[Distribution of the Prevalence of Human Leukocyte Antigen (HLA)-B*57:01 Positivity in HIV-1 Infected Individuals and Its Effects on Treatment: Türkiye Map-Buhasder Working Group]. / HIV-1 Enfekte Bireylerde Insan Lökosit Antijeni (HLA)-B*57:01 Pozitifligi Prevalansinin Dagilimi ve Tedavi Üzerine Etkileri: Türkiye Haritasi-BUHASDER Çalisma Grubu.

Human immunodeficiency virus (HIV)/acquired immundeficiency syndrome (AIDS) is a critical global public health problem that significantly affects both life expectancy and the overall quality of life of individuals in all age groups. The landscape of HIV infection has changed significantly in recent years due to the introduction of effective combination antiretroviral therapies (ART). A key component of first-line ART regimens for HIV treatment is abacavir, a nucleoside HIV reverse transcriptase inhibitor. Although abacavir is effective in suppressing viral replication and managing disease, its clinical utility is overshadowed by the potential for life-threatening hypersensitivity reactions in HLA-B*57:01-positive patients. In our country, local data obtained from various centers regarding the prevalence of HLA-B*57:01 in HIV-1-infected patients are available. In this study, it was aimed to determine the prevalence of the HLA-B*57:01 genotype in HIV-infected patients who were followed up and treated in many regions of our country. This retrospective study consists of the data of the patients aged 18 years and over diagnosed with HIV-1 infection between 01.01.2019 and 31.07.2022. Age, gender, place of birth, mode of transmission of the disease, death status, CD4+ T cell count and HIV RNA levels at the first clinical presentation, HLA-B*57:01 positivity, and the method used, clinical stage of the disease, virological response time with the treatment they received were recorded from the patient files. Data were collected from 16 centers and each center used different methods to detect HLA-B*57:01. These methods were sequence-specific oligonucleotide probe hybridization (SSOP), DNA sequence-based typing (SBT), single-specific primer-polymerase chain reaction (SSP-PCR), allele-specific PCR (AS-PCR) and quantitative PCR (Q-PCR). A total of 608 HIV-infected individuals, 523 males (86%) and 85 females (14%), were included in the study. The mean age of the patients was 36.9 ± 11.9 (18-73) years. The prevalence of HLA-B*57:01 allele was found to be 3.6% (22 patients). The number of CD4+ T lymphocytes in HLA-B*57:01 allele-positive patients was > 500/ mm3 in 10 patients (45.5%), while the number of CD4+ T lymphocytes in HLA-B*57:01 negative patients was > 500/mm3 in 216 patients (36.9%) (p> 0.05). Viral load at the time of diagnosis was found to be lower in patients with positive HLA-B*57:01 allele but it was not statistically significant (p> 0.05). Although different treatment algorithms were used in the centers following the patients, it was observed that the duration of virological response was shorter in HLA-B*57:01 positive patients (p= 0.006). Although the presence of the HLA-B*57:01 allele has a negative impact due to its association with hypersensitivity, it is likely to continue to attract interest due to its association with slower progression of HIV infection and reduced risk of developing AIDS. In addition, although the answer to the question of whether it is cost-effective to screen patients for HLA-B*57:01 before starting an abacavir-containing ART regimen for the treatment of HIV infection is being sought, it seems that HIV treatment guidelines will continue to recommend screening to identify patients at risk in this regard.

Analysis of liver fibrosis equations as a potential role of predictive models in Crimean-Congo hemorrhagic fever.

Crimean-Congo Hemorrhagic Fever (CCHF) is a formidable global health concern, characterized by its rapid onset and high fatality rate. Distinguishing between patients at different stages remains challenging because of overlapping clinical features. This study aimed to evaluate the diagnostic efficacy of 14 hepatic fibrosis indices for distinguishing fatal cases and intensive care unit requirement (ICU) in CCHF. This study enrolled 194 patients with confirmed CCHF. Laboratory measurements were performed using auto analyzers. Indirect indicators of fibrosis were calculated for each patient based on previously described formulas. Time-dependent receiver operating characteristic (tdROC) curve analyses were employed to evaluate the predictive effects of hepatic fibrosis indices on both intensive care unit requirement and overall survival among patients. Regarding the tdROC analyses results, the highest area under the curve statistics were obtained for the baseline S-INDEX, KING, and GPRI scores (0.920, 0.913, and 0.909 respectively) in the estimation of ten-day survival, and the baseline KING, Goteborg University cirrhosis index (GUCI), and gamma-glutamyl transferase to platelet ratio index (GPRI) scores (0.783, 0.773, and 0.769 respectively) in the estimation of intensive care requirements for up to ten days. S-index and KING index emerged as early predictors of ten-day survival, while KING, GUCI, and GPRI indices demonstrated predictive capabilities for ICU admission on the first day. The identified indices have the potential to assist healthcare providers in making timely and informed decisions regarding patient management and treatment strategies. Further research and validation are warranted to solidify the role of these hepatic fibrosis indices in the clinical setting and enhance their broader applicability in the management of CCHF.

