Epidemiological characteristics, clinical and laboratory findings supporting preliminary diagnosis of Crimean-Congo hemorrhagic fever in an endemic region in Turkey.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease that has various symptoms. Since rapid diagnosis is crucial for survival, understanding the characteristics of patients is important for clinicians while waiting for results. This study aimed to evaluate findings that support the preliminary diagnosis of suspected CCHF in patients and take a look at the management of CCHF in Turkey. METHODS: Demographics, presenting symptoms and laboratory findings of the patients admitted with a suspicion of CCHF, were recorded from the patient files and database of Ministry of Health. A diagnosis of CCHF was based on detection of immunoglobulin M (IgM) antibodies and/or viral RNA. The patients with and without CCHF were compared in terms of differences in epidemiological, clinical and laboratory findings. RESULTS: Out of 87 patients, 61 (70.1%) were CCHF and 26 (29.9%) were non-CCHF cases. Working with agriculture/livestock, tick exposure, contact with body fluids of animals, travel to rural areas within 2 weeks, fever, headache, leucopenia, anemia, international normalized ratio (INR) elevation were significantly more common in CCHF cases. According to multivariate analysis, tick exposure (odds ratio, OR 9.03, 95% confidence interval, CI 1.96-41.47, p = 0.005), contact with body fluids of animals (OR 14.9, 95% CI 2.23-99.94, p = 0.005), leucopenia (OR 13.65, 95% CI 2.55-72.91, p = 0.02) and anemia (OR 8.41, 95% CI 1.06-66.42, p = 0.04) were independently indicative for CCHF. CONCLUSION: As it takes a considerable time for a definitive diagnosis, determining epidemiological features and risk factors is an important step for preliminary diagnosis of CCHF as well as early implementation of precautions against nosocomial transmission of the virus.

Role of Preoperative Viral Load and Presence of Hepatocellular Carcinoma in the Biliary Complications After Liver Transplantation Due to Hepatitis C Virus.

BACKGROUND: Chronic hepatitis C virus (HCV) infection is a global health problem, and the need for liver transplants is ever-growing. For optimal surgical success, risk factors must be identified and HCV viral load must be reduced to a minimum to avoid complications. In this study, we aimed to investigate the role of HCV viral load on the post-transplant biliary complications. METHOD: Between 2004 and 2018, the cases of 114 liver transplant recipients with HCV infection were retrospectively reviewed. Data collection included demographic variables, preoperative and postoperative amount of serum HCV RNA copies, preoperative diagnosis of hepatocellular carcinoma (HCC), and postoperative biliary complications in the early and late period. After missing values were excluded, the remaining 97 patients were divided into 2 groups according to preoperative HCV RNA status (Group A: HCV RNA [+] and Group B: HCV RNA [-]). RESULTS: Demographic parameters were similar among both groups. There were 67 patients in Group A and 30 patients in Group B. The overall rate of biliary complications was higher in Group A without statistical significance (20% [n = 14] vs 13% [n = 4], respectively, P = .573). Biliary stricture occurrence in the late period was also higher in Group A. In HCC (+) patients (n = 26), biliary complications were significantly higher compared to HCC (-) patients (34% vs 12%, P = .018). However, in patients with biliary complications, the rate of multiple duct anastomoses was higher with no statistical significance (45% vs 26%, respectively, P = .14). CONCLUSION: The biliary complications on patient survival has been previously established, and this is mostly evident in those patients with viral etiology and hepatocellular carcinoma. As was also suggested in our study, hepatocellular carcinoma and positive viral status should be considered as predisposing factors for postoperative biliary complications after liver transplantation. However, the rate of multiple duct anastomoses should also be taken into consideration. New standards of antiviral medications and bridge therapy for HCC may improve transplant outcomes.

Impact of the ST101 clone on fatality among patients with colistin-resistant Klebsiella pneumoniae infection.

Objectives: We describe the molecular characteristics of colistin resistance and its impact on patient mortality. Methods: A prospective cohort study was performed in seven different Turkish hospitals. The genotype of each isolate was determined by MLST and repetitive extragenic palindromic PCR (rep-PCR). Alterations in mgrB were detected by sequencing. Upregulation of pmrCAB, phoQ and pmrK was quantified by RT-PCR. mcr-1 and the genes encoding OXA-48, NDM-1 and KPC were amplified by PCR. Results: A total of 115 patients diagnosed with colistin-resistant K. pneumoniae (ColR-Kp) infection were included. Patients were predominantly males (55%) with a median age of 63 (IQR 46-74) and the 30 day mortality rate was 61%. ST101 was the most common ST and accounted for 68 (59%) of the ColR-Kp. The 30 day mortality rate in patients with these isolates was 72%. In ST101, 94% (64/68) of the isolates had an altered mgrB gene, whereas the alteration occurred in 40% (19/47) of non-ST101 isolates. The OXA-48 and NDM-1 carbapenemases were found in 93 (81%) and 22 (19%) of the total 115 isolates, respectively. In multivariate analysis for the prediction of 30 day mortality, ST101 (OR 3.4, CI 1.46-8.15, P = 0.005) and ICU stay (OR 7.4, CI 2.23-29.61, P = 0.002) were found to be significantly associated covariates. Conclusions: Besides ICU stay, ST101 was found to be a significant independent predictor of patient mortality among those infected with ColR-Kp. A significant association was detected between ST101 and OXA-48. ST101 may become a global threat in the dissemination of colistin resistance and the increased morbidity and mortality of K. pneumoniae infection.

Overuse Injuries in Professional Anatolian Folk Dancers: A Descriptive Study Verified with MRI.

