Role of TGF-ß1 and PDGF-B in Crimean-Congo hemorrhagic fever in Eastern Anatolia Region in Turkey.

BACKGROUND & OBJECTIVES: In this study, we aimed to investigate the relationship between serum TGF-ß1 and PDGF-B levels with the pathogenesis, clinical course and prognosis of adult Crimean-Congo hemorrhagic fever (CCHF) patients. METHODS: 50 adult patients and 30 healthy individuals as a control group were included in the study, who were followed up and treated with the diagnosis of CCHF at the Atatürk University Faculty of Medicine Infectious Diseases and Clinical Microbiology Clinic, between March 2017 and September 2019 in Eastern Anatolia Region in Turkey. Blood samples were taken from patients on the first day of their hospitalization and on the sixth day of their complaints. TGF-ß1 and serum PDGF-B levels were studied by ELISA method using commercial kits, from serum samples taken from CCHF patient group and individuals in healthy control group and stored at -80°C. RESULTS: While the serum TGF- ß1 levels of patients with CCHF were found to be significantly higher on the sixth day of their complaints compared to the first day of hospitalization (42.33 ± 15.42, 28.40 ± 7.06, p = 0.001, respectively), the serum PGDF-B levels were found to be significantly lower on the sixth day of their complaints compared to those measured on the day of hospitalization (62.14 ± 19.75, 93.96 ± 20.02, respectively, p = 0.001). INTERPRETATION & CONCLUSION: Serum TGF-ß1 levels are higher and PDGF-B levels are lower in CCHF patients with severe disease, indicating that serum TGF-ß1 and PDGF-B play an important role in the pathogenesis of CCHF.

The Effects of Laboratory Parameters on the Prognosis of COVID-19.

OBJECTIVE: While the coronavirus disease 2019 pandemic is an ongoing issue across the world, understanding the course of the disease is important for early diagnosis and treatment. We aimed, with this study, to determine the differences between laboratory parameters in different clinical pictures of coronavirus disease 2019. MATERIALS AND METHODS: The study included 443 patients who presented to Atatürk University Medical Faculty Hospital between March 15, 2020, and June 15, 2020, and were diagnosed with coronavirus disease 2019 upon a positive Real Time Polymerase Chain Reaction (RT-PCR) result. The hospitalized patients were divided into 4 groups based on their clinical status. The roles of these markers in determining the severity of coronavirus disease 2019 were statistically evaluated. RESULTS: A total of 443 patients with RT-PCR confirmation were included in the study. The mean age was 46.0 ± 19.1 years and 54.4% of the patients were male. According to the clinical classification, 16.3% of the cases were asymptomatic, 25.7% uncomplicated, 35.7% mild/moderate, and 22.3% severe. The first 3 most frequent symptoms were cough (21.3%), fever (17.7%), and fatigue (15.5%). Hypertension (36.1%) was the major comorbidity among the patients. During the follow-up of severe cases, 39.4% developed the need for intensive care. The overall mortality rate, on the other hand, was 4.7%. Regarding laboratory parameters, procalcitonin (PCT), serum ferritin, erythrocyte sedimentation rate, C-reactive protein, neutrophil count, D-dimer, troponin, and lactate dehydrogenase were at the highest level in the severe patient group while albumin, platelet, and lymphocyte count were found to be at the lowest level in the same group. A statistically significant difference was detected between the groups (P < .001). CONCLUSION: The increase in C-reactive protein, PCT, erythrocyte sedimentation rate, ferritin, troponin, D-dimer, lactate dehydrogenase, and neutrophil count and the decrease in albumin, platelet, and lymphocyte count are significant in the severe patient group; it has been concluded that they can be used to determine the severity of coronavirus disease 2019.

Comparison of the Efficacy of Systemic Versus Local Steroid Treatment in Idiopathic Granulomatous Mastitis: A Cohort Study.

INTRODUCTION: Steroid therapy is known to be effective against granulomatous mastitis. We aimed to compare the efficacy of local versus systemic steroid administration in patients with idiopathic granulomatous mastitis. MATERIALS AND METHODS: This prospective cohort study included 58 patients who had either local (n = 42) or systemic (n = 16) treatment due to granulomatous mastitis between 2015 and 2019. Recurrence rates were determined as per ultrasound and magnetic resonance imaging examinations and the rate of side effects was evaluated as per patient complaints and physical examinations at the end of a 2-year follow-up period. RESULTS: Median doses of 140 mg and 3810 mg were administered to the local and systemic group, respectively. Six (14.3%) patients in the local treatment group and 13 (81.3%) in the systemic treatment group had steroid-related side effects. The local treatment group had significantly fewer side effects than the systemic treatment group (P < 0.001). The recurrence rates were similar in both groups (P > 0.05). CONCLUSIONS: Local steroid injection was as effective as systemic steroid therapy. Compared to systemic therapy, local steroid administration can be considered as a new therapeutic protocol with a lower dose and side effect rate.

