The Role of Dynamic Changes in Hematologic and Biochemical Parameters in Predicting Mortality in Covid-19 Patients.

Objectives: The role of hematologic, inflammatory and biochemical parameters as biomarkers, their role in identifying risky patients in the early stage and their role in prognosis in COVID-19 Coronavirus disease 2019 (COVID-19) were investigated. Methods: The study included patients who were hospitalized and followed up with a prediagnosis of COVID-19 in the first wave in our country at the University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital Demographic and clinical characteristics as well as complete blood count, C reactive protein (CRP), procalcitonin (PCT), fibrinogen (FIB), ferritin, albumin (ALB), lactate dehydrogenase (LDH) levels on admission, third, seventh and 14th days were analyzed. Patients were grouped and compared according to the occurrence of death during hospital follow-up. Variables considered significant on mortality were analyzed with univariate and multivariate logistic regression models. Results: The study was conducted with 485 patients, 273 (56.3%) males and 212 (43.72%) females. The mean age of the patients was 58±16.2 years, and 71% were in the mild-moderate and 29% in the severe-critical disease group. Disease severity, the need for intensive care unit (ICU) follow-up, and the development of death were positively correlated with age, comorbidity, neutrophil (NE), leukocyte, neutrophil-lymphocyte ratio (NLR), PCT, CRP, ferritin, LDH values, and negatively correlated with lymphocyte (LE), ALB and hemoglobin (HGB) values. In multivariate analysis, elevated PCT at hospital admission (OR: 6.96 [1.63;39.65]), LDH ≥ 352U/L (OR: 4.35 [1.23;16.61]), LE<0.810 × 109/L (OR: 3.0 [1.16;7.85]) and advanced age (OR: 1.08 [1.03;1.14]) were independently associated with in-hospital death. In hemogram and acute phase reactant monitoring, PCT, CRP and LDH were the most valuable markers for predicting death, respectively (third-day AUC: 0.90;0.83;0.83 and seventh-day AUC: 0.95;0.90;0.89, respectively). Conclusion: In our study, leukocytes, lymphocytes, NLR, CRP, PCT, ferritin, albumin and LDH at admission were valuable in predicting poor prognosis. In addition, it was determined that increases in PCT, LDH and CRP during follow-up could be used to predict in-hospital death and to identify patients requiring close follow-up.

Abducens Nerve Palsy in a Patient with COVID-19: A Case Report.

Numerous neurological manifestations associated with COVID-19 have been reported. However, abducens nerve palsy (ANP) associated with COVID-19 is very rare and mostly related to accompanying respiratory symptoms. Here we present a 29-year-old woman with unilateral ANP manifesting with diplopia and positive SARS-CoV-2 S antibodies, which were checked later. On admission, she had signs of viral pneumonia in thorax CT without any respiratory symptoms. Her cranial neuroimaging revealed no abnormality. Following treatment with favipiravir 2x1600 mg loading dose and then 2x600mg daily maintenance, dexamethasone 8 mg/day and enoxaparin 6000 IU/day, her CT findings recovered completely whereas her ANP only partially resolved. One week after the end of COVID-19 treatment, she also developed Herpes simplex keratitis which was successfully treated with valacyclovir. It should be kept in mind that isolated abducens nerve palsy may be the only finding of COVID-19 cases without any respiratory symptoms.

Turkish Translation and Cross-Cultural Validity of WHOQOL-HIV Bref Tool.

BACKGROUND: The assessment of health-related quality of life among people living with HIV (PLWH) has gained increasing importance as it assesses their overall well-being, guides treatment decisions, and addresses psychosocial challenges, improving their quality of life. This study focuses on adapting and validating the Turkish version of the WHOQOL-HIV Bref, a tool developed by the World Health Organization (WHO) to measure health-related quality of life in PLWH. This adaptation is based on the generic WHOQOL-Bref Turkish and WHOQOL-HIV Bref inventory. METHODS: In line with WHO guidelines, the tool was translated and tested on 189 PLWH from Istanbul Sisli Hamidiye Etfal Training and Research Hospital's HIV outpatient clinic. A variety of statistical methods were employed to assess content, construct, concurrent, and known-group validity, as well as internal consistency and reliability. RESULTS: Participants' median age was 35 years (IQR: 14), with 178(94%) being male. The Turkish WHOQOL-HIV Bref showed overall satisfactory psychometric properties. Despite limitations in the spirituality domain, it demonstrated good internal consistency (alpha coefficient: 0.93) and strong validity across several metrics, including test-retest reliability (ICC: 0.79). CONCLUSION: The WHOQOL-HIV BREF in Turkish is a reliable and valid instrument for assessing the quality of life in Turkish PLWH.