Molecular epidemiological investigation of carbapenem resistant Klebsiella pneumoniae isolated from intensive care unit patients of six geographical regions of Turkey.

INTRODUCTION: Klebsiella pneumonia causes serious infections in hospitalized patients. In recent years, carbapenem-resistant infections increased in the world. The molecular epidemiological investigation of carbapenem-resistant K. pneumoniae isolates was aimed in this study. METHODOLOGY: Fifty carbapenem-resistant K. pneumoniae isolates from six geographical regions of Turkey between September 2019-2020 were included in the study. The disk diffusion method was used for the antibiotic susceptibility testing. The microdilution confirmed colistin susceptibility. Genetic diversity was investigated by MLST (Multi-Locus Sequence Typing). RESULTS: The resistance rates were as follows: 49 (98%) for meropenem, 47 (94%) imipenem, 50 (100%) ertapenem, 30 (60%) colistin and amoxicillin-clavulanate, 49 (98%) ceftriaxone, 48 (96%) cefepime, 50 (100%) piperacillin-tazobactam, 47 (94%) ciprofloxacin, 40 (80%) amikacin, 37 (74%) gentamicin. An isolate resistant to colistin by disk diffusion was found as susceptible to microdilution. ST 2096 was the most common (n:16) sequence type by MLST. ST 101 (n:7), ST14 (n:6), ST 147 and ST 15 (n:4), ST391 (n:3), ST 377 and ST16 (n:2), ST22, ST 307, ST 985, ST 336, ST 345, and ST 3681 (n:1) were classified in other isolates. In Istanbul and Ankara ST2096 was common. Among Turkey isolates, the most common clonal complexes (CC) were CC14 (n:26) and CC11 (n = 7). CONCLUSIONS: In Turkey, a polyclonal population of CC14 throughout the country and inter-hospital spread were indicated. The use of molecular typing tools will highlight understanding the transmission dynamics.

Leukotriene metabolism and proiflammatory cytokines in Crimean Congo hemorrhagic fever.

Crimean-Congo hemorrhagic fever (CCHF) is an emerging acute viral infection disease, yet its pathophysiology remains largely uncharacterized. Lipid mediators are molecules that play numerous roles in the physiologic and pathophysiologic conditions in certain viral diseases. No previous study evaluated the status of cysteinyl leukotrienes (CYSLT) and 5-lipoxygenase (5-LO) and their relationship with proinflammatory cytokines in CCHF. A total of 90 subjects including 60 CCHF patients and 30 healthy controls were enrolled the study. Serum CYSLT, 5-LO, interleukin-6 (IL-6), and ferritin levels were determined in the study population. Lower median 5-LO level was determined in patients compared to healthy controls (p = 0.0004). Higher ferritin (p < 0.001) and IL-6 (p < 0.001) levels in patients than healthy controls. No statistically significant difference was observed between patients and controls in terms of CYSLT levels. No statistically significant differences were observed between mild, moderate, and severe groups in terms of both 5-LO and CYSLT levels. IL-6 and ferritin levels were higher in severe group compared mild and moderate groups. In conclusion, changes in 5-LO enzyme and increased inflammation are related with the disease molecular mechanism. Higher inflammatory status contributes to the impaired hemostatic balance in CCHF. Thus, treatment strategies to reduce inflammation may help to prevent bleeding and DIC in patients. IL-6 and ferritin can be used to as an additional biomarker in the estmation of the prognosis and diagnosis of the patients.

DYSREGULATED LEUKOTRIENE METABOLISM IN COVID-19 PATIENTS.