[Evaluation of epidemiologic and clinical features of oropharyngeal tularemia patients in the Eastern Anatolia Region of Turkey]. / Dogu Anadolu Bölgesi'nden hastanemize basvuran orofarengeal tularemi olgularinin epidemiyolojik ve klinik özelliklerinin degerlendirilmesi.

Tularemia is a zoonotic infectious disease caused by Francisella tularensis. Tularemia is endemic in the northern hemisphere and is usually seen in North America, Europe and Asia. Although the ulceroglandular tularemia is the most common form in these regions, the oropharyngeal form is more prevalent in Eastern Europe, including Turkey. The disease has importance in Turkey due to its wide geographic distribution and periodic outbreaks. The aim of this study was to determine the demographic, clinical and epidemiological characteristics of oropharyngeal tularemia patients. The demographic, clinical, epidemiological and laboratory findings of 26 tularemia patients admitted to our hospital from Erzurum and 5 neighbour provinces were analyzed retrospectively. Francisella tularensis microagglutination test (MAT) was performed for all patients whose clinical symptoms were consistent with tularemia and MAT titers ≥ 1/160 were considered positive. Twenty-six oropharyngeal tularemia patients (13 males and 13 females) were included in the study. All of the patients had cervical lymphadenopathy (LAP) at least one month period. Twenty (76.9%) of the patients included in the study were living in rural areas, and 17 (65.4%) were dealing with livestock. It was determined that 9 (34.6%) of the patients used water from municipal water supply, 9 (34.6%) of the patients used water from natural water supply and 8 (30.8%) of the patients used both of the water supplies. The most common symptoms among the patients in the study were fever in 23 (88.5%) patients, sore throat in 24 (92.3%) patients, and cervical LAP in all of the patients. Thirteen (50%) of the patients were treated with streptomycin, 7 (26.9%) with doxycycline and 6 (23.1%) with gentamicin. This is the first study showing that tularemia is present in Erzincan, Agri, Igdir as well as Erzurum provinces, and it provides that the incidence has increased in this region. Tularemia diagnosis is generally underestimated due to the lack of specific symptoms. Therefore, tularemia should also be considered in patients who have complaints of sore throat and cervical LAP in non-endemic regions.

Is Serum Angiotensin-Converting Enzyme Level Useful For Determining Necroinflammatory Activity In Chronic Hepatitis B Infection?

AIM: The purpose of this study was to investigate the relationship between the findings from liver biopsy and the serum angiotensin-converting enzyme (ACE) level to determine whether ACE might serve as a potential noninvasive sign of necroinflammatory activity in patients with Chronic Hepatitis B (CHB) infection. METHODS: A total of 54 CHB patients referred for liver biopsy were enrolled in the study. Serum ACE levels were determined photometrically with a kinetic test. RESULTS: The aspartate aminotransferase (AST), alanine aminotransferase (ALT), hepatitis B virus-deoxyribonucleic acid (HBV-DNA), histological activity index (HAI), and white blood cell counts were higher in patients with severe fibrosis, while albumin levels were low. The serum ACE levels showed a statistically significant correlation with HBV-DNA, HAI score, and ALT-AST levels. DISCUSSION: In this study, a statistically significant relation between serum ACE levels and HAI scores was observed. This represents the first analysis to compare necroinflammation of the liver and serum ACE levels. There may be some explanations that the suppression of hepatocyte growth factor (HGF) by Angiotensin II and increased inflammatory damage might be a reason for the correlation between HAI and ACE. Serum ACE levels, HBV-DNA levels, and serum transaminase levels might be used together as noninvasive markers for the prediction of necroinflammation in CHB patients.

Liver transplantation for alveolar echinococcosis in an endemic region.