Evaluation of the late presentation and associated factors of people living with HIV in Turkey.

To identify the frequency of late presentation and late presentation with advanced disease, and associated factors in people living with HIV (PLHIV). Data from PLHIV diagnosed between 2008 and 2021 were retrospectively analyzed. Time of diagnosis (categorized based on key events affecting HIV care continuum e.g., national strategies, HIV guidelines, COVID-19 pandemic) and characteristics of late presenters (LP: CD4 ≤350 cells/mm³ or an AIDS defining event) and late presenters with advanced disease (LPAD: CD4 <200 cells/mm³) were describe. Associations between dependent (LP, LPAD) and independent variables were assessed using univariate/multivariate regression tests and presented as odds ratios (95% confidential interval). Of 1585 individuals (93.7% men), 42.5% were LPs and 19.3% were LPADs. Most common route of transmission was sex between men (54.3%). Non-LPs were younger (30 vs. 34 and 36 years; p < 0.001) and included more men who have sex with men (60.3% vs. 46.3% and 39.5%; p < 0.001). Factors associated with being LP and LPAD were age >30 years, heterosexual/unknown route of transmission (vs. sex between men), diagnosis in 2008-2013 or 2020-2021, (vs. 2014-2019). With reference to Turkish subjects, migrants from Africa had higher odds of being LPAD. LP is still an important health issue in HIV care. Heterosexuality, older age (>30 years), migration from Africa, and the COVID-19 pandemic are associated with delays in HIV presentation in Turkey. These factors need to be considered when developing and implementing policies to enable earlier diagnosis and treatment of PLHIV to achieve UNAIDS 95-95-95 targets.

Immunization of guinea pigs with cement extract induces resistance against Ixodes scapularis ticks.

As hematophagous parasites, many tick species are important vectors of medical and veterinary disease agents. Proteins found in tick saliva and midgut have been used with some success in immunizations of animal hosts against feeding ticks, and whole saliva has been used effectively in this capacity against Ixodes scapularis, the primary vector of tickborne pathogens in the United States. Tick saliva is a complex substance containing hundreds of proteins, and the identification of specific protective antigens is ongoing. We performed a series of experiments immunizing guinea pigs with extracts prepared from midgut or attachment cement collected from adult female I. scapularis followed by challenge with nymphs of the same species. Midgut extract did not induce protective immunity, while immunization with cement extract resulted in partial protection of hosts as evidenced by premature tick detachment and 34-41% reduction in tick engorgement weights. Proteomic characterization of I. scapularis cement was performed, demonstrating that the cement extract was compositionally different from tick saliva, and vitellogenin-like lipoproteins were the most abundant proteins in cement extract (>40%). Cement was also heavily enriched with lysozymes and defensins, including those originating from both the mammalian host as well as ticks. These results demonstrate that I. scapularis cement contains immunogenic components capable of stimulating host resistance against tick feeding. Because the cement is present at the tick-host interface for an extended period of time during the feeding process, these antigens present auspicious candidates for further evaluation and potential inclusion in an anti-tick vaccine.

Tick immunity using mRNA, DNA and protein-based Salp14 delivery strategies.

