[Investigation of the Relationship Between the Immune Responses due to COVID-19 Vaccine and Peripheral Bloodlymphocyte Subtypes of Healthcare Workers]. / Saglik Çalisanlarinda COVID-19 Asisina Bagli Bagisik Yanit ile Hemogram Parametreleri ve Periferik Kandaki Lenfosit Alt Tipleri Arasindaki Iliskinin Arastirilmasi.

Worldwide vaccination is the best strategy to limit the Coronavirus disease-2019 (COVID-19) pandemic. The aim of this study was to investigate the antibody levels and hemogram parameters and the prediction of T-helper, T-cytotoxic and B lymphocyte subtypes in the peripheral blood for the development of these antibodies in the selected group of healthcare workers who were vaccinated with CoronaVac® (Sinovac, China). In a previous study with the same researchers, blood samples were taken from healthcare workers one month after the second vaccination, and anti-RBD anti-severe acute respiratory syndrome coronavirus-2 (anti-SARS-CoV-2) IgG antibodies were measured by enzyme linked immunosorbent assay (ELISA) method. Test results were classified as binding antibody <25.6 BAU/mL unresponsive, 25.6-35.1 BAU/mL weak response, <35.2 BAU/mL strong response, according to the assay manufacturer's recommendations. According to these criteria, it was determined that 22 (8.3%) people had no response, 25 (9.5%) people had a moderate response, and 217 (82.2%) people had a strong response. According to these results, 30 people from each group were invited. The results of three individuals were excluded from the evaluation due to chronic illness. A total of 87 health workers were included in the study. Twenty-two of these people had no response, 25 had a moderate response, and 40 had a good response. Flow cytometry was used to examine the peripheral blood lymphocyte percentage distribution. Statistical analyzes were performed with SPSS 26 software. The conformity of the variables to the normal distribution was examined using analytical methods (Kolmogorov-Smirnov/ Shapiro-Wilk tests). Pearson's Chi-square test was used to compare categorical variables. The correlation between the antibody level and the measurement results of hemogram parameters and lymphocyte indicators was evaluated by Pearson's correlation analysis. The model was established by performing linear regression analysis with the variables correlated with the antibody level. Cases with a p value below 0.05 were considered statistically significant. The age range of the participants in the study was 22-69. The mean age was 45.5 ± 10.4 years. Antibodies against SARS-CoV-2 virus were detected by ELISA method in 65 (74.7%) of the healthcare professionals, while no antibodies were detected in 22 (25.3%) of them. Lymphocyte count (p= 0.002), CD3 count (p= 0.0004), CD4 count (p= 0.0001), CD3/CD19 ratio (p= 0.011), CD4 percentage (p= 0.004) in the antibody positive group was found to be significant. According to the level of correlation between antibody level and lymphocyte indicators, a statistically significant negative correlation was found in CD3, CD4, CD8 and CD19 positive lymphocytes, respectively, and the best correlation was observed in CD3 positive lymphocytes. The formula f (Antibody level)= y= 358002 -0.176 x CD3 + 0.469 x CD19 was created using the linear regression model. In the light of the data of this study, the central role of T and B cells in COVID-19 immunization emerges. The vaccine-related antibody level-related formula may be useful for healthcare professionals in patient follow-up. It is thought that conducting vaccine related immune response studies involving larger populations will contribute more to the literature.

Quality of life and related factors among chronic hepatitis B-infected patients: a multi-center study, Turkey.

