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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+

Introduction: Although diabetic foot infections are polymicrobial, gram-positive microorganisms comprise the majority. Daptomycin is a novel agent in treating infections due to multidrug-resistant gram-positive pathogens. In this multicenter study, the outcomes of the daptomycin treatment were evaluated retrospectively in the treatment of diabetic foot infectious without osteomyelitis. Materials and Methods: Patients with diabetic foot infection without osteomyelitis and who received daptomycin treatment were included into the study. Sociodemographic characteristics of the patients, risk factors for methicillin resistant Staphylococcus aureus (MRSA), antimicrobial treatment, and the data of microbiological and clinical outcomes of the cases were registered in a standard form by eleven centers. Clinical success was defined as a combination of end-of-treatment laboratory parameters, clinical and microbiological responses. Results: A total of 46 patients (30 males, 16 females) were clinically evaluated for the outcome of daptomycin therapy. Mean age was 61.09 ± 11.82 years (31-81) and mean diabetes duration was 13 ± 8.2 years. The number of mild, moderate and severe infections identified according to the infection scoring system of the Infectious Diseases Society of America (IDSA) were 12 (26.1%), 25 (54.3%), and 9 (19.6%) respectively. Duration of daptomycin therapy was 17.5 ± 9.3 days and overall daptomycin success rate was 82.6% (n= 38). Two patients developed side effects. Conclusion: The clinical success rate of this study which assessed the efficacy of daptomycin in diabetic foot infections was 82.6%. Daptomycin can be safely used even in severe cases having had no success with previous antibiotic therapy.

Direct and indirect costs of diabetes and its complications figure prominently in health care expenditure globally. The diabetic foot is one of the most common complications of diabetes and is usually associated with neurological and peripheral vascular problems, yielding foot ulcers and infection. The aim of this study was to analyze hospitalized diabetic foot patient costs and amputation rate changes over time. Hospitalized patients with infected diabetic foot ulcerations within a 4-year span, starting in January 2012, were retrospectively evaluated to analyze cost and amputation rate changes over time. One hundred thirty-eight diabetic patients were hospitalized and treated. Major amputation rates tended to increase; however, minor amputation rates tended to decrease over time. Mean cost per patient was $2880. The distribution of the costs according to the years was not significant. Treatment of infected diabetic foot ulceration is challenging and incurs high healthcare costs. Through intensive foot care and multidisciplinary team approaches, major amputation rates have gradually increased in recent years.

This chapter examines the financial crises of the Ottoman Empire and how through press representations, reformers advocated for a ‘public’ that would unify fragmented and multiple actors to improve Ottoman society. Then in its early stages of development, the Ottoman press was used to establish a new political and social order. The discussion analyses how dissident newspapers, Tasvir-i Efkar, İbret, Hadika and İstikbal, all published in Istanbul, significantly influenced the establishment of a politically and economically engaged public. In conceptualising newspaper representations of the economic crises as an outcome of conflicting interests, it resituates the tension existing not only between state and society but also among other interests. The interpretations of the financial crises competed, coexisted and were utilised to promote particular interests and reveal how the press provided an arena of contestation for diverse groups and individuals.

INTRODUCTION[|]To evaluate the prevalence of Toxoplasma gondii, rubella and cytomegalovirus (CMV) among the pregnant Turkish women as well as Syrian refugees in Istanbul.[¤]METHODS[|]Among pregnant women who are admitted to \\\"xxxx\\\" Maternity and Children Hospital in İstanbul between January 2014 and January 2015, antibodies against Toxoplasma gondii, rubella and CMV were measured using the micro-elisa method. The test results were evaluated retrospectively.[¤]RESULTS[|]Out of total 1066 pregnant women screened in this study, 963 (90.3%) were Turkish, and 103 (9.7%) were Syrian refugees. IgM positivity rates of T. gondii rubella and CMV were determined as 0,2%, 0%, 0,2% in Turkish women and 0,1%, 0%, 0% in Syrian refugees, IgG positivity rates were determined as 26,3%, 93,8%, 99,5% in Turkish women and 58,3%, 87,4%, 100% in Syrian refugees. The seroprevalence of T. gondii was lower and the rubella seroprevalence was higher among pregnant Turkish women and among pregnant Syrian refugees and statistically significant ( p< 0.05).[¤]DISCUSSION AND CONCLUSION[|]Since immunity against T. gondii in pregnant Turkish women is lower than in Syrian refugees, who are in reproductive age group, should get routine screenings. Immunization against rubella should be considered for Syrian refugees who are in reproductive age group. [¤]

