Effect of IL-6, IL-8/CXCL8, IP-10/CXCL 10 levels on the severity in COVID 19 infection.

BACKGROUND: COVID 19 was first observed in December 2019 and has affected the world entire. Effective laboratory markers and prognostic indicators are needed to predict the clinical progression of the disease. AIMS: The purpose of this study was to investigate IL6, IL8/CXCL8, and IP10/CXCL10, and biochemical parameters associated with SARS, MERS, and SARS-CoV-2 infections and their significance on prognosis in healthy volunteers and mild-moderate and severe COVID 19 patients. METHODS: Healthy volunteers (n = 30), and patients with mild-moderate (n = 30) and severe (n = 30) COVID-19 patients were included in the study. IL-6, IL-8, and IP-10 levels and biochemical parameters were assessed among the groups and their correlations with each other were subjected to statistical analysis. RESULTS: Blood serum IL-6, IL-8, and IP-10 levels were the highest in the severe patient group (P = .001), and also higher in the mild-moderate group as compared with the healthy volunteers (P = .001). Statistically significant positive correlations were identified between serum IL-8 and IL-6 levels (P = .001, r = 0.660), between serum IP-10 and IL-6 (P = .001, r = 0.599) and between serum IP-10 and IL-8 (P = .001, r = 0.729). CONCLUSIONS: A statistically significant difference was found in WBC, NE%, NE, LY%, LY, HB, BUN, total protein, albumin, d-dimer, sedimentation differed significantly between the groups. Biomarkers of potential significance in terms of the severity of COVID 19 disease were examined, and high IL-6, IL-8, IP-10, CRP, PCT, and LY parameters values emerged as associated with the severity of the disease.

The relationship with clinical course and prognosis of serum endothelin-1, angiopoietin-2, and tie-2 levels in Crimean-Congo hemorrhagic fever

Background/aim: Crimean-Congo hemorrhagic fever (CCHF) is a serious illness characterized by fever and hemorrhage. Endothelin-1 (ET-1), angiopoietin-2 (Ang-2), and endothelial cell-specific receptor tyrosine kinase (Tie-2) are believed to be important markers of the pathogenesis, clinical course, and prognosis of the disease. The aim of this study was to determine ET-1, Ang-2, and Tie-2 levels in adults with CCHF and investigate the associations between these markers and pathogenesis and disease course. Materials and methods: Sixty CCHF patients were included in the study. The patients were classified according to disease severity criteria and Ang-2, Tie-2, and ET-1 levels were compared. Results: Mean serum ET-1 level was 36.62 ± 27.99 pg/mL in the patient group and 3.70 ± 4.71 pg/mL in the control group (P = 0.001). Mean serum Ang-2 levels were 2511.18 ± 1018.64 pg/mL in the patient group and 3570.76 ± 209.52 pg/mL in the control group (P = 0.001). Mean serum Tie-2 levels were 7.35 ± 7.75 ng/mL in the patient group and 0.67 ± 1.26 ng/mL in the control group (P = 0.001). Conclusion: Elevated ET-1 and Tie-2 levels were associated with more severe disease course, while Ang-2 level was negatively correlated with severity in adult CCHF patients. ET-1, Tie-2, and Ang-2 levels are important prognostic parameters in CCHF and may contribute significantly to treatment and follow-up.

[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.

Cerebral and Spinal Tuberculous Leptomeningitis: Advanced Magnetic Resonance Imaging Findings.

At diagnosis of the cerebral and spinal tuberculous meningitis magnetic resonance (MR) imaging is the primary imaging technique. Magnetic resonance images reveal cerebrospinal fluid collection and obliteration of the spinal subarachnoid space. The contrast-enhanced MR imaging shows nodular and thick intradural enhancement. Herein, the authors reported advanced MR imaging findings of the cerebral and spinal tuberculous leptomeningitis.

Serum fibronectin levels in acute and chronic viral hepatitis patients.

