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Objectives: Patients with hepatitis B e antigen-negative chronic infection (inactive carriers) account for most of the people living with hepatitis B virus (HBV). This study investigated the direct medical cost of monitoring patients within this group.Materials and Methods: A total of 293 outpatients receiving regular monitoring in a large university hospital were included in the study. Direct medical costs included laboratory tests, imaging, liver biopsies and co-payments. Linear mixed effect models were applied to investigate the effect of follow-up time on the annual cost of monitoring. We made quarterly, semi-annual and annual monitoring cost trajectories in accordance with international guideline recommendations.Results: The average annual direct medical cost per patient was 160 USD and the average laboratory visit cost per patient was 68.5 USD. HBV DNA testing contributed to a majority percentage of the total cost (59.6%). As follow-up time increased, the total annual cost (beta=-2.07) and annual cost for DNA testing (beta=-1.03) decreased. The cost trajectory of the first two years of monitoring remained above the semi-annual follow-up strategy. After three years, the cost trajectory of monitoring, while reducing slightly, remained between the semi-annual and annual follow-up strategy trend lines. Conclusion: Due to high-patient numbers, the total cost of monitoring presents a large economic burden. Taking into consideration the generally benign nature of the disease; the length of intervals between outpatient hospital visits could be reviewed and alternative strategies implemented with the aim of reducing expenditure.

Background: Low bone mineral density (BMD) is one of the comorbidities that develop in people living with HIV (PLWHIV). Objective: This study was conducted to review the frequency and risk factors of reduced BMD according to age in HIV-infected patients in Turkey. Material and Method: This retrospective cohort study included HIV-infected patients aged 18-50. Bone density was analysed using dual-energy X-ray absorptiometry (DXA) according to the Z-score in three different regions including the lumbar, total-hip and femoral-neck. Results: The study included 224 PLWHIV with a mean age of 35.84-7.54, and 59.8% were ART naive. Of the patients, 40.6% had lower BMD than expected at least in one of the three examined regions including the lumbar, total hip and femoral neck. The low BMD ratios were found respectively as 11.6%, 11.6% and 28.6% in the femoral neck, total hip and lumbar regions. According to the logistic regression model, a high body mass index (p=0.003) and HIV-RNA level of ≥100.000IU/ml during the diagnosis in the ART-naive group (p=0.008) were associated with reduced bone demineralization. The low BMD frequency was high in the group that received ART for

Background: People living with HIV need to use antiretroviral therapy throughout their lives. Objectives: Studies on the efficacy and safety of dual therapy are limited in Turkey. We sought to evaluate the treatment efficacy and side effects among patients who were given a combination of dolutegravir (DTG) and lamivudine (3TC) as a maintenance therapy. Methods: This retrospective, single-centre study included individuals with viral suppression who were older than 18 years of age, living with HIV, switched from a combination antiretroviral therapy regimen to DTG-3TC dual therapy, and followed up for at least 6 months. Results: The study included 63 patients living with HIV. The median age was 42 years (interquartile range (IQR): 36-51 years). The median follow-up under the DTG-3TC regimen was 10.4 months (7.1-16.0 months). In the course of dual therapy, no patients developed any serious adverse effects that would necessitate a therapy switch, but virological blips were seen in two patients. Two patients lost their lives, with one dying from suicide and one dying from respiratory failure associated with the underlying chronic obstructive pulmonary disease. Conclusion: The DTG-3TC dual-therapy regimen is a promising and effective therapy that can be used as a treatment of choice for eligible patients. Keywords: Dolutegravir; lamivudine; dual; antiretroviral therapy; efficacy.

