Use of flow cytometry method to detect contaminations of platelet suspensions.

In this study, it was aimed to investigate bacterial contamination in apheresis platelet suspensions (APS) by automated blood culture system and flow cytometry method (FCM).33 spiked APS each using 11 bacterial strains (5 standard strains, 6 clinical isolates), were prepared in three different dilutions (1-10, 10-50, 50-100 cfu/mL), incubated in two different temperatures (35-37 °C and 22-24 °C) and different incubation times (18-96 h) evaluated by FCM. This three different dilutions were also inoculated into special platelet culture bottles (BacT/ALERT® BPA) and loaded into the blood culture system. Additionally 80 APSs routinely prepared in the Transfusion Center were evaluated by both FCM and the blood culture system. Platelets were lysed by freeze-thaw method.All spiked samples were positive with BacT/ALERT® BPA in 12-18 h. In 96 h incubation at 22-24 °C, the presence of bacteria was detected by FCM in all other samples (31/33) except low dilutions (1-10 and 10-100 CFU/ml) of K.pneumoniae standard strain. In the 35-37 °C, the presence of bacteria was detected by FCM in all samples (33/33) after 48 h of incubation. In routine APS one sample detected as positive (Bacillus simplex) with BacT/ALERT® BPA and no positivity was detected by FCM.The freeze-thaw method, which we have optimized for the lysis of platelets, is very practical and can be easily applied. The BacT/ALERT® system has been found to be very sensitive in detecting bacterial contamination in PSs. Flow cytometry method has been found to be successful, fast, easy to use and low cost in detecting bacterial contamination in PSs.

Short and mid-term SARS-CoV-2 antibody response after inactivated COVID-19 vaccine in hemodialysis and kidney transplant patients.

The efficacy of the inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine has not been fully elucidated across the whole spectrum of patients on kidney replacement therapy. We aimed to characterize the long-term antibody response of inactivated SARS-CoV-2 vaccine administered in kidney transplant recipients (KTRs) and hemodialysis (HD) patients. We performed this prospective observational study in 50 HD, 64 KTR, and 41 healthy control groups (HG) given two doses of CoronaVac. We measured anti-Spike antibodies after 28 days of every vaccine dose, 3rd and 6th months after the first dose, and compared them between cohorts. After two doses, an anti-spike immunoglobulin G of ≥50 AU/ml was present in HD, KTR, and HG as 44%, 7.2%, and 58.5%, respectively (p < 0.001). Furthermore, the proportion of antibody titers peaked at 86.5%, 23%, and 97.6% (p < 0.001) at the 3rd month and decreased significantly at the 6th month in most HD and HG participants, whereas this effect was not observed in KTRs from basal until the 6th month (p < 0.001). During the follow-up, the incidence of coronavirus disease 2019 disease was higher (p < 0.003) in KTRs compared to the other groups, but there was no requirement for an intensive care unit and no death was recorded. We found a negative correlation between antibody seroconversion and age (p < 0.016). The antibody response following inactivated vaccine in dialysis patients is almost comparable to controls for 6 months. In contrast, kidney transplant patients have a poor response. These findings reinforce the need to discuss the vaccination strategy in immunocompromised patients, including the third dose with homologous or heterologous vaccines.

Evaluation of Using Direct Viral Transport Medium Samples without Nucleic Acid Isolation for SARS-CoV-2 Diagnosis by RT-PCR.

BACKGROUND: Diagnosis with reverse transcriptase polymerase chain reaction (RT-PCR) test is a very important step for the control of the COVID-19 pandemic. The aim of this study is to compare the RT-PCR results of the samples taken directly from the viral transport medium (VTM) without extraction with the RT-PCR results of two different extraction methods, one automated and the other manual, in the diagnosis of COVID-19. METHODS: Among the respiratory tract samples sent to Sakarya Training and Research Hospital Microbiology Laboratory for COVID-PCR study, 20 negative and 43 positive samples with different cycle threshold (CT) values were included in the study. Both manual nucleic acid isolation with the vNAT isolation kit (Bioeksen, Turkey) and automatic nucleic acid isolation with the EZ1 Virus Mini Kit v2.0 in the isolation device were performed simulta-neously from the patient samples included in the study and the results were compared. RESULTS: The mean Ct values of the samples were found to be 21.58 using manual vNAT as the extraction method, 17.63 using the automated magnetic bead method, and 21.45 in PCR from direct VTM without extraction. When the automatic magnetic beads extraction method was taken as the reference method, the sensitivity of direct PCR was 97.3%, the specificity was 95%, the positive predictive value was 97.3%, and the negative predictive value was 95%. Phi coefficients were found to be 0.927 between vNAT and direct PCR, 1 between vNAT and EZ1, and 0.922 between direct PCR and EZ1. CONCLUSIONS: Direct PCR has advantages such as eliminating RNA extraction and purification steps, providing a shorter detection time, and using less labor and less consumables without reducing the diagnostic accuracy. It is thought that this method can help as a useful process management for the control of the epidemic in countries with limited resources.

