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Background/aim: It was aimed to evaluate the positive effects of health behaviors (general hygiene, wearing face masks, physical distancing, and travel restrictions) acquired during the coronavirus disease 2019 (COVID-19) pandemic on the prevention of other infectious diseases in Ankara Province, Türkiye. Materials and methods: This study was designed retrospectively. Among the notifiable group A infectious diseases, acute intestinal infections (AIIs) with International Classification of Diseases, Tenth Revision diagnosis codes A09 (diarrhea and gastroenteritis presumed to be of infectious origin), R11 (nausea and vomiting), and K52 (other noninfectious gastroenteritis and colitis), as well as influenza, tuberculosis, measles, varicella, malaria, and meningococcal meningitis were included in the scope of this study.The data of the selected infectious diseases in Ankara Province for the last 2 years before the pandemic (January 2018-December 2019) and for the 2-year period of the pandemic (January 2020-December 2021) were analyzed after checking the data. The number of cases were presented as frequencies, the 1-sample chi-squared test was used in the statistical analysis and the statistical significance level (α) was taken as 0.05. Results: The findings for each disease/disease group were discussed under separate headings. Comparing the prepandemic period (2018-2019) with the pandemic period (2020-2021), the decreases in the number of cases of selected infectious diseases, except influenza, were statistically significant. Conclusion: Undoubtedly, the experience gained from the pandemic struggle will guide us in shaping our future lives. From this point forward, we should be aware that living in crowded environments and as a highly mobile population, that unhygienic habits are unfavorable for the spread of all infectious diseases, and we should take care to continuously apply the precautions for healthy living in our new lifestyle.
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COVID-19 , Conductas Relacionadas con la Salud , Humanos , COVID-19/prevención & control , COVID-19/epidemiología , Estudios Retrospectivos , Turquía/epidemiología , Enfermedades Transmisibles/epidemiología , SARS-CoV-2 , Higiene , Máscaras/estadística & datos numéricos , Distanciamiento Físico , Pandemias/prevención & control , Control de Enfermedades Transmisibles/métodos , Viaje/estadística & datos numéricosRESUMEN
BACKGROUND: Early identification of severe COVID-19 patients who will need intensive care unit (ICU) follow-up and providing rapid, aggressive supportive care may reduce mortality and provide optimal use of medical resources. We aimed to develop and validate a nomogram to predict severe COVID-19 cases that would need ICU follow-up based on available and accessible patient values. METHODS: Patients hospitalized with laboratory-confirmed COVID-19 between March 15, 2020, and June 15, 2020, were enrolled in this retrospective study with 35 variables obtained upon admission considered. Univariate and multivariable logistic regression models were constructed to select potential predictive parameters using 1000 bootstrap samples. Afterward, a nomogram was developed with 5 variables selected from multivariable analysis. The nomogram model was evaluated by Area Under the Curve (AUC) and bias-corrected Harrell's C-index with 95% confidence interval, Hosmer-Lemeshow Goodness-of-fit test, and calibration curve analysis. RESULTS: Out of a total of 1022 patients, 686 cases without missing data were used to construct the nomogram. Of the 686, 104 needed ICU follow-up. The final model includes oxygen saturation, CRP, PCT, LDH, troponin as independent factors for the prediction of need for ICU admission. The model has good predictive power with an AUC of 0.93 (0.902-0.950) and a bias-corrected Harrell's C-index of 0.91 (0.899-0.947). Hosmer-Lemeshow test p-value was 0.826 and the model is well-calibrated (p = 0.1703). CONCLUSION: We developed a simple, accessible, easy-to-use nomogram with good distinctive power for severe illness requiring ICU follow-up. Clinicians can easily predict the course of COVID-19 and decide the procedure and facility of further follow-up by using clinical and laboratory values of patients available upon admission.