Ebola virus disease (EVD), formerly known as Ebola hemorrhagic fever, is a severe, often fatal illness in humans. Ebola virus (EBOV) is transmitted through contact with blood or body fluids of a person who contracted or died from EVD, contaminated objects like needles and infected animals or bush meat. EVD has an incubation period of 2 to 21 days, and the infection has an acute onset without any carrier status. Currently, there is no standard treatment for EVD, so it is important to avoid infection or further spreading of the virus. Although historically the mortality of this infection exceeded 80%, modern medicine and public health measures have been able to lower this figure and reduce the impact of EBOV on individuals and communities. Its treatment involves early, aggressive supportive care with rehydration. Clinicians should consider the possibility of EVD in persons with travel or exposure history with the incubation period presenting constitutional symptoms in order to promptly identify diseased patients, and prevent further spreading of the disease.

Objectives: We described the clinical outcomes of the diabetic patients who had foot infections with multidrug resistant organisms. Methods: We included the patients with diabetic foot infections (DFI) from 19 centers, between May 2011 and December 2015. Infection was defined according to IDSA DFI guidelines. Patients with severe infection, complicated moderate infection were hospitalized. The patients were followed-up for 6 months after discharge. Results: In total, 791 patients with DFI were included, 531(67%) were male, median age was 62 (19-90). Severe infection was diagnosed in 85 (11%) patients. Osteomyelitis was diagnosed in 291(36.8%) patients. 536 microorganisms were isolated, the most common microorganisms were S. aureus (20%), P. aeruginosa (19%) and E. coli (12%). Methicillin resistance (MR) rate among Staphylococcus aureus isolates was 31%. Multidrug resistant bacteria were detected in 21% of P. aeruginosa isolates. ESBL (+) Gram negative bacteria (GNB) was detected in 38% of E. coli and Klebsiella isolates. Sixty three patients (8%) were rehospitalized. Of the 791 patiens, 127 (16%) had major amputation, and 24 (3%) patients died. In multivariate analysis, significant predictors for fatality were; dialysis (OR: 8.3, Cl: 1.82-38.15, p = 0.006), isolation of Klebsiella spp. (OR:7.7, Cl: 1.24-47.96, p = 0.028), and chronic heart failure (OR: 3, Cl: 1.01-9.04, p = 0.05). MR Staphylococcus was detected in 21% of the rehospitalized patients, as the most common microorganism (p < 0.001). Conclusion: Among rehospitalized patients, methicillin resistant Staphylococcus infections was detected as the most common agent, and Klebsiella spp. infections were found to be significantly associated with fatality. (C) 2018 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

Objective: Acinetobacter baumannii is a gram negative, antimicrobial-resistant bacilli difficult to control and treat. This pathogen has became more important in the last decades due to multidrug-resistant nasocomial infections. The aim of this study was to determine the antibiotic resistance rates of A.baumannii isolated from various clinical specimens of intensive care unit (ICU) patients between November 2010 and December 2011. Material and Methods: A total of 172 A.baumannii strains were isolated. Identification and antibiotic susceptibility testing were performed by VITEC 2 (bioMerieux, France) system. Results: A. baumannii strains were isolated 44% from tracheal aspirate, 25% from wounds, 24% from blood, and 7% from urine, consecutively. Although there were no resistant strains detected to colistin and tygecycline, resistance rates of the other antibiotics were found to be 64% for amicacin, 67% for gentamicin, %73 for levosoxacin, 76% for ciprosoxacin, %79 for cefoperazone/sulbactam, 84% for piperacillin/tazobactam, and 92% for imipenem and meropenem, consecutively. Conclusion: In conclusion, no resistant strains were detected to colistin and tygecycline and they were found to be the preferred empirical treatment for A. baumannii infections.