Rapid Molecular Diagnosis of Group A Streptococcus with a Novel Loop Mediated Isothermal Amplification Method.

BACKGROUND: Group A Streptococcus (GAS) is the most common bacterial cause of acute tonsillopharyngitis. In this study, it was aimed to evaluate the performance of a novel Loop Mediated Isothermal Amplification (LAMP) method in the rapid diagnosis of GAS in samples taken from children with a prediagnosis of acute bacterial tonsillopharyngitis by comparing it with culture and rapid antigen test (RAT) methods. METHODS: A total of 100 throat swab samples taken from children at the pediatrics outpatient clinic with suspected tonsillopharyngitis were included in the study. Throat swab samples were analyzed by RAT, throat culture, and LAMP method. GAS suspected colonies were identified with MALDI-TOF MS system. The isothermal amplification reaction for LAMP was conducted by a novel LAMP instrument. RESULTS: According to the results of throat cultures; 53 of them were positive and 47 were negative in terms of GAS. Six (11.32%) of the culture positive samples were found to be negative by the RAT (sensitivity; 88.68%, specificity 100%). While the antigen test was positive, no culture negative sample was detected. One of the culture positive samples was found negative by LAMP. In two samples, while throat culture was negative, it was observed that LAMP was positive (sensitivity; 98.11%, specificity; 95.74%). In one of these samples, the bacteria grown in the culture were identified as Streptococcus dysgalactiae by mass spectrophotometry. CONCLUSIONS: In this study, it was determined that the LAMP method used in the diagnosis of throat infections caused by GAS has high sensitivity and specificity. We believe that the instrument is easy to use, low cost, portable, and adaptable to point of care tests. There are very few studies in the literature regarding the use of the instrument in this field, and it should be evaluated in terms of its usability in daily practice with new studies.

Determination of antibiotic susceptibility of bacteria by flow cytometric method.

In this study, it was aimed to determine the antibiotic susceptibility of bacterial strains by using flow cytometry method by comparing them with current standardized methods. Eleven clinical isolates and 6 standard bacterial strains were included in the study. MIC values were determined by broth microdilution method (BMD), VITEK 2® automated system and flow cytometric method (FCM). FCM was performed with the Accuri C6 flow cytometer. For all strains except P. aeuruginosa ATCC 27853 [BMD-FCM:r = 0.557(p = 0.048); VITEK 2-FCM:r = 0.529(p = 0.063)], E. faecalis ATCC 29212 [BMD-FCM:r = 0.393(p = 0.295); BMD-VITEK 2:r = 0.393(p = 0.295)], and vancomycin-resistant E. faecium clinical isolate [BMD-FCM:r = 0.452(p = 0.063)] r values were in the range of 0.802-0.969 for BMD-FCM (p < 0.001), 0.655-0.941 for BMD-VITEK 2 (p < 0.005) and 0.667-0.953 for FCM-VITEK 2 (p < 0.005). Correlation values of antibiotic susceptibility test results between three methods for Gram-negative bacteria were found as follows; r = 0.927(p < 0.001) for BMD-FCM, r = 0.851(p < 0.001) for BMD-VITEK 2, r = 0.807(p < 0.001) for VITEK 2-FCM. Correlation values were found as follows for Gram positive bacteria; r = 0.848(p < 0.001) for BMD-FCM, r = 0.877(p < 0.001) for BMD-VITEK 2, r = 0.800(p < 0.001) for VITEK 2-FCM. When all bacteria included in the study were evaluated as a total; it was r = 0.911(p < 0.001) for BMD-FCM, r = 0.888(p < 0.001) for BMD-VITEK 2, r = 0.835(p < 0.001) for VITEK 2-FCM. The methicillin resistance of the clinical methicillin resistant S. aureus isolate could not be detected by FCM. It was determined that there was a high level of correlation between methods. FCM shortens the duration of antibiotic susceptibility tests by 12-14 h and gives results within the same day. However, it has not been standardized to be widely used in microbiology laboratories and experienced personnel are needed for its implementation.

