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Objective:Obesity might be a risk factor for patients with Coronavirus disease-19 (COVID-19). We aimed to investigate the association of the obesity with intensive care need and mortality caused by severe acute respiratory syndrome-CoV-2 (SARS-CoV-2) infection in this retrospective cohort.Methods:Between March 11th and May 1st, 135 patients, who were treated in our clinic, were enrolled in the study. Body mass index (BMIs) of the patients were grouped according as WHO criteria (30 kg/m2: obese).Results:Of our patients, 34.1% (n=46) were obese. Mean BMI of the mortality group was 31.2 kg/m2 and was not different from that of the survivors (p=0.09), However, mean BMI of the patients, in whom intensive care was needed, was 31.2 kg/m2 and higher than that of those intensive care was not needed (p=0.04). In subgroup analyses, obesity (BMI >30 kg/m2) was more common among mortality group versus survivors in males older than 60 years old (p=0.03).Conclusion:Obesity with associated disorders are negative prognostic factors for COVID-19 and should be tackled as the end of the pandemic is obscure.

Introduction The human population is aging at an astonishing rate. The aim of this study is to capture a situation snapshot revealing the proportion of individuals aged 65 years and over among inpatients in healthcare institutions in Turkey and the prevalence and type of infections in this patient group in order to draw a road map. Materials and Methods Hospitalized patients over 65 years at any of the 62 hospitals in 29 cities across Turkey on February 9, 2017 were included in the study. Web-based SurveyMonkey was used for data recording and evaluation system. Results Of 17,351 patients 5871 (33.8%) were ≥65 years old. The mean age was 75.1 ± 7.2 years; 3075 (52.4%) patients were male. Infection was reason for admission for 1556 (26.5%) patients. Pneumonia was the most common infection. The median length of hospital stay was 5 days (IQR: 2–11 days). The Antibiotic therapy was initiated for 2917 (49.7%) patients at the time of admission, and 23% of the antibiotics prescribed were inappropriate. Healthcare-associated infections developed in 1059 (18%) patients. Urinary catheters were placed in 2388 (40.7%) patients with 7.5% invalid indication. Conclusion This study used real data to reveal the proportion of elderly patients in hospital admissions. The interventions done, infections developed during hospitalization, length of hospital stay, and excessive drug load emphasize the significant impact on health costs and illustrate the importance of preventive medicine in this group of patients.

Objective:The aim of this study is to investigate the effect of hypertension on the clinical severity and prognosis of Coronavirus disease-2019 (COVID-19) patients.Methods:In this retrospective observational study, reverse transcription-polymerase chain reaction (RT-PCR) positive COVID-19 patients over the age of 18 years who were hospitalized in Bezmialem Vakıf University between March and May 2020 were included. The patients were divided into two groups as hypertensive and non-hypertensive and compared for clinical, laboratory and prognosis.Results:Two hundred sixty COVID-19 patients were included in the study, 55.4% of them were male and the mean (± standard deviation) age was 54.1±15.5 years. Hypertensive patients were older (64.6±11.5 and 47.2±13.9) (p

Objective:This study aims to assess the effectivity of a rapid antibody test on detecting the occupational exposure in healthcare professionals who have been working in a pandemic hospital since the initial cases were seen in our country.Methods:Prevention of Coronavirus disease 2019 (COVID-19) in our institution was managed according to the Republic of Turkey (T.C.) Ministry of Health recommendations. Between 20.04.2020 and 05.05.2020, 376 high-risk professionals (triage, emergency room, COVID-19 outpatient unit, COVID-19 clinic and intensive care unit) were screened by rapid antibody test for COVID-19. Positive cases were retrospectively examined in terms of COVID-19 diagnosis or potential symptoms of COVID-19 infection (fever, perspiration, debility, cough, myalgia, sour throat, nasal flow, diarrhea, loss of smell/taste sensation).Results:The mean age was 32.7±8.9 years, 222 patients were female and 154 were male. Positive rapid antibody test was detected in 27 (7.2%) patients: 24 of those had COVID-19 diagnosis or potential symptoms of COVID-19 infection, where 3 patients had no signs or symptoms of the disease.Conclusion:During pandemic, the reliability of rapid antibody tests has become under question due to validation issues. However, rapid antibody test may be feasible for COVID-19 screening among healthcare professionals in order to assess the precautions and prevent nosocomial infection.

