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Purpose: This study aims to evaluate the correlations between the severity of the disease and serum steroid levels by analyzing the serum steroid levels in COVID-19 patients with different levels of disease progression and the control group.Methods: Morning plasma Aldosterone, 11-deoxycortisol, Androstenedione, 17- hydroxyprogesterone, Dihydrotestosterone (DHT), Dihydroepiandrostenedion (DHEA), Corticosterone, Dihydroepiandrostenedion sulfate (DHEAS), Estrone, 11- deoxycorticosterone, Cortisol, Corticosterone, Androsterone, Pregnenolone, 17- hydroxypregnenolone levels were measured in 153 consecutive patients were grouped as mild, moderate, and severe based on the WHO COVID-19 disease severity classification and the control group. Steroid hormone levels were analyzed at once with a liquid chromatography-tandem mass spectrometric method (LC-MS/MS). Results: In our study, all of the steroids except DHT and DHEAS were statistically significantly higher in the patients’ group than in the control group (p>0.001). Also, DHEA was an independent predictor of the disease severity with COVID-19Conclusions: Our study reveals that altered steroid hormone levels have a negative impact on COVID-19 prognosis by simultaneous measurement of steroid hormones levels with LC-MS/MS. Also, adrenal insufficiency due to COVID-19 is an endocrinological pathology that should be followed up.

Objectives: The aim of this study was to share the results, follow-up, and treatment characteristics of our pregnant women who were followed-up with anti-Toxoplasma gondii Immunoglobulin (Ig) M positivity during pregnancy. Methods: Anti-T. gondii IgM- and IgG-positive pregnant women were evaluated between 2014-2018. Demographic characteristics, treatment, and information about pregnancy were obtained from the electronic database. Pregnant women were divided into three groups; primary infection, no infection, and suspected infection in pregnancy. Primary and suspected infection in pregnancy were followed up congenital toxoplasmosis risky pregnancy. Fetal ultrasonography (USG), T. gondii DNA polymerase chain reaction (PCR) result in amniotic fluid were recorded. Results: Twenty-four pregnant women with a mean age of 27.9 years were followed up. IgG avidity results were low in 37.5% (n = 9), intermediate avidity in 8.3% (n = 2), and high avidity in 54.2% (n = 13) of pregnant women. Eleven (45.9%) pregnant women had congenital toxoplasmosis risky pregnancy. Fetal USG was performed on ten pregnant women, and no signs of congenital toxoplasmosis were found. Amniocentesis was performed in 72.7% (n = 8) of the participants, and the amniotic fluid T. gondii DNA-PCR result was negative in all of them. Ten (90.9%) pregnancies resulted in mature birth and one (9.1%) resulted in miscarriage. Conclusions: Anti-T. gondii IgM positivity is an indication of acute infection. But IgM can persist for years, and be false-positive in pregnancy. Therefore, additional tests are required, and leading to emotional distress and unnecessary interventions in pregnacy women. These results can aid in developing an approach to screening and diagnosis of T. gondii infection in pregnancy.

The development of candidemia is a highly fatal condition in severe COVID-19 infection.This study aimed to develop a candidemia prediction score in COVID-19 patient based on the patient's clinical characteristics, and healthcare-related factors during intensive care units (ICU) follow-up.Severe COVID-19 patients hospitalised in ICU in Ankara City Hospital during the one-year period (August 15, 2020, and August 15, 2021) were included. After univariate analysis, multivariate analysis was applied using variable selection approach to investigate the effects of variables together and to create a score model for candidemia. Statistically significant factors were included in the development process of candida prediction score.Of 1305 COVID-19 ICU patients, 139 had a candidemia episode. According to the final model, four variables, presence of central venous catheter (CVC) (OR 19.07, CI 8.12-44.8, p .0001), multifocal colonisation (OR 2.28, CI 1.39-3.72, p 0.001), length of ICU stays ≥14 days (OR 3.62, CI 2.42-5.44, p .0001) and corticosteroids (OR 0.51, CI 0.34-0.76, p 0.0011) were the only statistically significant independent risk factors for candidemia. Score model was demonstrated by a nomogram, and the risk for candidemia was calculated to be high in patients who scored ≥56 points by using the criteria [CVC = 51, multifocal colonisation = 14, prolonged hospitalisation = 23, no steroid use = 12 points]. The AUC of the score is 0.84 (CI 0.81-0.87).We developed and validated an easy-to-use clinical prediction score for candidemia in severe COVID-19 infection. In COVID-19 ICU patients, the risk of candidemia is high if one of the other risk factors is present together with CVC.