[Shedding of SARS-CoV-2 Virus in COVID-19 Patients and Neutralizing Antibody Level]. / COVID-19 Hastalarinda SARS-CoV-2 Virüs Saçilimi ve Nötralizan Antikor Düzeyleri.

The coronavirus disease 2019 (COVID-19) turned into a pandemic shortly after emerging in December 2019, in the city of Wuhan, China. In this study, it was aimed to investigate the presence of severe acute respiratory system coronavirus-2 (SARS-CoV-2) RNA in various clinical samples and the scattering profile of the virus and the variation of anti-SARS-CoV-2 IgG and neutralizing antibody levels over time in infected patients during and after the period of COVID-19 disease. The study included COVID-19 patients from the community (CCP) (n= 47) (May-June 2020) and healthcare workers (HCWP) (n= 30) (November-December 2020). To investigate the presence of SARS-CoV-2 in clinical samples, oropharynx (OF), nasopharynx (NF), sputum, stool, blood and urine samples were taken from the CCP group on days 0, 3, 7, 14 and 28. For the detection of anti SARS-CoV-2 IgG and neutralizing antibodies serum samples were taken from the CCP group on days 0, 3, 7, 14, 28, 60, 90 and 120 and on days 14, 28, 60, 90, 120 and 150 from HCWP group. Virus RNA was detected by reverse transcription polymerase chain reaction (RT-PCR), anti SARS-CoV-2 IgG antibody levels by enzyme-linked immunosorbent assay (ELISA), neutralizing antibody levels (NAb) by cell culture neutralization and representative neutralization test (sVNT) methods. With the onset of the vaccination program in our country, 11 of the HCWP group patients had SARS-CoV-2 vaccine after the second month serum samples were taken, the remaining HCWP group patients did not get vaccinated during the study period. SARS-CoV-2 RNA was detected with the highest rates in NF (100%), stool (65.8%), sputum (45.7%), OF (41.3%), blood (5.3%), and urine (2.2%) samples, respectively. It was found that viral shedding continued for 14 days in respiratory tract samples and up to 60 days in stool samples, and no virus was detected in blood samples after the third day. It was observed that the viral load was highest at the time of diagnosis in both upper and lower respiratory tract samples, peaking on the seventh day in stool samples and following an irregular course throughout the disease. Anti-SARS-CoV-2 IgG antibody positivity was found in 41.4% of CCP group patients on the first day of diagnosis, and seroconversion was observed in all patients at the fourth month. During the study period, seropositivity was detected in only 82.1% of the patients in the HCWP group. It was observed that the IgG antibody levels peaked at the 7th day in the CCP group patients and at the third month in the HCWP group patients (S/Co: 9.6 and 2.8, respectively). Anti-SARS-CoV-2 IgG antibody levels detected in the CCP group were found to be significantly higher than the HCWP group (p<0.05). At the end of the first month, NAb was detected in all (100%) patients in the CCP group. It was found that NAb titers peaked (1/256) on the 28th day and showed a decreasing trend from the second month. NAb median titers were observed to peak earlier in the severe HCWP group (14 days in the severe group, 28 days in the mild group, p> 0.05). It was observed that 6 (26.1%) of HCWP group patients had low, 11 (47.8%) moderate, 6 (26.1%) high titers of representative NAb. The distribution of representative NAb levels by vaccine status was examined and no statistically significant difference was found (p= 0.400, p= 0.077 and p= 0.830, respectively). As a result; SARS-CoV-2 RNA was detected in many samples such as sputum, stool, blood and urine, and it was observed that viral shedding in stool samples could continue for months. Anti-SARS-CoV-2 IgG antibody positivity was observed in most of the patients in the fourth month, and it was found that the antibody titers decreased after the third month. It was determined that protective antibody levels continued in the fourth month. These findings are important in vaccination strategies and in the fight against the pandemic. However, considering the emergence of new mutant forms of the virus in today's conditions where the pandemic continues, more detailed and comprehensive studies are needed for viral shedding and antibody titer studies.

Investigation of Hepatitis E Seroprevalence in HIV Positive Patients by a Novel Enzyme Linked Fluorescent Assay Test.

