Search

OBJECTIVE: The epidemiology of hepatitis A virus (HAV) infection is influenced by variables such as age, sex, environmental conditions, and vaccination status. This study aimed to evaluate HAV seropositivity after the inclusion of hepatitis A vaccination in the national childhood immunization program and identify demographic risk factors of the susceptible population before routine vaccination. PATIENTS AND METHODS: This cross-sectional epidemiological study was conducted by retrospectively examining the laboratory records of patients who underwent HAV serology testing in a tertiary care center in eastern Turkey between 2008 and 2019. RESULTS: Overall immunity to HAV was 81.6%. According to birthplace and year, the rate of anti-HAV positivity was higher among people born before 2006 in the Southeast and Eastern Anatolia regions. For those born in 2012 or later, the lowest seropositivity was among those born in the Southeast region, while it was over 60% in the other regions. When analyzed by year of birth, the lowest seropositivity was in those born between 1994 and 2011, and the frequency of seropositivity increased with age. Of those born between 1982 and 1999, the seropositivity rate was higher among men than women. Rural dwellers born before 2012 had higher seropositivity than urban dwellers. Among those born before the introduction of routine childhood HAV vaccination, female sex, urban dwelling, and each additional year of age were identified as independent demographic risk factors for HAV susceptibility. CONCLUSIONS: Socioeconomic development and immunization programs have altered HAV seroprevalence patterns. Planning catchup vaccinations, especially in adolescents and young adults (born in 1994-2011) with low seropositivity and ensuring the continuity of hygiene and sanitation practices are important to protect the susceptible population. [ABSTRACT FROM AUTHOR]

Background and Aim: This study aimed to define the relapse frequency and risk determinants in chronic hepatitis B (CHB) patients who discontinued nucleoside analog (NA) treatment, were HBeAg-negative, and had achieved both a virological and biochemical response., Materials and Methods: This retrospective cohort study reviewed patients with HBeAg-negative CHB who received antiviral therapy for at least 65 months between January 1, 2013, and December 31, 2020. These patients discontinued treatment after demonstrating a biochemical and virological response and were evaluated at 6, 12, and 24 months post-treatment discontinuation., Results: Sixty-seven patients with CHB who received NA therapy for at least 65 months, discontinued treatment, and had undetectable HBV DNA and normal ALT values were evaluated. After cessation of NA therapy, a relapse was observed in 38 patients (56.7%). The relapse rate was 71.0% in patients treated with tenofovir disoproxil fumarate (TDF) as the last NA type and 37.9% in patients treated with entecavir (ETV) (p=0.017). The cutoff value for the best estimate of age for predicting relapse was 42 years. The relapse rate was 69.2% in patients aged ≥42 years and 39.2% in patients aged <42 years (p=0.007). The relapse rate was 51.3% in patients with a pre-treatment fibrosis score of 2, 56.0% in those with a fibrosis score of 3, and 100% in those with a fibrosis score of 4 (p=0.089)., Conclusion: Among HBeAg-negative CHB patients who achieved a virological and biochemical response to long-term antiviral therapy, those aged 42 years and older, those with high fibrosis scores before treatment, and those who used TDF before treatment cessation should be closely monitored for relapse, especially in the first 12 months after stopping NA treatment., Competing Interests: The authors have no conflict of interest to declare.

Background: This study aimed to evaluate the prevalence of fear of falling and associated factors in older adults with heart failure., Methods: A prospective, cross-sectional study. The study included 100 geriatric patients who were hospitalised and treated in the cardiology department of our hospital with ventricular ejection fraction (LVEF) lower than 50% for at least 1 year. A series of geriatric assessments were performed by face-to-face interview on the day of admission. Electrocardiography (ECG) and transthoracic echocardiography (TTE) were also performed on the day of admission., Results: The median age of the patients was 72 years, and 72.0% were men. Falls Efficacy Scale scores indicated a fear of falling in 46 (46.0%) of the patients. Charlson Comorbidity Index (CCI) was significantly higher in patients with fear of falling (P < 0.001). Severe depression, severe clinical insomnia, daytime sleepiness, and malnutrition were significantly more frequent among patients with fear of falling. Fear of falling was associated with significantly lower LVEF (P = 0.001). The presence of severe depression increased the risk of fear of falling by 13.97 times (95% CI: 3.064-63.707; P = 0.001), and the presence of daytime sleepiness increased the risk by 3.49 times (95% CI: 1.012-12.037; P = 0.048). A one-unit increase in CCI increased the risk of fear of falling by 1.56 times (95% CI: 1.093-2.238; P = 0.014)., Conclusions: Heart failure patients with concomitant depression, sleep disorders, and high comorbidities have greater fear of falling., (© 2023 Japanese Psychogeriatric Society.)

