Pentraxin-3: A new parameter in predicting the severity of diabetic foot infection?

This study was undertaken to evaluate the diagnostic and prognostic values of pentraxin-3 (PTX-3) in patients with infected diabetic foot ulcers (IDFU) as well as to assess the association between PTX-3 levels and IDFU severity. This study included 60 IDFU patients (Group 1), 45 diabetic patients without DFU (Group 2), and 45 healthy controls. Patients with IDFU were divided into mild, moderate, and severe subgroups based on classification of clinical severity. Patients who underwent amputation were also documented. Blood samples were collected to determine PTX-3 levels. PTX-3 levels in healthy controls, Group 1, and Group 2 were 5.83 (3.41-20) ng/mL, 1.47 (0.61-15.13) ng/mL, and 3.26 (0.67-20) ng/mL, respectively. A negative correlation between plasma PTX-3 and glucose levels was found. There were significant differences in terms of procalcitonin (PCT) and PTX-3 levels in the subgroup analysis of Group 1. The PTX-3 level in patients who did or did not undergo amputation was 4.1 (0.8-13.7) and 1 (0.6-15.1) ng/mL, respectively. Results suggest that PTX-3 is a particularly effective marker in patients with IDFU, both in terms of predicting disease severity and assisting in the decision to perform amputation.

[Evaluation of Infections in Intensive Care Units: A Multicentre Point-Prevalence Study]. / Yogun Bakim Ünitelerindeki Enfeksiyonlarin Degerlendirilmesi: Çok Merkezli Nokta Prevalans Çalismasi.

Infection control is a top priority for hospitals, especially in intensive care units (ICU). In intensive care units, prevalence of infection is estimated to be 30% worldwide, which is a major cause of morbidity and mortality. Many factors are known to increase the risk of infection in ICU patients. Since each of these may lead to different infections, it is important to recognize and identify predisposing factors for early diagnosis and treatment. The regional health care-associated infections (HCAI) prevalence and distribution of risk factors are important strategies in infection control. In this regard, the aim of this point prevalence study was to obtain data related to infections, the prevalence of HCAI among these infections, the epidemiology, agents and antibiotics used among adult ICU patients in the university hospitals, training and research hospitals and public hospitals located in eight of the cities of our region. In the light of these data, we aimed to review and emphasize the guidelines on HCAI prevention. The study included adult ICU patients followed up in nine hospitals in the Eastern and South-eastern Anatolia Regions of eight different cities (Sivas, Erzurum, Mardin, Batman, Diyarbakir Elazig, Van, Adiyaman) in Turkey. Of the hospitals six were university hospitals, one was training and research hospital, and two were public hospitals. The number of beds ranged from 358 to 1418. A specific day was determined on which the researchers concurrently carried out a prospective surveillance in all adult intensive care unit patients. The researchers collected data and recorded the demographic characteristics (age, gender), underlying diseases, length of hospital stay, presence of invasive intervention (urinary catheter, central venous catheter, external ventricular drainage, mechanical ventilator, presence of risk factors such as burn, trauma and surgery, number of infection cases, type of infection (hospital-acquired, community-acquired), type of microorganisms and whether polymicrobial or monomicrobial, which antibiotics were administered, and duration of antibiotic treatment. Our study assessed data of 429 inpatients in the adult ICU of nine hospitals in eight different cities. There were a total of 881 intensive care beds in these hospitals, and 740 (84%) beds were occupied. Of the study group 49.7% was male with a mean age (min-max) of 64.08 ± 18.78 (2-97) years. The point prevalence of HCAI was 21.7% (n= 93). Of the patients who were followed-up 182 (42.4%) presented infections. Of these infections, 21.4% were diagnosed as community-acquired pneumonia, 18.6% were ventilator-associated pneumonia (VAP), 16.3% were communityacquired urinary tract infection (UTI), and 16.3% were bloodstream infection. In addition, the most commonly administered antibiotics in the study group were piperacillin/tazobactam, carbapenem, quinolone and ceftriaxone, respectively. The most common types of HCAI were community-acquired pneumonia (10.7%), ventilator-associated pneumonia (8.9%) and bloodstream infections (8.2%). The mean length of hospital stay was 32.05 ± 66.85 (1-459) days and the mean duration of antibiotic therapy in patients with HCAIs was 7.76 ± 7.11 (1-41) days. The most widely accepted method to handle infection is to carry out active, prospective and patient-based surveillance studies on a regular basis, and to take control measures and arrange appropriate treatment in the light of the data obtained. We attribute the high prevalence of HCAI in our region to lack of personnel, lack of materials, inappropriate use of antibiotics, insufficiency of physical conditions, and little support for infection control committees. In conclusion, we emphasize that it is of importance to work closely with the hospital administration to take measures and that necessary assistance is provided.