The aim of this study was to examine leukotriene metabolism in COVID-19. A total of 180 people were included in the study. Of these, 60 were healthy controls, 60 were patients who needed intensive care unit (ICU), and 60 were patients who did not need intensive care (non-ICU). Serum levels of 5-lipoxygenase (5-LO), 5-LO activating protein (ALOX5AP) and cysteinyl leukotriene (CYSLT) were measured and mRNA expressions of 5-LO, ALOX5AP and cysteinyl leukotriene receptor 1 (CYSLTR1) were investigated. As compared to the control group, both non-ICU and ICU groups had lower levels of 5-LO and mRNA expression. ICU patients had lower levels of 5-LO and mRNA expression compared with non-ICU patients. The expression of CYSLTR1 mRNA was higher in patients compared to healthy controls. CYSLTR1 mRNA expression was found to be higher in ICU group than in non-ICU group. CYSLT levels were higher in the control group compared to both non-ICU and ICU patients. Due to the higher expressions of CYSLTR1 in patients than control group, selective leukotriene receptor blockers can be used as a treatment option. CYSLTR1 expressions were also higher in ICU group than non-ICU group. Thus, CYSLTR1 mRNA expression could be a promising biomarker of COVID-19 severity.

[A Case of Oropharyngeal Tularemia Mimicking Lymphoma During Pregnancy]. / Gebelikte Lenfomayi Taklit Eden Bir Orofarengeal Tularemi Olgusu.

Tularemia is a zoonotic bacterial infectious disease caused by a gram-negative coccobacillus namely Francisella tularensis. In humans, disease leads to several different clinical forms (ulceroglandular, glandular, oculoglandular, respiratory, typhoidal and oropharyngeal). Since the main mode of transmission of the disease to humans in Türkiye is by drinking water contaminated with F.tularensis, the oropharyngeal form is the most common clinical manifestation. Since tularemia cases with pregnancy are rare, the literatüre about maternal and fetal complications of tularemia is sparse. In this report, a case of oropharyngeal tularemia mimicking lymphoma during pregnancy was presented. A 33-year-old 11-week pregnant patient living in a village in Sivas province admitted to the infectious diseases and clinical microbiology outpatient clinic with the complaint of swelling in the neck region that continued for six days. The patient, who was engaged in animal husbandry stated that she consumed raw milk and admitted to the otorhinolaryngology outpatient clinic of a hospital 10 days ago with the complaints of fever, chills, and sore throat. She stated that her complaints did not regress with the amoxicillin-clavulanate treatment recommended by her doctor and she noticed the swelling in her neck on the 4th day of the treatment. Upon further questioning, it was understood that the patient had a history of consumption of unchlorinated spring water. Her vital signs were normal and physical examination revealed non-fluctuant lymph nodes with the largest of 5 x 2 cm in the right posterior cervical region, and 3 x 2 cm in the left. Laboratory tests revealed a blood leukocyte count of 13.32 x 103/mm3 (75% granulocytes), a blood hemoglobin of 11.4 g/dL, an erythrocyte sedimentation rate of 45 mm/hour, and C-reactive protein of 90 mg/L. A non-contrast MRI examination revealed wall thickening of the nasopharynx and enlarged lymph nodes which were suspicious for lymphoma with significant diffusion restriction on diffusionweighted images. As the past medical history and clinical findings were suggestive for tularemia, the microagglutination test (MAT) was studied, but it was reported as negative with a titer at 1/80. Since the patient's complaints continued and tularemia cases were encountered in our region in the past years, the repeated MAT after two weeks was reported as positive with a titer at 1/320. An oropharyngeal form of tularemia was diagnosed and oral ciprofloxacin (2 x 750 mg) was given for three weeks by starting at the 14th gestational week. Lymphoma was excluded by histopathological examination of the fine needle aspiration biopsy performed on the patient's cervical lymph nodes, but the biopsy sample was compatible with granulomatous diseases. Histopathological findings of diagnostic biopsies of the larynx and nasopharynx were reactive. A healthy male baby, 2425 grams, 47 cm, was delivered by cesarean section from the patient who presented with labor contractions at the 37th week of pregnancy. There was no sign of congenital infection in the newborn. The patient and the baby were followed up to the end of one year and no abnormality was found. The evaluation of 17 cases reported in the literatüre including this case, suggest that tularemia may progress to involve serious obstetric complications during pregnancy, such as abortion, premature birth and intrauterine fetal death when appropriate and effective antibiotic treatment is not given.