Alveolar echinococcosis (AE) is a chronic disease caused by ingestion of the eggs of the parasitic cestode Echinococcosis multilocularis (EM). In severe cases, liver transplantation (LT) may represent the only possibility of survival and cure. Patients undergoing LT associated with hepatic AE at our institution between April 2011 and October 2014 were investigated retrospectively. The clinical findings of the 27 patients who participated in the study were noted. Kaplan-Meier and chi-square tests were used to investigate the effect of these characteristics on survival and mortality. Living donor LT was performed on 20 patients (74.1%), and deceased donor LT was performed on 7 patients (25.9%). Hilar invasion was the most common indication (14 patients, 51.9%) for transplantation. The patient follow-up was 16.1 ± 11.4 months, and the overall survival rate was 77.8%. Primary nonfunction developed only in 2 patients in the posttransplantation period. Six patients died during monitoring, the most common cause of death being sepsis (3 patients). The relationship between the mortality rate of the patients and the invasion of the bile duct and/or portal vein by alveolar lesions was found to be statistically significant (P = 0.024 and P = 0.043, respectively). According to PNM staging, when the AE disease exceeds the resectability limits, the only alternative for the treatment of the disease is LT. However, different from LT due to cirrhosis, it is extremely difficult to perform a transplantation for AE disease because of the invasive characteristics of it. In order to decrease the difficulty of the operation and the postoperative mortality, the intracystic abscess and cholangitis which occur because of AE must be treated via medical and percutaneous methods before transplantation.

Comparison of coagulase-negative staphylococci isolated from blood cultures as a true bacteremia agent and contaminant in terms of slime production and methicillin resistance.

OBJECTIVE: The aim of this study is to determine the species distribution, slime activity, and methicillin resistance of coagulase-negative staphylococci (CoNS) isolated from blood cultures as either contaminants or true bacteremia agents. MATERIALS AND METHODS: In this study, 13.268 blood culture samples sent to our laboratory from various clinics during a two-year period were examined in terms of the presence of CoNS to clarify whether the isolates are true bacteremia agents, as defined by Centers for Disease Control and Prevention (CDC) criteria. The slime activities of true bacteremia agents (58 CoNS strains) and contaminants (50 randomly selected CoNS strains) were investigated by the Christensen method. The methicillin susceptibilities of the strains were determined by the disk diffusion method. RESULTS: Although the frequency of slime production was 39.7% among the true bacteremia CoNS agents, it was 18% in CoNS that were judged to be contaminants (p<0.05). S. epidermidis was the most frequently isolated species for both the true bacteremia agent group (56.9%) and contaminant group (74%). Additionally, S. epidermidis was the bacterium most frequently characterized as slime producing in both groups. The methicillin resistance of slime-producing CoNS was determined to be 82.6% for the true bacteremia agent group and 77.8% for the contaminant group. CONCLUSION: The presence of slime activity in CoNS isolated from blood culture samples is supportive evidence that they are most likely the agents of true bacteremia cases.

Co-existence of tuberculous meningitis and pulmonary tuberculosis in a denim sandblaster.

Silicosis is a well-known occupational lung disease that was discovered by the ancient Greeks and Romans. In 2001, it has emerged again in an unexpected occupation: denim sandblasting. Exposure to crystalline silica, with or without clinical disease, is one of the most important predisposing factors for the development of tuberculosis; however, there has been no previous report of tuberculosis among cases of silicosis due to denim sandblasting. Herein, we report the first case of a denim sandblaster with silicosis who developed both pulmonary tuberculosis and tuberculous meningitis.

[Tularemia seroprevalence in the risky population living in both rural and urban areas of Erzurum]. / Erzurum Merkez ve Kirsalinda Yasayan Riskli Gruplarda Tularemi Seroprevalansi

