Seroprevalence of human brucellosis in Turkey: A comprehensive meta-analysis.

AIMS: Brucellosis remains a common zoonotic disease, in developing countries, as well as in Turkey where it is endemic, underdiagnosed, and underreported. The aim of this meta-analysis was to provide a comprehensive estimate of seroprevalence with a large sample size, covering all regions of Turkey, including both grey literature and published studies. METHODS AND RESULTS: A systematic search was performed in MEDLINE (via PubMed), TürkMedline (National Health Sciences-Periodicals Database), and YÖKSIS database (Higher Education Council Information System) until May 5th, 2023. The quality of the studies was evaluated independently using Joanna Briggs Institute (JBI) critical assessment tool for prevalence studies. A random-effects model (DerSimion and Laird) was utilized to estimate the overall pooled prevalence. A sensitivity analysis was performed, excluding studies with a high risk of bias. The subgroup analyses and meta-regression were conducted to explore sources of heterogeneity. Egger test and funnel plot were used to assess publication bias. The meta-analysis included 30 studies in total published between 1999 and 2021 with 51,560 individuals. In Turkey, the pooled seroprevalence of human brucellosis was estimated to be 4.5% (95% confidence interval [CI]: 3.8%-5.3%). According to the subgroup analysis, a higher seroprevalence was found in rural areas (8.0%, 95% CI: 5.4%-10.7%), high-risk occupational groups (9.9%, 95% CI: 5.3%-14.6%), and the Central East Anatolia Region (13%, 95% CI: 3.2%-22.8%). The meta-regression analysis identified living in rural areas and certain geographic regions as significant risk factors associated with higher seroprevalence. CONCLUSIONS: This meta-analysis revealed a significant burden of human brucellosis in Turkey. The findings highlight the need for public health measures and targeted interventions to reduce the burden of this zoonotic disease, especially in rural areas, high-risk occupational groups, and the East Anatolia Region.

Optimal cut-off value of procalcitonin and procalcitonin/albumin ratio for predicting bacteremia among patients living with cancer: a test-negative case-control study.

OBJECTIVE: The occurrence of bacteremia is critically important for the survival of cancer patients. Therefore, our study aims to evaluate the efficacy of procalcitonin (PCT) and the procalcitonin to albumin ratio (PAR) in predicting bacteremia among this population. METHODS: In this retrospective test-negative case-control study, we included 903 hospitalized cancer patients, divided into two groups: the bacteremia-positive group (BSI group, n = 384) and the bacteremia-negative group (non-BSI group, n = 519). We assessed the diagnostic significance of PCT and PAR through receiver operating characteristic (ROC) analysis and determined the optimal cut-off values using Youden's index. RESULTS: Both the duration of hospital stay and the 30-day mortality rate were significantly higher in the BSI group. The areas under the curve (AUC) for PAR and PCT were 0.749 (95% CI: 0.715-0.782) and 0.742 (95% CI: 0.708-0.776), respectively, indicating higher levels in the BSI group. The optimal cut-off values for predicting bacteremia were 0.72 for PAR and 1.32 for PCT. PAR showed the highest specificity (92.7%) and positive predictive value (PPV = 83.4%), while PCT demonstrated the highest sensitivity (51.3%) and negative predictive value (NPV = 71.6%). DISCUSSION: This study is the first in the literature to suggest that PAR and PCT are valuable biomarkers for diagnosing bacteremia in cancer patients. The identified cut-off values offer practical thresholds for bacteremia diagnosis.

Influential Factors of Tuberculosis Notification Rates in Turkey: A Provincial-Level Spatial Analysis.

OBJECTIVE: The total annual count of reported tuberculosis (TB) cases continues to decline throughout Turkey. Recognizing the regions with high and low burdens and revealing the factors affecting TB notification rates may play a role in guiding national control programs. This study aimed to analyze the spatial distribution of TB notification rates from 2005 to 2018 and evaluate the factors contributing to TB rates. MATERIAL AND METHODS: In this ecological study, we used freely available open data from the Internet. We employed global and local spatial autocorrelation analysis to identify the spatial distribution and the clusters with low and high burdens. We conducted an ordinary least square regression model, spatial lag model, and spatial error model. The best-fitting model was selected via model parameters. RESULTS: Throughout the study period, the provinces in West Marmara Region (Edirne, Kirklareli, Tekirdag, Çanakkale) were consistently in a high-burden cluster. In univariate ordinary least square regression, population density, the proportion of contacts screened for TB, the proportion of TB contacts who received prophylaxis, TB dispensary count, mean particulate matter 10 levels, and gross domestic product were found to be positively associated with TB notification rate. The best-fitting multivariate spatial lag model revealed that the proportion of contacts screened for TB (ß, z-value: 0.89, 2.21) positively affected TB notification rate. CONCLUSION: The high TB burden in West Marmara Region should warn policymakers to maintain a focused approach to controlling TB in this area. This study showed the importance of contact tracing efforts to prevent the underdetection of TB cases.