Which scoring system is effective in predicting mortality in patients with Crimean Congo hemorrhagic fever? A validation study.

We aimed to decide which scoring system is the best for the evaluation of the course of Crimean-Congo Hemorrhagic Fever (CCHF) by comparing scoring systems such as qSOFA (quick Sequential Organ Failure Assessment), SOFA (Sequential Organ Failure Assessment), APACHE II (Acute Physiology and Chronic Health Evaluation II) and SGS (Severity Grading System) in centers where patients with CCHF were monitored. The study was conducted with patients diagnosed with CCHF in five different centers where the disease was encountered most commonly. Patients having proven PCR and/or IgM positivity for CCHF were included in the study. The scores of the scoring systems on admission, at the 72nd hour and at the 120th hour were calculated and evaluated. The data of 388 patients were obtained from five centers and evaluated. SGS, SOFA and APACHE II were the best scoring systems in predicting mortality on admission. All scoring systems were significant in predicting mortality at the 72nd and 120th hours. On admission, there was a correlation between the qSOFA, SOFA and APACHE II scores and the SGS scores in the group of survivors. All scoring systems had a positive correlation in the same direction. The correlation coefficients were strong for qSOFA and SOFA, but poor for APACHE II. A one-unit rise in SGS increased the probability of death by 12.818 times. qSOFA did not provide significant results in predicting mortality on admission. SGS, SOFA and APACHE II performed best at admission and at the 72nd and 120th hours.

[COVID-19 Co-infection in a patient with Crimean Congo Hemorrhagic Fever: A Case Report]. / Kirim Kongo Kanamali Atesi Hastasinda COVID-19 Ko-enfeksiyonu: Bir Olgu Sunumu.

Crimean-Congo Hemorrhagic Fever (CCHF) is an acute viral zoonotic disease. Coronavirus disease-2019 (COVID-19) is a newly emerging viral disease and it is caused by "severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)". In this article, a case diagnosed with CCHF and COVID-19 coinfection confirmed by the polymerase chain reaction (PCR) method and its management was presented. A thirtyfive years old female patient admitted to the hospital with the complaint of fever for one day and common body pain. It was learned that three days before the onset of her complaints, she removed a tick adhering to the anterior abdominal wall with no precaution. Her body temperature was 38°C degrees and her respiratory rate was 22 per minute. The leucocyte count was 3660/mm³ and the platelet count was 138.000/mm³. It was determined that prothrombin time was 15.4 seconds, international normalized ratio (INR) was 1.35 seconds, and D-dimer level was 1310 ng/ml. The patient was hospitalized with prediagnosis of CCHF. Supportive treatment was started. On the second day at the clinical follow-up of the patient, complaints of sore throat and cough without sputum started. A combined nasopharyngeal and throat swab sample was taken from the patient because of the suspicion of COVID-19. COVID-19 PCR test result was reported as positive. Favipiravir treatment was started. The CCHF-PCR test, which was studied from the serum sample sent to the Microbiology Reference Laboratories was reported as positive. From the third day of favipiravir treatment; the patient did not have a fever and her complaints regressed. On the ninth day of her hospitalization, she was discharged. In this case; it is important to show that both diseases, especially in regions where CCHF disease is endemic, can be confused due to the similarity of the clinical picture with COVID-19 and to know that they can coexist.

[Klebsiella pneumoniae Infections in the Intensive Care Unit: Risk Factors Related to Carbapenem Resistance and Patient Mortality]. / Yogun Bakim Ünitesinde Gelisen Klebsiella pneumoniae Enfeksiyonlari: Karbapenem Direnci ve Hasta Mortalitesi ile Ilgili Risk Faktörleri.