Treatment initiation rates of patients with positive anti-hepatitis C virus results in tertiary hospitals in Turkey.

INTRODUCTION: The aim of this national, multicenter, cross-sectional, retrospective chart review study was to determine the proportion of patients in Turkey who received hepatitis C virus (HCV) treatment after receiving positive anti-HCV results during HCV screening. METHODOLOGY: Data related to patients' demographics, laboratory results, time interval from obtaining a positive anti-HCV result to treatment initiation, specialty of the physician requesting anti-HCV screening, and type of hospital were analyzed. RESULTS: Among 1,000 patients who received a positive anti-HCV result, 50.3% were male and 78.5% were screened for HCV-RNA. Among HCV-RNA screened patients, 54.8% (n = 430) had a positive result. Among patients who tested positive for HCV-RNA, 72.8% received HCV treatment in line with their positive anti-HCV results. The median time from obtaining a positive anti-HCV result to initiation of HCV treatment was 91.0 days (interquartile range 42.0 to 178.5). Non-surgical branches requested HCV-RNA testing more frequently than surgical branches (p < 0.001). The rate of access to HCV treatment was higher among patients screened in university hospitals than among patients screened in training and research hospitals (p < 0.001). CONCLUSIONS: Our results indicate a higher rate of treatment initiation among patients with HCV infection than is described in the published literature. Furthermore, the time from screening to treatment initiation was considerably shorter compared with other international studies. However, since HCV-RNA testing was not requested in a significant portion of patients with a positive anti-HCV test result, there might be a large patient population with HCV who do not receive treatment.

An Unusual Cause of Acute Isolated Hepatitis in a Cancer Patient Post-COVID Pneumonia: HSV-2.

Herpes simplex virus is a rare cause of hepatitis in immunosuppressed and immunocompetent individuals. It can cause clinical pictures in patients ranging from an asymptomatic course to fatal acute fulminant hepatitis. Early diagnosis and treatment may be delayed if it is not suspected because of the patients' nonspecific clinic. This study presents a case of isolated HSV-2 hepatitis in a patient with a history of cancer chemotherapy and a recent diagnosis of COVID-19 who received steroid therapy.

Crimean-Congo Hemorrhagic Fever in Differential Diagnosis During the Coronavirus Disease-2019 Pandemic

Objective: Crimean-Congo Hemorrhagic Fever (CCHF) is a disease of the viral hemorrhagic fever group and is endemic in certain regions in Turkey. Here, the demographic, clinical, and laboratory findings of patients diagnosed with CCHF during the Coronavirus disease-2019 (COVID-19) pandemic were examined, and differential diagnosis was stressed. Methods: This study comprised 12 patients over the age of 18 who were admitted to our clinic after the onset of the COVID-19 pandemic on March 11, 2020 and whose CCHF diagnosis was confirmed by reverse transcription-polymerase chain reaction with viral-RNA or enzyme-linked immunosorbent assay with immunoglobulin M antibodies. Epidemiological, clinical, and laboratory findings as well as treatment and prognosis of the patients were investigated. Results: Of the 12 cases, 10 (83.3%) were men and 2 (16.7%) were women. The median (interquartile range) age was 51 (27-64) years. Eleven (91.7%) patients lived in rural regions, and seven (58.3%) had a history of tick contact. Five patients were hospitalized in an external center with a preliminary diagnosis of COVID-19 and transferred to our center due to clinical and laboratory deterioration. Loss of appetite, headache, fever, weakness, and muscle-joint pain were the most common complaints of the patients. Following the suspicion of COVID-19, thoracic computed tomography (CT) was performed in six patients, five of whom were transferred to an external center. None of the patients had any pathological findings following thoracic CT. Conclusion: Although it is thought that the COVID-19 pandemic will end in the following months owing to vaccine applications, it can be predicted that sporadic cases will still occur for a long time. Therefore, clinicians should take CCHF into consideration in their differential diagnosis. Also, it should be remembered that co-infections can be observed in endemic areas.

In a Real-Life Setting, Direct-Acting Antivirals to People Who Inject Drugs with Chronic Hepatitis C in Turkey.