BACKGROUND: The aim of this study was to investigate the serum fibronectin (FN) levels and liver enzyme activities in patients with acute hepatitis (A, B, C) and chronic viral hepatitis (B, C); determine whether the virus types correlated with disease severity; and assess whether FN could be used as a marker of virus type or disease severity in patients. METHODS: A total of 60 subjects were enrolled in the study, including 20 patients with acute hepatitis (A, B, C), 20 with chronic hepatitis (B, C), and 20 healthy controls. Serum fibronectin (FN), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), and albumin were measured in all patients from blood samples. RESULTS: Serum FN levels were significantly lower in acute (122.9 µg/mL (SD 43.1), P < 0.001) and chronic hepatitis patients (135.7 µg/mL (SD 46.0), P < 0 .001) compared to controls 221.4 µg/mL (SD 32.5). A negative correlation was found between serum FN and AST (r(2) = 0.528, P < 0.001), ALT (r(2) = 0.425, P < 0.001), and GGT (r(2) = 0.339, P < 0.001). Additionally, high serum GGT levels (ß = -0.375, P = 0.010), and low serum albumin levels (ß = -0.305, P = 0.008) were associated with low serum FN levels. CONCLUSION: Serum FN levels were lower in both acute and chronic hepatitis patients, and an inverse relationship between serum FN and serum AST, ALT, and GGT levels was found. A decrease in serum FN levels may indicate hepatitis severity as AST and ALT represent hepatocyte damage.

COVID-19: Gastrointestinal manifestations, liver injury and recommendations.

Coronavirus disease 2019 (COVID-19) has caused a pandemic that affected all countries with nearly 270 million patients and 5 million deaths, as of as of December, 2021. The severe acute respiratory syndrome coronavirus 2 virus targets the receptor, angiotensin-converting enzyme 2, which is frequently found in human intestinal epithelial cells, bile duct epithelial cells, and liver cells, and all gastrointestinal system organs are affected by COVID-19 infection. The aim of this study is to review the gastrointestinal manifestations and liver damage of COVID-19 infection and investigate the severe COVID-19 infection risk in patients that have chronic gastrointestinal disease, along with current treatment guidelines. A literature search was conducted on electronic databases of PubMed, Scopus, and Cochran Library, consisting of COVID-19, liver injury, gastrointestinal system findings, and treatment. Liver and intestinal involvements are the most common manifestations. Diarrhea, anorexia, nausea/vomiting, abdominal pain are the most frequent symptoms seen in intestinal involvement. Mild hepatitis occurs with elevated levels of transaminases. Gastrointestinal involvement is associated with long hospital stay, severity of the disease, and intensive care unit necessity. Treatments and follow-up of patients with inflammatory bowel diseases, cirrhosis, hepatocellular carcinoma, or liver transplant have been negatively affected during the pandemic. Patients with cirrhosis, hepatocellular carcinoma, auto-immune diseases, or liver transplantation may have a greater risk for severe COVID-19. Diagnostic or therapeutic procedures should be restricted with specific conditions. Telemedicine should be used in non-urgent periodic patient follow up. COVID-19 treatment should not be delayed in patients at the risk group. COVID-19 vaccination should be prioritized in this group.

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.

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.

Seroprevalence of hepatitis B, hepatitis C, and HIV in pregnant women from Eastern Turkey.

BACKGROUND/AIMS: The vertical transmission of hepatitis B virus, hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections are essential public health problems. In this study, we aimed to investigate the seroprevalence of the aforementioned infections among pregnant women. MATERIALS AND METHODS: This study was done retrospectively on pregnant women who presented for antenatal follow-up and delivery between 2013 and 2016. Data were collected from the hospital's electronic health records and patient files. Blood samples were analyzed at the microbiology laboratory of the hospital. HBsAg, anti-HBs, anti-HCV, and anti-HIV titers were tested using the chemiluminescence enzyme immunoassay method (Architect, Abbott Laboratories, USA). RESULTS: HBsAg and anti-HBs levels were tested in 35,295 pregnant women aged 18-45 years. The HBsAg and anti-HBs levels were positive in 425 (1.2%) and 9583 (27.7%) patients, respectively. From 2013 to 2016, the HBV carrier rates have continuously decreased from 1.4% to 0.8%, whereas the anti-HBs positivity has increased from 25.4% to 30.2%. Anti-HCV was detected in 6 of the 9709 (0.06%) patients. All the 7113 pregnant women screened for HIV showed negative results. CONCLUSION: Hepatitis B carrier rates among pregnant women gradually decreased with a simultaneous increase in the immunity rates. HCV seroprevalence was low and HIV positivity was not encountered in the study population.