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COVID-19 , Nomogramas , Cuidados Críticos , Estudios de Seguimiento , Humanos , Unidades de Cuidados Intensivos , Estudios Retrospectivos , SARS-CoV-2RESUMEN
BACKGROUND: In this study, we aimed to compare the intensive care unit (ICU) admission rate of hospitalized mild/moderate COVID-19 patients treated with hydroxychloroquine (HCQ), favipiravir, and HCQ plus favipiravir. METHODS: Single center retrospective designed observational study conducted in Ankara City Hospital. Patients who were hospitalized between March 15, 2020 and June 1, 2020 in COVID-19 inpatient clinics with laboratory confirmed diagnosis of COVID-19 were included in the study. An inverse probability of treatment weighting (IPTW) for multiple treatment groups approach was used to balance the differences in several variables on admission. RESULTS: Among 2441 patients hospitalized with diagnosis of COVID-19 during the study period, 824 were eligible for the analysis. Median age of patients was 42 (18-93 years). Among all, 347 (43.2%) of the patients had mild disease, 470 (56.8%) had pneumonia. Propensity scores ranged from 0.1841 to 0.9381 in the HCQ group, from 0.03643 to 0.29885 in the favipiravir group, and from 0.03542 to 0.56184 in the HCQ plus favipiravir group. After IPTW for multiple treatment groups was applied, all the covariates in the planned propensity score had weighted standardized effect sizes below 10% which were ranged from 0.005 to 0.092. Multivariate analysis of treatment effect (adjusted effect of treatment) was indicated that there is no statistically significant difference between HCQ, favipiravir, and HCQ plus favipiravir treatment. After using combination of SMOTE and Bootstrap resampling approach, we found no statistically significant difference between HCQ and HCQ plus favipiravir groups in terms of ICU admission. However, compared with the HCQ group, ICU admission rate was statistically significantly higher in the favipiravir group. We obtained the similar results after the sensitivity analysis. CONCLUSIONS: HCQ with or without favipiravir treatment is associated with reduced risk of ICU admission compared to favipiravir alone in mild to moderate COVID-19 adult patients.
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Amidas , Antivirales , Tratamiento Farmacológico de COVID-19 , Hidroxicloroquina , Unidades de Cuidados Intensivos/estadística & datos numéricos , Pirazinas , Adulto , Anciano , Anciano de 80 o más Años , Amidas/uso terapéutico , Antivirales/uso terapéutico , Quimioterapia Combinada , Femenino , Humanos , Hidroxicloroquina/uso terapéutico , Masculino , Persona de Mediana Edad , Pirazinas/uso terapéutico , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Background/aim: The aim of this study is to evaluate the epidemiological and clinical characteristics and parameters that determined the clinical course and prognosis of the COVID-19 patients admitted to Ankara City Hospital during the first month of the pandemic in Turkey. Materials and methods: SARS-CoV-2 PCR positive patients who were hospitalized between March 10 and April 10, 2020 were included. Results: Among 222 patients, mean age was higher in severe acute respiratory illness (SARI)/critical disease group (P < 0.001). Median time from illness onset to admission and presence of comorbidity, especially coronary artery disease and chronic obstructive pulmonary disease, were significantly higher in the SARI/critical disease group (P < 0.05). Cough and fever were the most common symptoms, while anosmia and loss of taste were observed in 8.6% and 7.7% patients, respectively. The mortality rate was 5.4%. A high neutrophil/lymphocyte ratio; low lymphocyte, monocyte, and platelet count; elevated liver enzymes; low GFR; and high levels of muscle enzymes, ferritin, and IL-6 on admission were found to be associated with SARI/critical disease (P < 0.05). Bilateral ground-glass opacity and patchy infiltration were more frequently seen in the SARI/critical disease group (P < 0.001). Patients older than 65 years had an 8-fold increased risk for development of SARI/critical disease. Conclusion: This cohort study regarding COVID-19 cases in Turkey reveals that older age, presence of comorbidity, bilateral infiltration on CT, high neutrophil/lymphocyte ratio, low monocyte and platelet count, elevated liver enzymes, low GFR, high levels of muscle enzymes, and high levels of ferritin and IL-6 on admission are predictors of SARI and severe disease.