Objective: Patients receiving palliative care are more prone to dermatological disease. The aim of our study was to determine the frequency of dermatological diseases and associated factors in patients receiving palliative care support., Methods: This prospective observational study included inpatients in the palliative care unit of our university hospital in Erzurum/TURKEY. The patients were evaluated by the same dermatologist within the first 48 h of admission and 3 days a week during follow-up. Demographic data, reasons for admission to the palliative care unit, and skin lesions at the time of admission and during follow-up were recorded., Results: The median age of the 259 patients included in the study was 77.0 years (min- max, 19-108) and 54.4% were women. Dermatological disease was detected in 246 patients (96.1%) at admission to the palliative care unit and in 185 patients (71.4%) patients during follow-up. The most common dermatological disease at admission was dry skin (n  =  175, 67.6%), which was also the most common cause of pruritis (n  =  29, 11.2%). The most common skin infection was dermatophytosis (n  =  57, 22.0%) and the most common type of dermatitis was contact dermatitis (n  =  17, 6.6%). Nearly all tumors were benign (n  =  32, 12.4%) and most chronic wounds were pressure ulcers (n  =  96, 37.1%). During hospital follow-up, the most frequent dermatitis was contact dermatitis (n  =  44, 17.0%), the most frequent skin infection was candidiasis (n  =  25, 9.7%), the most common chronic wound was pressure ulcers (n  =  25, 9.7%), the most common dermatological disease was urticaria (n  =  14, 5.4%), and all cases of pruritus were associated with dry skin (n  =  8, 3.1%)., Conclusions: The frequency of dermatological findings is high among patients receiving palliative care. Therefore, dermatologists should be included in multidisciplinary palliative care teams and evaluate palliative care patients early and regularly., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Mortality rates after hip fractures increase by up to 30% with age. This study investigated the contribution of various parameters to prognosis and mortality., Methods: Our study prospectively examined patients with hip fracture aged 65 years and over who applied to the Atatürk University Medical Faculty Hospital Orthopedics Service in 2020-2021., Results: The 120 patients included in the study had a mean age of 79.71±7.27 years, and 51.7% were female. Twenty patients (16.7%) died within the first 30 days after a hip fracture. They had a significantly lower median Lawton-Brody instrumental activities of daily living (IADL) scale score (p=0.045) and a higher rate of malnutrition according to the Mini Nutritional Assessment (MNA) score (p=0.016). Additionally, these patients with 30-day mortality had a significantly lower rate of surgical treatment (p=0.027) and a longer time from injury to surgery (p=0.014). The time to surgery was a significant independent risk factor for 30-day mortality, with each 1-hour delay increasing the odds of mortality by 1.066 (odds ratio [OR]=1.066; 95% confidence interval [CI], 1.001-1.013; p=0.013). In addition, the presence of malnutrition was another independent risk factor that increased the odds of mortality by 4.166 times (OR=4.166; 95% CI, 1.285-13.427; p=0.017)., Conclusion: We recommend placing more importance on supportive treatment in patients presenting with hip fractures, especially in those with malnutrition; performing surgical intervention as early as possible; and more closely following up with patients with the aforementioned risk factors.

Background and Aim: In chronic hepatitis B infection, antiviral therapy significantly reduces the incidence of complications. This study aimed to present real-life 12-month effectiveness and safety data for TAF., Materials and Methods: This Pythagoras Retrospective Cohort Study included patients from 14 centers in Turkiye. The study presents 12-month results of 480 patients treated with TAF as initial therapy or after switching from another antiviral drug., Results: The study shows treatment of about 78.1% patients with at least one antiviral agent (90.6% tenofovir disoproxil [TDF]). The rate of undetectable HBV DNA increased in both treatment-experienced and naive patients. In TDF-experienced patients, the rate of alanine transaminase (ALT) normalization increased slightly (1.6%) within 12 months, but the change was not statistically significant (p=0.766). Younger age, low albumin, and high body mass index and cholesterol were identified as risk factors for abnormal ALT after 12 months, but no linear relationship was detected. In TDF-experienced patients, renal and bone function indicators showed significant improvement three months after the transition to TAF and remained stable for 12 months., Conclusion: Real-life data demonstrated effective virological and biochemical responses with TAF therapy. After switching to TAF treatment, gains in kidney and bone functions were achieved in the early period., Competing Interests: The authors have no conflict of interest to declare., (© Copyright 2023 by Hepatology Forum.)