The recent pandemic of COVID-19 has caused a tremendous alarm around the world. Details of the infection process in the host have significant bearings on both recovery from the disease and on the correlates of the protection from the future exposures. One of these factors is the presence and titers of neutralizing Abs (NAbs) in infected people. In the current study, we set out to investigate NAbs in the recovered subjects discharged from the hospital in full health. Serum samples from a total of 49 documented consecutive COVID-19 subjects were included in the study. All the subjects were adults, and serum samples collected during the discharge were tested in viral neutralization, enzyme immunoassay (EIA), and Western immunoblot tests against viral Ags. Even though a majority of the recovered subjects had raised significant NAb titers, there is a substantial number of recovered patients (10 out of 49) with no or low titers of NAbs against the virus. In these cohorts as well as in patients with high NAb titers, viral Ag binding Abs were detectable in EIA tests. Both NAb titers and EIA detectable Abs are increased in patients experiencing a severe form of the disease, and in older patients the Ab titers were heightened. The main conclusion is that the recovery from SARS-CoV-2 infection is not solely dependent on high NAb titers in affected subjects, and this recovery process is probably produced by a complex interplay between many factors, including immune response, age of the subjects, and viral pathology.

Objectives The response rate of patients to hepatitis B virus (HBV) vaccination receiving anti-tumor necrosis factor (TNF) agents is quite low. We aimed to assess the efficiency of HBV vaccination in patients with chronic inflammatory diseases (CIDs) receiving anti-TNF agents as well as in healthy controls. We also evaluated the impact of different factors on the efficacy of HBV vaccination. Methods Patients with CIDs receiving anti-TNF agents and healthy controls vaccinated for HBV were included in the study during 2018-2019. An adequate immune response and an effective immune response to HBV were defined as >10 IU/L and > 100 IU/L, respectively. Results Among 274 participants, 187 were patients with CID and 87 were healthy controls. The mean age of the patients with CID (43.9 ± 11.7 years) was significantly higher than that of the healthy controls (31.4 ± 7 years) (P = 0.000). Adequate immune response was 60.8 and 94.3% in patients with CID and healthy controls (P = 0.000), respectively, whereas effective immune response was 37.9 and 75.9% (P = 0.000), respectively. In logistic regression analysis, male sex [odds ratio (OR), 0.408; 95% confidence interval (CI), 0.201-0.830; P = 0.013), use of infliximab (OR, 2.694; 95% CI, 1.203-6.035; P = 0.016) and sertoluzimab (OR, 3.307; 95% CI, 1.287-8.498; P = 0.013), vaccination after anti-TNF treatment (OR, 0.224; 95% CI, 0.083-0.602; P = 0.003) were identified as risk factors of nonresponse to HBV vaccine. Conclusions Infliximab and sertoluzimab usage, male sex, and vaccination after anti-TNF treatment were risk factors of nonresponse. HBV vaccination should be given to patients with CID before initiation of anti-TNF treatment and awareness should be spread on this subject.

We sought to characterize the causative pathogens of prosthetic joint infections (PJIs), evaluate the trends in microbial etiologies, and identify potential risk factors for PJI. This was a retrospective study analyzing 70 patients with PJI following 3,253 total joint arthroplasties between 2011 and 2017. Staphylococci were the most common cause of infection (52.9%). There was a significant trend in the percentage of carbapenem-resistant gram-negative bacilli (GNB) (increased to 66.7% in 2016 from 0.0% in 2011) (p=0.021). GNB and polymicrobial etiology were found at significantly high levels in cases involving early PJIs (p=0.005 and p=0.048, respectively). While staphylococci were significantly higher in PJIs after total knee arthroplasty (75%), GNB were significantly higher in PJIs after total hip arthroplasty (49.1%) (p0.001 and p=0.001, respectively). Binary logistic regression analysis showed that the risk of PJI was significantly higher in cases with fracture and diabetes mellitus (odds ratio [OR], 4.3, 95% confidence interval [CI], 1.78-10.5 ; OR, 4.1, 95% CI, 1.66-10.5, respectively). These results suggest that the empirical and targeted antimicrobial treatment of PJIs may become more difficult in the future.