Klebsiella pneumoniae is the cause of complicated and difficult-to-treat nosocomial infections such as sepsis, urinary tract infection, catheter related infections, pneumonia and surgical site infections in intensive care units. The biggest problem in infections with K.pneumoniae is that treatment options are limited due to multiple antibiotic resistance and consequently the increased morbidity and mortality. The widespread and improper use of carbapenems can lead to epidemics that are difficult to control, especially in intensive care units because of the acquired resistance to this group of antibiotics. Outbreaks and sporadic cases caused by carbapenem resistant K.pneumoniae (CRKP) species have been reported all over the world in recent years with increased frequency. The aim of this study was to determine the risk factors related to carbepenem resistance and mortality caused by K.pneumoniae infections in a university hospital anesthesia intensive care unit. The study was conducted between January 1st, 2016, and December 31st, 2018. Retrospective data were obtained from the patient and laboratory-based surveillance records. Adult patients (≥ 18 years) with K.pneumoniae growth in the blood, urine, abscess and tracheal aspirate samples collected 48 hours after admission to the intensive care unit were considered as the relevant infection locus-related agent and treated with antibacterial therapy. Clinical samples collected from patients were inoculated onto 5% sheep blood and eosin-methylene-blue (EMB) agar except the blood samples. Blood samples were cultured in blood culture bottles and incubated in an automated system. Gram staining was performed for the samples showing growth signal within five days and then inoculated onto 5% sheep blood and EMB agar media and were incubated for 18-24 hours at 35.5-37°C. Identification of the isolates was performed using Bruker IVD MALDI Biotyper 2.3 (Bruker Daltonik GmbH, Bremen, Almanya) based on "matrix-assisted laser desorption/ionization time-of-mass spectrometry (MALDI-TOF MS)". K.pneumoniae isolates were identified by obtaining reliability scores of 2.0 and above in the study. Antibiotic susceptibility tests were performed with Phoenix 100 (BD, New Jersey, ABD) automated system. Interpretations were made according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. Combination disk diffusion test and polymerase chain reaction based tests were used to show the presence of carbapenemase in CRKP isolates. A total of 88 patients with K.pneumoniae infection were included in the study. The mean age of the patients was 74 ± 15 (range= 21-93) years and 60.2% were female. CRKP was detected in 32 patients (36.4%) and carbapenem-sensitive K.pneumoniae (CSKP) was detected in 56 patients. The presence of OXA-48 was found to be 68.8% in the carbapenem screening test performed by combination disc method in patients with CRKP. Multivariate logistic regression analysis showed that previous use of colistin [Odds ratio (OR)= 19.108; 95% confidence interval (CI)= 2.027-180.133; p= 0.010] and aminoglycoside (OR= 12.189; 95% CI= 1.256-118.334; p= 0.031) was an independent risk factor in terms of CRCP among the patients with K.pneumoniae infection. The 28-day mortality rates were 71.9% in the CRKP group (23/32) and 37.5% in the CSKP group (21/56). Presence of CRKP in terms of 28-day mortality (OR= 5.146; 95% CI= 1.839-14.398; p= 0.002) was an independent risk factor. The data obtained in this study will guide for conducting effective and continuous surveillance studies and implementing rational antibiotic programs to prevent the increase in CRKP.

Comparison of the Predictive Performances of qSOFA, APACHE II, and SGS for Evaluation of the Disease Prognosis of CCHF Patients at the Emergency Department.

In this study, we compared the predictive performances of quick sequential organ failure assessment (qSOFA), the acute physiology and chronic health evaluation (APACHE II) scores, and the severity grading score (SGS) for evaluation of the disease prognosis of patients with Crimean-Congo hemorrhagic fever (CCHF) at the emergency department. We recorded the qSOFA, SGS, and APACHE II scores at admission and at the 72nd and 120th hour in 97 patients admitted to the emergency department and diagnosed with CCHF. In our study, the area under a receiver operating characteristic curve values of qSOFA, SGS, and APACHE II at admission were found to be 0.640, 0.824, and 0.576, respectively. No statistical significance was found for a qSOFA score ≥ 2 at admission as a predictor of mortality. The use of qSOFA score for diseases with a mortal prognosis such as CCHF is insufficient in predicting the prognosis.

Association of MCP-1 promotor polymorphism with disease severity of Crimean-Congo hemorrhagic fever.