Tularemia which is a zoonotic infection, caused by Francisella tularensis, has become a re-emerging disease in Turkey. Infection is often transmitted to human by handling animal tissues and products, but it is also possible to acquire the disease from contaminated water or food. Recently several cases and epidemics of tularemia have been reported in the northwest areas of Turkey, particularly in Marmara and West Black Sea regions. Erzurum is a city in Eastern Anatolia Region, Turkey and animal husbandry is the main agricultural activity in that area. However, neither tularemia cases were reported from this province nor seroprevalence studies were performed. In this study we aimed to determine F.tularensis antibody seropositivity in the risky population living at both rural and urban area of Erzurum. Blood samples from 240 volunteer subjects (134 male with mean age: 36.2, age range: 17-75 years and 106 female with mean age: 39.1, age range: 16-77 years) whose occupations were farming and animal husbandry, were included in the study. Serum samples were screened for the presence of F.tularensis antibodies by slide agglutination method (BD, USA) and Serazym ELISA kit (anti-F.tularensis IgG/IgA/IgM, Seramun, Germany). The positive samples with those tests were also retested by microagglutination test (MAT) in National Tularemia Reference Laboratory of Refik Saydam Hygiene Center, using antigen prepared in the same laboratory from the local strain. The serum samples were also searched for the presence of Brucella and Salmonella antibodies in terms of cross-reactivity. Seropositivity was detected in 71 (29.6%) out of 240 subjects by slide agglutination test (SAT), whereas only 5 (2.1%) gave positive result for total antibody by ELISA. Twenty-five of the 71 SAT positive samples yielded F.tularensis antibodies by MAT, of which 21 were between 1/20-1/40 and four were between 1/80-1/160 titers. However, all of the MAT positive samples (n= 25) were found reactive in Brucella and/or Salmonella antibody tests. One of the four MAT positive samples with 1/40 titer and all of the four MAT positive samples with ≥ 1/80 titer yielded positive results in ELISA. Since MAT gave very high cross reactive results, the five subjects (2.1%) found positive with ELISA were evaluated as seropositive for tularemia. Of those subjects (four were female, one was male; age range: 27-38 years), four were the inhabitants of the same village, and one from another neighboring village. All of the seropositive subjects were dealing with raising livestock and two were also farming. No history of contact with rat and wild animals or tick bite were detected, however it was noted that non-chlorinated fountain water has been used in both of these villages. In conclusion, our data emphasized that, populations inhabiting especially in rural area and dealing with farming and stock raising in our region are at risk for tularemia.

Prognostic significance of antithrombin activity in patients with crimean-congo hemorrhagic Fever.

OBJECTIVE: Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral hemorrhagic fever. Disseminated intravascular coagulation (DIC) is an important complication of this disease, especially in severe and fatal cases. Antithrombin (AT) acts as an anticoagulant by inactivating thrombin, Factor IX, Factor X and Factor XI. We conducted this study to investigate the AT levels and their prognostic value in CCHF. MATERIALS AND METHODS: Twenty-eight confirmed CCHF patients were included in this study. Diagnosis of the disease was made by CCHF IgM and/or PCR positivity. Patients were grouped based on the severity criteria described previously. The patients with platelet counts <20 000×10(6) cell/L, white blood counts >10×10(9) cell/L, prothrombin times >60 seconds, aspartate aminotransferase levels >700 IU/L or alanine aminotransferase levels >900 IU/L were accepted as severe cases. Patients whose illnesses were self-limited and who did not require blood component replacement were accepted as mild cases, and patients who improved but required blood component replacement were accepted as moderate cases. Blood samples were obtained on the day that the patient had the lowest platelet count and before any thrombocyte replacement. The antithrombin activity was measured using a chromogenic substrate test (Diagnostica Stago STA Compact) at a research laboratory. RESULTS: Twenty-two (78.6%) of the cases were mild, 3 (10.7%) were moderate, and 3 were (10.7%) severe. The mean AT value was 101% for mild cases, 116.6 % for moderate cases, and 88% for severe cases (p>0.05). Although there were no statistically significant differences between the AT values, the mean AT activity was lower in severe CCHF cases. CONCLUSION: The AT activity may have been decreased in severe CCHF cases. Further studies with greater numbers of patients are required to determine the level of AT activity and its correlation with disease severity and the prognosis of CCHF.

Cardiac echinococcosis: recurrent intramyocardial-extracardiac hydatid cysts with pericardial protrusion.

A 26-year-old male patient was diagnosed with an isolated recurrent intramyocardial-extracardiac hydatid cyst with pericardial protrusion after being admitted with chest pain and palpitation. He had undergone surgical resection of an intramyocardial pericardial hydatid cyst without cardiopulmonary bypass 10 years earlier. In the current admission, the results from transthoracic and transesophageal echocardiography and multislice computed tomography were confirmed by serological and histopathological tests. The cyst was excised under cardiopulmonary bypass, and the patient was treated postoperatively with albendazole for 9 months. His clinical status improved postoperatively and he was asymptomatic without signs of recurrence as determined by echocardiography.

The diagnostic value of bronchoscopy in smear negative cases with pulmonary tuberculosis.