Background: Serum cytokine levels over the course of HIV infection usually increase with immunosuppression and decrease after antiretroviral treatment (ART). Objectives: The aim of the study is to compare cytokine levels between HIV-infected patients (HIP) and controls and investigate the relationship between CD4+T cell count, HIV-RNA levels, and cytokine levels. Methods: The study subjects comprised ART-naive HIP (n=30) with no comorbidities and age-and sex-matched healthy controls. We measured levels of IL-6, IL-1β, TNF-α, and IFN-γ in serum samples of HIP at the beginning and at month 6 of ART and in controls. Results: The mean age of the study subjects was 38.7 ±10.3 years, with men making up 86.7% of the study subjects (n=26). IL-6, IL-1β, and TNF-α levels were significantly higher in both ART-naive (p0.00). Conclusions: Although serum concentrations of IL-6, IL-1β and TNF-α showed a significant decrease after ART, they were still significantly higher than the controls. IFN-γ responded differently to ART compared to the other cytokines, indicating that it may play a distinct and important role in the pathogenesis of HIV infection.

BACKGROUND/OBJECTIVES The data regarding the microbial spectrum in necrotizing pancreatitis and its impact on mortality is limited. Therefore, in this study, we aimed to investigate the agents identified in cultures and their impact on in-hospital and 1-year all-cause mortality. METHODS Patients with necrotizing pancreatitis were retrospectively included in the study. Based on culture results, patients were classified as either negative culture or positive culture necrotizing acute pancreatitis. The main outcomes of the study were the identification of agents isolated in patients with pancreatic necrosis and to assess in-hospital, 30-day and 1-year all-cause mortality according to culture results. RESULTS In total, 109 patients of whom 33 had positive cultures were included in the study. Most positive cultures were polymicrobial (66%) with a marked gram-negative bacterial dominance (63%). Klebsiella spp. were the most common identified pathogens. The patients a with positive culture had worse outcomes in terms of in-hospital, 30-day and 1-year all-cause mortality compared to patients with sterile culture results (n = 9, 27.3% vs. n = 4, 5.3%, P < 0.01 for in-hospital mortality; n = 11, 33.3% vs. n = 5, 6.6%, P < 0.01 for 30-day mortality; and n = 14, 42.4% vs. n = 10, 13.2%, P < 0.01 for 1-year mortality). CONCLUSION When a microorganism was identified in patients with necrotizing acute pancreatitis, it was mostly polymicrobial in etiology with a gram-negative bacterial dominance. In our cohort, Klebsiella spp. were the most common isolated organisms. Especially the patients with polymicrobial etiology showed a very poor outcome both in-hospital and in the long-term. Local hospital flora may have an impact on culture results.

Background / Aims:Clostridium difficile is a Gram-positive, strict anaerobe, spore-forming bacterium. It can cause self-limiting mild diarrhea, severe diarrhea, pseudomembranous colitis, and fatal fulminant colitis. We aimed to investigate the changes in epidemiology and incidence of C. difficile infection in our hospital database. Patients and Methods: Episodes of C. difficile toxin were identified in hospital database, and data such as age, sex, community versus hospital acquisition, intensive care follow-up, current or previous treatments with antibiotics within the past 3 months, medication with proton pump inhibitors, or immunosuppressive therapies were collected. Results: Toxin-positive 78 individuals constituted the patient group. In univariate analyses, independent risk factors for toxin positivity were community versus hospital acquisition [odds ratio (OR), 5.49; 95% confidence interval (CI), 2.52–11.95; P = 0.0001], presence of inflammatory bowel diseases (IBDs) (OR, 21.5; 95% CI, 8.65–53.44; P = 0.0001), proton pump inhibitors' use (OR, 4.53; 95% CI, 1.97–10.43; P = 0.0001), immunosuppressive drug use (OR, 4.1; 95% CI, 2.01–8.3; P = 0.0001), and use of quinolone group of antibiotics (OR, 5.95; 95% CI, 1.92–18.46; P = 0.001). Antibiotic use was a protective risk factor (OR, 0.09; 95% CI, 0.01–0.78; P = 0.01) and presence of IBDs was an independent risk factor (OR, 6.8; 95% CI, 1.5–30.08; P = 0.01) in community-acquired group (OR, 0.09; 95% CI, 0.01–0.78; P = 0.01). Conclusion: In recent studies, C. difficile infections were demonstrated to be more frequent in younger individuals who did not have a history of hospitalization but had an underlying disease such as IBD. In our study, we showed the change in the epidemiological data with prominence of underlying diseases such as IBDs.