We analysed a carbapenem-resistant

Objectives: Patients with chronic hepatitis C virus (HCV) infectionand superinfection by hepatitis A or hepatitis B virus have highermorbidity and mortality when compared with those without HCVinfection. The aim of this study was to determine hepatitis A and Bseroprevalence rates and immunity in patients with chronic HCV indifferent regions of TurkeyMaterials and Methods: This multi-center study involving HCVinfected chronic cases was conducted between July 2016 andOctober 2017. Serological tests of Hepatitis B surface antigen, antiHBs, hepatitis B core antibody (anti-HBc) immunoglobulin G (IgG)and anti-HAV IgG were evaluated by ELISA, and the files of HCVinfected patients at the age of 18 or over who applied to 15 hospitalsin 13 different cities of our country were screened.Results: Three hundred sixty-two of the 828 patients were menand 466 were women. The prevalence of HBV/HCV coinfection was2.4%, while the anti-HBs positivity rate was 46.9%. Of the 610patients evaluated in terms of anti-HAV IgG serology, 88.8% wereanti-HAV IgG positive, while 11.1% were anti-HAV IgG negative.Isolated anti-HBc IgG positivity was detected in 5.8% of patients.Conclusion: Revealing the serological status of other hepatitisagents, such as hepatitis A and B, in patients with chronic hepatitisC is important in terms of providing the opportunity to immunize ortreat when required Gereç ve Yöntemler: HCV ile enfekte kronik olguları içeren çok merkezli bu çalışma Temmuz 2016-Ekim 2017 tarihleri arasında yapıldı. Hepatit B yüzey antijeni (HBsAg, antiHBs, antiHBcIgG ve antiHAVIgG’nin serolojik testleri ELISA ve 18 yaşında HCV ile enfekte hastaların dosyaları veya Ülkemizin 13 farklı ilinde 15 hastaneye başvuranlar tarandı. Ülkemizin 13 farklı ilindeki 15 hastanenin HCV ile enfekte hastalarının dosyaları tarandı ve ELISA yöntemi ile değerlendirilen HBsAg, anti-HBs, anti-HBc IgG ve antiHAV IgG bakıldı. Bulgular: Sekiz yüz yirmi sekiz hastanın üç yüz altmış ikisi erkek, 466 kadındı. HBV/HCV koenfeksiyon prevalansı %2,4 iken antiHBs pozitiflik oranı %46,9 idi. Anti-HAV IgG serolojisi açısından değerlendirilen 610 hastanın %88,8’i anti-HAV IgG pozitif, %11,1’i anti-HAV IgG negatif idi. Hastaların %5,8’inde izole anti-HBc IgG pozitifliği saptandı. Sonuç: Kronik hepatit C’li hastalarda hepatit A ve B gibi diğer hepatit ajanlarının serolojik durumunun ortaya konması, gerektiğinde aşılama veya tedavi fırsatı sağlama açısından önemlidir WOS:000605350300005

Prosthetic joint infections cause serious morbidity and mortality among joint arthroplasty patients. Rifampin-accompanied antibiotic regimens are recommended for gram-positive infections. This study aimed to combine current evidence supporting the rifampin supplement to an effective antibiotic in the treatment of prosthetic joint infections. We conducted a random-effects meta-analysis with frequentist and Bayesian approaches. A total of 13 studies, all observational, were included in the final analysis. The predominant bacteria in eight, two, and three studies were Staphylococcus spp., Propionibacterium spp., and Streptococcus spp., respectively. We pooled data from 568 patients in the staphylococcus subset (OR, 1.18; 95% CIs, [0.76; 1.82]; I2 = 23%) and data from 80 patients in the propionibacterium subset (REM OR, 1.61; 95% CIs [0.58; 4.47]; I2 = 0%). Both were insignificant with little heterogeneity. We pooled data from 483 patients in the streptococcus subset; the pooled estimate in this subset favored the use of rifampin supplemented regimens (1.84; [0.90; 3.76]) with moderate to high unaccounted heterogeneity (I2 = 57%). Bayesian random-effects models produced a posterior probability density indicating that future studies will not favor rifampin supplementation in Staphylococcus infections (μ, 0.074; τ, 0.570; 89% HPD, [- 0.48; 0.54]). Bayesian posterior distribution in the Streptococcus subset displayed a tendency toward rifampin supplementation. Studies had a substantial selection bias. Available evidence did not encourage rifampin-accompanied regimens for staphylococcal infections.