BACKGROUND: People who inject drugs (PWID) should be treated in order to eliminate hepatitis C virus in the world. The aim of this study was to compare direct-acting antivirals treatment of hepatitis C virus for PWID and non-PWID in a real-life setting. METHODS: We performed a prospective, non-randomized, observational multicenter cohort study in 37 centers. All patients treated with direct-acting antivirals between April 1, 2017, and February 28, 2019, were included. In total, 2713 patients were included in the study among which 250 were PWID and 2463 were non-PWID. Besides patient characteristics, treatment response, follow-up, and side effects of treatment were also analyzed. RESULTS: Genotype 1a and 3 were more prevalent in PWID-infected patients (20.4% vs 9.9% and 46.8% vs 5.3%). The number of naïve patients was higher in PWID (90.7% vs 60.0%), while the number of patients with cirrhosis was higher in non-PWID (14.1% vs 3.7%). The loss of follow-up was higher in PWID (29.6% vs 13.6%). There was no difference in the sustained virologic response at 12 weeks after treatment (98.3% vs 98.4%), but the end of treatment response was lower in PWID (96.2% vs 99.0%). In addition, the rate of treatment completion was lower in PWID (74% vs 94.4%). CONCLUSION: Direct-acting antivirals were safe and effective in PWID. Primary measures should be taken to prevent the loss of follow-up and poor adherence in PWID patients in order to achieve World Health Organization's objective of eliminating viral hepatitis.

Pancreatic Damage and Radiological Changes in Patients With COVID-19.

Background and objective The novel coronavirus disease 2019 (COVID-19) primarily affects the lungs. However, others organs are also affected in varying degrees. We aimed to investigate the changes in pancreatic density on CT and its correlation with amylase/lipase values in patients diagnosed with COVID-19. Materials and methods Radiological changes using non-contrast CT and amylase/lipase values were evaluated retrospectively in patients admitted to the pandemic clinic. The patients were classified into two groups: [polymerase chain reaction (PCR)-positive and PCR-negative]. The correlation and difference between the data were evaluated statistically. Results There was no significant difference with respect to age and gender between the two groups (PCR-positive and PCR-negative). There was a significant difference in the head, neck, trunk, and tail of the pancreas and mean density values, but no statistically significant difference in amylase and lipase values between the two groups. No significant correlation was found using Spearman's correlation test. Conclusion Based on our findings, pancreatic involvement and severe necrotizing pancreatitis can be seen in COVID-19 patients. Pancreatic involvement is more common in patients with severe disease. Patients with gastrointestinal complaints should be evaluated for pancreatitis and their amylase/lipase values should be assessed. We believe that decreased pancreatic density on CT scans can be an early sign of pancreatitis.

Association Between Dermcidin, Salusin-α, Salusin-ß Molecules and Diabetic Foot Infections.

Dermcidin, salusin-α, and salusin-ß are three recently discovered molecules that confer antimicrobial properties. The present study aims to investigate the association between dermcidin, salusin-α, and salusin-ß in the etiopathology of patients with diabetic foot infection. The study included three groups: Group 1 - diabetic foot infection; Group 2 - diabetes without history of diabetic foot; and Group 3 - the control group. Plasma dermcidin, salusin-α, and salusin-ß levels were compared across the groups. Median (Q1-Q3) values of plasma dermcidin levels in Groups 1, 2, and 3 were 3.45 (0.8-4.4), 5.2 (3.7-6.4), and 5.8 (3.1-10) ng/mL, respectively. Diabetic foot infection group had significantly lower plasma dermcidin levels compared to diabetes only group and control group (P = .000, ANOVA), whereas there was no statistically significant difference between the Group 2 and Group 3 (P = .163, ANOVA). Salusin-α and salusin-ß levels were significantly higher in the Group 3 compared to the other groups. Based on our findings, diabetic foot infection group had significantly lower plasma dermcidin levels and salusin-α and salusin-ß levels were significantly higher in the control group. These molecules (dermcidin specifically) can be researched as an adjuvant therapeutic agent in addition to conventional treatments in diabetic foot diabetic foot infections. Also, it can be searched this may prevent many complications including amputation.

Pentraxin-3: A Novel Marker for Indicating Liver Fibrosis in Chronic Hepatitis B Patients?