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Biomarcadores/sangre , COVID-19 , Hospitalización/estadística & datos numéricos , Evaluación de Síntomas , Factores de Edad , Anciano , COVID-19/sangre , COVID-19/epidemiología , COVID-19/fisiopatología , COVID-19/terapia , Prueba de Ácido Nucleico para COVID-19/métodos , Prueba de Ácido Nucleico para COVID-19/estadística & datos numéricos , Deterioro Clínico , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Pronóstico , Factores de Riesgo , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos , Turquía/epidemiologíaRESUMEN
PURPOSE: This study was conducted to assess the health-related quality of life (HRQOL) and perceived health status of the Turkish population. METHODS: The data came from a nationwide survey, which was conducted by Ministry of Health on prevalence and risk factors for chronic diseases in Turkey, with a representative random sample of 18,477 people aged ≥ 15 years from Turkey. Each family physician invited two individuals selected from their registered population to the Family Health Center, conducted the survey by face to face interviews using an electronic form. HRQOL was determined using EQ-5D-3L scale. RESULTS: In Turkish population, each four women out of 10, two men out of 10 have problems in pain/discomfort and anxiety/depression dimensions of the scale; three women out of 10, one man out of 10 have some or severe problems in mobility. Proportion of people without health problems (health state 11,111) were 64,1% in men, 40,7% in women. The mean VAS score for males was 71.5 ± 0.2 (95% CI 70.9-72.1), 66.4 ± 0.2 (95% CI 65.8-66.9) for females (p < 0.05).The most important determinants of having a problem in any of the five dimensions are age, gender, education, diabetes mellitus, coronary heart disease, stroke, alzheimer, cancer, renal failure. The OR of having some or severe problems in any dimensions was 4.6 (95% CI 38-5.4) for over 65-74 and 7.5 (95% CI 5.8-9.6) for over 75 compared to 15-24 age group. CONCLUSIONS: The perceived health level and HRQOL is worse in women, in older age groups, in people from lower socioeconomical status.
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Enfermedad Crónica/psicología , Estado de Salud , Calidad de Vida/psicología , Adolescente , Adulto , Anciano , Depresión/psicología , Femenino , Encuestas Epidemiológicas/métodos , Humanos , Masculino , Persona de Mediana Edad , Dolor/psicología , Encuestas y Cuestionarios , Turquía , Adulto JovenRESUMEN
BACKGROUND: Clinical diagnosis of diphtheria is often difficult, in particular in countries where the disease is rarely observed, such as Turkey. In 2011, after 12 years of no recorded diphtheria cases in Turkey, a 34-year-old woman was diagnosed with diphtheria; she later died of myocarditis. In this study, we aimed to demonstrate the diagnostic potential of an immunofluorescent antibody method to determine the presence of diphtheria toxin (DT) in the myocardial cells of DT-injected rabbits and the female subject. METHODS: We randomly divided rabbits into two groups: a control group and a DT-injected group. Diphtheria intoxication was simulated in the rabbits by intravenous injection of DT. The myocardium of the rabbits and the female subject were harvested for histopathologic and immunofluorescence examination. A mouse monoclonal anti-DT antibody was used for the immunofluorescent antibody method. RESULTS: The presence of DT in the myocardial cells of both the rabbits and the female subject was visualized using the immunofluorescent method. CONCLUSIONS: Laboratory diagnosis of diphtheria is challenging because of non-toxigenic C. diphtheriae strains and/or the dysfunction of DT. However, visualizing the presence of DT in the myocardial tissue may act as an indicator of biologically active DT. We validated that an immunofluorescent method, which utilizes a monoclonal anti-DT (A-subunit specific) antibody, is a useful diagnostic tool to determine the presence of DT in the myocardium of rabbits and human.