Introduction: Worldwide influenza vaccination rates remain low despite guideline recommendations to support vaccinations. It is important to identify attitudes, barriers and motivating factors influencing patients’ vaccination behaviours. We aimed to evaluate the knowledge, attitudes and factors influencing the vaccination behaviours against influenza and sources of information used by patients about influenza vaccine. Materials and Methods: This was a cross-sectional, self administered questionnaire-based study of 229 patients who visited infectious diseases and clinical microbiology outpatient clinic between December 2018 and February 2019. The questionnaire consisted of 39 items in 5 sections: Demographic data (8), questions about influenza vaccine (9), vaccination history (2), factors influencing vaccination behaviours (18) and sources of information used by patients about influenza vaccination (2). Results: Vaccinated group had a higher education level compared to the unvaccinated group, and the difference was statistically significant (p= 0.007). Vaccination against any diseases in adulthood was also statistically higher in the influenza-vaccinated group (p= 0.000). Other features were similar in both groups. The percentage of correct answers to proposals were similar and high between the two groups. Correct answers given to “People with chronic illness should have a flu vaccine” was statistically higher in the vaccinated group (80.5% vs. 61.8%, p= 0.004). Regular annual vaccination rate was only 10.3% in the vaccinated group. The most common motivating factor in vaccination was doctor’s advice (54.5%). The most common barrier against influenza vaccination was the idea that they did not need vaccination (51.3%). The information source affecting the patients mostly was the doctors in both vaccinated and unvaccinated groups. Conclusion: In order to increase the knowledge level and vaccination rates, doctors should be informed rigorously about advising influenza vaccine to patients, especially high risk groups. Education and advice from healthcare professionals about vaccine is crucial for increasing vaccination rate.

Introduction: The Standardized Infection Ratio (SIR) is a statistic used to track healthcare associated infections over time, at a national or facility level. SIR gives clearer data due to patient and institutional characteristics. It makes it possible to fairly compare hospital performance because the data are risk-adjusted. The aim of our study is to evaluate SIR and cumulative attributable difference (CAD) and to compare for national data. Materials and Methods: The study was conducted in Atatürk Training and Research Hospital reanimation 1 and 2, coronary, cardiovascular surgery, internal medicine-neurology and general surgery intensive care units (ICU). Based on total data reported at national level, stratified calculations based on type of institution and intensive care unit (ICU) type ventilator-associated pneumonia, central line-associated bloodstream infection and catheter-associated urinary tract infection rates calculated, and SIR and CAD were calculated by SIR-matic, which was organized by the Department of Infectious Diseases, General Directorate of Public Health of the Turkish Ministry of Health. Results: According to the infection rate and SIR value for ventilator-associated pneumonia, our ventilator-associated pneumonia rate in all ICUs, the ventilator utilization rate of coronary, internal medicine-neurology and general surgery ICUs is above the Turkey’ average, and in all ICUs except coronary and general surgery ICU, SIR values for ventilator-associated pneumonia were found to be statistically significant > 1.00. According to the infection rate and SIR values for catheter-associated urinary tract infection, our rates were high in ICUs, while SIR value was calculated equal to 1.00. There was no more infection than predicted on an institution basis. When the CAD values were examined, it was found that the unit-based cardiovascular surgery and general surgery ICUs had less infection than expected within one year. According to the infection rate and SIR values for central line-associated bloodstream infection, the rates in our ICUs are higher than the national average. Conclusion: As a result of the study, infection rates and SIR values were higher in most intensive care units than national values. SIR values were found to be more reliable in infection monitoring.

Critically ill COVID-19 patients have a high risk for the development of candidemia due to being exposed to both well-defined classical risk factors and COVID-19-specific risk factors in ICU.In this study, we investigated the incidence of candidemia in critically COVID-19 patients, and the independent risk factors for candidemia.COVID-19 patients hospitalised in ICU during 1-year period (August 2020 to August 2021) were included. Clinical and laboratory characteristics of all COVID-19 patients, applied treatments, and invasive procedures that may predispose to candidemia were recorded.Of 1229 COVID-19 patients, 63 developed candidemia. Candidemia incidence rate was 4.4 episodes per 1000 ICU days. The most common species was Candida albicans (52.3%). Only 37 patients (58.7%) received antifungal therapy. The presence of central venous catheter (OR 4.7, 95% CI 1.8-12.2, p .005), multifocal candida colonisation (OR 2.7, 95% CI 1.4-5.2, p .005), a prolonged ICU stay (≥14 days) (OR 1.9, 95% CI 1.08-3-37, p .05), the absence of chronic lung disease (OR 0.4, 95% CI 0.1-0.9, p .05) and the absence of corticosteroid use (OR 0.3, 95% CI 0.14-0.52, p .0001) were significantly associated with candidemia.Our study filled the knowledge gap in the literature about the impact of COVID-19-associated risk factors for the development of candidemia. The classical risk factors for candidemia had a significant effect on candidemia, and contrary to expectations, corticosteroids had a protective effect against the development of candidemia. The results of these studies showing interesting effects of corticosteroids in critically ill COVID-19 patients should be confirmed by further studies.