BACKGROUND: Hepatitis E virus (HEV) infection is usually an acute self-limiting disease, which causes rapidly progressive cirrhosis and chronic infection in patients with hematological malignancies, patients requiring chemotherapy, and HIV-infected patients. The aim of this study was to investigate the positivity of hepatitis E IgM and IgG in HIV positive patients with the recently introduced Enzyme Linked Fluorescent Assay (ELFA) commercial kits. MATERIALS AND METHODS: The study included 126 patients who were followed up by the Infectious Diseases and Clinical Microbiology Clinic of Sakarya University Training and Research Hospital between October 2017 and December 2018 for HIV positivity. Serum samples of the patients were evaluated for anti-HEV IgG and IgM positivity with a novel commercially available kit using the ELFA method (bioMerieux, France). The study group consisted of 126 patients with HIV infection. Anti-HEV IgG antibodies were studied primarily from plasma samples. Anti-HEV IgM positivity was also investigated in patients with anti-HEV IgG positivity. RESULTS: The study group consisted of 114 (90.5%) males and 12 (9.5%) females with a mean age of 38.11 ± 13.32 (min: 18, max: 80) years. Anti-HEV IgG was positive in 5 (4.0%) HIV-positive patients. One of the anti-HEV IgG positive patients was newly diagnosed with HIV and the other four patients were being followed up for HIV positivity. Anti-HEV IgM was negative in all patients. None of the patients with anti-HEV IgG positivity had anti-HCV and HBsAg positivity. CONCLUSIONS: In the study, anti-HEV IgG positivity was found to be 4% in HIV-positive individuals, and no HCV and HBV co-infection was detected in any patients with HIV and HEV coexistence. HEV infections do not emerge as a priority among HIV-infected people, but HEV should also be investigated in HIV-infected individuals with liver abnormalities of uncertain etiology.

The Prevalence of Mixed Genotype Infections in Turkish Patients with Hepatitis C: a Multicentered Assessment.

BACKGROUND: HCV virus infections are one of the major health problems in the world that can cause cirrhosis and liver cancer at a higher rate than other hepatitis data. The aim of this study was to determine the prevalence of mixed infections with different HCV genotypes in Turkey and also to evaluate the current HCV genotype and sub-type distributions by a multicentered assessment. METHODS: The HCV genotype data of 17,578 hepatitis C patients collected from 23 centers from different geographic regions covering all Turkey were collected. The data included information about the HCV genotypes in the last 10 years (between 2007 and 2016), demographic properties of the patients and the methods/systems used to determine the genotypes. RESULTS: Two hundred twenty-eight of the patients (1.3%) had mixed genotype. The most common mixed genotype combination was 1b + 4 (0.83%) followed by 1a + 1b (0.26%). Genotype distribution varies according to geographical regions. However, genotype 1 (82.92%) was the most common genotype in all regions and all years. This was followed by genotype 3 (7.07%) and genotype 4 (5.43%). A variety of methods were used by the centers including sequencing, pyrosequencing, real-time PCR, in-house RFLP, reverse hybridization (LIPA), and hybridization. CONCLUSIONS: Infection with mixed HCV genotypes in Turkey is uncommon. Genotype distribution varies according to geographic regions; the most common genotype 1 is encountered all over the country, while genotypes 3 and 4 are only in some of the centers. Since there is limited information about mixed HCV infection, further investigations are needed to determine the clinical importance of mixed HCV infection.

[Investigation of blaOXA-48-like genes in carbapenemase producing Klebsiella spp. isolates]. / Karbapenemaz üreten Klebsiella pneumoniae suslarinda blaoxa-48-benzeri genlerin arastirilmasi.

The emergence and spread of multi-drug-resistant (MDR), extended-spectrum beta-lactamase (ESBL) producing carbapenem-resistant members of Enterobacteriaceae family has become a worldwide health problem. Carbapenem resistance caused by blaKPC, blaNDM gene regions are sporadic and blaOXA-48 gene region is endemic in our country. The aim of this study was to determine the presence of blaOXA-232, blaOXA-181, blaOXA-162, blaOXA-204, blaOXA-244, blaOXA-163, blaOXA-245 genes in OXA-48 like carbapenemase producing Klebsiella pneumoniae isolates. The isolates used in this study were provided from the Medical Microbiology Laboratory collection of Sakarya University Sakarya Training and Research Hospital. Identification and antibiotic susceptibility tests were determined by the VITEK 2® automated system (biomerieux, France) and the carbapenemase production of isolates was determined by the modified Hodge test. Minimal inhibitor concentration (MIC) values were determined with broth microdilution method. The isolates containing the blaOXA-48-like gene region were identified by real-time polymerase chain reaction (Rt-PCR) method using consensus primers. In "High Resolution Melting Analysis (HRMA)" method carried out by using "Type-it HRM PCR" (Qiagen, Hilden, Germany) kit, isolates which showed a deviation in melting temperatures (Tm) were selected with the suspicion of OXA-48 variant. The sequence analysis (ABI 3500, Applied Biosystems, USA) was carried out to determine which variants were present in these isolates. Compatibility of MIC values was determined between VITEK 2® and the microdilution method with the rate of 82% for imipenem, 77% for meropenem and 90% for ertapenem in carbapenemase-producing K.pneumoniae isolates. In 45 of 100 K.pneumoniae isolates, the blaOXA-48-like gene region was found to be positive by the Rt-PCR method. For the determination of OXA-48 variants, these 45 isolates were evaluated by HRMA method. The sequence analysis revealed that 41 (91.2%) isolates contained blaOXA-48/blaOXA-245 gene regions, while 2 (4.4%) isolates were found to contain blaOXA-181 gene regions and 2 (4.4%) isolates were found to contain blaOXA-244 gene regions. This is the first study to determine OXA-48 and OXA-244 positivity in blaOXA-48-like gene regions in Turkey. As a result of this study, the OXA-48-like gene region was found to be 45%, of which 4.4% had blaOXA-181 and 4.4% had blaOXA-244 gene regions. The detection of blaOXA-48-like gene regions will guide for the selection of antibiotics in critical patient groups.