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BACKGROUND: In 2011, Turkish Ministry of Health (MoH) initiated a nation-wide "Smoking Cessation Treatment Support Program" (SCTSP), to provide smoking cessation drugs free of charge. METHODS: SCTSP was conducted in all 81 cities of Turkey, at 228 smoking cessation clinics, and by over 400 physicians. In total, 164,733 participants took advantage of the program between January and November 2011. Varenicline (Champix(®), Pfizer) and Bupropion (Zyban(®), GlaxoSmithKline) were used in the program at a ratio of 0.7 and 0.3 respectively. Post-program data were obtained by phone interviews from randomly selected participants, who had completed a 1-year follow-up after enrollment in the program. FINDINGS: Quit rates were 29.6% for those given Varenicline and 25.1% for those given Bupropion. The quit rates for participants with hypertension (35.0%), diabetes mellitus (36.9%), coronary artery disease (32.1%) and cerebrovascular events (34.0%) were higher than those without. Increased age, female gender, longer duration of cessation drug use, low Fagerstrom score, the presence of hypertension, the absence of chronic obstructive pulmonary disease, and the absence of cancer were found to be associated with higher success rates. INTERPRETATION: SCTSP is the first successful report of a nation-wide community-based smoking cessation intervention. The real-life quit rates obtained herein are comparable to those of clinical evidence to date. The centralization of smoking cessation clinics, standardization of treatment guidelines, application of a specific drug assignment algorithm, and provision of primary care support and follow-ups by trained physicians, appeared to be key elements for success.
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Política de Salud , Cese del Hábito de Fumar , Adulto , Bupropión/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Cese del Hábito de Fumar/métodos , Cese del Hábito de Fumar/estadística & datos numéricos , Dispositivos para Dejar de Fumar Tabaco/estadística & datos numéricos , Turquía , Vareniclina/uso terapéuticoRESUMEN
During the second year of the "Iron-like Turkey" Project, in which all children aged 4-6 months in Turkey receive iron supplementation for 5 months, we aimed to assess the utilization of iron supplementation in the field, as well as the prevalence of anemia in healthy infants aged 12-23 months, while determining a variety of sociodemographic and nutritional factors for anemia in three of the 12 NUTS (Nomenclature of Territorial Units for Statistics) regions (regions with the highest, lowest and middle under-5 malnutrition levels). In a community-based, cross-sectional survey using a multi-staged, weighted, cluster-selected sample, children aged 12-23 months with birthweight ≥2500 g, no chronic illness, no history of blood disease, and from term and singleton pregnancy were enrolled; 1589 children met the criteria. The mean±SD age of children surveyed was 17.8±3.6 months. Of the parents, 72.4% claimed that their physician had recommended iron supplementation, and 68.8% had given supplementation to their children. Overall prevalence of anemia was 7.3%. Multivariate analysis revealed that the frequency of anemia decreased significantly in older infants, when supplementation was recommended by health providers, when an infant was breastfed longer than 6 months, and when the mother received iron supplementation during pregnancy. However, anemia prevalence increased when the infant received iron supplementation at a later age (³9 months), lived in a crowded family (³6 persons), and when the mother had a history of iron deficiency anemia. Anemic infants had significantly lower z scores of weight for age than non-anemic ones. This survey suggests that iron supplementation during pregnancy, initiation of iron supplementation in infants at 4-6 months of age, effective counseling on supplementation, subsequent compliance, support of breastfeeding, and effective training of health care personnel are effective strategies for prevention of anemia in the community.