Introduction: After the definition of the first H1N1 case on 15 April 2009, the first case in our country was reported on 15 May 2009, and the first local case was seen on 18 June 2009. In this study, we evaluated patients hospitalized with a pre-diagnosis of H1N1 virus infection, according to epidemiologic, clinical and laboratory features. Materials and Methods: Cases hospitalized between October 2009 and January 2010 with a pre-diagnosis of pandemic influenza and for whom samples of nasal and oropharyngeal swabs were obtained were included in the study. Epidemiologic and laboratory properties of the cases (for both H1N1 positive and H1N1negative groups) were evaluated, as well as their prognoses and treatment. Results: Between October 2009 and January 2010, 155 patients with pre-diagnoses of H1N1 were hospitalized. Eighty-four H1N1 positive and 71 H1N1 negative patients were evaluated. Cough, fatigue and fever were the most frequently observed symptoms. Obesity, fatigue and diarrhea were more common in the H1N1 negative group. Abnormal chest X-ray, lymphopenia and leukopenia were more common in the H1N1 positive group. The fatality rate was determined as 7.1%. 21.4% of the patients (18/84) required intensive care. Twelve patients were monitored with invasive and 3 with non-invasive mechanical ventilation. None of the patients in the H1N1 negative group required intensive care. In the H1N1 positive group, 69 patients received oseltamivir and 47 patients received oseltamivir and antibiotherapy. Conclusion: The new pandemic influenza virus came under the spotlight because of its fast spread and the complications seen in young patients with no comorbidities, where normally influenza-related complications are not expected. The majority of our cases were young adult patients. Most of the cases hospitalized with H1N1 diagnosis had symptoms similar to pneumonia, low oxygen saturation and deterioration in their general condition. Antiviral treatment initiated during the early phases of the disease was successful. Respiratory support and intensive care play a vital role in the cases in which they are needed. Informing the population about the disease and educating them on its transmission and immunization are very important in preventing its spread.

In cases with upper thoracal and cervical spine injury, it is difficult to distinguish fever based on autonomic dysfunction from that with infectious causes. Fever can be associated with autonomic dysfunction by eliminating all possible causes, primarily infectious and noninfectious diseases. We present a case with fever of unknown origin after cervical spine injury to call attention to autonomic dysfunction in the etiology of fever in such cases.

Objective:Vaccination and education play an important role in prevention of hepatitis B virus (HBV) infection.Materials and Methods:In our study, a survey consisting of 27 questions was filled out face to face to evaluate the knowledge level of our patients, who were infected with HBV. SPSS 15.0 for Windows was used for statistical analysis.Results:A total of 105 patients with average age 43.7±12.4 participated in the survey. 63.8% of the participants were male, 69.5% were hepatitis B carrier and 30.5% were chronic hepatitis B. 20% of the patients became aware of their disease during blood donation and 16.2% have been informed during pre-surgical routine tests. Most attributed transmission routes were blood and sexual contact, however kissing, sneezing, common use of kitchenettes like glass, plate, fork, sharing the house with infected patient were the other ways for transmission. 85.7%, 65.7% and 61.9% of the patients had information about some of the complications of HBV like cirhosis, liver cancer and liver failur, respectively. There was no statistically significant relation between education level of the patients and their awareness about possible consequences of the disease. 33.3% of the cases believed that scouring the food was one of the ways of preventing the disease and there was no relation between this wrong belief and education level of the patients. 72.9% of the patients told that the disease was curable and 78% of them reported that the aim of the treatment was to stop the progression of the disease. 13.8% of the patients thought that herbal treatments might be a solution in treatment of the disease.Conclusion:The knowledge level of the patients infected by HBV is obviously insufficient regardless of the patients’ education level. It is extremely important to concentrate on catch-up works for society not only for the patients to deal with the negative consequences of the disease on their social life, but also for follow-up and treatment of the patients.