Guinea pigs exposed to multiple infestations with Ixodes scapularis ticks develop acquired resistance to ticks, which is also known as tick immunity. The I. scapularis salivary components that contribute to tick immunity are likely multifactorial. An anticoagulant that inhibits factor Xa, named Salp14, is present in tick saliva and is associated with partial tick immunity. A tick bite naturally releases tick saliva proteins into the vertebrate host for several days, which suggests that the mode of antigen delivery may influence the genesis of tick immunity. We therefore utilized Salp14 as a model antigen to examine tick immunity using mRNA lipid nanoparticles (LNPs), plasmid DNA, or recombinant protein platforms. salp14 containing mRNA-LNPs vaccination elicited erythema at the tick bite site after tick challenge that occurred earlier, and that was more pronounced, compared with DNA or protein immunizations. Humoral and cellular responses associated with tick immunity were directed towards a 25 amino acid region of Salp14 at the carboxy terminus of the protein, as determined by antibody responses and skin-testing assays. This study demonstrates that the model of antigen delivery, also known as the vaccine platform, can influence the genesis of tick immunity in guinea pigs. mRNA-LNPs may be useful in helping to elicit erythema at the tick bite site, one of the most important early hallmarks of acquired tick resistance. mRNA-LNPs containing tick genes is a useful platform for the development of vaccines that can potentially prevent selected tick-borne diseases.

What were the changes during the COVID-19 pandemic era concerning occupational risks among health care workers?

BACKGROUND: Accidental exposure to percutaneous needle stick and sharp injuries (NSSIs) and blood and other body fluids is the unintended contact with risky medical instruments or patient secretions during a medical intervention. During the COVID-19 pandemic, the significance of occupational injuries in healthcare professionals was revealed once again. To assess the occupational injuries, we compared rates, distribution and type of exposure to blood and body fluids and NSSIs of health care workers for 2019 (pre-pandemic era) and 2020 (pandemic era) years, respectively. MATERIAL AND METHODS: Our study included data collected by the 'Hospital Infection Control Committee' for the years 2019-2020. Data collected using the active surveillance method were analyzed retrospectively. RESULTS: During 2019 (pre-pandemic period) and 2020 (pandemic period), 112 (27.65%0) and 82 (21.4%0) NSSIs reported, respectively. Of the exposed HCWs in 2019 (pre-pandemic period), 16.8%0 (14) were doctor, 53.6%0 (60) were nurse and 47.4%0 (14) were intern doctors. In the 2020 (pandemic period), NSSIs were observed most frequently in nurses and cleaning staff, 50.24%0 and 33.64%0, respectively. Concerning the total percentage of exposure to blood and other body fluids, a slight increase was revealed from 1.48%0 to 2.62%0 in 2019 and 2020, respectively. A significant decrease in exposure rate was reported among the doctors between the pre-pandemic and pandemic era; 3.6%0 and 1.19%0 at 2019 and 2020, respectively. A significant increase in exposure rate was reported among the nurses between pre-pandemic and pandemic era; 0.8%0 and 6.89%0, respectively. CONCLUSION: In conclusion, the exposure to NSSIs during the pandemic period decreased; however, there was no severe difference at pre-pandemic and pandemic periods concerning exposure to blood and body fluids. Well-designed training and awareness programs can be effective in preventing exposure to NSSIs and blood and other body fluids and exposure to respiratory acquired viruses.

Naturally Acquired Resistance to Ixodes scapularis Elicits Partial Immunity against Other Tick Vectors in a Laboratory Host.

In many regions where ticks negatively impact public health or economic production, multiple medically important tick species may have overlapping geographic distribution, and in North America, this includes members of Ixodes, Dermacentor, and Amblyomma genera. Acquired tick resistance is the process by which some animals develop an immune response against feeding ticks after one or more exposures. This form of immunity can restrict the ability of ticks to feed and may inhibit transmission of pathogens. Likewise, many proteins present in tick saliva are conserved among tick species, and prior studies have reported cross-protective host immunity against certain combinations of ticks. In this study, we used a guinea pig model to assess whether host resistance against Ixodes scapularis could confer protection against two other medically important tick vectors, Dermacentor variabilis and Amblyomma americanum. Tick challenges using nymphs were used to induce host resistance against a primary species, followed by additional challenge using a secondary tick species. Tick attachment to hosts and engorgement weights were reduced significantly for D. variabilis and A. americanum feeding on I. scapularis-sensitized hosts. Reciprocally, I. scapularis engorgement weights were reduced to a lesser extent, and attachment was unaffected when feeding on hosts sensitized with either D. variabilis or A. americanum. These results indicate that immunity against I. scapularis could potentially be exploited for use in an anti-tick vaccine targeting multiple tick species and their associated pathogens.