Q fever is a zoonotic disease that is known to be widespread throughout the world by many researches since its discovery in 1935 and it is important in terms of animal and public health. Coxiella burnetii, which is the etiological agent of the disease, is an obligate intracellular pathogen. While the disease generally manifests itself with abortion in animals, disease manifests as atypical pneumonia or granulomatous hepatitis in the acute form and as endocarditis in the chronic form in humans. Its presence in Turkey has been shown with a large number of studies. The aim of this study was to show the genotypic relationship with MLVA analysis of C. burnetii samples found in cattle, sheep and goat samples in Erzurum and Samsun Veterinary Control Institutes and blood samples collected from humans with atypical pneumonia findings. In the study, MLVA analyses of 100 positive samples from 50 cows, 41 sheep and 9 goats from Northeast Anatolia and Black Sea regions and C. burnetii positive samples found in 6 individuals with atypical pneumonia were performed. As a result of the study, it was found that 106 C. burnetii samples had belong to 16 genotype groups. It was found that genotype XVI was the most prevalent among these groups and it was seen in both regions. In addition to this, genotype IX profile was the second largest group with 83.3% (5/6) of human samples. In this study, the genotypes common in the regions were determined and a data source was created for possible outbreaks., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: Sarcopenia, a geriatric syndrome, is an indicator of poor prognosis in elderly inpatients. In this study, we aimed to determine the effect of sarcopenia on mortality in elderly patients., Materials and Methods: Mobile/immobile geriatric inpatients, treated in the internal medicine ward between February and November 2018, were included in the study between Days 2 and 7 of hospitalization. The patients' fat-free mass (FFM) was measured by bioimpedance. The FFM index (FFMI) (kg/m 2 ) was determined by dividing fat-free mass by body surface area (FFM/BSA). Sarcopenia was defined as a FFMI value at least two standard deviations below the gender-specific mean of normal young adults., Results: The study included 200 geriatric inpatients; 96 (48.0%) were men, and the mean age was 74.49±6.32 years. Sarcopenia was detected in 28 (14%) of the patients. Diabetes mellitus was associated with a significantly lower sarcopenia prevalence (p=0.006). The risk of sarcopenia was 9.046 times higher in malnourished patients. The sarcopenia group had more deaths (p=0.012)., Conclusion: Sarcopenia in geriatric inpatients increased the length of hospital stay and mortality. Our findings may guide future studies examining the relationship between sarcopenia and mortality among elderly inpatients in other hospitals., Competing Interests: Conflict of Interest: The authors have no conflicts of interest to declare., (©Copyright 2020 by the Atatürk University School of Medicine - Available online at www.eurasianjmed.com.)

Purpose: In this multicentre, retrospective, matched cohort study we aimed to evaluate the outcomes of neutropenic fever cases that were treated with daptomycin or a glycopeptide (vancomycin or teicoplanin)., Methods: Data and outcomes of adult (aged > 18-years old) patients with neutropenic fever [(1) without clinical and radiological evidence of pneumonia, (2) who were treated with daptomycin or a glycopeptide (teicoplanin or vancomycin) for any reason and for at least 72 h] were extracted from the hospital databases. Matching was performed with all of the three following criteria: (1) underlying disease, (2) reason for starting daptomycin or glycopeptide (microbiologic evidence vs. microbiologic evidence, clinical infection vs. clinical infection and empirical therapy vs. empirical therapy) and (3) neutropenic status., Results: Overall 128 patients [(69/123) (56.1%) in the daptomycin cohort (D) and 59/123 (48%) in the glycopeptide cohort (G)] had a resolution of fever at the end of 72 h antibiotic treatment (p = 0.25). There was no significant difference in cured, improved and (cured + improved) rates between (D) and (G) cohorts as well as fever of unknown origin cases or microbiologically confirmed infections or clinically defined infections subgroups (p > 0.05). There was also no significant difference (p > 0.05), in terms of persistent response in the (D) versus (G) cohorts, CONCLUSIONS: These findings suggest that although not better, daptomycin efficacy is comparable to vancomycin if used as empiric therapy in the treatment of adult febrile neutropenia. We conclude that daptomycin may be used at least as a salvage therapy alternative to glycopeptides in the treatment of adult febrile neutropenia cases. A large, randomized-controlled trial may further consolidate the evidence related to this question.

Background: The aim of this study was to determine the value of C-reactive protein level in the diagnosis and prognosis of infection in elderly patients., Study Population: This prospective study included inpatients in the palliative care unit during the 1-year period between January 2016 and January 2017. Patients' demographic data, Acute Physiology and Chronic Health Evaluation score, and Charlson Comorbidity Index were recorded., Results: A total of 233 patients were included in the study. A total of 199 instances of infection were diagnosed in 175 of those patients; 75.3% of the infections were detected at admission and 24.7% during hospitalization. At a cut-off value of 4.82, CRP value had 81.0% specificity and 75.4% sensitivity in the diagnosis of infection. Among the patients with infection, there was no difference between those who died and those who survived in terms of baseline CRP level, but a significant difference emerged in CRP level at 48 and 96 h. Factors which were found to significantly reduce survival time were the presence of chronic kidney disease, chronic obstructive pulmonary disease, hypoxia and tachycardia at admission, APACHE-II score over 20.5, initial albumin level below 2.44 g/dL, and serum CRP clearance rates of less than 11% at 48 h and 20% at 96 h., Conclusion: In elderly patients with infection, the initial CRP value alone does not have prognostic value, but changes observed in serial CRP measurement are a valid indicator of prognosis.