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Anemia Ferropénica/epidemiología , Anemia Ferropénica/prevención & control , Suplementos Dietéticos , Promoción de la Salud , Hierro/administración & dosificación , Estudios Transversales , Humanos , Lactante , Prevalencia , Turquía/epidemiologíaRESUMEN
INTRODUCTION: Brucellosis is the most prevalent bacterial zoonosis worldwide. In this study, we aimed to compare our 1028 brucellosis cases with other big series in the literature in view of epidemiological, clinical, and laboratory findings and therapeutic features. METHODS: A total of 1028 brucellosis cases admitted to the Department of Infectious Diseases and Clinical Microbiology over a 10-year period were included in the study. A retrospective analysis was undertaken and patient files were reviewed for history, clinical and laboratory findings, and therapeutic features, as well as complications. RESULTS: Of the 1028 patients, 539 (52.4%) were female and 489 (47.6%) were male. The mean age of patients was 33.7+/-16.34 years and 69.6% of cases were aged 13-44 years. Four hundred and thirty-five cases (42.3%) had a history of raising livestock and 55.2% of the cases were found to have no occupational risk for brucellosis. Six hundred and fifty-four of the cases (63.6%) had a history of raw milk and dairy products consumption. The most frequently seen symptoms were arthralgia (73.7%) and fever (72.2%), while the most common clinical findings were fever (28.8%) and hepatomegaly (20.6%). The most frequent laboratory finding was a high C-reactive protein level (58.4%). The standard tube agglutination (STA) test+Coombs STA test was positive in 1016 cases (98.8%). Focal involvement was present in 371 (36.1%) cases. The most frequent involvement was osteoarticular involvement with 260 cases (25.3%). The overall relapse rate for patients with brucellosis was 4.7%. The highest relapse rate, 8.5%, was observed in the group of patients with osteoarticular involvement. Regimens including doxycycline and streptomycin with or without rifampin appeared more effective than other regimens in osteoarticular involvement. CONCLUSIONS: In humans, brucellosis may lead to serious morbidity, and it continues to be a major health problem in Turkey. There is no recommended treatment protocol for complicated brucellosis. Large multicenter studies are needed to determine the most appropriate treatment choices and durations in complicated brucellosis.
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Brucelosis/complicaciones , Brucelosis/diagnóstico , Adolescente , Adulto , Anciano , Artralgia/diagnóstico , Artralgia/microbiología , Artritis/microbiología , Enfermedades Óseas/diagnóstico , Enfermedades Óseas/microbiología , Brucelosis/tratamiento farmacológico , Brucelosis/epidemiología , Niño , Preescolar , Productos Lácteos/microbiología , Femenino , Fiebre/diagnóstico , Fiebre/microbiología , Hepatomegalia/diagnóstico , Hepatomegalia/microbiología , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/microbiología , Enfermedades Profesionales/epidemiología , Enfermedades Profesionales/microbiología , Estudios Retrospectivos , Factores de Riesgo , Turquía/epidemiologíaRESUMEN
Crimean-Congo hemorrhagic fever virus (CCHFV) is the causative agent of a tick-borne disease with high mortality rates in humans. The distribution of CCHFV includes over 30 countries in Asia, the Middle East, southeastern Europe, and Africa. It was first recognized in Turkey in 2002, with an increasing number of cases reported between 2002 and 2009. Recent analysis of complete genome sequences of CCHFV isolates has revealed that the genomic plasticity of the virus is surprisingly high for an arthropod-borne virus. We have determined the complete nucleotide and deduced amino acid sequences of strain CCHFV Turkey-Kelkit06 isolated from the blood of a patient in an endemic region of Turkey in 2006. The complete sequence length of the CCHFV Turkey-Kelkit06 strain is 19,186 nt, consisting of a 1673 nt S segment, a 5364 nt M segment, and a 12,149 nt L segment. Based on the analysis of S, M, and L segments, CCHFV Turkey-Kelkit06 clustered in Group V, which represents the Europe/Turkey geographic lineage. Although glycoproteins encoded by the M gene are the most variable part of the CCHFV Turkey-Kelkit06 strain, some functional domains of the glycoproteins are well conserved. Here, we report the complete sequence and genome organization of the CCHFV Turkey-Kelkit06 strain and its phylogenetic relationship to other strains of CCHFV. Collecting data on viral sequences among isolates from CCHF epidemics may provide valuable information regarding the molecular basis of the epidemic potential of the virus.