Repeat tick exposure elicits distinct immune responses in guinea pigs and mice.

Ticks deposit salivary proteins into the skin during a bite to mediate acquisition of a blood meal. Acquired resistance to tick bites has been demonstrated to prevent Borrelia burgdorferi sensu lato (s.l.) transmission. However, the mechanism of resistance, as well as the protective antigens, have remained elusive. To address these unknowns, we utilized a guinea pig model of tick resistance and a mouse model of permissiveness. Guinea pigs developed immunity after multiple Ixodes scapularis tick infestations, characterized by rapid tick detachment and impaired feeding. In comparison, mice tolerated at least 6 infestations with no significant impact on feeding. We analyzed the bite sites by RNA-sequencing and histology, identifying several inflammatory pathways in tick immune animals, such as FcεRI signaling and complement activation, and activation of coagulation pathways that could impair local blood flow. Together, these results identify important pathways altered during tick rejection and potential tick proteins that could serve as vaccine candidates.

Ixodes scapularis saliva components that elicit responses associated with acquired tick-resistance.

Ticks and tick-borne diseases are on the rise world-wide and vaccines to prevent transmission of tick-borne diseases is an urgent public health need. Tick transmission of pathogens to the mammalian host occurs during tick feeding. Therefore, it is reasoned that vaccine targeting of tick proteins essential for feeding would thwart tick feeding and consequently prevent pathogen transmission. The phenomenon of acquired tick-immunity, wherein, repeated tick infestations of non-natural hosts results in the development of host immune responses detrimental to tick feeding has served as a robust paradigm in the pursuit of tick salivary antigens that may be vaccine targeted. While several salivary antigens have been identified, immunity elicited against these antigens have only provided modest tick rejection. This has raised the possibility that acquired tick-immunity is directed against tick components other than tick salivary antigens. Using Ixodes scapularis, the blacklegged tick, that vectors several human pathogens, we demonstrate that immunity directed against tick salivary glycoproteins is indeed sufficient to recapitulate the phenomenon of tick-resistance. These observations emphasize the utility of tick salivary glycoproteins as viable vaccine targets to thwart tick feeding and direct our search for anti-tick vaccine candidates.

A novel id-iri score: development and internal validation of the multivariable community acquired sepsis clinical risk prediction model.

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.

Development and validation of a modified quick SOFA scale for risk assessment in sepsis syndrome.

Sepsis is a severe clinical syndrome owing to its high mortality. Quick Sequential Organ Failure Assessment (qSOFA) score has been proposed for the prediction of fatal outcomes in sepsis syndrome in emergency departments. Due to the low predictive performance of the qSOFA score, we propose a modification to the score by adding age. We conducted a multicenter, retrospective cohort study among regional referral centers from various regions of the country. Participants recruited data of patients admitted to emergency departments and obtained a diagnosis of sepsis syndrome. Crude in-hospital mortality was the primary endpoint. A generalized mixed-effects model with random intercepts produced estimates for adverse outcomes. Model-based recursive partitioning demonstrated the effects and thresholds of significant covariates. Scores were internally validated. The H measure compared performances of scores. A total of 580 patients from 22 centers were included for further analysis. Stages of sepsis, age, time to antibiotics, and administration of carbapenem for empirical treatment were entered the final model. Among these, severe sepsis (OR, 4.40; CIs, 2.35-8.21), septic shock (OR, 8.78; CIs, 4.37-17.66), age (OR, 1.03; CIs, 1.02-1.05) and time to antibiotics (OR, 1.05; CIs, 1.01-1.10) were significantly associated with fatal outcomes. A decision tree demonstrated the thresholds for age. We modified the quick Sequential Organ Failure Assessment (mod-qSOFA) score by adding age (> 50 years old = one point) and compared this to the conventional score. H-measures for qSOFA and mod-qSOFA were found to be 0.11 and 0.14, respectively, whereas AUCs of both scores were 0.64. We propose the use of the modified qSOFA score for early risk assessment among sepsis patients for improved triage and management of this fatal syndrome.

