12 2020. the disease shows a wide spectrum, ranging from asymptomatic course to severe acute respiratory syndrome. Although data on SARS-CoV-2 infection in HIV-infected cases are still limited, it is thought that the presence of comorbidities is important for mortality and morbidity in infected cases. in this report, it was aimed to evaluate SARS-CoV-2 infection in a patient diagnosed with HIV for six years with negative HIV-1 viral load and a CD4 lymphocyte count of 240 cells/mm(3).

Visceral Leishmaniasis (VL) is a parasitic disease frequently seen in Mediterranean countries, including our country, which still constitute a major public health problem. In this study, it was aimed to investigated retrospectively 20 cases diagnosed with visceral leishmaniasis (VL) among the cases referred from different clinics/centers for further examination to our department due to fever of unknown origin in terms of demographic characteristics, underlying diseases, laboratory, clinical data and treatment results between 2007-2017. Adults with chronic systemic diseases are always at risk in endemic regions and VL should be considered in differential diagnosis, particularly in cases of fever of unknown origin.

Aim: The aim of this study is to evaluate the attitudes of healthcare workers against seasonal influenza vaccine and the reasons for vaccine avoidance. Materials and Methods: This national survey was conducted from April 1st to June 30th in 2017. The study was carried out among health care workers working in primary, secondary and tertiary care settings. A total of 12 questions were sent to 5046 health care professionals from 55 different cities who agreed to participate in the survey.Results: 7% of the participants stated that they get vaccinated regularly every year. 65.8% of the participants stated that they don’t get vaccinated at all. The most important reason for those who did not receive influenza vaccination was their disbelief in the necessity of the vaccination (51.9%). The most common reason for the seasonal influenza vaccination was the prevention of influenza infection (56.7%).Conclusion: The results of the study showed that HCWs influenza vaccination rates are very low. Doctors have been found to have slightly better rates than other HCWs. The high level of education and the increase in professional experience had a positive effect on the vaccination rate. It is important to know the HCWs attitudes and behaviors towards the vaccination to increase the rates., Amaç: İnfluenza tüm dünyada önemli ölçüde morbidite, mortalite ve maliyet yükünden sorumludur. Sağlık çalışanları (HCP) mesleksel bulaş açısından risk altındadırlar. Bu çalışmada sağlık çalışanlarının mevsimsel influenza aşısına karşı tutumlarının ve aşıdan kaçınma nedenlerinin değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Bu çok merkezli ulusal anket çalışması 1 Nisan-30 Haziran 2017 tarihleri arasında gerçekleştirildi. Ankete katılmayı kabul eden 55 şehirden toplam 5046 HCP uzaktan katılım yoluyla cevaplamaları için toplam 12 sorudan oluşan bir anket gönderildi.Bulgular: Çalışmaya katılanların %7’si her yıl düzenli olarak aşı yaptırdığını belirtti. Hiç yaptırmıyorum diyenlerin oranı %65,8 idi. İnfluenza aşışını yaptırmayanların en önemli nedeni grip aşısının gerekliliğine inanmama idi (%51,9). Mevsimsel grip aşısı yaptıranların en önemli gerekçesi grip infeksiyonundan korunma (%56,7) idi.Sonuç: Sonuçlarımız, tüm HCP influenza aşılama oranlarının çok düşük olduğunu göstermiştir. Doktorların diğer HCP’lerden biraz daha iyi oranlara sahip olduğunu görülmüştür. Eğitim düzeyinin yüksek olması ve mesleki tecrübenin artması aşılama oranını olumlu yönde etkilemiştir. Sağlık çalışanlarının aşılanma oranlarının artırılabilmesi için öncelikle aşı konusundaki tutum ve davranışlarının bilinmesi gerekir.

Manure-based biogas may make an important contribution both to the energy transition and to the reduction in greenhouse gas emissions. Despite these benefits, in Switzerland the use of manure as an energy source is still very limited. The engagement of farmers in biogas production is low and the barriers to their participation are not well known. This study investigates the behavior of Swiss farmers towards anaerobic digestion and the potential impact of changing incentives. Based on a comprehensive survey, including a choice experiment, their willingness to participate in manure-based biogas production is investigated at different levels. An Agent-Based Model (ABM) is designed and used to simulate the development of biogas facilities under different framework conditions. The agent's' properties are derived from the farmers’ survey. Simulation results show that revenue for produced energy is the main driver. An increase of 0.10 CHF/kWh energy revenues (compared to 0.45 CHF/kWh today) would enable the establishment of 10 additional biogas facilities (10% more than today) enabling the manure of an additional 4285 livestock units to be mobilized for biogas, (