BACKGROUND: Professional dancers are artists as well as athletes who push their bodies beyond limits for aesthetic expression. Therefore, overuse injuries are common. We present our findings on overuse injuries in Anatolian (Turkish) folk dancers. METHODS: The Fire of Anatolia dance group comprises of 82 dancers (37 male, 45 female) with a mean age of 27.96±5.05 yrs (range 18 to 38). Forty-one dancers from this group presented to our clinic between February 2009 and April 2016 with complaints of pain, and 25 of them had magnetic resonance imaging (MRI) for verification. The type, frequency, and anatomical locations of their overuse injuries as found on MRI were investigated. RESULTS: We evaluated a total of 70 overuse injuries in 25 dancers. All injuries were seen on separate occasions, and multiple injuries in the same dancers at separate times were recorded. Most of the overuse injuries were seen around the knee joint. Ankle ligament injuries were not seen in our study, in contrast to ballet and modern dance. Overuse injuries were observed in the knee in 68% of cases, thigh in 24%, lumbar region in 24%, feet in 20%, shoulder in 16%, and hip in 12%. CONCLUSIONS: Overuse injuries occur mostly in the knee region in Anatolian folk dancers. There were no statistically significant differences between dancers with and without overuse injuries in terms of age, sex, and dance style (p>0.05).

Protease Inhibitors Drug Resistance Mutations in Turkish Patients with Chronic Hepatitis C.

BACKGROUND: Drug resistance development is an expected problem during treatment with protease inhibitors (PIs), this is largely due to the fact that Pls are low-genetic barrier drugs. Resistance-associated variants (RAVs) however may also occur naturally, and prior to treatment with Pls, the clinical impact of this basal resistance remains unknown. In Turkey, there is yet to be an investigation into the hepatitis C (HCV) drug associated resistance to oral antivirals. MATERIALS AND METHODS: 178 antiviral-naïve patients infected with HCV genotype 1 were selected from 27 clinical centers of various geographical regions in Turkey and included in the current study. The basal NS3 Pls resistance mutations of these patients were analyzed. RESULTS: In 33 (18.5%) of the patients included in the study, at least one mutation pattern that can cause drug resistance was identified. The most frequently detected mutation pattern was T54S while R109K was the second most frequently detected. Following a more general examination of the patients studied, telaprevir (TVR) resistance in 27 patients (15.2%), boceprevir (BOC) resistance in 26 (14.6%) patients, simeprevir (SMV) resistance in 11 (6.2%) patients and faldaprevir resistance in 13 (7.3%) patients were detected. Our investigation also revealed that rebound developed in the presence of a Q80K mutation and amongst two V55A mutations following treatment with TVR, while no response to treatment was detected in a patient with a R55K mutation. CONCLUSION: We are of the opinion that drug resistance analyses can be beneficial and necessary in revealing which variants are responsible for pre-treatment natural resistance and which mutations are responsible for the viral breakthrough that may develop during the treatment.

Evaluation of knowledge of the healthcare personnel working in Giresun province regarding Crimean-Congo hemorrhagic fever before and after educational training.

UNLABELLED: BACKGROUNDS & OBJECTIVES: Crimean-Congo hemorrhagic fever (CCHF) is a highly fatal and contagious tick-borne viral disease. Healthcare workers (HCWs) should know how and with which symptoms can CCHF patients attend to hospitals, and be aware of nosocomial transmission capability. The aim of this study was to investigate the knowledge of HCWs working in Giresun province regarding CCHF. METHODS: This research was carried out during an educational programme arranged for healthcare personnel working in district state hospitals in June 2012. In total, 428 workers completed a self-administered questionnaire including personal demographic characteristics, general knowledge of CCHF disease, knowledge of nosocomial transmission and infection control during hospitalization. RESULTS: Almost all participants (95.3%) knew that the workers in livestock and agriculture were at risk. About 93.5% of participants knew that tick bite is the cause of CCHF transmission. In contrast to this high ratio, only 73 and 77% workers knew that CCHF can be transmitted by direct contact with animal's or patient's blood and body fluids, but after imparting relevant information in the form of one hour lecture given by a doctor expertised in infectious diseases, 92% gave correct answers. Nearly, all healthcare workers were aware that ticks should be removed by using fine-tipped tweezers without crushing (90.7%). Doctors were the most and the laboratory personnel the least well-informed groups. The knowledge degree significantly increased from 67.48 ± 13.89 to 80.92 ± 10.80 points after providing the CCHF related information (p<0.05). INTERPRETATION & CONCLUSION: It was observed that the healthcare personnel working in district state hospitals of the province were moderately aware of CCHF disease. There is possibility of achieving improvement in their knowledge by educating them regarding CCHF and such educational programmes should be conducted from time-to-time.

Effects of glutamine and curcumin on bacterial translocation in jaundiced rats.

AIM: To investigate the effect of curcumin on bacterial translocation and oxidative damage in an obstructive jaundice model and compare the results to glutamine, an agent known to be effective and clinically used. METHODS: Twenty-four female Wistar-Albino rats, weighing 200-250 g, were randomly divided into three groups (8 in each group). After ligation of the common bile duct in all animals, Group I received oral normal saline, Group II received oral glutamine and Group III received oral curcumin for seven days. Blood samples via cardiac puncture, tissue samples (terminal ileum, liver and mesenteric lymph node) and peritoneal fluid were obtained from the animals at the time of death to investigate bacterial translocation and oxidative damage. RESULTS: We observed that both glutamine and curcumin reduced bacterial translocation in blood, hepatocellular damage, plasma cytokine levels, oxidative tissue damage and apoptosis significantly compared to the control group. Additionally, glutamine showed protective effects on ileal epithelium and reduced villus atrophy. CONCLUSION: On the basis of these findings, both curcumin and glutamine are thought to be effective in preventing or reducing bacterial translocation and oxidative damage in obstructive jaundice.