Crimean-Congo hemorrhagic fever (CCHF) is a thick-borne viral zoonotic disease. The pathogenesis and the reasons why cases have a mild or severe course in CCHF have not yet been explained. In this study, we investigated the relationship between promoter -2518 A/G single-nucleotide polymorphism (SNP) of the MCP-1 gene and the clinical course of CCHF. The MCP-1-2518 A/G SNP (rs1024611) frequency was examined in 128 virologically/serologically confirmed CCHF patients and 181 healthy controls by using the PCR-RFLP method. When CCHF patients and controls were compared, no significant difference was found between genotype distributions and allele frequencies of the -2518 A/G SNP of MCP-1 gene (P > .05). Compared to the AA genotype, both AG (P = .016; OR = 2.57) and GG genotype (P = .039; OR = 3.43) were found with significantly higher frequencies in mild/moderate cases than in severe cases. Compared to the AG + GG genotype, AA showed a significant risk for severe CCHF (60.0% vs 38.4%, P = .02; OR = 2.41). In contrast, the AG genotype showed a significant protective effect against severe disease compared to AA + GG genotype (29.1% vs 47.9%, P = .013; OR = 2.58). Compared to mild/moderate cases, the A allele was found to be significantly higher in severe cases (0.745 vs 0.623, P = .039; OR = 1.77). However, no significant relationship was found between fatal and nonfatal cases in terms of genotype or allele frequencies (P > .05). In conclusion, both -2518 AA genotype and A allele of MCP-1 were associated with disease severity, and the AG genotype had a protective effect against a severe disease course in CCHF patients.

[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.

Current status of HIV/AIDS-syphilis co-infections: a retrospective multicentre study.

OBJECTIVE: Treponema pallidum and HIV are transmitted frequently through sexual contact, these agents with epidemiological similarities co-infect the same host. The current number of HIV-infected cases in Turkey is increasing. For this reason, we aimed to reveal the characteristics of syphilis in HIV/AIDS cases. METHODS: A retrospective longitudinal cohort study was performed, patients were followed up at 24 clinics in 16 cities from all seven regions of Turkey between January 2010 to April 2018. We examined the socio-demographic characteristics, laboratory parameters and neurosyphilis association in HIV/AIDS-syphilis co-infected cases. RESULTS: Among 3,641 patients with HIV-1 infection, 291 (8%) patients were diagnosed with syphilis co-infection. Most patients were older than 25 years (92%), 96% were males, 74% were working, 23% unemployed, and 3% were students. The three highest prevalence of syphilis were in Black Sea (10.3%), Mediterranean (8.4%) and Marmara Regions (7.4%). As for sexual orientation, 46% were heterosexuals, 42% men who have sex with men (MSM), and no data available for 12%. Patients with the number of CD4+ ≤ 350 mm3 reached 46%, 17% of the patients received antiretroviral therapy and neurosyphilis association reached 9%. CONCLUSION: Although HIV/AIDS-syphilis co-infection status appeared high in heterosexuals, MSM had a moderate level increase in cases. Our results suggested syphilis co-infection in HIV/AIDS cases should be integral part of monitoring in a national sexual transmitted diseases surveillance system. However, our data may provide base for HIV/syphilis prevention and treatment efforts in the future.

An evaluation of the different biomarkers to discriminate bleeding in Crimean-Congo Hemorrhagic Fever.

Crimean-Congo Hemorrhagic Fever (CCHF) is an acute viral hemorrhagic disease. In this study, an evaluation was made of the potential use of iron metabolism and liver function biomarkers to estimate the bleeding status in CCHF patients. This prospective study was conducted in Cumhuriyet University, Turkey. Only patients with confirmed CCHF were enrolled in the study. The study subjects comprised 40 CCHF patients and 37 healthy control subjects. Serum iron, unsaturated iron binding capacity (UIBC), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels were determined using the colorimetric method. Serum ferritin levels were measured using the electrochemiluminescent method. The serum ferritin (p = 0.037), AST (p = 0.0002), ALT (p = 0.002), LDH (p = 0.0005) and aPTT (p = 0.001) values were higher in patients with bleeding than in patients without bleeding. Receiving operating characteristic analyses were applied for the area under the curve (AUC) values for ferritin, aPTT, and AST to discriminate the bleeding status in patients, an these were determined as 0.717, 0.819, and 0.882, respectively. A cut-off value of 149 U/L for AST was obtained to discriminate the bleeding condition in CCHF patients. Higher ferritin (p < 0.0001) levels were determined in patients compared to the control group. The iron (p = 0.180) and UIBC (p = 0.0017) values were lower in patients than in the control group. Cytokine storm due to an increase in ferritin levels may contribute to the increased inflammation and coagulation abnormalities in CCHF patients. It was concluded that routine screening of the AST level would be helpful to estimate the bleeding status in addition to screening liver damage in CCHF patients.