Objective: Toxoplasma gondii may lead to opportunistic infections that threaten life in patients infected with HIV as opposed to the case of healthy individuals. It was aimed to investigate the seroprevalence of Toxoplasma gondii in HIV-infected patients admitted to our clinic. Methods: The files of HIV-infected patients who were admitted to our polyclinic in the period of January 1995- December 2019 were examined. From the files, information was recorded on demographic characteristics, first diagnosis date, CD4+ T lymphocyte counts at first admission, HIV RNA, T. gondii Ig G / M values and whether or not they received antibiotic prophylaxis. Findings: Although the files of 804 HIV-infected patients were examined, data on T. gondii antibodies could be accessed only in the files of 685 patients. The median values of the ages and disease durations of the patients were respectively 33 (range: 17-83) and 4 (range 0-27) years. Among the patients, 88.5% (n: 606) were male. While no patients showed T. gondii Ig M antibody positivity, 41.6% (N= 285) had T. gondii Ig G positivity. The CD4+ T lymphocyte count was under 100 in 10.0% (n: 68/678) of the patients, and among 36.8% (n: 25/68) of these patients, T. gondii Ig G was positive. While T. gondii IgG positivity was significant in the patients over the age of 40, no significant relationship was found between sex and CD4+ T lymphocyte counts. Conclusion: In patients with T. gondii Ig G positivity, the risk of toxoplasmosis reactivation increases especially when the CD4+ T lymphocyte counts fall below 200. For this reason, investigating the seroprevalence of T. gondii in patients of all ages is important to be able to assess the risks that may develop, and it should be kept in mind that seropositivity may increase by advanced age.

WOS:000560834200001 PubMed ID: 32803484 A new infectious outbreak sustained by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is now spreading all around the world. The aim of this study was to evaluate the prognostic value of left ventricular global longitudinal strain (LV-GLS) and right ventricular longitudinal strain (RV-LS) in patients with coronavirus disease 2019 (COVID-19). In this prospective, single-center study, data were gathered from patients treated for COVID-19 between April 15 and April 30, 2020. Two-dimensional echocardiography (2-DE) and speckle tracking echocardiography (STE) images were obtained for all patients. Patients were divided into three groups: those with severe COVID-19 infection, those with non-severe COVID-19 infection, and those without COVID-19 infection (the control group). Data regarding clinical characteristics and laboratory findings were obtained from electronic medical records. The primary endpoint was in-hospital mortality. A total of 100 patients hospitalized for COVID-19 were included in this study. The mean age of the severe group (n = 44) was 59.1 +/- 12.9, 40% of whom were male. The mean age of the non-severe group (n = 56) was 53.7 +/- 15.1, 58% of whom were male. Of these patients, 22 died in the hospital. In patients in the severe group, LV-GLS and RV-LS were decreased compared to patients in the non-severe and control groups (LV-GLS: - 14.5 +/- 1.8 vs. - 16.7 +/- 1.3 vs. - 19.4 +/- 1.6, respectively [p < 0.001]; RV-LS: - 17.2 +/- 2.3 vs. - 20.5 +/- 3.2 vs. - 27.3 +/- 3.1, respectively [p < 0.001]). The presence of cardiac injury, D-dimer, arterial oxygen saturation (SaO2), LV-GLS (OR 1.63, 95% confidence interval [CI] 1.08-2.47; p = 0.010) and RV-LS (OR 1.55, 95% CI 1.07-2.25; p = 0.019) were identified as independent predictors of mortality via multivariate analysis. LV-GLS and RV-LS are independent predictors of in-hospital mortality in patients with COVID-19.