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Genoma Viral , Virus de la Fiebre Hemorrágica de Crimea-Congo/genética , Virus de la Fiebre Hemorrágica de Crimea-Congo/aislamiento & purificación , Fiebre Hemorrágica de Crimea/virología , ARN Viral/genética , Análisis de Secuencia de ADN , Sangre/virología , Análisis por Conglomerados , Orden Génico , Genes Virales , Humanos , Datos de Secuencia Molecular , Filogenia , Homología de Secuencia , TurquíaRESUMEN
In the winter of 2006-2007, several parotitis cases were reported in different provinces of Turkey. Serological and virological studies were undertaken to investigate these cases with the aim of determining the genotype of the mumps virus (MuV) circulating in Turkey. Samples from 23 cases-Ankara (n:5), Kirklareli (n:4), Mugla (n:10), Isparta (n:3), Trabzon (n:1)-with a diagnosis of clinical parotitis were investigated. Serum samples were tested against mumps IgM and IgG, nested PCR amplification of a 639-bp fragment encompassing the entire SH gene was performed using buccal swabs, and PCR products were sequenced. Of 18 serum samples, 16 (88.9%) were positive for mumps IgM. Seven (30.4%) of 23 buccal swab samples were positive by PCR. In five PCR-positive cases, the sample was also positive for mumps IgM, and serum samples were not available from two of the PCR-positive cases. There was 98% identity between the different sequences, and all were identified as genotype H. The sequences were most similar to sequences identified in Spain, Japan, Switzerland and the UK, and less closely related to the H strains identified in Belarus, Korea and Russia. This is the first report of the mumps virus genotypes circulating in Turkey. Turkey is, geographically, a bridge between Europe and Asia, and therefore, a better understanding of the molecular epidemiology of MuV in Turkey may led to improved tracking of the circulation of strains between the two continents. Moreover, there is a need to further investigate the existence of other genotypes in Turkey.
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Genotipo , Virus de la Parotiditis/genética , Paperas/virología , Anticuerpos Antivirales/sangre , Niño , Preescolar , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Masculino , Paperas/epidemiología , Filogenia , Turquía/epidemiologíaRESUMEN
BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) is a serious disease caused by the CCHF virus of the Bunyaviridae family. The disease has been reported in 30 countries in Africa, Asia, Eastern Europe, and the Middle East. It has been present in Turkey since 2002. In this study we present and discuss the epidemiological features, clinical and laboratory findings, treatment, and outcome of cases diagnosed with CCHF between 2002 and 2007 from the surveillance results of the Turkish Ministry of Health (MoH). METHODS: According to the surveillance system of the MoH, data for patients with clinical, laboratory, and epidemiological findings compatible with CCHF are recorded on case reporting forms. These forms are submitted to the General Directorate of Primary Health Care of the MoH by the city health directorates. All the surveillance data regarding CCHF were recorded on a database (SSPS 11.0) established in the Communicable Diseases Department of the MoH. RESULTS: According to the surveillance reports of the Turkish MoH, between 2002 and 2007, 1820 CCHF cases occurred (150 in 2002-2003, 249 in 2004, 266 in 2005, 438 in 2006, and 717 in 2007). The crude fatality rate was calculated to be 5% (92/1820). Two thirds of the CCHF cases were reported from five cities located in the Mid-Eastern Anatolia region; 69.4% of the cases were from rural areas. The male to female ratio was 1.13:1. Of all the reported cases, 68.9% had a history of tick-bite or tick contact and 84.1% were seen in the months of May, June, and July. Of 1820 CCHF cases, three (0.16%) were nosocomial infections. CONCLUSIONS: CCHF appears to be a seasonal problem in the Mid-Eastern Anatolia region of Turkey. The possible risk factors for transmission and the clinical and laboratory findings of patients with a diagnosis of CCHF were found to be similar to those reported in the literature. The mean fatality rate for Turkey is lower than the rate reported for other series from other parts of the world.