BACKGROUND/AIMS: PTX-3 is an important marker that plays a role in suppressing inflammation and tissue repair. The aim of this study is to investigate the diagnostic and prognostic characteristics of PTX-3 in CHB patients and the relationship between PTX-3 levels and fibrosis. MATERIALS AND METHODS: A total of 52 CHB patients and 40 healthy subjects were included in the study. All of the CHB patients underwent liver biopsy and were then scored using a Ishak histologic scoring system. Blood samples were collected to evaluate the PTX-3 levels. RESULTS: Of the subjects who participated in the study, 53% were female. PTX-3 levels were determined as 5.63ng/mL in the control group, and as 0.88ng/mL in the CHB patient group. PTX-3 levels were found to be 1.19ng/mL in stage 1, 0.89ng/mL in stage 2, 0.68ng/mL in stage 3 and 0.55ng/mL in stage 4. Of the CHB patients, 44.2% had significant fibrosis, while 55.7% were identified as not having significant fibrosis. PTX-3 values were 0.64 and 1.0ng/mL in patients with and without significant fibrosis, respectively. The cut-off value for PTX-3 in predicting the absence of significant fibrosis was estimated as 0.9ng/mL. CONCLUSION: CHB patients were found to have lower serum PTX-3 levels compared to the control group, and these levels decreased even further as the fibrosis stage progressed in these patients. In addition, the significant decrease in PTX-3 levels in patients with stage 1 fibrosis compared to the control group shows that PTX-3 can be used as a non-invasive marker for the early detection of fibrosis (p<0.001).

Crimean Congo Hemorrhagic Fever in Eastern Turkey: Epidemiological and Clinical Evaluation

Objective: The present study aimed to evaluate Crimean-Congo Haemorrhagic Fever (CCHF) in patients hospitalized in our hospital. Methods: A total of 61 adult patients who were diagnosed as having CCHF between January 2011 and August 2018, in whom the diagnosis was confirmed by detecting virus-specific IgM by ELISA and/or by showing viral RNA by RT-PCR and who were managed at our clinic were evaluated retrospectively for their epidemiological and clinical findings, treatment and prognosis. Results: Of the 61 cases, 41 (67.2%) were male and 20 (32.8%) female. The mean age of the patients was 45.31±2.12 years. Sixty (98.4%) patients were living in rural area. Forty four patients (72.1 %) had a tick-bite history. According to months, most of the cases were seen in June, July and May, respectively. Fever, weakness and loss of appetite were the most common complaints of the patients. Treatment of ribavirin was started on the day of admission in all patients. One patient who was admitted in the late period died. The other 60 patients were discharged after being healed. Conclusions: Especially during summers when the disease is seen frequently, the history of tick contact should be questioned and tick should be searched in the examination in the patients with suspected clinical findings. A significant number of the patients do not have a known tick contact. Therefore, training meetings should be organized about the symptoms and findings of the disease in the endemic areas and awareness should be raised among the community and the doctors working in emergency services and primary care.

Roles of Dermcidin, Salusin-α, Salusin-ß and TNF-α in the Pathogenesis of Human Brucellosis.

BACKGROUND: Brucella spp. are facultative intracellular pathogens that can cause chronic infections in many tissues and organs. OBJECTIVES: To investigate serum dermcidin, salusin-alpha, salusin-beta and TNF-alpha levels and their correlation with each other in patients with acute brucellosis. METHODS: From 50 patients hospitalized upon diagnosis of acute brucellosis, blood samples were collected and dermcidin, salusin-alpha, salusin-beta and TNF-alpha levels in serum samples were measured using an ELISA assay. The control group included 40 volunteers. RESULTS: Brucellosis group had significantly lower plasma dermcidin, salusin- alpha, salusin-beta levels compared to the healthy control group (respectively p=0.008, p<0.001, p<0.001). Moreover, Brucellosis group had significantly higher plasma TNF-alpha levels comparisons with the controls (p=0.002). In the examination of the correlation between TNF-alpha and dermcidin, salusin-alpha and salusin-beta in the brucellosis group, only a negative correlation was found between salusin-beta and TNF-alpha. In the control group, there was a positive and statistically significant correlation between salusin-beta and TNF-alpha. CONCLUSION: Dermcidin, salusin-alpha, and particularly salusin-beta levels are important in Brucella pathogenesis. The paradoxical correlation between TNF-alpha and salusin-beta in patients with brucellosis and control group is remarkable. However, there is a need for extensive studies conducted with more patients to further elucidate this topic.

Does microbial resistance profile change in community-based intra-abdominal infections? Evaluation of the culture results of patients with appendicitis.