This manuscript aims to present a treatment algorithm we applied to manage COVID-19 patients admitted to our hospital. During the study period, 2043 patients with suspected COVID-19 were admitted to the emergency department. Molecular tests indicated that 475 of these patients tested positive for COVID-19. We administered hydroxychloroquine plus doxycycline to mild cases (isolated at home) for 3 days and lopinavir plus doxycycline to moderate and severe cases (hospitalized) for 5 days. The overall case fatality rate was 4.2% (20/475).

Mother-to-child transmission of hepatitis B virus can occur during the intrauterine, antenatal and postnatal periods, with an increased risk of perinatal transmission. Appropriate management of patients who are hepatitis B surface antigen positive during pregnancy can substantially reduce the rates of perinatal transmission. Herein, two pregnant women with chronic hepatitis B are presented; one became pregnant while receiving tenofovir disoproxil fumarate and continued the treatment during pregnancy, the other discontinued tenofovir disoproxil fumarate treatment on her own due to conception, but restarted at 26 weeks of pregnancy. At birth the newborns of both women were vaccinated and immunoglobulin was given, with no perinatal transmission. Whether pregnant women should receive antiviral therapy or immunoprophylaxis still remains controversial. In order to keep the mother's liver stable and to prevent perinatal transmission, it is of paramount importance to manage pregnant women in line with the current information and guidelines.

We analysed a carbapenem-resistant Klebsiella pneumoniae (CRKP) outbreak in the coronavirus disease (COVID) ICU. We retrospectively collected data from ICU records. We identified 25 cases between 12 November 2020 and 19 December 2020, and compared them to 42 controls present in the ICU during the same period. The presence of a femoral haemodialysis catheter was strongly associated with invasive CRKP infections (cases, 9 [36%]; controls, 0 [0%]; odds ratio [OR] 95% confidence intervals [CIs], 21 (5; 89)). We found a significant association between old age and CRKP infection with adverse outcomes. Sequence analysis revealed three distinct carbapenemase genes: blaNDM-1, blaOXA-48 and blaKPC-2. We launched rectal swab sampling upon admission to the ICU, cohorted colonized patients and cases and conducted an intensive training programme for newly employed staff. This study revealed that the emergence and dissemination of CRKP in COVID ICUs were associated with increased adverse outcomes. The presence of a femoral haemodialysis catheter was a significant risk factor for CRKP infections.

WOS: 000471726700008, PubMed ID: 30989418, Brucellosis in pregnant women is reported to be associated with obstetric complications (OCs), and adequate data for human brucellosis during pregnancy are largely lacking. We performed this multicenter retrospective cross-sectional study to evaluate the epidemiology, clinical course, treatment responses, and outcomes of brucellosis among pregnant women. The study period comprised a 14-year period from January 2002 to December 2015. All consecutive pregnant women diagnosed with brucellosis in 23 participating hospitals were included. Epidemiological, clinical, laboratory, therapeutic, and outcome data along with the assessment data of the neonate were collected using a standardized questionnaire. Data of 242 patients were analyzed. The OC rate was 14.0% (34/242) in the cohort. Of the 242 women, 219 (90.5%) delivered at term, 3 (1.2%) had preterm delivery, 15 (6.2%) aborted, and 5 (2.1%) had intrauterine fetal demise. Seventeen (7.0%) of the newborns were considered as low birth weight. Spontaneous abortion (6.1%) was the commonest complication. There were no maternal or neonatal deaths and pertinent sequelae or complications were not detected in the newborns. Splenomegaly (p=0.019), nausea and/or vomiting (p41IU/L; p=0.025), oligohydramnios on ultrasonography (p=0.0002), history of taking medication other than Brucella treatment during pregnancy (p=0.027), and Brucella bacteremia (p=0.029) were the significant factors associated with OCs. We recommend that pregnant women with OC or with fever should be investigated for brucellosis if they live in or have traveled to an endemic area.