An investigation of the effectiveness against bacteriuria of silver-coated catheters in short-term urinary catheter applications: A randomized controlled study.

AIM: The aim of this study was to investigate the effectiveness of antimicrobial-coated catheters against bacteriuria and urinary tract infection in patients who have urinary catheterization. METHODS: Twenty eight and twenty six people similar in terms of demographic characteristics and primary and underlying diseases were randomly selected from patients undergoing short-time urinary catheterization in the intensive care unit. Silver-coated slicone foley catheters and normal slicone foley catheters were used for uninary catheterization in the first and second group of the patients respectively. Urine specimens were collected from patients at 2-day intervals and assessed in terms of bacteriuria. RESULTS: Bacteriuria was found in 12 (46.2%) of the patients using normal catheters and 13 (46.4%) of those using silver-coated catheters throughout the monitoring period. No significant relationship was determined between use of different catheter types and bacteriuria (p = 0.98). The most common microorganism was identified as E. coli in the normal catheter group while microorganism other than E. coli was identified in the silver-coated catheter group. The prevalence of bacteriuria was statistically significantly higher in patients with a history of hospitalization in the previous 3 months (p = 0.028). CONCLUSION: The use of silver-coated silicone catheters was not shown to have a protective effect against bacteriuria in this study. Further well-designed studies with larger case numbers are now needed to confirm whether history of hospitalization, which emerged as a statistically significant factor in this study, increases the prevalence of catheter-related bacteriuria.

Apoptosis and its relation with clinical course in patients with Crimean-Congo hemorrhagic fever.

Crimean-Congo hemorrhagic fever (CCHF) is a tick-mediated viral infection. Patients with CCHF may show various clinical presentations. The cause of this difference in the clinical course is not completely understood. Apoptosis is programmed cell death and plays an important role in regulating the immune system. Our knowledge of the role of apoptosis in CCHF disease is limited. We investigated the role of apoptosis and their relationship with the severity of the disease in CCHF. Thus, in 30 patients with CCHF and 30 healthy individuals, we analyzed the serum levels of cytochrome C, apoptotic protease activating factor-1 (Apaf 1), caspase 3, caspase 8, caspase 9, sFas, sFasL, perforin, granzyme B, and CK18 by enzyme-linked immunosorbent assay. This is the first study that research the serum levels of the mentioned apoptosis markers in adult patients with CCHF. We found that the serum levels of sFasL, cytochrome C, Apaf 1, caspase 3, caspase 8, caspase 9, perforin, granzyme B, and M30 were statistically significantly different in the acute phase of the disease compared with healthy individuals and patients in convalescent period. There was no association between the clinical severity of the disease and apoptosis markers. In conclusion, the results of our study suggested that the extrinsic and intrinsic apoptosis pathway play an important role in CCHF.

The protective effect and diagnostic performance of NOX-5 in Crimean-Congo haemorrhagic fever patients.

INTRODUCTION: Crimean-Congo haemorrhagic fever (CCHF) is an acute viral haemorrhagic disease. Reactive oxygen species that are mainly generated by the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX) enzyme family have a pivotal role in the pathophysiology of many diseases. The serum levels of NOX isoforms in patients with CCHF have yet to be assessed. METHODS: This prospective study was conducted at Cumhuriyet University, Turkey. Only patients with CCHF confirmed by the National Reference Virology Laboratory were enrolled in the study. The study subjects comprised 67 CCHF patients and 70 healthy control subjects. The quantitative sandwich ELISA technique was used for the determination of serum NOX 1, 2, 4 and 5. RESULTS: Higher median median NOX-1 (P=0.001) and NOX-5 (P<0.001) levels were found in patients compared to the control group. Higher median serum NOX-5 levels were found in the low-grade disease group compared to the intermediate-high disease group according to two different severity scores (P=0.003). Negative correlations were also found between the serum NOX-5 levels and the severity scores [(P<0.05, r=-0.259), (P<0.01, r=-0.417)]. The area under the curve (AUC) values for the NOX-1 and NOX-5 were 0.67 (confidence interval: 0.58-0.75) and 0.99 (confidence interval: 0.95-1.00), respectively. Lower NOX-5 levels were found in patients receiving thrombocyte suspension (P=0.004)Conclusions. NOX-5 may have a protective effect on CCHF patients and the measurement of serum NOX-5 levels may be used as a novel biochemical test in the diagnosis of CCHF.