Hakyemez, Ismail Necati/0000-0001-6133-9604; Mert, Ali/0000-0001-8945-2385; YILMAZ, Mesut/0000-0001-8022-7325 WOS: 000394632300009 PubMed: 28013184 Aim: To examine the variables associated with mortality in patients with Acinetobacter baumannii-related central nervous system infections treated with intrathecal colistin. Materials and methods: This multi-centre retrospective case control study included patients from 11 centres in Turkey, as well as cases found during a literature review. Only patients with CNS infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii treated with intrathecal colistin were included in this study. The variables associated with mortality were determined by dividing the patients into groups who died or survived during hospitalisation, and who died or survived from Acinetobacter meningitis. Results: Among the 77 cases enrolled in the study, 35 were found through a literature review and 42 were cases from our centres. Forty-four cases (57.1%) were male and the median age was 48 years (range: 20-78 years). Thirty-seven patients (48%) died during hospitalisation. The variables associated with increased all-cause mortality during hospitalisation included old age (odds ratio, 1.035; 95% confidence interval (Cl), 1.004-1.067; p = 0.026) and failure to provide cerebrospinal fluid sterilisation (odds ratio, 0.264; 95% confidence interval, 0.097-0.724; p = 0.01). There is a trend (P=0.062) towards higher mortality with using of meropenem during meningitis treatment. Fifteen cases (19%) died from meningitis. There were no significant predictors of meningitis-related mortality. Conclusions: The mortality rate for central nervous system infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii is high. Old age and failure to provide CSF sterilisation are associated with increased mortality during hospitalisation. (C) 2016 Published by Elsevier B.V.

Sayan, Murat/0000-0002-4374-7193; Gunduz, Alper/0000-0001-9154-844X; ULCAY, ASIM/0000-0003-0531-0668 WOS: 000375126200003 PubMed: 27125365 Objectives: Integrase strand transfer inhibitor (INSTI) is a new class of antiretroviral (ARV) drugs designed to block the action of the integrase viral enzyme, which is responsible for insertation of the HIV-1 genome into the host DNA. The aim of this study was to evaluate for the first time INSTI resistance mutations in Turkish patients. Methods: This study was conducted in Turkey, between April 2013 and April 2015 using 169 HIV-1-infected patients (78 ARV naive patients and 91 ARV-experienced patients). Laboratory and clinical characteristics of ARV naive and ARV-experienced patients were as follows: gender (M/F): 71/7 and 80/11, median age: 38 and 38.4; median CD4+ T-cell: 236 and 216 cells/mm3, median HIV-1 RNA: 4.95+ E5 and 1.08E+ 6 copies/ml. Population-based seqeunces of the reverse transcriptase, protease, and integrase domains of the HIV-1 pol gene were used to detect HIV-1 drug resistance mutations. Result: INSTI resistance mutations were not found in recently diagnosed HIV-1-infected patients. However, ARV-experienced patients had major resistance mutations associated with raltegravir and elvitegravir; the following results were generated: F121Y, Y143R, Q148R and E157Q (6/91 - 6.6%). Conclusions: The prevalence of INSTI resistant mutations in ART-experienced patients suggested that resistance testing must be incorporated as an integral part of HIV management with INSTI therapies.

Background/aims The present study aimed to determine the changes in the epidemiology of hepatitis in recent years in an adult Turkish population. Materials and methods Overall, 852 patients with acute viral hepatitis from 17 centers were included in this study. Their sociodemographic characteristics, clinical courses, treatments, and laboratory findings were retrospectively analyzed. Results The most commonly found microorganisms were the hepatitis B virus (55.2%) and hepatitis A virus (37.6%), and the types of acute viral hepatitis differed significantly according to the age group (p≤0.001). The most frequently reported symptom was fatigue (73.7%), and the most common complications were cholecystitis (0.4%) and fulminant hepatitis (0.4%). The median hospital stay was 9 days (range 1-373). In total, 40.8% patients with acute hepatitis B virus developed immunity. Conclusion In Turkey, there are significantly large adolescent and adult populations susceptible to acute viral hepatitis. Therefore, larger vaccination programs covering these age groups should be implemented.