Comparison of relationship between histopathological, serological and biochemical parameters in patients with chronic hepatitis B infection.

OBJECTIVE: To demonstrate the relationship between liver histology, alanine aminotransferase (ALT)/aspartate aminotransferase (AST) and hepatitis B virus (HBV) DNA levels based on hepatitis B e antigen (HBeAg) seropositivity status in naive patients with chronic hepatitis B (CHB). MATERIALS AND METHOD: Naive patients with CHB admitted to our hospital between January 2012 and April 2014 were evaluated retrospectively. The patients were allocated into one of two groups based on HBeAg-seropositivity status. RESULTS: Two hundred and fourteen patients were enrolled in the study. Of these 214 patients, 103 (48.1%) were HBeAg-positive and 111 (51.9%) were HBeAg-negative. In the HBeAg-positive group, positive correlations were found between histologic activity index (HAI) scores and ALT (t=3.3, r=0.31, p=0.001), AST (t=2.8, r=0.27, p=0.005) and HBV DNA load (t=2.5, r=0.24, p=0.014). Additionally, in this group, fibrosis scores had positive correlations with ALT (t=3.3, r=0.32, p=0.001) and AST (t=2.7, r=0.26, p=0.008). In the HBeAg-negative group, positive correlations were found between HAI scores and ALT (t=3, r=0. 28, p=0.003), AST (t=3, r=0. 28, p=0.003) and HBV DNA (t=5.3, r=0. 45, p=0). In this same group, fibrosis scores had a positive correlation with HBV DNA (t=2.2, r=0. 21, p=0.024). Multivariate logistic regression analysis showed a positive relationship between fibrosis and ALT in the HBeAg-positive group and a positive relationship between fibrosis and HBV DNA load in the HBeAg-negative group. CONCLUSIONS: This study showed that HBV DNA load is an independent predictive factor for evaluating HAI and fibrosis in the HBeAg-negative group. Also, ALT is an independent predictive factor for evaluating fibrosis in the HBeAg-positive group.

Giant isolated mesenteric hydatid cyst case report without organ involvement.

A 21-year-old man presented with a 1-year history of intermittent attacks of abdominal distention and abdominal pain. Abdominal ultrasonography (USG) and abdominal computed tomography (CT) showed a large multicystic mass. After the operation, histopathological findings revealed a lamellated ectocyst and germinal layer with a thick outer, non-cellular membrane in the wall of the cyst, making a diagnosis of primary hydatid cyst for sure. He was discharged on the 10th postoperative day with albendazole 800 mg/day treatment. Herein, we report an unusual case of an isolated primary hydatid cyst of the mesenterium. As a conclusion, in endemic areas, hydatid cysts should be considered for the diagnosis of a patient with cystic mass lesions.

Mortality indicators in pneumococcal meningitis: therapeutic implications.

BACKGROUND: The aim of this study was to delineate mortality indicators in pneumococcal meningitis with special emphasis on therapeutic implications. METHODS: This retrospective, multicenter cohort study involved a 15-year period (1998-2012). Culture-positive cases (n=306) were included solely from 38 centers. RESULTS: Fifty-eight patients received ceftriaxone plus vancomycin empirically. The rest were given a third-generation cephalosporin alone. Overall, 246 (79.1%) isolates were found to be penicillin-susceptible, 38 (12.2%) strains were penicillin-resistant, and 22 (7.1%) were oxacillin-resistant (without further minimum inhibitory concentration testing for penicillin). Being a critical case (odds ratio (OR) 7.089, 95% confidence interval (CI) 3.230-15.557) and age over 50 years (OR 3.908, 95% CI 1.820-8.390) were independent predictors of mortality, while infection with a penicillin-susceptible isolate (OR 0.441, 95% CI 0.195-0.996) was found to be protective. Empirical vancomycin use did not provide significant benefit (OR 2.159, 95% CI 0.949-4.912). CONCLUSIONS: Ceftriaxone alone is not adequate in the management of pneumococcal meningitis due to penicillin-resistant pneumococci, which is a major concern worldwide. Although vancomycin showed a trend towards improving the prognosis of pneumococcal meningitis, significant correlation in statistical terms could not be established in this study. Thus, further studies are needed for the optimization of pneumococcal meningitis treatment.