Actinomycosis is a chronic, suppurative disease caused by gram-positive anaerobic bacteria from the Actinomycetaceae family. Actinomyces israelii is the most commonly encountered cause of actinomycosis. Other Actinomyces species responsible for actinomycosis are A. odontolyticus, A. meyeri, A. naeslundii, and A. viscosus. Based on the site of involvement, the four most common forms are cervicofascial, abdominal, thoracic and pelvic actinomycosis. Purulent matter, sputum, vaginal discharge, fistulae content or tissue biopsy specimens are generally used to diagnose actinomycosis. However, it is very difficult to identify Actinomyces in these samples due to other filamentous and anaerobic bacteria. In this study, we evaluated actinomycosis cases who were followed up in Ege University Infectious Diseases and Clinical Microbiology Clinic between 2011 and 2016, retrospectively. Cases were evaluated in terms of age, gender, form of application, symptoms, underlying diseases, location of infection, diagnosis, and treatment. Six patients [five women; mean age 52.16 ± 21.21 (min 20-max 83)] were included into this study. Two patients had pelvic, two had cervicofascial, one had skin involvement and one had pulmonary, skin and brain actinomycosis. As a result, actinomycosis is a rare and serious disease. Unless considered in differential diagnosis, appropriate treatment may be delayed. This cohort is one of the largest series reported in Turkey. Being aware of risk factors and clinical forms as well as being skeptical are important fordiagnosis and treatment.

WOS: 000579899200006, [No abstract available]

Objectives: Data about the psychosocial side effects of directacting antiviral agents (DAA) used for the treatment of hepatitis C virus (HCV) infection is scarce. in this study, it is aimed to assess the psychiatric and sexual effects of ledipasvir/sofosbuvir (L/S) combination and paritaprevir-ritonavir-ombitasvir-dasabuvir (PROD) combination in patients with HCV infection. Materials and Methods: the sample of this retrospective study consisted of patients who were diagnosed with HCV infection and received PROD or L/S treatment. the patients were assessed by the Hospital Anxiety and Depression (HAD) scale and Arizona Sexual Experiences (ASEX) scale at baseline and first-, third- and sixth-month visits. Besides these, demographic data and data about the liver disease were collected. Results: During the studied period, 42 patients were started DAA treatment. the average age of the sample was 56.64±12.04 years. Thirty-five (83.3%) patients achieved sustained viral response. Data of the patients who filled HAD or ASEX at baseline and at least in one of the following visits within six months were used. Anxiety, depression and sexual measures did not differ between baseline and following assessments. Conclusion: L/S and PROD do not seem to have a significant effect on anxiety and depression levels and sexual experiences of the patients while they made an improvement in viral load., Amaç: Hepatit C tedavisinde kullanılan direkt etkili antiviral ajanların (DAA) psikososyal yan etkileri ile ilgili veri çok sınırlıdır. Bu çalışmada ledipasvir/sofosbuvir (L/S) kombinasyonu ile paritaprevir-ritonavirombitasvir-dasabuvir (PROD) kombinasyonunun hepatit C virüsü (HCV) ile enfekte hastalardaki psikiyatrik ve cinsel etkilerinin araştırılması amaçlanmıştır. Gereç ve Yöntemler: Bu retrospektif çalışmanın örneklemini HCV enfeksiyonu tanısı konan ve PROD ya da L/S tedavisi görmüş olan hastalar oluşturmaktadır. Hastalar tedavi öncesi ilk vizit ile birinci, üçüncü ve altıncı aylardaki vizitlerde Hastane Anksiyete Depresyon (HAD) ölçeği ve Arizona Cinsel Yaşantılar (ACYÖ) ölçeği ile değerlendirilmişlerdir. Bunların yanı sıra hastaların demografik ve karaciğer hastalığı ile ilgili verileri de çalışmada kullanılmıştır. Bulgular: Çalışma dönemi sürecinde 42 hastaya DAA başlanmıştır. Örneklemin ortalama yaşı 56,64±12,04’tür. Hastaların 35’inde (%83,3) kalıcı viral yanıt sağlanabilmiştir. Bazı hastaların ölçekleri tam olarak doldurmaması nedeniyle bazal ve takip eden altı ay içindeki en az bir vizitte HAD ya da ACYÖ’yü dolduran hastaların verileri kullanılmıştır. Anksiyete, depresyon ve cinsel yaşantı ile ilgili ölçümler açısından bazal ve izlemdeki değerlendirmeler arasında bir farklılık saptanmamıştır. Sonuç: L/S ve PROD tedavileri viral yük açısından iyileşme sağlarken, anksiyete ve depresyon düzeyleri ile cinsel yaşantı üzerinde belirgin bir etki göstermemiştir.