Comparison of Metabolic Effects of Three Different Treatment Combinations with Retrospective Real-life Data in People Living with HIV.

INTRODUCTION: Comorbidities are increasing in people living with HIV (PLHIV), and different treatment options have advantages and disadvantages. It is important to compare information from real-life treated cases. The aim of this study was to retrospectively evaluate the data on efficacy and clinical and laboratory findings during different antiretroviral therapies. METHODS: Retrospective file data of 47 PLHIV using Dolutegravir and Lamivudine (3TC/DTG), Tenofovir Alafenamide Emtricitabine and Elvitegravir Cobicistat (EVG/c/TAF/FTC) and Tenofovir Disoproxil Fumarate and Emtricitabine and Efavirenz (EFV/FTC/TDF) were analyzed. Data of the patients at baseline and 12 months after antiretroviral therapy (ART) were compared. RESULTS: About 47 PLHIV were included in the study. Of the patients, 22 (46.8%) were in the 3TC/DTG group, 19 (40.4%) in the EVG/c/TAF/FTC, and 6 (12.8%) in the EFV/FTC/TDF group. After 12 months of treatment, BMI, HIV-RNA, CD4, WBC, hemoglobin, MCV, PDW, RDW, platelet count, creatinine, eGFR, HDL, AST, glucose values of the 3TC/DTG group were significantly different (p<0.05). After 12 months of treatment, BMI, HIV-RNA, CD4 count, MCV, creatinine, eGFR, HDL, LDL, TG, TC, AST, and HOMA-IR values of the EVG/c/TAF/FTC treatment group were significantly different (p<0.05). After 12 months of treatment, HIV RNA, total bilirubin, and LDL values in the EFV/FTC/TDF treatment group were statistically different (p<0.05). CONCLUSION: All treatment groups showed a decrease in HIV-RNA and an increase in CD4 at the end of one year. While CD4 elevation is lower in EFV recipients than in integrase inhibitor (INSTI) recipients, weight gain is higher in INSTI recipients. While the lipid profile was more positively affected in the 3TC/DTG group, lipid profiles were more negatively affected in the EVG/c/TAF/FTC group, although liver and kidney functions were preserved.

Can Fetuin-A Deficiency Predict the Severity of COVID-19 Disease in Kidney Transplant Recipients?

BACKGROUND: This study aims to investigate whether fetuin A deficiency predicts the prognosis of COVID-19 disease in kidney transplant recipients (KTRs). METHOD: The study was conducted on 35 hospitalized KTRs with COVID-19 pneumonia between November 2020 and June 2021. Serums were collected for fetuin-A measurement at admission and after six months of follow-up. The demographic and laboratory data of the patients were recorded and analyzed with the appropriate statistical method. RESULTS: A total of 35 KTRs, 23 of which (65.7%) were men, were included in the study. The mean age of the patients was 51.6 ± 14.0 years. Seventeen (48.6%) patients had severe disease criteria and required intensive care (ICU) support. Biopsy-proven acute rejection developed in 6 (17.1%) patients in the follow-up. At admission, the median fetuin-A value was 173.5 mcg/mL (143.5-199.25) in the moderate disease group and 126.0 mcg/mL (89.4-165.5) in the severe patient group (p = 0.005). While the Median fetuin-A value at the time of diagnosis was 173.5 mcg/mL (143.5-199.25), and in the 6th month was 208 mcg/mL [184-229] (p<0.001). By ROC analysis, the effect of serum fetuin-A level in predicting the severity of COVID-19 disease was significant (AUC: 0.771, p = 0.006, 95% CI: 0.615-0.927). When serum fetuin-A cut-off value was taken as 138 mcg/mL to determine disease severity, it was shown to have 83.3% sensitivity and 64.7% specificity. CONCLUSIONS: Serum fetuin-A level can predict disease severity in kidney transplant recipients in the presence of active COVID-19 disease.