Synovial sarcoma is a highly aggressive malignancy with a 10-year disease-free survival of around 50%. Synovial sarcoma accounts for 5 to 10% of all soft tissue sarcomas. It is more common in young people and adolescents and it is seen in lower extremities, especially around the knee. The prognosis of the disease is worse in the elderly population. Microscopic imaging, positive staining of epithelial markers and molecular study are required to confirm the the presence of the disease. We present a 44-year-old male patient with a history of falling from the same level and presenting with only shoulder pain. Further investigations have shown that our patient is a rare form of biphasic synovial sarcoma originating from the pulmonary system, which is rarely reported in the literature.

Introduction: A new infectious outbreak sustained by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is now spreading all around the world. The aim of this study was to evaluate the prognostic value of left ventricular global longitudinal strain (LV-GLS) and right ventricular longitudinal strain (RV-LS) in patients with coronavirus disease 2019 (COVID-19). Hypothesis: As some studies have shown that COVID-19 could affect the cardiovascular system due to the capability of pathogenity of the virus, biventricular functions could be affected in the tissue level even though the routine evaluations of the heart functions seem normal. Methods: In this prospective, single-center study, data were gathered from patients treated for COVID-19, who had biventricular systolic function and no history of coronary artery disease. Two-dimensional echocardiography (2-DE) and speckle tracking echocardiography (STE) images were obtained for all patients. Patients were divided into three groups: those with severe COVID-19 infection, those with non-severe COVID-19 infection, and those without COVID-19 infection (the control group). Data regarding clinical characteristics and laboratory findings were obtained from electronic medical records. The primary endpoint was in-hospital mortality. Results: A total of 100 patients hospitalized for COVID-19 were included in this study. The mean age of the severe group (n = 44) was 59.1 ± 12.9, 40% of whom were male. The mean age of the non-severe group (n = 56) was 53.7 ± 15.1, 58% of whom were male. Of these patients, 22 died in the hospital. In patients in the severe group, LV-GLS and RV-LS were decreased compared to patients in the non-severe and control groups (LV-GLS: -14.5 ± 1.8 vs. -16.7 ± 1.3 vs. -19.4 ± 1.6, respectively [p < 0.001]; RV-LS: -17.2 ± 2.3 vs. -20.5 ± 3.2 vs. -27.3 ± 3.1, respectively [p < 0.001]). The presence of cardiac injury, D-dimer, arterial oxygen saturation (SaO2), LV-GLS (OR:1.63, 95% confidence interval [CI] 1.08-2.47; p = 0.010) and RV-LS (OR:1.55, 95% CI 1.07-2.25; p = 0.019) were identified as independent predictors of mortality via multivariate analysis. Conclusions: LV-GLS and RV-LS are independent predictors of in-hospital mortality in patients with COVID-19.

Introduction: Though there is currently no approved treatment for COVID-19, potential medications include lopinavir and doxycycline. Lopinavir is a broad-spectrum protease inhibitor successfully used during the SARS outbreak. Doxycycline is an antibiotic with immunomodulatory effects, which successfully treats dengue hemorrhagic fever. Comparing lopinavir combined with doxycycline with other commonly implemented COVID-19 treatment regimens is of medical significance. Methods: We conducted a retrospective study comparing two cohorts. One cohort strictly adhered to a treatment protocol of lopinavir combined with doxycycline (Lop/Dox), while the other cohort (Others) applied protocols based on combinations of favipiravir, hydroxychloroquine, and azithromycin. The outcomes evaluated were death from coronavirus and intubation. Results: During the study period, 161 and 114 patients were followed in the Lop/Dox cohort and the Others cohort, respectively. The Lop/Dox cohort was older and had lower O2 saturation at admission. The proportion of patients needing intubation did not differ between the cohorts (Lop/Dox, 15∙5%; Others, 16∙7%). The overall fatality rate likewise did not differ (12∙4%) in Lop/Dox and 8∙7% in the Others cohort). Older age and elapsed time between the onset of symptoms and hospitalization, O2 saturation at admission, and the lymphocyte to white blood cell ratio were independent risk factors for poor outcomes of the illness. Conclusion: This study showed that lopinavir plus doxycycline therapy is an effective treatment amongst moderate to severe COVID-19 patients.