Evaluation of the associations between endothelial dysfunction, inflammation and coagulation in Crimean-Congo hemorrhagic fever patients.

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne zoonotic viral disease. The aim of this study was to evaluate the association between inflammation, coagulation and endothelial dysfunction in CCHF. The study population consisted of 40 patients and 50 healthy controls. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), endocan, high sensitive C-reactive protein (hsCRP), international normalized ratio (INR), prothrombin time (PT), activated partial thromboplastin time (aPTT) and platelets values were determined in blood samples. Median hsCRP (p < 0.0001), ALT (p < 0.001), AST (p < 0.001) and aPTT (p < 0.001) values were found to be higher in CCHF patients than in the healthy control subjects. In contrast, median endocan (p = 0.0006) and platelet (p < 0.001) concentrations were found to be lower in CCHF patients than in healthy controls. Serum hsCRP concentrations positively correlated with PT, aPTT and INR in CCHF patients, whereas serum endocan levels were not correlated with hsCRP, PT, aPTT and INR. In conclusion, endothelial dysfunction is one of the key steps in CCHF disease development and serum endocan may be used as a biomarker to evaluate endothelial dysfunction in patients. There is no relationship between increased inflammation and endothelial dysfunction. Coagulation abnormalities might be related to the impaired hepatic synthetic function of coagulation factors. Increased hsCRP concentrations may have a compensatory role in restoring impaired hemostasis in CCHF. Further research is needed to confirm these findings and to examine possible explanations.

Increased Irisin Concentrations in Patients with Crimean- Congo Hemorrhagic Fever.

Crimean-Congo Hemorrhagic Fever (CCHF) is a life-threatening viral infection. The pathogenesis of the disease is not well understood. The aim of this study was to determine the change in irisin concentrations in patients with CCHF. The study included a total of 30 patients with CCHF and 30 control participants. Irisin concentrations were determined using a commercial ELISA kit. Median irisin concentrations were 9.03 (5.81-12.22) µg/mL and 4.2 (3.39-7.62) µg/mL, respectively, in each group. There was no correlation between irisin and disease severity. Any correlations between irisin, and lactate dehydrogenase (LDH), international normalization ratio (INR), Alanine aminotransferase (ALT), aspartate aminotransferase (AST), platelets, activated partial thromboplastin time (aPTT), D-dimer and hemoglobin, were also investigated. There were statistically significant positive correlations between the values of irisin, and platelet (p = 0.005, r: 0.369), ALT (p = 0.049, r: 0.261), INR (p = 0.006, r: 0.359) and aPTT values (p = 0.002, r: 0.405). A negative correlation was also found between the values of irisin and LDH (p = 0.008, r: －0.348). No correlations were determined between the values of irisin, and AST, hemoglobin and D-dimer. These results suggest that irisin may have a role in CCHF.

Secondary infections after cytotoxic chemotherapy in patient with hematological malignancies.

INTRODUCTION: This study was initiated to investigate the risk factors of secondary infections in febrile neutropenic patients following chemotherapy, and to evaluate the clinical, microbiological, and mortality outcomes of these infections. METHODOLOGY: An evaluation was done on all patients with hematological malignancy who developed a febrile neutropenic episode (FNE) after cytotoxic chemotherapy in the Department of Hematology, Akdeniz University Faculty of Medicine, between January 2007 and December 2008. RESULTS: A total of 294 primary FNEs that responded to the initial empirical or targeted treatment were included in the study, and secondary infections developed after 72 (24.5%) of 294 primary FNEs. Risk factors for secondary infections were determined as acute leukemia as the underlying disease, salvage chemotherapy for refractory/relapse diseases, prolonged neutropenia (10 days and over), Multinational Association of Supportive Care in Cancer (MASSC) score < 21, and fungal infection during the primary episode. The mortality rate of patients who developed secondary infections was significantly higher compared to patients without secondary infections (27.8% and 5.4%, respectively; p = 0.001). CONCLUSIONS: The development of secondary infections in patients with hematological malignancy was not very rare. Greater concern should be shown for these infections to increase patient survival rates.