Objective: Infectious spondylodiscitis (SD) is an infectious disease that is rare and difficult to diagnose due to its non-specific clinical features. In this study, we aimed to describe the clinical and diagnostic features of infectious spondylodiscitis. Methods: All patients who were diagnosed with SD at our hospital during a 7-year period from January 1, 2011 through December 31, 2017 were included in the study. Spondylodiscitis is divided into the following three types: pyogenic, tuberculous, and brucellar. Clinical and laboratory data were collected retrospectively from the medical records of the patients. Results: Of the 118 patients, 66 (55.9%) were female, 81 (68.6%) had pyogenic SD (PSD), 21 (17.8%) had tuberculous SD (TSD), and 16 (13.6%) had brucellar SD (BSD). The mean age was 59.3 ± 14.6 years. Leucocytosis was significantly higher in patients with PSD (p=0.01) than in patients with other types of SD. Thoracic involvement (47.6%) was significantly higher in patients with TSD (p=0.005) than in other patients. Sacral involvement (12.5%) was significantly higher in patients with BSD (p=0.01) than in other patients. Paravertebral abscess formation (42.8%) occurred most frequently in patients with TSD. Microbiologic agents were defined in 50% (18/36) of the surgical specimens and in 12.5% of the fine needle aspiration biopsy (FNAB) specimens. Staphylococcus aureus was the most common microbiological agent in patients with PSD. Spinal surgery was defined as a risk factor for PSD (p = 0.0001). Binary logistic regression analysis revealed that female gender, thoracic involvement and night sweats were the predictive markers for TSD (OR 4.5 [95% CI 1.3-15.3] and OR 5 [95% CI 1.7-14.6]). Conclusion: PSD is the most frequent form of SD. Leucocytosis is most common in patients with PSD. Thoracic involvement and paraspinal abscess were prominent in patients with TSD. Sacral involvement was most common in patients with BSD. Thoracic involvement, female gender and night sweats were the predictive markers for TSD. The microbiological culture positivity rate was higher in surgical specimens compared to FNAB specimens. The need for surgical treatment was most common in patients with TSD.

Pseudomonas stutzeri, non-fermentatif, gram negatif bakteridir. Nadirenenfeksiyonlara neden olur. Bu yazıda, ilk defa P. stutzeri’nin etken olduğukaraciğer apsesi olgusu sunulmuştur., Pseudomonas stutzeri is non-fermentative gram negative bacteria which rarely leads to infections. In this report, we presented for the first time a liver abscess which was caused by P. stutzeri.

Purpose: Klebsiella pneumoniae is the most common endogen agent for nosocomial infections. In this study, mortality markers were investigated in patients with nosocomial K. pneumoniae blood stream infection (NKp BSI). Methods: The characteristics of patients >16 years who had NKp BSI diagnosis by daily active surveillance between January 2012 and January 2016 were retrospectively evaluated. Patients who died until 28th day of the clinical follow up and those who survived until this time were statistically compared in terms of various risk factors. Results: One hundred ninety patients were included into the study. Mortality rate was 47.9%, carbapenem resistance was 43.2%. Statistical analysis have shown that in presence of post-NKp BSI sepsis, septic shock, following in intensive care unit (ICU), meropenem resistance, kidney failure, NKp BSI secondary to pneumonia, use of invasive instruments such as central venous catheter (CVC), urinary catheter (UC) and mechanical ventilator (MV), colostomy, transfusion and hemodialysis mortality was significantly higher. In patients admitted into the hospital for neurological disorders, pancreaticobiliary tract (PBT) diseases and patients who have undergone endoscopic retrograde cholangiopancreatography (ERCP) and patients in whom NKp BSI secondary to PBT infection mortality rate was lower. Conclusions: Sepsis, septic shock, clinical conditions requiring ICU treatment and meropenem resistance increase mortality rates in NKp BSI significantly. Mortality was higher also in patients with NKp BSI secondary to pneumonia, in kidney failure and when invasive instruments were used. On the other hand, in patients who were admitted to the hospital for neurological disorders and PBT diseases mortality rate was lower.