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.

Objectives: In this study, we aimed to evaluate the clinical course of treatment-naive patients infected with hepatitis C virus (HCV) who were followed up in various centers in Turkey. Materials and Methods: This was a retrospective study performed with the participation of 15 centers. Patients aged 18 years and older with HCV infection were included. Results: A total of 391 treatment-naive patients infected with HCV were included in this study. During the follow-up period, the final values of alanine aminotransferase, aspartate transaminase, and total protein were significantly decreased when compared to the initial values (p

Aim: Infective endocarditis (IE) is a serious heart disease with high mortality and morbidity. Antibiotic prophylaxis is recommended for patients at risk of infective endocarditis before dental procedures. This Turkish online descriptive survey aimed to evaluate the knowledge and awareness levels of dentists and dental students regarding antibiotic prophylaxis for patients at risk of infective endocarditis. Method: Data on participants’ demographics and responses regarding dental treatments and heart diseases requiring prophylaxis as well as antibiotic dosage, duration, and administration time were collected between February 1 and June 30, 2016 in Turkey. For each correct answer one point was given. A score of >4 was considered successful. Results: In total, 584 dentists and 199 dental students participated in the questionnaire survey. The rate of ad- ministration of antibiotic prophylaxis against infective endocarditis was found as 92.59%. Overall success rates of dental procedures requiring prophylaxis and knowledge regarding heart diseases were 90.3% and 72.6%, respectively. Knowledge levels regarding the use of antibiotic prophylaxis for heart diseases and antibiotic do- sage and duration were greater in women, those with ?5 years of professional experience, dentists, and those working at dental faculties (p5 years of experience (p

Neurosyphilis (NS) has different clinical manifestations and can appear during any stage of syphilis. We aimed to identify the factors affecting poor outcome in NS patients. Patients with positive cerebrospinal fluid Venereal Disease Research Laboratory test, and positive serological serum treponemal or nontreponemal tests were classified as definite NS. The data of 141 patients with definite NS were submitted from 22 referral centers. Asymptomatic NS, syphilitic meningitis, meningovascular syphilis, tabes dorsalis, general paresis, and taboparesis were detected in 22 (15.6%), 67 (47.5%), 13 (9.2%), 10 (7%), 13 (9.2%), and 16 patients (11.3%), respectively. The number of HIV-positive patients was 43 (30.4%). The most common symptoms were headache (n = 55, 39%), fatigue (n = 52, 36.8%), and altered consciousness (50, 35.4%). Tabetic symptoms were detected in 28 (19.8%), paretic symptoms in 32 (22.6%), and vascular symptoms in 39 patients (27.6%). Eye involvement was detected in 19 of 80 patients (23.7%) who underwent eye examination and ear involvement was detected in eight of 25 patients (32%) who underwent ear examination. Crystallized penicillin was used in 109 (77.3%), procaine penicillin in seven (4.9%), ceftriaxone in 31 (21.9%), and doxycycline in five patients (3.5%). According to multivariate regression analysis, while headache was a protective factor in NS patients, double vision was significantly associated to poor outcome. We concluded that double vision indicated unfavorable outcome among NS patients. A high clinical suspicion is needed for the diagnosis NS. As determined in our study, the presence of headache in syphilitic patients can help in early diagnosis of central nervous system disease.