Retrospective Evaluation of Anti-Toxoplasma gondii Antibody Among First Trimester Pregnant Women Admitted to Nenehatun Maternity Hospital between 2013-2017 in Erzurum.

OBJECTIVE: We aimed to investigate the Toxoplasma gondii seropositivity in pregnant women who referred to Erzurum Nenehatun Hospital for antenatal care, and to compare our data with other regions of Turkey. METHODS: In this retrospective study we evaluated Anti-Toxoplasma gondii IgM and anti-Toxoplasma gondii IgG screening results of pregnant women who admitted to our hospital between January 2013 and December 2016 for antenatal care. The data was obtained from hospital's digital data system and patient folders. Blood samples were investigated in microbiology laboratory with Macro-ELISA (Architect System, Abbott Diagnostics, Germany) method. Anti-Toxoplasma IgM positive cases were also evaluated with anti-Toxoplasma IgG avidity test. The results were evaluated as case numbers and percentages. RESULTS: In 151 (0.6%) of the 25525 pregnant women, who were aged between 18 and 45, Anti-Toxoplasma gondii IgM positivity was detected. In 5119 (31%) of the 16433 pregnant women, Anti-Toxoplasma gondii IgG positivity was detected. CONCLUSION: Our data was similar to the rest of the country. We suppose that every pregnant women should be educated about the disease and the transmission routes to raise an awareness and while the ones in the risk group should be screened instead of the whole group.

Global Alert: Zika Virus-an Emerging Arbovirus.

Zika virus (ZIKV) is an arbovirus of the Flavivirus genus, and it has an envelope and a single RNA molecule. In early 2016, the World Health Organization declared ZIKV infection to be an emerging global health threat. The major transmission route of the virus to humans is Aedes mosquitoes. ZIKV can be transmitted between humans by transplacental, perinatal, and sexual routes and via blood and body fluids. ZIKV infection usually results in a mild and self-limiting disease with low-grade fever, conjunctivitis, and periorbital edema. Neurological complications such as Guillain-Barré syndrome, meningoencephalitis, acute disseminated encephalomyelitis, acute myelitis, and transverse myelitis have been reported during ZIKV infection. Intrauterine and congenital ZIKV infections have strong teratogenic effects on the fetus. Intrauterine or congenital ZIKV infection can lead to microcephaly, ocular anomalies (such as macular atrophy, pigment mottling, and optic nerve anomalies), and cardiac anomalies (such as atrial or ventricular septal defect). Calcification in the brain between the cortical and subcortical areas, ventriculomegaly, cerebellar hypoplasia, corpus callosum hypoplasia, cortical/subcortical atrophy, delayed myelination, enlarged cisterna magna, and craniofacial disproportion have been reported as brain development defects. ZIKV infection usually results in a mild disease, and it does not require specific therapy. However, complications of infection during the early period of life are serious. Thus, many drugs have been investigated, and vaccine development studies have been conducted to prevent ZIKV infection. Vector control and personal protection from mosquito-borne transmission are important for decreasing the prevalence of ZIKV infection. In particular, pregnant residents or travelers to endemic areas should be carefully protected against mosquito-borne transmission.

Cutaneous Anthrax on Eyelid in a Pregnant Woman.

A 32-year-old patient who was 17 weeks of pregnant referred to our hospital due to a lesion on the eyelid and swelling on her face. Patient's history revealed that she helped her husband for slaughtering of a sick animal and contacted with the meat. A scabby lesion was detected on the inferior eyelid with hyperaemia around, central necrotic appearance and swelling. The diagnosis of anthrax was performed based on her epidemiological data, physical examination findings, and Bacillus anthracis were seen on direct preparation. This case was considered worthy to present since she was pregnant, the disease was located on the inferior eyelid, which is a rare place for location, and caused no complication or sequel either in mother or in baby.