There are many studies showing usefulness of bronchoscopy in patients with suspected pulmonary tuberculosis (Tbc) and negative sputum smear. However, there is no enough data concerning that in which cases bronchoscopy is more useful. We aimed to investigate in which cases bronchoscopy is more diagnostic and also an in which cases presence of endobronchial involvement is more likely. A total of 60 smear negative patients undergoing bronchoscopy due to tuberculosis suspicion were evaluated. The characteristics of cases with or without positive diagnosis via bronchoscopy and also of the ones with or without endobronchial involvement were compared. Bronchoscopy provided positive result for Tbc in 29 (76%) of 38 cases with confirmed as Tbc later and 7 (18%) cases had endobronchial involvement. In the cases who are diagnosed as Tbc via bronchoscopy, the mean serum levels of C-reactive protein (CRP) were significantly higher than those of undiagnosed (p< 0.05). In the cases with endobronchial involvement, the duration of symptoms was significantly shorter (p= 0.01); the diameter of tuberculin skin test induration was significantly smaller (p< 0.05); and mean serum level of CRP was significantly higher (p< 0.05) than those of without endobronchial lesion. The results suggest that it is more likely to diagnose Tbc bronchoscopically in the cases who had increased serum levels of CRP, and possibility of endobronchial involvement may be increased among the cases in active and earlier period of the disease. However, further studies are required to support this hypothesis.

Clinical and social characteristics of the patients with tuberculosis in Eastern Anatolia.

Tuberculosis (TB) is an important public-health problem. The risk factors for TB are well-known. However, there may be some regional differences. In this study, we aimed to investigate the demographic characteristics and regional risk factors for TB and to discuss possible explanations for the difference. The study included totally 253 hospitalized patients (145 male and 108 female, with an average age 38+/-18) with TB (117 pulmonary and 136 extrapulmonary) between 1997 and 2004. Their demographic and clinical characteristics were reviewed. TB frequency was higher among the non-working females in urban area (38.3%). TB was also common in farmers which are male (19.8%). TB frequency was higher in the school persons including students, the teachers and the school officials (14.6%) and in the building workers compared with the other workers. There were a history of previous TB, TB exposure (mostly from family members) and associated disease in 10.3%, 14.2% and 17.4% of cases, respectively. The most encountered associated disease was diabetes. The results indicate that TB was most common among non-working females and was also increased among the men in rural areas, and schools seem to be an important source of TB transmission. Thus, an effective control program covering the treatment of cases with active disease, such as directly observed treatment, and especially preventive measures should be considered to control the disease transmission in our region.

Changes in antibiotic use, cost and consumption after an antibiotic restriction policy applied by infectious disease specialists.

The study was designed to compare antibiotic use, cost and consumption before and after an initiation of an antibiotic-restriction policy in our hospital. The policy was applied in 2003, and the prescription of two groups of antibiotics (intravenously used and expensive antibiotics) was restricted. A prescription for the restricted antibiotics could be obtained with approval by an infectious disease specialist (IDS). All the hospitalized patients who received antibiotics were evaluated by a cross-sectional study with standard criteria. The annual cost and consumption of antibiotics were evaluated. After restriction, the rate of antibiotic use decreased from 52.7 to 36.7% (P < 0.001), and the appropriate use increased from 55.5 to 66.4% (P < 0.05). Appropriate use was higher for restricted antibiotics (88.4%) than for unrestricted ones (58.2%) (P < 0.001), and higher in the presence of ID consultation (97.5%) than in the absence of consultation (55.7%) (P < 0.001). Culture-based treatment was increased, and appropriate use in such cases (93.0%) was higher than empirical treatment (33.3%) (P < 0.001). After the restriction policy, consumption of antibiotics belonging to the restricted groups was decreased by 44.8%. Total expenditure of all antibiotics was decreased by 18.5%, and the savings were US$332,000 per year. This restriction policy was effective in promoting rational antibiotic prescription and lowering antibiotic cost and consumption in our hospital.

Serum IL-18 levels in tuberculosis: comparison with pneumonia, lung cancer and healthy controls.

OBJECTIVE: The aim of the present study was to document the serum IL-18 levels in patients with pulmonary tuberculosis (P-TB), extrapulmonary tuberculosis (EP-TB), pneumonia, lung cancer and in healthy controls, and to investigate whether it may assist in the differential diagnosis of P-TB. METHODOLOGY: A total of 116 patients were included in the study. The study population consisted of patients with P-TB, EP-TB, pneumonia and lung cancer and controls. P-TB patients were graded according to sputum positivity and extent of disease. Serum levels of IL-18 (ELISA) were compared between groups and with other clinical measures of disease. RESULTS: Compared with the controls, all groups of patients had increased serum levels of IL-18. The highest mean concentration of IL-18 was observed in P-TB. Serum levels of IL-18 in the patients with P-TB correlated well with the extent of disease. CONCLUSIONS: Although increased serum levels of IL-18 were not specific for TB, the increased levels may favour active TB in radiologically advanced disease where CXR findings are difficult to interpret, and sputum smears or cultures are not helpful.