We report a case of infective endocarditis secondary to healthcare-associated bloodstream infection caused by an uncommon etiologic agent, multidrug-resistant Enterobacter cloacae . The patient was treated with a combination of antimicrobial therapy and surgery, but could not be saved. With this case, we discuss the prevalence, risk factors, treatment options, and outcomes of the rarely encountered Enterobacter cloacae -associated infective endocarditis.

Background: Percutaneous endoscopic gastrotomy (PEG) enables long-term enteral feeding. The aim of this study was to identify biomarkers that may guide the decision of whether to perform the elective procedure of PEG., Methods: The medical records of all patients who underwent PEG in our hospital from 2010 to 2016 were screened retrospectively. Patients with mortality within a 30-day follow-up period and those without were compared using the Chi-square test, and continuous variables were compared with the Kruskal-Wallis and Mann-Whitney U tests. Receiver operating characteristic (ROC) curve analysis was used to demonstrate the ability of biomarkers to predict mortality; a cut-off point was determined and its sensitivity, specificity, and positive and negative predictive values were calculated. The Youden index was used to determine the cut-off point. Kaplan-Meier analysis was used to identify PEG-related mortality risk factors and a Cox regression model was applied for risk characterization., Results: A total of 120 patients who underwent PEG were evaluated in the study. The mean age was 67.00 ± 18.00 years. The most common indication for PEG was cerebrovascular disease, in 69 (57.5%) of the patients. Infection of the PEG site was most common within 14 days after PEG tube placement, occurring in 13 patients (10.3%). The mortality rate among patients with post-PEG infection was 68.2%, significantly higher than in patients without infection (P = 0.012). Thirty-four patients (28.3%) died within 30 days of undergoing PEG. CRP values ≥ 78.31 mg/L increased mortality by 8.756-fold, and albumin levels < 2.71 g/dL increased mortality by 2.255-fold., Conclusion: Our results indicate that the presence of both high CRP level and low albumin level were associated with significantly higher rate of mortality (73.1%) in patients who underwent PEG.

Introduction: Risk factors for nosocomial carbapenem-resistant Klebsiella spp. (CRK) infections were analyzed in this study., Methodology: The incidence, clinical characteristics, risk factors, antimicrobial susceptibility, and outcomes of CRK infections during a seven-year period (2004-2010) were retrospectively analyzed., Results: A total of 720 patients were included in the study. Carbapenem resistance among Klebsiella spp. were significantly increased between 2003 and 2007 (p<0.001). CRK strains were mostly isolated from ICUs (p<0.001). Use of imipenem and cefoperazone-sulbactam within prior three months, stay in ICU, receiving immunspressive therapy, receiving H2 receptor antagonists, tracheostomy, mechanical ventilation, hemodialysis, urinary catheter were found to be significant risk factors for carbapenem resistance Klebsiella spp. infections. In a multivariate analysis, prior use of imipenem (OR 3.35; CI 1.675-6.726, p<0.001), stay in ICU (OR 3.36; 95% CI 1.193-9.508; p=0.022), receiving H2 receptor antagonist (OR 4.49; 95% CI 1.011-19.951; p=0.048) were independently associated with carbapenem resistance. Respiratory tract infections were the most seen nosocomial infection. Attack mortality rate was significantly higher in patients infected with CRK strains (p<0.001). CRK strains showed significantly higher resistance rates to other antibiotics., Conclusions: In conclusion, the emergence and rapid spread of CRK strains in our hospital is worrisome. The patients in ICU are most important risk group for the acquisition of CRK strains. High resistant rates to other antibiotics except than colistin and tigecycline limits therapeutic options, and increases mortality rates.

Background: In the past, Staphylococcus aureus infections have displayed various patterns of epidemiologic curves in hospitals, particularly in intensive care units (ICUs). This study aimed to characterize the current trend in a nationwide survey of ICUs in Turkey., Methods: A total of 88 ICUs from 36 Turkish tertiary hospitals were included in this retrospective study, which was performed during the first 3 months of both 2008 (period [P] 1) and 2011 (P2). A P value ≤.01 was considered significant., Results: Although overall rates of hospital-acquired infection (HAI) and device-associated infection densities were similar in P1 and P2, the densities of HAIs due to S aureus and methicillin-resistant S aureus (MRSA) were significantly lower in P2 (P < .0001). However, the proportion of HAIs due to Acinetobacter was significantly higher in P2 (P < .0001)., Conclusions: The incidence of S aureus infections is declining rapidly in Turkish ICUs, with potential impacts on empirical treatment strategies in these ICUs., (Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.)