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Fiebre Hemorrágica de Crimea/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Fiebre Hemorrágica de Crimea/transmisión , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Estaciones del Año , Vigilancia de Guardia , Turquía/epidemiología , Adulto JovenAsunto(s)
Antivirales , Fiebre Hemorrágica de Crimea/tratamiento farmacológico , Fiebre Hemorrágica de Crimea/mortalidad , Ribavirina , Antivirales/administración & dosificación , Antivirales/uso terapéutico , Estudios de Casos y Controles , Virus de la Fiebre Hemorrágica de Crimea-Congo/efectos de los fármacos , Fiebre Hemorrágica de Crimea/virología , Humanos , Inyecciones Intravenosas , Ribavirina/administración & dosificación , Ribavirina/uso terapéutico , Tasa de Supervivencia , Resultado del Tratamiento , Turquía/epidemiologíaRESUMEN
The aim of this study was to indicate the presence of tick-borne encephalitis (TBE) in an endemic area for Crimean-Congo haemorrhagic fever (CCHF) in Turkey. Of 39 CCHF suspected cases, one was found to be TBE virus immunoglobulin M positive and seven were TBE virus immunoglobulin G positive. It is important to report this first appearance of the TBE virus in Turkey since 1967.
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Encefalitis Transmitida por Garrapatas/epidemiología , Enfermedades Endémicas , Anticuerpos/sangre , Virus de la Encefalitis Transmitidos por Garrapatas/inmunología , Humanos , Inmunoglobulina G/inmunología , Inmunoglobulina M/inmunología , Turquía/epidemiologíaRESUMEN
We report here a 70-year-old female patient who was diagnosed with brucellosis and presented with mass formation resembling a tumor. The mass was protuberant, 10 cm from the skin surface with a diameter of 15 cm, located at the inferior-lateral region of the left scapula. Brucella melitensis was yielded from culture of mass fluid. The patient responded to ceftriaxone, rifampin and doxycycline therapy and recovered without any sequela at the end of surgery and 3 months of medical treatment.
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Brucelosis/diagnóstico , Anciano , Antibacterianos/uso terapéutico , Brucella melitensis/aislamiento & purificación , Brucelosis/tratamiento farmacológico , Ceftriaxona/uso terapéutico , Diagnóstico Diferencial , Doxiciclina/uso terapéutico , Quimioterapia Combinada , Femenino , Humanos , Rifampin/uso terapéutico , Escápula , Neoplasias de los Tejidos Blandos/diagnósticoRESUMEN
Since prozone is a well known phenomenon in the serologic diagnosis of Brucella infections, it is necessary to prepare higher serum dilutions in the standard tube agglutination (STA) test for the brucellosis suspected patients. However, due to limited economical support, the serum dilutions generally last at 1/320-1/640 titers in some laboratories in Turkey. In this report, a brucellosis case whose STA test was found negative until the titer of 1/1280, has been presented. A 36-year-old female was admitted to our hospital with the complaints of fever, sweating, fatigue, generalized arthralgia and weight loss, lasting for 45 days. Hepatosplenomegaly was detected in the physical examination, and laboratory tests yielded anemia, leucopenia, elevated erythrocyte sedimentation rate and high C-reactive protein levels. Although brucellosis was suspected, Brucella STA test was found negative at 1/640 titer. On the sixth day of admission, Brucella melitensis was isolated from her blood culture. Since a positive result at 1/40 titer was detected in Brucella STA test with the use of Coombs antiserum, the patient's serum was retested at higher dilutions than 1/640, and positive result was obtained starting from 1/1280 dilution and extended to 1/5120 titer. The patient was treated with rifampin and doxycyline and discharged with complete cure. In conclusion, in countries endemic for brucellosis, STA test should be performed at 1/1280 or higher titrations in suspected patients especially in the presence of negative culture results, for the prevention of false negative results due to prozone phenomenon.