Multi-center prospective evaluation of discharge criteria for hospitalized patients with Crimean-Congo Hemorrhagic Fever.

INTRODUCTION: The information of discharge criteria in patients with Crimean-Congo Hemorrhagic Fever (CCHF) is limited. In this study, we aimed to determine the clinical and laboratory parameters used in discharging the patients by the experienced centers. MATERIALS AND METHODS: The study was done in 9 reference centers of CCHF from May 1, 2015 to December 1, 2015 and included laboratory-confirmed patients with CCHF. The study was prospective, observational and non-interventional. RESULTS: The study included 260 patients. Mean age was 51.3 ± 16.3 years; 158 (60.8%) were male. Mean hospital stay was 7 ± 2.6 days. The decision of discharging was taken considering clinical and laboratory findings. On discharge, no patients had fever or hemorrhage. The patients were followed-up clinically and a repeat CCHF PCR was not studied. All centers considered the following criteria for discharge: no fever and hemorrhage, improvement in clinical findings and laboratory studies. For all patients except one, platelet count was >50,000/mm(3) and had a tendency to increase. Prothrombin time and international normalized ratio (INR) were normal in 258 (99.6%) and 254 (98.1%) patients respectively. Alanine aminotransferase (ALT) was either normal or not higher than 10-fold and had a tendency to decrease in 259 (99.6%) patients. ALT and aspartate aminotransferase (AST) levels were not taken as discharge criteria with priority. During 30 days following the discharge, complication, relapse, or secondary transmission were not reported. CONCLUSIONS: The discharging practice of the centers based on clinical and laboratory parameters seems safe considering no complications, relapses, or secondary infection thereafter. Current discharge practice of the centers composed of no fever and hemorrhage, improvement in clinical findings, platelet count of either >100,000/mm(3) or >50,000/mm(3) with a tendency to increase, and normal bleeding tests can be used as the criteria of discharge.

Prevalence of metallo-beta-lactamase among Pseudomonas aeruginosa and Acinetobacter baumannii isolated from burn wounds and in vitro activities of antibiotic combinations against these isolates.

The prevalence of metallo-beta-lactamases (MBLs) produced by isolates of Pseudomonas aeruginosa and Acinetobacter baumannii and the activities of various antmicrobial combinations against MBL producer strains were investigated. During the period from June 2003 till July 2004, 120 P. aeruginosa and 9 A. baumannii nonduplicate isolates were obtained from burn wounds. Forty strains (37 P. aeruginosa, 3 A. baumannii) were selected because of resistance to carbapenems. Screening for MBL production was performed in the latter isolates by the combined disk method which depends on comparing the zones given by disks containing imipenem with and without ethylenediaminetetraacetic acid (EDTA). Of imipenem resistant P. aeruginosa strains, 21 and 1 of A. baumannii were found metallo-beta-lactamase producers. Disk approximation studies were then performed to test for in vitro activities of various antimicrobial combinations. For a total of 21 P. aeruginosa strains, synergy was demonstrated predominantly by ciprofloxacin in combination with ceftazidime and imipenem, by ofloxacin in combination with astreonam. Against MBL producer A. baumannii strain, synergy was detected only with imipenem-ofloxacin combination. None of the combinations were antagonistic. These results suggest that MBL producing P. aeruginosa and A. baumanni strains have been introduced into burn centers, and to prevent the further spread of MBL producers, it is essential for carbapenem resistant isolates to be screened for MBLs.

The risk factors for acquisition of imipenem-resistant Pseudomonas aeruginosa in the burn unit.