BACKGROUND: The aim of this study was to assess health-related quality of life (HRQOL) among chronic hepatitis B (CHB) patients in Turkey and to study related factors. METHODS: This multicenter study was carried out between January 01 and April 15, 2015 in Turkey in 57 centers. Adults were enrolled and studied in three groups. Group 1: Inactive HBsAg carriers, Group 2: CHB patients receiving antiviral therapy, Group 3: CHB patients who were neither receiving antiviral therapy nor were inactive HBsAg carriers. Study data was collected by face-to-face interviews using a standardized questionnaire, Short Form-36 (SF-36) and Hepatitis B Quality of Life (HBQOL). Values equivalent to p < 0.05 in analyses were accepted as statistically significant. RESULTS: Four thousand two hundred fifty-seven patients with CHB were included in the study. Two thousand five hundred fifty-nine (60.1 %) of the patients were males. Groups 1, 2 and 3, consisted of 1529 (35.9 %), 1721 (40.4 %) and 1007 (23.7 %) patients, respectively. The highest value of HRQOL was found in inactive HBsAg carriers. We found that total HBQOL score increased when antiviral treatment was used. However, HRQOL of CHB patients varied according to their socio-demographic properties. Regarding total HBQOL score, a higher significant level of HRQOL was determined in inactive HBV patients when matched controls with the associated factors were provided. CONCLUSIONS: The HRQOL score of CHB patients was higher than expected and it can be worsen when the disease becomes active. Use of an antiviral therapy can contribute to increasing HRQOL of patients.

Results of a multinational study suggest the need for rapid diagnosis and early antiviral treatment at the onset of herpetic meningoencephalitis.

Data in the literature regarding the factors that predict unfavorable outcomes in adult herpetic meningoencephalitis (HME) cases are scarce. We conducted a multicenter study in order to provide insights into the predictors of HME outcomes, with special emphasis on the use and timing of antiviral treatment. Samples from 501 patients with molecular confirmation from cerebrospinal fluid were included from 35 referral centers in 10 countries. Four hundred thirty-eight patients were found to be eligible for the analysis. Overall, 232 (52.9%) patients experienced unfavorable outcomes, 44 died, and 188 survived, with sequelae. Age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02 to 1.05), Glasgow Coma Scale score (OR, 0.84; 95% CI, 0.77 to 0.93), and symptomatic periods of 2 to 7 days (OR, 1.80; 95% CI, 1.16 to 2.79) and >7 days (OR, 3.75; 95% CI, 1.72 to 8.15) until the commencement of treatment predicted unfavorable outcomes. The outcome in HME patients is related to a combination of therapeutic and host factors. This study suggests that rapid diagnosis and early administration of antiviral treatment in HME patients are keys to a favorable outcome.

Antimicrobial susceptibility and resistance mechanisms of methicillin resistant Staphylococcus aureus isolated from 12 Hospitals in Turkey.

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most important nosocomial pathogens and is also emerging in Turkish hospitals. The aim of this study was to determine the antimicrobial susceptibility profiles of MRSA isolated from Turkish hospitals. MATERIALS AND METHODS: A total of 397 MRSA strains isolated from 12 hospitals in Turkey were included to present study. Antimicrobial susceptibilities were tested using agar dilution method. Presence of ermA, ermB, ermC, msrA, tetM, tetK, linA and aac-aph genes were studied by PCR. RESULTS: All strains were susceptible to vancomycin and linezolid. The susceptibility rates for fusidic acid, lincomycin, erythromycin, tetracyclin, gentamycin, kanamycin, and, ciprofloxacin were 91.9%, 41.1%, 27.2%, 11.8%, 8.5%, 8.3% and 6.8%, respectively. Lincomycin inactivation was positive for 3 isolates. Of 225 erythromycin resistant isolates 48 had ermA, 20 had ermC, and 128 had ermA-C. PCR was negative for 15 strains. Of 3 isolates with lincomycin inactivation one had linA and msrA. Of 358 gentamycin resistant isolates 334 had aac-aph and 24 were negatives. Among 350 tetracyclin resistant isolates 314 had tetM. Of 36 tetM negative isolates 10 had tetK. CONCLUSION: MRSA isolates from Turkish hospitals were multiresistant to antimicrobials. Quinolone and gentamycin resistance levels were high and macrolide and lincosamide resistance were relatively low. Susceptibility rates for fusidic asid were high. Linezolide and vancomycin resistance are not emerged. The most common resistance genes were ermA, tetM and aac-aph. Evolution of antimicrobial susceptibilities and resistance genes profiles of MRSA isolates should be surveyed at regional and national level for accurate treatment of patients and to control dissemination of resistance genes.