Streptococcus parasanguinis, oral floranın doğal bir üyesidir. Fırsatçı patojen olup, düşük virülansı nedeniyle nadiren sistemik infeksiyonlara yol açar. Subakut infektif endokarditi olan hastalar, spondilodiskit gibi farklı klinik tablolar ile prezente olabilmektedir. Kuzey Irak’lı, 65 yaşında erkek hasta; yüksek ateş, kilo kaybı, bel ağrısı ve yürüyememe yakınmaları ile acil servisimize başvurdu. Veteriner hekim olan hastamızın üç yıl önce kolon kanseri nedeniyle cerrahi ve ışın tedavisi aldığı öğrenilmiştir. Manyetik rezonans görüntülemede; lomber 1-2 de spondilodiskit saptandı. Transtorasik ekokardiyografide aort kapağında vejetasyon tespit edildi. Kan kültürlerinde S. parasanguinis izole edildi. Sonuç olarak; mesleği veteriner hekimlik olan, öyküsünde kolon kanseri bulunan spondilodiskit kliniği ile başvuran hastamızda, infektif endokadit etkeni olarak S. parasanguinis izole edilmesi dikkat çekici bulunmuştur., Streptococcus parasanguinis is a natural member of oral flora. It is an opportunistic pathogen, and rarely cause systemic infections due to it’s low virulence. Subacute infective endocarditis may present with various clinical manifestations (eg., spondylodiscitis). A sixty-five years old male patient from Northern Iraq has referred to our emergency service with high fever, weight loss, back pain and inability to walk. The patient was a veterinarian. He was operated three years ago for colonic carcinoma and irradiated. In magnetic resonance imaging, spondylodiscitis was detected localized in lumbar 1-2 region. Transthorasic echocardiography demonstrated aortic valve vegetation. S. parasanguinis was identified in the blood cultures. In conclusion; all in all, it’s remarkable to isolate S. parasanguinis as a causal agent of infective endocarditis in a patient who is a veterinarian with history of colonic carcinoma presented with clinical manifestation of spondylodiscitis.

The Hantaviruses within the Bunyaviridia family carried by rodents cause two different diseases in humans: Hemorrhagic Fever with renal syndrome (HFRS) and Hantavirus Pulmonary Syndrome (HPS). It is transmitted through contact with the secretion of infected rodents or through the inhalation of aerosols containing the virus. In different parts of the world, various virus subtypes cause the disease. In HPS, mostly Sin Nombre, Andes, Laguna, Negra and New York types are causative agents, whereas in HFRS the agents are Dobrava, Puumala, Hantaan, Saaremaa and Seoul. It is more frequently observed in forest areas receiving heavy rain and having a large rodent population. While HPS is seen in America, HFRS is mostly seen in Asia and Europe. The number of Hantavirus infections have been on the rise in the world day by day. Clinic cases associated with Hantavirus known to exist by seroepidemiological trials conducted in Turkey were defined for the first time in 2009 with an outbreak occurred in the north-west region of the country. The number of cases reported so far has reached 28. Here, it is aimed to review the Hantavirus cases occurred in Turkey up to the present and increase awareness about the disease., Kemirgenler tarafından taşınan Bunyaviridae ailesinde yer alan, Hantavirüsler, insanda iki farklı klinik tabloya neden olur: “Renal Sendromlu Hemorajik Ateş” (HFRS) ve “Hantavirüs Pulmoner Sendrom” (HPS). Enfekte kemirgenin salgıları ile temasla veya virüs içeren aerosollerin solunum yolu ile alınması ile bulaşır. Dünyanın farklı bölgelerinde farklı virüs alt tipleri hastalığa neden olur. HPS’de en sık SinNombre, Andes, Laguna, Negra ve New York türleri etkendir. HFRS’de Dobrava, Puumala, Hantaan, Saaremaa ve Seoul türleri neden olur. Bolca yağış alan ve büyük rodent popülasyonuna sahip ormanlık bölgelerde daha sık görülmektedir. HPS Amerika’da HFRS ise Asya ve Avrupa’da daha sık görülmektedir. Dünyada Hantavirüs enfeksiyonlarının sayısı her geçen gün artmaktadır. Türkiye’de yapılan seroepidemiyolojik çalışmalar ile varlığı bilinen Hantavirüs’ebağlı klinik olgular ilk defa 2009 yılında ülkenin kuzey-batı bölgesinde meydana gelen salgınla tespit edilmiştir. Günümüze kadar bildirilen olgu sayısı 28’e ulaşmıştır. Burada Türkiye’de bugüne kadar görülen Hantavirus olguları gözden geçirilerek hastalıkla ilgili farkındalığın arttırılması amaçlanmıştır