The spine is the most common site of musculoskeletal involvement of brucellosis. However, there is no case report presented in the literature of both cervical vertebrae spondylodiscitis and pulmonary involvement of brucella. We reported a 52-year-old woman complaining for one month of fever with rigors, fatigue, malaise, pain on the neck and arm, and sweating. The Wright agglutination test for brucella was positive at titers of 1/640. MRI of the cervical vertebrae was consistent with spondylodiscitis and paravertebral and epidural abscesses. Ground glass opacity was seen in the left upper lobe on CT scanning of the chest. Percutaneous image-guided biopsy was performed and Brucella melitensis was isolated. The patient was treated with streptomycin for 3 weeks, plus doxycycline and rifampicin for 3 months. We recommend tissue culture for brucella patients with lung lesions. Isolation of the microorganism from a biopsy material provides conclusive evidence. J Microbiol Infect Dis 2015;5(4): 173-175 Key words: Bacterial infection, brucellosis, cervical vertebrae, pulmonary involvement, spondylodiscitis

Study design Retrospective clinical study. Objective The aim of this study is to reveal the effectiveness of HBO therapy in iatrogenic spinal infections intractable to antibiotic therapy alone. Summary of background data The efficiency of hyperbaric oxygen (HBO) therapy, which is currently being used in many areas, has been proven in infections in deep and superficial locations and in osteomyelitis. The aim of this study is to reveal effectives of HBO therapy in iatrogenic spinal infections intractable to antibiotic alone therapy. Methods HBO therapy was given to 19 cases of iatrogenic spinal infection between 2008 and 2013. Adjuvant HBO therapy was applied to cases that had exhibited no improvement in clinical and laboratory findings despite medical treatment for at least 3 weeks. Several parameters including demographic characteristics, surgical area, etiology and the surgical treatment modality, microbiology (culture material and causative organism), clinical and laboratory results, duration of HBO therapy, and outcome were reviewed. Results The mean age was 54.6 years (range: 32-75 years). Iatrogenic spinal infections were most frequent in the lumbar region. It occurred after spine instrumentation in 12 cases and after micro-discectomy in 7 cases. The average number of HBO therapy sessions applied was 20.1 (range: 10-40). Wound discharge and clinical and laboratory findings recovered in all cases at the end of the therapy course. No revision or removal of the instrumentation was necessary in the instrumented cases. Conclusion HBO therapy is a treatment modality, which is safe and efficient as an adjuvant therapy in the treatment of infections. It was also seen to be effective in the prevention of revision procedures and instrumentation failures in iatrogenic osteomyelitis cases, which had occurred following spinal instrumentation. Level of evidence 4.

We aimed to investigate the predictors for limb loss among patients with diabetes who have complicated skin/soft-tissue infections. In this observational study, consecutive patients with diabetic foot infection (DFI) from 17 centres in Turkey, between May 2011 and May 2013 were included. The Turkish DFI Working Group performed the study. Predictors of limb loss were investigated by multivariate analysis. In total, 455 patients with DFI were included. Median age was 61 years, 68% were male, 65% of the patients were hospitalized, 52% of the patients had used antibiotics within the last month, and 121(27%) had osteomyelitis. Of the 208 microorganisms isolated, 92 (44.2%) were Gram-positive cocci and 114 (54.8%) were Gram-negative rods (GNR). The most common GNR was Pseudomonas; the second was Escherichia coli, with extended spectrum beta-lactamase positivity of 33%. Methicillin-resistant Staphylococcus species were found in 14% (29/208). Amputations were performed in 126/455 (28%) patients, 44/126 (34%) of these were major amputations. In multivariate analysis, significant predictors for limb loss were, male gender (OR 1.75, 95% Cl 1.04-2.96, p 0.034), duration of diabetes >20 years (OR 1.9, 95% Cl 1.18-3.11, p 0.008), infected ulcer versus cellulitis (OR 1.9, 95% Cl 1.11-3.18, p 0.019), history of peripheral vascular disease (OR 2, 95% Cl 1.26-3.27, p 0.004), retinopathy (OR 2.25, 95% Cl 1.19-4.25, p 0.012), erythrocyte sedimentation rate >70 mm/hr (OR 1.6, 95% Cl 1.01-2.68, p 0.05), and infection with GNR (OR 1.8, 95% Cl 1.08-3.02, p 0.02). Multivariate analysis revealed that, besides the known risk factors such as male gender, duration of diabetes >20 years, infected ulcers, history of peripheral vascular disease and retinopathy, detection of GNR was a significant predictor of limb loss. Clinical Microbiology and Infection (C) 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