Risk factors for prolonged viral RNA shedding in patients with COVID-19; a nested case-control study.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic continues to have a global impact. The behavior and viral course of severe acute respiratory syndrome coronavirus (SARS-CoV-2) remains unpredictable. We aimed to investigate the prediction factors associated with prolonged viral shedding in COVID-19 patients. METHODOLOGY: This is a retrospective, nested, case-control study with 155 confirmed COVID-19 infected patients divided into two groups based on nucleic acid conversion time (NCT), a prolonged group (viral RNA shedding >14 days, n = 31) and a non-prolonged group (n = 124). RESULTS: The mean age of participants was 57.16 years, and 54.8% were male. Inpatient numbers were 67.7% across both groups. No statistically significant differences between the two groups were observed in terms of clinical manifestation, comorbidities, computer tomography, severity index, antiviral treatment, and vaccination. However, C-reactive protein and D-dimer levels were significantly higher in the prolonged group (p = 0.01; p = 0.01). Using conditional logistic regression analysis, D-dimer and bacterial co-infection were found to be independent factors associated with the prolonged NCT (OR: 1.001, 95% CI: 1.000-1.001, p = 0.043; OR: 12.479, 95% CI: 2.701-57.654, p = 0.001 respectively). We evaluated the diagnostic value of the conditional logistic regression model by using receiver operating characteristic curve analysis. The area under the curve was 0.7 (95% Cl: 0.574-0.802; p < 0.001). CONCLUSIONS: Our study design included controlling confounders. We showed a clear result associating predicting factors with prolonged NCT of SARS-CoV-2. D-dimer level and bacterial co-infection were considered as independent predictors of prolonged NCT.

Clinical efficacy and safety of prolonged versus intermittent administration of antipseudomonal beta-lactam antibiotics in adults with severe acute infections: A meta-analysis of randomized controlled trials.

INTRODUCTION: In order to compare the clinical efficacy and safety of prolonged versus intermittent antipseudomonal beta-lactam antibiotic infusion for the treatment of severe acute infections in adult patients, a meta-analysis of randomized controlled trials (RCTs) was performed. METHODS: We systematically searched MEDLINE and Cochrane Library databases until December 2022. The outcomes were all-cause mortality, clinical success, microbiological eradication and adverse events. The pooled risk ratios (RR) were estimated by the fixed or random effect methods according to heterogeneity statistics. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the certainty of evidence for each outcome. RESULTS: Twenty eligible RCTs with 2081 participants were included in the meta-analysis. The risk of all-cause mortality was significantly lower in the prolonged infusion group than in the intermittent infusion group (RR 0.77, 95% confidence interval [CI] 0.63-0.95, p = 0.01, I2 = 0%; moderate certainty). Treatment with prolonged infusion showed significant benefit in clinical success (RR 1.09, 95% CI 1.02-1.17, p = 0.008, I2 = 19%; moderate certainty). There were no significant differences in microbiological eradication (RR 1.12, 95% CI 0.99-1.28, p = 0.07, I2 = 49%; low certainty), any adverse events (RR 0.96, 95% CI 0.86-1.08, p = 0.50, I2 = 27%; moderate certainty) and serious adverse events (RR 0.99, 95%CI 0.70-1.39 p = 0.95, I2 = 0%; low certainty). CONCLUSIONS: Prolonged antipseudomonal beta-lactam infusion probably decreases all-cause mortality. Additionally, it probably increases clinical success in adults with severe acute infections. This infusion strategy may result in little to no difference in microbiological eradication and is probably not associated with a rise in any adverse events.The evidence suggests that prolonged infusion may not increase serious adverse events.