Background/aim: The aim of this study was to determine epidemiologic characters of patients with candidemia and to evaluate risk factors that can affect mortality rates among these patients. Materials and methods: Patients admitted to the İstanbul Medeniyet University Göztepe Training Hospital between 2009 and 2011 who had a positive blood culture for Candida spp. during hospitalization were studied retrospectively for demographic characteristics and risk factors. Statistical comparisons were estimated with the Stata 12 package. Independent variables associated with mortality were estimated by Cox regression analyses. Results: A total of 89 patients were identified with a positive blood culture. Of the isolates, 72% (64/89) were C. albicans and 10% (9/89) were non-albicans Candida, while 18% (16/89) were unidentified. C. parapsilosis was the most frequently isolated species among non-albicans Candida. The crude mortality rate among candidemia cases was 30% (27/89). By univariate analysis, being in the ICU and age (≥50 or ≥60) were found to be statistically significant, whereas by multivariate analysis only age of ≥50 years was independently more associated with mortality (OR, 2.7; CI, 1.05-6.73). Conclusion: Candidemia is associated with high mortality rates. Patients older than 50 years are found to be at considerable risk in terms of adverse outcomes.

We aimed to develop a scoring system for predicting in-hospital mortality of community-acquired (CA) sepsis patients. This was a prospective, observational multicenter study performed to analyze CA sepsis among adult patients through ID-IRI (Infectious Diseases International Research Initiative) at 32 centers in 10 countries between December 1, 2015, and May 15, 2016. After baseline evaluation, we used univariate analysis at the second and logistic regression analysis at the third phase. In this prospective observational study, data of 373 cases with CA sepsis or septic shock were submitted from 32 referral centers in 10 countries. The median age was 68 (51-77) years, and 174 (46,6%) of the patients were females. The median hospitalization time of the patients was 15 (10-21) days. Overall mortality rate due to CA sepsis was 17.7% (n = 66). The possible predictors which have strong correlation and the variables that cause collinearity are acute oliguria, altered consciousness, persistent hypotension, fever, serum creatinine, age, and serum total protein. CAS (%) is a new scoring system and works in accordance with the parameters in third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). The system has yielded successful results in terms of predicting mortality in CA sepsis patients.

27th International Congress of the Transplantation-Society (TTS) -- JUN 30-JUL 05, 2018 -- Madrid, SPAIN WOS: 000444541201323 … Transplantat Soc, Soc Espanola Trasplante, Soc Madrilena Trasplante

This article describes the emergence of resistance and predictors of fatality for 1556 cases of healthcare-associated Gram-negative bloodstream infection in 2014 and 2015. The colistin resistance rate in Klebsiella pneumoniae was 16.1%, compared with 6% in 2013. In total, 660 (42.4%) cases were fatal. The highest fatality rate was among patients with Acinetobacter baumannii bacteraemia (58%), followed by Pseudomonas aeruginosa (45%), Klebsiella pneumoniae (41%), Enterobacter cloacae (32%) and Escherichia coli (28%). On multi-variate analysis, the minimum inhibitory concentrations for carbapenems [odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01-1.04; P = 0.002] and colistin (OR 1.1, 95% CI 1.03-1.17; P = 0.001) were found to be significantly associated with fatality. (C) 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved. WOS: 000426316700011 29248504 Q1

WOS: 000386954300001, PubMed: 27809934, Background: The aim of this study was to assess health-related quality of life (HRQOL) among chronic hepatitis B (CHB) patients in Turkey and to study related factors. Methods: This multicenter study was carried out between January 01 and April 15, 2015 in Turkey in 57 centers. Adults were enrolled and studied in three groups. Group 1: Inactive HBsAg carriers, Group 2: CHB patients receiving antiviral therapy, Group 3: CHB patients who were neither receiving antiviral therapy nor were inactive HBsAg carriers. Study data was collected by face-to-face interviews using a standardized questionnaire, Short Form-36 (SF-36) and Hepatitis B Quality of Life (HBQOL). Values equivalent to p < 0.05 in analyses were accepted as statistically significant. Results: Four thousand two hundred fifty-seven patients with CHB were included in the study. Two thousand five hundred fifty-nine (60.1 %) of the patients were males. Groups 1, 2 and 3, consisted of 1529 (35.9 %), 1721 (40.4 %) and 1007 (23.7 %) patients, respectively. The highest value of HRQOL was found in inactive HBsAg carriers. We found that total HBQOL score increased when antiviral treatment was used. However, HRQOL of CHB patients varied according to their socio-demographic properties. Regarding total HBQOL score, a higher significant level of HRQOL was determined in inactive HBV patients when matched controls with the associated factors were provided. Conclusions: The HRQOL score of CHB patients was higher than expected and it can be worsen when the disease becomes active. Use of an antiviral therapy can contribute to increasing HRQOL of patients.