WOS: 000329585200001, PubMed ID: 24118178, We evaluated the efficacy and tolerability of antibiotic regimens and optimal duration of therapy in complicated and uncomplicated forms of spinal brucellosis. This is a multicentre, retrospective and comparative study involving a total of 293 patients with spinal brucellosis from 19 health institutions. Comparison of complicated and uncomplicated spinal brucellosis was statistically analysed. Complicated spinal brucellosis was diagnosed in 78 (26.6%) of our patients. Clinical presentation was found to be significantly more acute, with fever and weight loss, in patients in the complicated group. They had significantly higher leukocyte and platelet counts, erythrocyte sedimentation rates and C-reactive protein levels, and lower haemoglobulin levels. The involvement of the thoracic spine was significantly more frequent in complicated cases. Spondylodiscitis was complicated, with paravertebral abscess in 38 (13.0%), prevertebral abscess in 13 (4.4%), epidural abscess in 30 (10.2%), psoas abscess in 10 (3.4%) and radiculitis in 8 (2.7%) patients. The five major combination regimens were: doxycycline 200mg/day, rifampicin 600mg/day and streptomycin 1g/day; doxycycline 200mg/day, rifampicin 600mg/day and gentamicin 5mg/kg; doxycycline 200mg/day and rifampicin 600mg/day; doxycycline 200mg/day and streptomycin 1g/day; and doxycycline 200mg/day, rifampicin 600mg/day and ciprofloxacin 1g/day. There were no significant therapeutic differences between these antibiotic groups; the results were similar regarding the complicated and uncomplicated groups. Patients were mostly treated with doxycycline and rifampicin with or without an aminoglycoside. In the former subgroup, complicated cases received antibiotics for a longer duration than uncomplicated cases. Early recognition of complicated cases is critical in preventing devastating complications. Antimicrobial treatment should be prolonged in complicated spinal brucellosis in particular.

Adult onset Still's disease is a rare systemic inflammatory disease of unknown origin. It is common to involve liver and spleen, and less often lungs. A 24-year-old man presenting with spiking fever, pulmonary infiltrations, and pleural effusion on the right side mimicking pneumonia. All serologic tests of infectious causes, antinuclear antibody, and rheumatoid factor were negative. He was diagnosed as Adult onset Still's disease according to the criteria of Yamaguchi. Adult onset Still's disease is considering in the differential diagnosis pneumonia that is unresponsive to antimicrobial treatment, negative cultures and serologically diagnostic laboratory tests, and high-level serum ferritin.

The aim of this case report is to draw attention to the frequent occurrence of metoclopramide-induced movement disorders. We report a case of an acute dystonic reaction to metoclopramide in a patient treated for hepatitis A. Metoclopramide can cause severe adverse events, such as an acute dystonic reaction, and should be used with caution in patients with infectious diseases.

Sporotrichosis is a cutaneous or systemic fungal infection caused by Sporothrix schenckii. The infection is characterized by nodular, pustular, or ulcerative lesions. Infection usually occurs after traumatic implantation of the fungus into the skin. We report a case presenting first cellulitis and later on as a non-healing ulcer which was diagnosed by punch biopsy as sporotrichosis and managed successfully with itraconazole. A 56-year-old woman admitted to our department with complaint acute onset of swelling of the right lower-extremity with erythema and warmth. The patient was diagnosed initially as celulitis and started on ampicillin-sulbactam. Diagnosis of sporotrichosis was made with histological examination skin biopsy and the patient was started on itraconazole. One month after commencement of antifungal treatment, the ulcer began to dry up and at 3 months the lesions had healed. This case shows that if a wound do not respond to antibiotics in cases with ulcer, some rare etiological agents should be considered. [Dis Mol Med 2016; 4(3.000): 34-36]