Tartar T, Sagmak-Tartar A, Saraç M, Bakal Ü, Akbulut A, Kazez A. Does microbial resistance profile change in community-based intra-abdominal infections? Evaluation of the culture results of patients with appendicitis. Turk J Pediatr 2018; 60: 520-526. Most common origin of intra-abdominal infections in children is appendicitis. Microorganisms responsible for community-based and hospital-acquired intra-abdominal infections vary. The aim of this study was to evaluate microbial culture outcomes and antibiotic susceptibilities of these microorganisms in samples obtained intraoperatively from pediatric patients with appendicitis, and to define the infectious microorganisms responsible for the community-based intra-abdominal infections in our region, and their antibiotic susceptibilities. This study included 231 patients between 0 and 16 years of age, operated on due to appendicitis between 2014 and 2017. Appendicular tissues were sampled intraoperatively. Antibiogram was studied in case of reproduction in tissue culture. Forms included information on the age and gender of the patients, intra-abdominal event, bacterial growth in microbial culture and antibiogram, antibiotic switch during follow-up, duration of the treatment, complications and outcomes were recorded. No microbial growth was observed following inoculation of the samples obtained from appendiceal tissue of 24.7% patients, whereas growth was positive in 75.3%. Gram negative bacteria were isolated in 94.3% of the patients, whereas gram positive bacteria was isolated in 5.7%. Polymicrobial growth was observed in 2.2% of the patients. E. coli in 79.9%, P. aeruginosa in 5.2%, Enterobacter cloacae in 3.4%, Coagulase-negative staphylococci in 3.4%, Klebsiella spp. in 1.7%, Citrobacter spp. in 1.7%, Enterococcus spp. in 1.7%, Comamonas testosteroni in 1.2% of patients produced. ESBL positivity is present in 51 (36.7%) of 139 E. coli strains reproducing in appendiceal tissue culture. ESBL was positivity detected in one of the reproduced 3 Klebsiella spp. strains. In E. coli, ciprofloxacin resistance as 20.86%, ampicillin-sulbactam resistance as 83.45%, and co-trimoxazole resistance as 41% were found. Our study clearly demonstrates that the resistance profile varies in community-based intra-abdominal infections. Empirical treatment protocols should be revised in especially the patients admitted with septic presentation and where the source control is not possible.

Epidemiological, Clinical, and Laboratory Evaluation of Plasmodium falciparum Malaria Cases Followed in Firat University Hospital: A 6-Year Retrospective Analysis.

OBJECTIVE: Malaria is an infectious disease caused by Plasmodium parasite. Sporadic cases have not been observed in Turkey since 2010, but imported malaria cases are still prevalent owing to migration. The present study aimed to evaluate Plasmodium falciparum malaria in patients hospitalized in our hospital. METHODS: A total of 15 adult patients (14 males and 1 female) who were diagnosed with malaria and who were managed at our clinic between January 2011 and 2017 were evaluated retrospectively for their epidemiological, clinical, and laboratory findings; treatment; and prognosis. RESULTS: Of the 15 cases, 14 (93.3%) were male and (6.7%), female. All patients had a history of travelling to endemic areas, and none of them undertook regular chemoprophylaxis. Fever (100%), splenomegaly (86.7%), hepatomegaly (26.7%), leukopenia (13.3%), thrombocytopenia (80%), elevated liver function tests (40%), and increased serum creatinine levels (13.3%) were found in the patients. CONCLUSIONS: The number of import cases is increasing owing to tourism, migration, and deficiency in eradication programs. Malaria caused by P. falciparum is an import case in Turkey. The current study emphasizes on the necessity of providing proper education to Turkish individuals traveling to endemic areas for the purpose of work or travel and on the necessity of initiating chemoprophylaxis.

A Case of Severe Plasmodium falciparum Malaria Co-Infected with HIV Improved with Exchange Transfusion.

In our country, within years, despite a dramatic drop in the number of patients with malaria, a dramatic increase in the number of patients with import malaria is noteworthy. A 32-year-old male patient presented with fever, shivering, malaise, and loss of appetite. He had travelled to West Africa. Laboratory findings were as follows: hemoglobin: 8.8 g/dL and anti-HIV: positive. Microscopic examinations of thin blood smears and thick blood preparations revealed widespread trophozoites. The presence of double-dotted ring forms and banana-shaped gametocytes resulted in Plasmodium falciparum malaria being diagnosed. The patient was started treatment with oral artemether 20 mg/ lumefantrine 120 mg 2×4 tablets and trimethoprim-sulfamethoxazole. During his follow-up, hemoglobin levels regressed to 5.8 g/dL. The patient was diagnosed as having severe malaria. He visited our hematology unit, and exchange transfusion (EET) was recommended. Using an EET apheresis device, eight units of erythrocyte suspension was transfused. The cured patient was discharged. This case was found to be interesting and reminds us the possible presence of comorbid conditions associated with malaria in patients who have a history of travelling abroad. Although its effectiveness has not been proved thus far, as a striking result, EET was used as an alternative treatment in a patient with severe malaria.

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.