OBJECTIVE: This study was conducted to determine the risk factors for acquisition of imipenem-resistant Pseudomonas aeruginosa (IRPA) in the burn unit. METHODS: Patients hospitalized in the burn unit from July 2003 to November 2004 were included in this study. The features of patients with isolated IRPA were compared with those of patients with isolated imipenem-susceptible P. aeruginosa (ISPA). Demographic features, total burn surface area (TBSA), burn depth, antimicrobials used in 15-day period before isolation, and presence of IRPA in the unit at the same period were included in the risk factors analysis. RESULTS: P. aeruginosa was recovered from 133 patients in this period, 93 were IRPA and 40 were ISPA. There was no significant difference between patients with ISPA and patients with IRPA in terms of age, TBSA, and burn depth. In multivariate logistic regression analysis, hospital stay before isolation (odds ratio (OR): 3.6), carbapenem usage (OR: 7.4), broad-spectra antibiotic usage (OR: 6.5), previous presence of ISPA in the patient (OR: 1.7) and presence of IRPA in the unit at the same period (OR: 2.6) were independent risk factors for acquisition of IRPA. CONCLUSION: Long hospitalization time, previous imipenem/meropenem use, previous broad-spectra antibiotic use, previous presence of ISPA in a patient and presence of IRPA in a unit at the same period were associated with acquisition of IRPA in the burn unit. In order to decrease the incidence of IRPA isolation, the usage of broad-spectra antibiotics, especially carbapenem, should be restricted, hospitalization time should be shortened if possible, and universal isolation precautions should be strictly applied to prevention cross-contamination.

Genotoxic effect of ribavirin in patients with Crimean-Congo hemorrhagic fever.

In this study, we investigated the in vivo genotoxicity of ribavirin in humans, studying 3 patients with Crimean-Congo hemorrhagic fever who were treated with high-dose ribavirin. In order to evaluate genotoxicity, both the micronucleus (MN) test and the sister chromatid exchange (SCE) test were used. In all patients, blood samples were taken during and after therapy. Whole blood cultures were performed for 72 h and the MN assay and SCE test were then carried out to demonstrate the genotoxicity. In all patients, both SCE and MN amounts were found to be higher in the samples which were taken during therapy than in those at 1 month after therapy. The results of our study reveal that ribavirin has a reversible in vivo genotoxic effect on humans.

Nosocomial methicillin-resistant Staphylococcus aureus endocarditis with splenic abscess in a pregnant woman.

A 36-year-old, 7-week-gravida patient with catheter-related nosocomial infective endocarditis due to methicillin-resistant Staphylococcus aureus (MRSA) is presented in this paper. The patient was admitted to our hospital because of carbon monoxide intoxication. After 14 days, MRSA catheter-related bacteremia developed. The central venous catheter was immediately removed, and teicoplanin therapy was started. Because of persistent fever, leukocytosis, and high C-reactive protein values, endocarditis was suspected. A transesophageal echocardiogram revealed 19-mm vegetation on her mitral valve, confirming the diagnosis of endocarditis. Gentamicin and rifampicin were added to the therapy regimen, and the dose of teicoplanin was increased to 12 mg/kg-day. After 8 days, a splenic abscess was detected by ultrasonography. Vegetation excision, mitral valve replacement by open-heart surgery and splenectomy were performed in the same operation. Antibiotherapy was continued for 6 weeks after surgery, and the patient's condition improved. The development of endocarditis could be prevented by proper clinical practices.

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.

[A transfusion-transmitted malaria case]. / Transfüzyonla bulasan bir sitma olgusu.

Malaria is a rare but potentially serious complication of blood transfusion. In this report a transfusion-transmitted malaria case has been presented. A 47-years-old woman admitted to our clinic with the complaints of striking fever with chills, diarrhea and vomiting. She had history of an operation and transfusion before 10 days of admission. On physical examination jaundice, splenomegaly and abdominal tenderness were detected. Laboratory results revealed anemia, and elevated LDH and bilirubin levels. Examination of thin blood films yielded Plasmodium vivax trophozoites. Chloroquine was initiated for therapy and the patient was successfully treated. On the other hand, informations about her blood donor indicated that he had been in the military service in Southeast Anatolia of Turkey where malaria is endemic. All the efforts to reach the donor, for his diagnosis and treatment, were failed. Since our region (Northeast Anatolia) is not an endemic area for malaria and the patient had no travel history to an endemic area, it has been considered that the transmission route of malaria in this case was blood transfusion. In conclusion, as there are no available approved tests for malaria screening of donations, the transfusion-transmitted malaria can only be prevented by careful questioning of the donors.