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Pruebas de Aglutinación/normas , Brucella melitensis/aislamiento & purificación , Brucelosis/diagnóstico , Adulto , Pruebas de Aglutinación/métodos , Antibacterianos/uso terapéutico , Bacteriemia/microbiología , Brucella melitensis/inmunología , Brucelosis/tratamiento farmacológico , Doxiciclina/uso terapéutico , Reacciones Falso Negativas , Femenino , Humanos , Rifampin/uso terapéutico , Resultado del TratamientoRESUMEN
Cases of botulism in a family in eastern Anatolia were studied. In late September 2005, an outbreak of botulism developed in our region, first in 2 patients, a teenage boy and his mother, in whom the disease culminated in respiratory insufficiency and death. An additional 8 cases of botulism were identified later; most of them presented to our medical centre the next d. These patients with milder symptoms recovered gradually. All the patients received anti-botulinum toxin. The investigation of the source of the outbreak showed an unexpected vehicle for botulism infection in the these patients, süzme (condensed) yoghurt buried under soil. Type A botulinal toxin was detected in the yoghurt sample. The clinical diagnosis was also confirmed by a mouse bioassay performed with the serum samples of the patients. The most common symptoms were dry mouth, difficulty in speaking and swallowing, and change in voice quality. The 10 identified patients with botulism constitutes the largest-ever outbreak of botulism reported in Turkey to date. The present study shows the importance of considering a diagnosis of botulism soon after patients present with acute cranial nerve dysfunction and of promptly treating suspected cases with antitoxin.
Asunto(s)
Botulismo/epidemiología , Brotes de Enfermedades , Contaminación de Alimentos , Suelo , Yogur/microbiología , Adolescente , Adulto , Animales , Botulismo/microbiología , Niño , Familia , Femenino , Contaminación de Alimentos/estadística & datos numéricos , Humanos , Masculino , Ratones , Persona de Mediana Edad , Turquía/epidemiologíaRESUMEN
In the last few years, Crimean-Congo haemorrhagic fever (CCHF) has been reported as an emerging tickborne disease in Turkey. This paper deals with the preparation of an early warning system, aimed to predict the beginning of the CCHF season in Turkey based on a clear, simple and repeatable remotely-sensed signal. Decadal (mean of 10 days) values of the normalized difference vegetation index (NDVI) at 1 km resolution were used on a set of 952 confirmed, accurately geo-referenced, clinical cases between 2003 and 2006. A prerequisite is that the signal should be observable between 2 and 3 decadals before a given moment of the season to be of value as early warning. Decadals marking the 10th percentile or the 25th quartile in the frequency distribution of case reporting were selected as markers for the beginning of season of risk. Neither raw nor accumulated decadal NDVI signals were able to predict the onset of this season. However, when we defined the NDVI anomaly (NDVIa) as the positive difference between decadal NDVI values and the average for the previous year, this standardized measure gave a homogeneous overview of the changes in the NDVI signal producing a NDVIa slope for the decadals 10 to 13 that was always greater than 0. We conclude that observing this slope over time can be used as an early-warning system as it would predict the build-up of the number of cases 20 days in advance with an accuracy of 82% (10th percentile) or 98% (25th quartile).
Asunto(s)
Virus de la Fiebre Hemorrágica de Crimea-Congo , Fiebre Hemorrágica de Crimea/epidemiología , Estaciones del Año , Animales , Brotes de Enfermedades , Predicción , Humanos , Vigilancia de la Población/métodos , Nave Espacial , Enfermedades por Picaduras de Garrapatas , Turquía/epidemiologíaRESUMEN
This study compared the application of intramuscular recombinant hepatitis B vaccine in hemodialysis patients with the application of accelerated intradermal recombinant hepatitis B vaccine, which can be applied with one-tenth of the standard dose. Sixty seronegative patients for hepatitis B were randomly separated into two groups. Twenty mug of the recombinant hepatitis B vaccine was intramuscularly applied at 0-, 1-, 2-, and 6-month intervals to the first group (32 cases). One more dose was applied at month 12 to those whose anti-HBs titers remained below 100 mIU/mL at month 7. The same vaccine was intradermally applied at 2 microg dose six times with one-month intervals to the second group (28 cases). Vaccine applications were continued in those whose anti-HBs titers remained below 100 mIU/mL at month 7 until antibody titers reached above this value or until the dose number became 12. Measurements of antibody titers were repeated at month 13 in both groups. As a result, in the vaccination of hemodialysis patients against hepatitis B, the accelerated ID application of hepatitis B vaccine with a dose reduced to one-tenth is more cost-effective than the standard dose vaccination schedules. Especially for hemodialysis patients, the time has come for routine application of ID hepatitis B vaccine as an alternative vaccination method.