Does Monocyte Chemoattractant Protein-1 Levels Determine the Prognosis of Covid-19 Disease in Kidney Transplant Recipients?

BACKGROUND: In the normal population, a high monocyte chemoattractant protein (MCP-1) level is an important biomarker for the progression of COVID-19. This study investigated whether MCP-1 level can determine the disease prognosis in kidney transplant (KT) patients with COVID-19. METHODS: A total of 89 patients, including 49 KT patients (group 1) diagnosed with COVID-19 who required hospitalization, and 40 KT patients who did not have COVID-19 disease (group 2), were included. Demographic characteristics and laboratory results of the patients were recorded. The serum reserved for MCP-1 was stored at -80°C and studied blindly by a single microbiologist at the end of the study. RESULTS: While the mean age of the patients was 51.0 years (40.0-59.50) in group 1, it was 48.0 years (40.75-54.75) in group 2 (P > .05). In terms of the female sex, it was 36 (73.5%) and 27 (67.5%) in group 1 and group 2, respectively (P > .05). Similarly, there was no significant difference between the 2 groups regarding primary disease and basal graft function (P > .05). There was a statistically significant difference in inflammation indicators in group 1 compared with group 2 (P < .05). A correlation was found between inflammation indicators and COVID-19 (P < .05). However, no significant correlation was detected between COVID-19 disease and MCP-1 levels in both groups (P > .05). Also, according to basal MCP-1 levels, we did not find a significant difference between survival and nonsurvival patients (164.0 pg/mL [146.0-202.0] vs 156.0 pg/mL [143.0-173.0], respectively (P > .05). CONCLUSION: Monocyte chemoattractant protein, an indicator of inflammation, was not found to predict the prognosis of COVID-19 disease in kidney recipients.

Investigation of the Presence of SARS-CoV-2 in Aerosol After Dental Treatment.

AIMS: The objective of the present study was to investigate the presence of SARS-CoV-2 in aerosol and COVID-19 contamination distance asssociated with ultrasonic scaling and tooth preparation. METHODS: Twenty-four patients with COVID-19 were included in this study. Removal of supragingival plaque with ultrasonic instruments for 10 minutes and high-speed air-turbine using for the simulation of cutting the maxillary right canine tooth with a round diamond bur for 5 minutes were performed. Patients were randomly assigned to 2 groups: In group A, medium-volume suction was used during treatment. In group B, high-volume suction with an aerosol cannula was added to medium-volume suction. Prior to treatment, 5 glass petri dishes containing viral transport medium were placed in the operating room. After treatment, petri dishes were immediately delivered to a microbiology laboratory for real-time polymerase chain reaction (RT-PCR) analysis. RESULTS: RT-PCR test results were negative for all specimens in group B. However, 5 positive test results for COVID-19 were detected in group A specimens. CONCLUSIONS: Suction with an aerosol cannula is very important to prevent COVID-19 viral contamination via aerosol. In addition, a high-volume suction capacity (air volume) of 150 mm Hg or 325 L/min is sufficient for elimination of viral contamination. Thus, high-volume suction should be used during dental treatments in COVID-19 patients.

Comparison of syphilis seropositivity between non-immigrant and immigrant populations in the Anatolian side of Istanbul, Turkiye: Results of five-years retrospective study.