EASL International Liver Congress -- APR 13-17, 2016 -- -- Barcelona, SPAIN, WOS: 000398711700582, …, EASL

Introduction: The epidemiological features, clinical symptoms and laboratory findings of HIV/AIDS cases who refered to our clinic between 1993-2010 were evaluated retrospectively. Materials and Methods: Our study is a descriptive retrospective research. Descriptive characteristics were compared regarding gender. Blood samples obtained from anti-HIV 1-2 positive patients were used to confirm the diagnoses with Western Blot test. HIV-RNA and lymphocyte subgroups were examined in all patients. Graphpad Prism 5.0 was used for statistical analysis. A value of p< 0.05 was accepted as statistically significant. Results: Ninety nine (73.9%) of the cases were male and 35 (26.1%) were female. The mean age was 40.45 ± 12.32 years. The housewife ratio was extremely high (78.7%) among all patients. The heterosexual and homosexual intercourse ratios were 63.5% and 8.9% respectively. The route of transmission was not known in 23.1% of the patients 17.9% of those patients were tested due to diagnosis of their partners and 14.1% were tested due to fever. Mean CD4 count was 312.5 ± 222.7 and mean viral load was 314.900 ± 1.003.000 IU. Pulmonary tuberculosis was diagnosed in 9.7% of the patients. Patients were also evaluated for depressive symptoms and no statistical difference was found between genders (p= 0.07). Mortality rate was 8.9%. Conclusions: Heterosexual intercourse was found as the main transmission route of HIV. Unknown transmission route seems to be a problem. The most common co-infection was pulmonary tuberculosis. No significant difference was determined between males and females in terms of the occurrence of depressive symptoms.

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.

OBJECTIVE: More than 95% of all urinary tract infections are caused by a single bacterium. Although E. coli is the most common bacterium causing community-acquired infections, Klebsiella spp., enteric gram-negative bacteria and S. saprophyticus have been also identified. This study evaluated the microorganisms isolated from the urine cultures of patients admitted to our outpatient clinics in 2010 and assessed E. coli resistance and the frequency of extended-spectrum beta lactamase (ESBL)-producing bacteria. MATERIAL AND METHODS: In total, 7145 urine cultures were obtained from patients admitted to all clinics between 1 January 2010 and 31 December 2010. The double-disk synergy test was used to identify the presence of ESBL producers. RESULTS: The most frequently isolated microorganisms were E. coli (60.6%), Enterococcus spp. (10.3%), Klebsiella spp. (7.3%), Pseudomonas spp. (4.8%), and Streptococcus spp. (3.3%). E. coli strains were more resistant to ciprofloxacin (45.12%), trimethoprim-sulfamethoxazole (44.8%) and amoxicillin-clavulanate (31.6%), but they were less likely to be resistant to meropenem (0%), imipenem (0.2%), and amikacin (0.7%). The frequency of ESBL-producing E. coli strains was 14%. CONCLUSION: The choice of antibiotic treatment influences the overall success of treatment and the development of resistance, and it is also closely related to the cost of the treatment. As a result, there is a need to review the current treatment protocols. As resistance rates show regional differences, it is necessary to regularly examine regional resistance rates to determine the appropriate empiric antibiotic treatment and reduce costs.