WOS: 000511368300009, Introduction: Necrotizing fasciitis (NF) is a complicated and rapidly spreading soft tissue infection that affects the superficial fascia, skin, and subcutaneous tissue. in this study, we evaluated patients who were diagnosed with NF and treated in two tertiary-care educational university hospitals. Materials and Methods: Patients diagnosed with NF in three centers (Ege University Department of Orthopedics and Traumatology and Department of Infectious Diseases and Clinical Microbiology and Celal Bayar University Department of Infectious Diseases and Clinical Microbiology) between November 2016 and December 2018 were retrospectively analyzed. the patients' demographic characteristics, significant risk factors for infection, sites of infection, models of surgical treatment, department(s) that performed the surgery, causative infectious agents, empirical and agent-specific treatment regimens and their duration, length of hospital stay, need for intensive care, and one month survival were evaluated. Results: Eighteen patients (10 females, mean age 53.7 [19-86 years]) who were diagnosed with NF were included in the study. Diabetes mellitus, trauma/surgery history, and decubitus wound were the most common predisposing factors. the most common anatomic site was lower extremity (n=10, 55.5%). All patients underwent surgical debridement. the most commonly isolated microorganisms were Escherichio coli (n=4), Klebsiella pneumoniae, Proteus mirabilis, and Acinetobacter boumannii (each n=3). Empirical treatment was initiated with meropenem in eight patients (32%) and tigecycline in four patients (12.5%), and the antibiotic was changed in five patients based on culture results. the mean duration of antibiotic therapy was 35.5 (9-68) days. the average hospital stay was 55 (11-186) days. Six patients (33.3%) required intensive care during follow-up. the mortality rate was 16.6%. Conclusion: NF is a fulminant disease, and early diagnosis and effective multidisciplinary treatment are crucial for reducing mortality rates. When the diagnosis is suspected, early surgical debridement should be performed and empirical antibiotherapy should be started immediately.

Giriş: Tüberküloz genel olarak akciğerlerde görülmekle birlikte tüm organları etkileyebilmektedir. Ancak akciğer dışı tutulum olduğunda tanı koymak, akciğer tutulumundan daha zordur. Mycobacterium tuberculosis’in izole edilmesi, ekstrapulmoner tüberküloz (EPTB) tanısında altın standart olmasına karşın, özellikle EPTB’de bakteriyolojik izolasyon oranı düşüktür. Eğer M. tuberculosis elde edilebilirse, hastalığın epidemiyolojik özellikleri ve ilaç duyarlılığı hakkında bilgi vermektedir. Materyal ve Metod: Bu çalışmada, 2009-2016 yılları arasında mikobakteriyoloji laboratuvarında M. tuberculosis izole edilen ekstra pulmoner örnekler değerlendirilmiştir. İzole edilen bakterilerin genotiplerin belirlenme işlemi ve ilaç duyarlılık testleri yapılmıştır. Spoligotipleme, daha önce tarif edilen standart bir teknik kullanılarak gerçekleştirilmiştir. Bulgular: Çalışma süresince 165 hastaya ait 171 ekstrapulmoner örnekte M. tuberculosis (75 erkek, 90 kadın, ortalama yaş: 53.35 ± 19.92) kültürde üretilmiştir. Birden fazla ekstrapulmoner organ tutulumu 6 hastada mevcuttur. En yaygın EPTB şekli 60 hastada lenf nodu, 32 hastada plevral tüberküloz ve 25 hastada kemik tüberkülozdur. Yedi hasta insan immün yetmezlik virüsüyle infekte olmak üzere 44 hastada immün yetmezlik saptanmıştır. Tüberküloz ilaç direnci 175 örneğin 21’inde tespit edilmiştir. Rifampisin direnci 7 örnekte, yüksek düzeyde izoniazid direnci 11 örnekte ve rifampisin ve izoniazid direnci (çoklu ilaç direnci) 6 örnekte gösterilmiştir. Tüberküloz hastalarının farklı örneklerinden elde edilen 135 klinik izolatın genetik profili Spoligotyping kullanılarak belirlenmiştir. Majör Spoligotipler, T (n= 62; %45.9), LAM7-TUR (ST41) (n= 11; %8.1) ve H1 (n= 9; %6) genotipleridir. Sonuç: En yaygın EPTB şekli, kültürle kanıtlanmış hastalarda lenf nodu tüberkülozudur. Bu hasta grubunda, çoklu ilaç direnci oranı düşüktür (%3.6). Spoligotip T (%45.9) en sık görülen genetik profil olarak tespit edilmiştir., Introduction: Tuberculosis is seen generally in the lungs. Besides, all organs in the body can be affected by tuberculosis. Diagnosis of extra pulmonary tuberculosis (EPTB) is more difficult than pulmonary tuberculosis (PTB). Although, the isolation of Mycobacterium tuberculosis is gold standard of diagnosis of EPTB, the rate of bacteriologic isolation is low especially in EPTB. If M. tuberculosis is detected, it gives some information about the epidemiological features of the disease and drug susceptibility. Materials and Methods: in this study, extra pulmonary samples isolated M. tuberculosis in mycobacteriology laboratory were evaluated between 2009-2016. the identification of the genotype of isolated bacteria and drug sensitivity tests were conducted. Spoligotyping was accomplished using a standard technique as described previously. Results: During the study period, M. tuberculosis were cultured in 171 extra pulmonary samples of 165 patients (75 male, 90 female, mean age: 53.35 ± 19.92). Initial direct microscopically examination was revealed M. tuberculosis in 44 patients. There were more than one extra pulmonary organ involvement in six patients. the most common EPTB forms were lymph node TB in 60 patients, pleural tuberculosis in 32 patients and bone tuberculosis in 25 patients. Immunosuppression was detected in 44 (%26.6) patients. Among these, seven patients were infected with HIV. in 21 of 175 samples, drug resistance was detected. Rifampicin resistance in 7 samples, high level isoniazid resistance in 11 samples and rifampicin plus isoniazid resistance (multiply drug resistance) in 6 samples were demonstrated. One hundred thirty-five clinical isolates were cultured from tuberculosis patient’s different samples, of which the genetic profile was determined by using Spoligotyping. the major Spoligotypes were T (n= 62; 45.9%), LAM7-TUR (ST41) (n= 11; 8.1%) and H1 (n= 9; 6%) genotypes. Conclusion: the most common EPTB form was lymph node tuberculosis in culture proven patients. in these patients group, multiply drug resistance rate was low (3.6%). Spoligotypes T (45.9%) was detected as most common genetic profile.