OBJECTIVE: Our study aimed to evaluate the seropositivity for syphilis in non- immigrant and immigrant populations and compare the results regarding demographic data. METHODS: In accordance with the reverse algorithm, syphilis tests were performed between May 2014 and December 2018 in hospitals in our service zone for syphilis screening or symptomatic disease. RESULTS: A total of 135.328 non- immigrant and 6.641 immigrant were screened for syphilis. Seropositivity rates were 1.3% in the non- immigrant and 3.8% in immigrant groups (p=0.0001). There was a statistically significant difference in terms of seropositivity rates between the various age groups in the local group and immigrant groups (except 18 25 age group) (p<0.05). Syphilis seropositivity rates were found to be lower in indigenous population than immigrant groups according to the years tested (p=0.0001). The seropositivity rates were 2.4% and 3.2% among the males (p=0.025) and 0.6% and 4.0% among females (p=0.0001) in non-immigrantand immigrant groups, respectively. Whereas, 0.6% of pregnant women in the local group and 3.7% of pregnant women in immigrant groups were seropositive for syphilis (p=0.0001). Among the HIV positive group, syphilis seropositivity was only observed in the non-immigrant group with a rate of 23.0% (p=0.0001). CONCLUSION: The antibodies against syphilis were found more frequently in immigrants than non-immigrant. Among the HIV positive individuals syphilis seropositivity was only observed in the non-immigrant group.

SARS-CoV-2 is not present in the vaginal fluid of pregnant women with COVID-19.

BACKGROUND: Data concerning the presence of SARS-CoV-2 in the female genital system is scarce; however, this information is important for understanding whether the virus can transmit sexually or from mother to child. The aim of this study was to investigate whether pregnant women with COVID-19 have virus in their lower genital tract. METHODS: In this cross-sectional study, we present an analysis of prospectively gathered data collected at a single tertiary university hospital from 19 April to 19 May 2020. We included 13 pregnant women hospitalized with suspected COVID-19. Results of laboratory tests, imaging tests, and nucleic acid tests on vaginal swabs for SARS-CoV-2 were also analyzed for pregnant women with a clinical diagnosis of COVID-19. RESULTS: Twelve pregnant women with confirmed COVID-19 were included in this study. Mean age was 32 ± 7.9 years. All patients had mild symptoms and were followed in the maternity ward, with none of them needing critical care unit follow-up. All lower genital tract samples were negative for SARS-CoV-2. CONCLUSION: We demonstrated that SARS-CoV-2 was not present in the vaginal fluid of pregnant women. This finding may indicate that the female genital tract is not a route of SARS-CoV-2 transmission.

Relationship between serum osteopontin levels and the severity of COVID-19 infection.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is an acute inflammatory respiratory disease. Osteopontin (OPN) is a glycoprotein expressed in various cell types, such as bone, immune, smooth muscle, epithelial and endothelial cells. It also acts as a regulator of immune response. The aim of the present study was to reveal the place of serum osteopontin levels in predicting severity among patients with COVID-19. METHODS: This study included 84 patients, 43 female and 45 male. Patients were divided into 2 groups, group 1 non-severe group (n: 48), group 2 severe (n: 40). Demographic data, neutrophil, lymphocyte, platelet, white blood cell counts, albumin, procalcitonin, C­reactive protein (CRP) and OPN levels were recorded. The OPN levels and these inflammatory parameters of the two groups were compared. RESULTS: There were no significant differences in terms of gender (female/male 25/23 vs. 18/22) and platelet count (178 K/µL vs. 191 K/µL) between the groups (p > 0.05). Ages (57.7 ± 17.0 years vs. 71.4 ± 12.8 years), procalcitonin (0.07 vs. 0.24 ng/mL), CRP (17 vs 158 mg/l), neutrophil count (3.7 vs 5.64 K/µL), WBC counts (5.38 vs 7.85 K/µL) and number of deaths (0 vs 26) (p < 0.001). The OPN levels (98.5 vs 13.75 ng/mL, p = 0.002) were found to be statistically higher, in group 2 than group 1. CONCLUSION: The present study showed that OPN can be used to predict the severity in patients with COVID-19.

Evaluation of taste and smell disorders in pediatric COVID-19 Cases.

OBJECTIVE: Pediatric coronavirus disease 2019 (COVID-19) cases have a high risk of contagiousness, as they usually progress with asymptomatic or mild respiratory symptoms. Disorder in taste and/or smell has rarely been reported in pediatric cases. In our study, early diagnosis and isolation measures were emphasized by evaluating the clinical, laboratory, and radiological imaging findings of pediatric COVID-19 cases presenting with symptoms of taste and/or smell disorder. METHODS: Seven cases aged 0-18 years were included in the study. The severe acute respiratory syndrome coronavirus-2 polymerase chain reaction test was performed for the seven cases presented with taste and/or smell disorders. Clinical findings, laboratory tests, and radiological imaging of all the cases were evaluated on the day of admission and on the fifth day. RESULTS: Seven (5.7%) of 122 pediatric COVID-19 cases had disorder in taste and/or smell. In two cases, pneumonia findings were detected in thorax computed tomography imaging. It was observed that all the patients fully recovered at the latest on the 21st day. In the cranial diffusion magnetic resonance imaging of a case, diffusion restriction was detected in the corpus callosum splenium. CONCLUSION: Although less common than adults, children with COVID-19 may also have taste and smell disorders, and this may be accompanied by central nervous system imaging findings.