Knowledge, attitudes and behaviour towards sexually transmitted diseases in Turkish Cypriot adolescents.

BACKGROUND: The incidence of sexually transmitted diseases (STDs) is increasing among adolescents all around the world. There may be differences in knowledge and attitudes among different cultures and ethnic populations. The aim of this study is to determine knowledge, attitudes and behaviour of Turkish Cypriot adolescents related to STDs. OBJECTIVES: To assess knowledge of STDs, attitudes towards sexual behaviour and STDs among the secondary school students. METHODS: A cross sectional study, with a sample size of 423 students, was conducted by using a semi-structured questionnaire. Simple random sampling method was applied during the selection of the sample. RESULTS: The mean age of all participants was 15.61 +/- 1.22, 211 (49.88%) of them were male and 212 (50.12%) female. The majority of students (91.25%) stated that they had some knowledge about STDs; hovewer, 8.75% of the participants did not have any knowledge at all. Most of them, 42.32% described school as a source of information on STDs, nonetheless, only 7.57% of the group cited health care professionals as the information source. The majority of students (97.64%) has never been treated for STDs. Among 423 applicants, 93.14% indicated that they would have appreciated information about STDs during the high school years. CONCLUSIONS: There is a general understanding that the students are willing to participate and are in need of seminars that will be held about STDs during high school attendance. Furthermore, awareness raising educational events on this matter should be reviewed and revised in order to come up with more powerful ways of fighting against STDs transmission in this young population group of Turkish Cypriot (TC) community.

Mortality indicators in community-acquired pneumonia requiring intensive care in Turkey.

BACKGROUND: Severe community-acquired pneumonia (SCAP) is a fatal disease. This study was conducted to describe an outcome analysis of the intensive care units (ICUs) of Turkey. METHODS: This study evaluated SCAP cases hospitalized in the ICUs of 19 different hospitals between October 2008 and January 2011. The cases of 413 patients admitted to the ICUs were retrospectively analyzed. RESULTS: Overall 413 patients were included in the study and 129 (31.2%) died. It was found that bilateral pulmonary involvement (odds ratio (OR) 2.5, 95% confidence interval (CI) 1.1-5.7) and CAP PIRO score (OR 2, 95% CI 1.3-2.9) were independent risk factors for a higher in-ICU mortality, while arterial hypertension (OR 0.3, 95% CI 0.1-0.9) and the application of non-invasive ventilation (OR 0.2, 95% CI 0.1-0.5) decreased mortality. No culture of any kind was obtained for 90 (22%) patients during the entire course of the hospitalization. Blood, bronchoalveolar lavage, and non-bronchoscopic lavage cultures yielded enteric Gram-negatives (n=12), followed by Staphylococcus aureus (n=10), pneumococci (n=6), and Pseudomonas aeruginosa (n=6). For 22% of the patients, none of the culture methods were applied. CONCLUSIONS: SCAP requiring ICU admission is associated with considerable mortality for ICU patients. Increased awareness appears essential for the microbiological diagnosis of this disease.

Assessment of the requisites of microbiology based infectious disease training under the pressure of consultation needs.

BACKGROUND: Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists. METHODS: A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included. RESULTS: A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients. CONCLUSIONS: The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole.

[Hydatid cyst presenting with multiple recurrence and pelvic involvement: case report]. / Multiple rekürrensle seyreden pelvik tutulumlu hidatik kist: olgu sunumu.

Hydatid cyst disease is a parasitic infection which is caused by the metacestode form of Echinococcus granulosus and affects primarily the liver and lung. Bone involvement is found in 1% of patients afflicted with this disease. The spine is involved in about 50% of these cases. Herein, we report a 70 year old male case with pelvic and spinal hydatid cyst who was operated on eleven times.