[t030 is the most common spa type among methicillin-resistant Staphylococcus aureus strains isolated from Turkish hospitals]. / t030, Türkiye'deki Hastanelerden Izole Edilen Metisiline Dirençli Staphylococcus aureus Izolatlari Arasinda En Yaygin spa Tipidir.

Staphylococcus aureus is one of the most frequent agents causing hospital infections. S.aureus has a great ability to adapt itself to variety of conditions and successful clones can be epidemic and even pandemic by its ability spread from one continent to another. The aims of this study were to detect spa types of 397 methicillin-resistant S.aureus (MRSA) strains isolated from 12 centers in different geographical regions of Turkey from 2006 to 2008, and to investigate their clonality by PFGE and MLST typing. Additionally, 91 MRSA from four of those 12 centers isolated during 2011 were also studied for their spa types. PFGE profiles indicated the presence of a major pulsotype, namely pulsotype A with a rate of 91.4% (363/397), followed by pulsotype B (n= 18, 4.5%) and pulsotype C (n= 11, 2.8%). Among isolates tested 363 (91.4%) were SCCmec type III, 30 (7.6%) were SCCmec type IV. Sequence analysis of representative isolates revealed that ST239 (85.1%) was the most common MLST type followed by two MLST types ST737 (4%), and ST97 (2.8%), both SCCmec type IV. Two isolates were ST80 with SCCmec type IV. Of 397 isolates, 338 (85.1%) were t030, followed by t005 (2.5%) and t632 (2%). Among MRSA isolated during 2011, 64 (70.3%) of 91 were t030, 4 (4.4%) were t005, 2 (2.2%) were t015, and 2 (2.2%) were t1094. Among centers the t030 prevalence of 2006-2008 isolates ranged from 59-100%. The highest t030 prevalence was found in Ankara (100%) and lowest in Trabzon (59%) provinces which are located at central and northestern Anatolia, respectively. In Istanbul province, the prevalence of t030 was 94.5% among 2006-2008 isolates which decreased to 55.5% among 2011 isolates. Also a decrease in t030 rates was observed among samples from Konya and Trabzon but not from Aydin. Our results showed that the most common MRSA clone in Turkey is ST 239-SCCmec type III, t030 which persisted during the six years of the study period. Presence of PVL toxin gene was tested by PCR and 5 (3%) isolates found to be positive, of them two were SCCmec Type IV-ST80 and three were SCCmec Type III-ST239. This study is the largest epidemiological survey ever done in Turkey which showed presence of a hospital Turkish clone TR09 (ST239-SCCmecIII-t030) and a community clone TR10 (ST737-SCCmecIV-t005) largely disseminated in Turkey.

Clinical, diagnostic and therapeutic approaches to complications of brucellosis: an experience of 12 years.

OBJECTIVE: To describe the clinical presentations, laboratory findings, prevalence and pattern of complications and the response to treatment of brucellosis in a 12-year period in a Turkish research hospital. MATERIALS AND METHODS: Between 1996 and 2008, 231 patients were diagnosed with brucellosis and treated in our clinic. Medical records of 189 of the 231 patients with at least one demonstrable complication of the disease were reviewed for anamnesis, diagnosis, complications, treatment and clinical outcomes. RESULTS: The decreasing order of the complications was: hematological, 104 (55%); osteoarticular, 70 (37%); hepatobiliary, 59 (31%), and gastrointestinal, 23 (12%). The most common laboratory findings were anemia, lymphomonocytosis, elevated sedimentation rate and C-reactive protein, and elevated aminotransaminases. CONCLUSION: The hematological, osteoarticular and hepatobiliary manifestations were predominant. Bursitis, synovitis, glomerulonephritis, cutaneous lesion and deep vein thrombosis were the rare complications observed in our study. In clinical practice, brucellosis should be considered in the differential diagnosis in the presence of infrequent complications.

[Septic arthritis of hip due to Salmonella Typhi in a patient with multiple sclerosis]. / Multipl Sklerozlu Bir Olguda Salmonella Typhi'ye Bagli Kalça Eklemi Artriti.