Evaluation of the presence of SARS-COV-2 in the vaginal fluid of reproductive-aged women.

OBJECTIVES: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is mainly transmitted through respiration and direct contact. The status of the infection in the female genital system is still unknown. The study aimed to evaluate whether SARS-CoV-2 is present in the vaginal fluid of women with COVID-19 infection in reproductive period. MATERIAL AND METHODS: Women who were between the ages of 18-50 years and clinically confirmed to have COVID-19 infection at our hospital between 20 April-31 May 2020 were included in the study. Women who were in their menstrual cycle during the study and who had a known cervical intraepithelial lesion and/or cancer, sexually transmitted disease and history and/or symptoms of vaginitis were excluded from the study. In patients in whom no pathology was detected during the examination, a sample was taken from the vaginal fluid for PCR by using Dacron tip swab. Analysis was performed with Genesig Real-Time PCR COVID-19 kit (Primer Design, England). RESULTS: Eighteen women who were in reproductive period and diagnosed with severe COVID-19 pneumonia were included in the study. The mean age of the patients was 38.16 ± 8.54. None of the patients were in their menopause period. The clinical symptoms of these women were similar to those of confirmed severe COVID-19 cases. SARS-CoV-2 was found to be negative in the samples taken from the vaginal fluid in all patients. CONCLUSIONS: SARS-CoV-2 virus was not detected in the vaginal fluid of the patients who tested positive for COVID-19 in reproductive period.

The effectiveness of dexamethasone on the prognosis of dialysis patients with severe COVID-19.

OBJECTIVE: This study aimed to investigate the effectiveness of dexamethasone in dialysis patients with COVID-19 and whether it predicts mortality. METHODS: This is a comparative cross-sectional study of 113 consecutive patients with COVID-19 with severe pneumonia signs. The patients were divided into two groups according to the use of dexamethasone treatment: group 1 (n=45) included patients who were treated with dexamethasone and group 2 (n=68) who did not receive dexamethasone. RESULTS: The mean age of both groups was 67.0±10.6 and 67.2±13.0 years, respectively (p=0.947). With respect to demographic and laboratory findings, there were no significant differences between the two groups (p>0.05). The hospitalization time of patients in group 1 was longer than that in group 2 (11 [7-17] days vs. 8 [5.3-14] days, p=0.093]. The 28-day survival rate was 54.2% in the group receiving dexamethasone treatment and 79.5% in the group not receiving dexamethasone treatment (p=0.440). CONCLUSION: Dexamethasone did not reduce mortality rates and the requirement for intensive care unit in dialysis patients with COVID-19. Larger prospective randomized clinical trials are required to associate personalized medicine with the corticosteroid treatment to select suitable patients who are more likely to show a benefit.

Comparison of saliva and oro-nasopharyngeal swab sample in the molecular diagnosis of COVID-19.

BACKGROUND: Healthcare personnel are at risk of becoming infected while taking upper and/or lower respiratory tract specimens. Therefore, there is a need for sampling methods that do not risk infecting them. In this study, we aimed to compare the saliva and Oro-Nasopharyngeal Swab (ONS) sampling methods. METHODS: Patients were divided into three groups. Group 1 included patients whose diagnosis of COVID-19 was confirmed by polymerase chain reaction (PCR). Group 2 included patients with COVID-19 compatible findings in lung computed tomography (CT), but with a negative PCR. Group 3 included patients who presented to the emergency department with COVID-19 compatible complaints but had normal CT. Saliva and ONS samples were taken on the third day of hospitalization in groups 1 and 2, whereas in group 3, they were taken at the time of admission to the hospital. RESULTS: A total of 64 patients were included in the study. The average age was 51.04 ± 17.9 years, and 37 (57.8%) were male. SARS-CoV-2 was detected in 27 (42.2%) patients' saliva samples. While the sensitivity and positive predictive value of saliva samples were 85.2%, specificity and negative predictive value were 89.2%. The value of kappa was in substantial agreement (0.744), and it was found statistically significant (<0.001). CONCLUSIONS: Saliva samples can be used instead of ONS samples in detecting SARS-CoV-2. Investigating SARS-CoV-2 with saliva is cheaper, easier for the patient and overall, and, most importantly, it poses much less risk of SARS-CoV-2 contamination to healthcare personnel.