Objectives: We aimed to determine tetanus antitoxin levels and to evaluate their relationship with history of vaccination among patients applying to the outpatient clinics of a University hospital. Methods: A questionnaire including socio-demographic characteristics and tetanus vaccination status was applied and blood samples taken from 218 subjects between 1 and 30 June 2015. Participants were classified into five groups according to their vaccination timing. Results: The mean age of participants was 46.7±15.4 years and 134 (61.5%) were women. Tetanus antitoxin levels were found weak positive in 54 (24.8%) patients, positive in 44 (20.2%) and strong positive in 120 (55.0%). Tetanus antitoxin level positivity was significantly associated with vaccination timing according to history. Among 105 participants who did not remember being vaccinated or who knew they were vaccinated but did not remember the date, 16 (15.2%) remembered the vaccination time when their injury, military service and pregnancy were questioned specifically. Antitoxin levels decreased with increasing age independent of gender (0.9-fold increase/year). Conclusion: We found that the booster dose recommended every 10 years was not applied sufficiently. Tetanus vaccination history must be questioned in more detail among people who do not remember/know their vaccination history, with specific questions regarding pregnancy, military service and injury histories.

Background In this study it was aimed to compare the effects of qSOFA (Quick Sequential Organ Failure Assessment) score with modified qSOFA score (PLoS One. 2018 Sep 26;13(9):e0204608) for predicting one month survival in patients with diagnosed septic shock (SS) in a tertiary-care educational university hospital in a developing country. Methods Modified qSOFA was created by adding age factor (>50 years=1 point) to patients with qSOFA scale 1 or 2 or 3 who had SS (sepsis+hypotension+adrenergic agent) and consulted by Infectious Diseases consultants between December 2013-December 2018. Arterial lactate level of >2 mmol/L criterion was added as an including criteria for SS according to 3rd International Sepsis and Septic Shock Consensus Statement after 23rd February 2016. Statistical analysis was performed via Chi-square test and a p-value Results The number of patients with qSOFA score of 1 or 2 or 3 from 527 patients are in Table1 [some of the cases were diagnosed as septic shock according to elder definition (without lactate criterion) and there was a subgroup with qSOFA score 1]. Among the >50-year aged group, the 30-day survival rate was lower in patients with qSOFA3 vs. qSOFA 2 vs. qSOFA 1 (Table1, 3x2 Chi Square test, P = 0.0057). Among the 50 years (table, Chi-square test, 12/21 vs. 39/97 P = 0.224, 11/29 vs. 75/244 P = 0.526, 3/25 vs. 22/111 P = 0.572). Conclusion In terms of survival at one month, there was a significant difference between qSOFA score 1, 2, 3 and 4 subgroups. In patients with qSOFA score of 1 or 2 or 3, being under 50 years did not have a significant effect on one-month survival. Modified qSOFA may be beneficial to foresee the probable mortality but these findings need to be validated in larger cohorts Disclosures All authors: No reported disclosures.