The most common microorganisms isolated from septic arthritis are Staphylococcus aureus and streptoccocci. Septic arthritis due to Salmonella spp. are rare and the most commonly isolated species are S.Choleraesuis and S.Typhimurium. However the number of septic arthritis cases due to S.Typhi is low in literature. In this report, septic arthritis of hip due to S.Typhi in a multiple sclerosis patient who was under steroid therapy, was presented. A 25-year-old female patient was admitted to our clinic with the complaints of fever, left hip pain, standing and walking disability for 10 days. Her anamnesis revealed that she had had a multiple sclerosis attack and underwent triple pulse steroid therapy. Laboratory findings were as follows; WBC count: 16.300/mm3 (70% polymorphonuclear leukocyte), hemoglobin: 10.6 g/dl, erythrocyte sedimentation rate: 140 mm/hour, CRP: 28.7 g/L, AST: 86 U/L and ALT: 77 U/L. In lumbosacral magnetic resonance imaging, trochanteric bursitis and generalized myositis were detected in left hip joint compatible with septic arthritis. S.Typhi was isolated from patient's blood and operational tissue samples. Serum Salmonella TO and TH titers were found as 1/400 and 1/200, respectively. Antibiotic susceptibility test was performed by disk diffusion method, and the isolate was found susceptible to ampicillin, chloramphenicol, ceftriaxone, ciprofloxacin and trimethoprim-sulphametoxazole. The patient was treated by surgery and also by two weeks parenteral (2 x 400 mg) and 6 weeks oral (2 x 500 mg) ciprofloxacin treatment. Six months follow-up of the patient revealed that clinical, radiological and laboratory findings were normal. As far as the national literature was considered, this was the first S.Typhi septic arthritis case involving the hip joint and demonstrating bacterial growth both in blood and operational tissue. The presentation of the infection as arthritis plus diffuse myositis and bursitis, is also noteworthy.

Long-term treatment of persistent disseminated Nocardia cyriacigeorgica infection.

In this paper a disseminated persistent Nocardia cyriacigeorgica infection in an immunocompetent patient is described. The patient's long-term treatment, as well as its implications for managing similar cases in the future, is emphasized. Presenting with high fever, multiple nodules, and ulcerative cutaneous lesions of body sites, the patient was treated with various antimicrobials. Under combined therapy, empyema and arthritis, leading to disseminated nocardiosis, were seen. The overall treatment course was 28 months. It can be concluded that the choice of the antibiotics and optimal duration of treatment are uncertain; therefore the treatment of nocardiosis requires expertise.

Hospital acquired infections (HAI) in the elderly: comparison with the younger patients.

The aim of this retrospective study is to determine the frequency, type, microbiological characteristics and outcome of HAIs in the elderly (age ≥ 65) and to compare the data with younger patients in a Turkish Training and Research Hospital. From January 2008 to December 2009, the infection control team analyzed HAIs among 60,585 hospitalized patients (20,109 aged ≥ 65 and 40,747 aged between 18 and 64 years) with a total number of 419,017 patient days. A total of 825 HAIs episodes were detected in 607 patients, of which 395 episodes were in 301 elderly patients. The incidence of HAIs per 1000 patient days was 2.49 in the elderly and 1.64 in the younger patients' group (p<0.001). The most common site of infection in the elderly patients was the urinary tract, whereas in non-elderly group this was the lower respiratory tract. The incidence density of urinary tract infections, respiratory tract infections, surgical site, skin and soft tissue infections, primary bacteremia, and prosthesis infections were significantly higher in the elderly group (p<0.05). Gram-negative species were the most frequently isolated agents in both groups. There were no significant differences between the groups in the frequency of isolated pathogens or antibiotic susceptibility patterns. Overall, the fatality rate was found 16.8%. The elderly patients were more likely to have crude mortality rates (22% vs. 12%; p<0.01). The death was most often related to pneumonia, primary bacteremia or intravascular catheter infections in both groups.