A patient presented with genital eruptions: The second case of monkeypox from Turkiye

İnsan maymun çiçeği (MPX) hastalığı, vaccinia ve variola gibi “poxviridae” ailesine ait maymun çiçeği virüsünün neden olduğu, yeniden önem kazanan zoonotik bir hastalıktır. Avrupa Hastalık Önleme ve Kontrol Merkezi [European Center for Disease Prevention and Control (ECDC)] tarafından Avrupa’da olağandışı bulaşma yollarına sahip bir MPX salgını bildirilmiştir. Bu raporda, erkekten erkeğe cinsel ilişki ilk kez insandan insana yakın bir temas yolu olarak tanımlanmıştır. Türkiye Cumhuriyeti Sağlık Bakanlığı, Türkiye’de MPX virüsü polimeraz zincir reaksiyonu [polymerase chain reaction (PCR)] ile doğrulanmış ilk olgunun 30 Haziran 2022’de bir hastanede kabul edildiğini ve izole edildiğini sosyal medya paylaşımı ile bildirmiştir. Bu bildiriden dört gün sonra merkezimize başvuran yirmi dört yaşında Türk erkek hasta lokal cerrahi işlem sonrası peniste ve skrotumda ortaya çıkan bakteriyel yumuşak doku enfeksiyonu ile kliniğimize yatırılmıştır. Öyküsünde bir hafta önce ortaya çıkan siğil benzeri lezyonlar nedeni ile dış merkezde lokal radyofrekans ablasyon tedavisi yapıldığını belirtmiştir. Yatışından bir gün sonra yüzünde, burun ucunda, vücudunda, kollarında ve parmaklarında giderek belirginleşen farklı evrelerde cilt lezyonları (makül, papül, göbekli papül) ve birkaç erüpsiyon gözlenen hasta, risk faktörleri değerlendirilerek MPX hastalığı açısından izole edilmiş ve Sağlık Bakanlığı rehberine göre MPX virüsü aranmak üzere örnekleri referans laboratuvara gönderilmiştir. Alınan örneklerde PCR ile MPX nükleik asidi saptanmıştır. Hastanın sekonder bakteriyel enfeksiyon tedavisi ve 21 günlük izolasyon süresi tamamlanarak taburcu edilmiştir. Bu olgu raporunda daha önce Türkiye’den bildirilmemiş olan MPX hastalığı, cinsel yolla bulaşan enfeksiyonlar (CYBE) ayırıcı tanısının ve tarama testlerinin önemi ve MPX hastalığı olgusuna uygulanan lokal ablasyon tedavisi sonrası gelişen yumuşak doku enfeksiyonu sunulmuştur. Yeni ve yeniden önem kazanan enfeksiyon hastalıklarına hazırlıklı olmak için güncel epidemiyolojik verilere dayalı iyi kurgulanmış sürekli eğitimin gerekliliğine vurgu yapılmıştır. Son zamanlarda, cinsel temas, MPX hastalığının yeni bulaşma yolu olarak tanımlanmaktadır ve semptom ve bulgular, “molluscum contagiousum” veya sifilis gibi diğer ülseratif cinsel yolla bulaşan enfeksiyonları (CYBE) taklit edebilir. Türkiye için ORF hastalığı da MPX hastalığı ayırıcı tanısı içindedir. Ayrıca bildirimi zorunlu olmayan CYBE ile başvuran hastalar, diğer tarama testleri yapılmadan sağlık hizmeti alabilmektedir. Kolay ulaşılabilen tanısal yeterliliği yüksek CYBE tarama merkezlerinin yaygınlaşması ile bu hastalıkların kontrol altına alınması sağlanabilir.Human monkeypox (MPX) disease is a re-emerging zoonotic infection caused by the monkeypox virus belonging to the same family as vaccinia and variola. The European Center for Disease Prevention and Control (ECDC) has documented an outbreak of MPX with atypical transmission paths throughout Europe. In this report, male-to-male sexual intercourse was first defined as a means of close human -to-human contact. The Ministry of Health of the Republic of Turkey announced via social media on June 30, 2022 that the first case confirmed by polymerase chain reaction (PCR) for the MPX virus in Turkey was admitted and isolated in a hospital. Four days after this statement, a 24-year-old Turkish man was hospitalized in our clinic with a bacterial infection of the penis and scrotum following local radiofrequency ablation therapy. A week ago, lesions resembling warts were noted in his medical history, for which a local radiofrequency ablation procedure was conducted at an external center. One day after his hospitalization, skin lesions of different stages (from macules, papules to umbilical papules) and several eruptions were detected on his face, nose tip, body, arms, and fingers, which gradually became more evident. After evaluating the risk factors, the patient was isolated with a preliminary diagnosis of MPX disease and samples were collected and sent for MPX virus detection to the reference laboratory according to the Ministry of Health guidelines. MPX virus nucleic acid was detected by PCR in samples taken from the lesion. The patient was discharged after 21 days of isolation and treatment for a secondary bacterial infection. In this case report the significance of differential diagnosis and screening tests for sexually transmitted infections (STI), a previously unreported case of MPX disease in Turkey, and a soft tissue infection that developed after local ablation treatment which was administered to a patient with MPX disease were presented. To be prepared for new and re-emerging infectious diseases, it was emphasized that well-structured continuing education based on current epidemiological data is required. Sexual contact has recently been identified as a new mode of transmission for MPX disease, and symptoms and signs may resemble those of other ulcerative sexually transmitted infections (STIs), such as "molluscum contagiousum" or syphilis. ORF disease is also in the differential diagnosis of MPX disease in Turkey. In addition, patients admitted with unreported STIs are permitted to receive health services without additional screenings. For this reason, easily accessible sexually transmitted disease centers with a high diagnostic efficiency can provide greater control over these diseases

Acinetobacterspp in Intensive Care Unit: Risk Factors Associated with Infection and Mortality

Purpose: Acinetobacter was known as a saprophytic colonizer, yet it is considered an important etiologic agent which is isolated from hospital-acquired infections. In this study, we aimed to investigate fatality rates, factors for fatality of Acinetobacter infections and relationship between combination therapies and survival.Patients and Methods: We evaluated patients with Acinetobacter infection in ICU for demographic and clinical characteristics, combination therapies and adverse effects of these therapeutic options, retrospectively.Results: Ninety-one patients with proved Acinetobacter infection were included in this study. We found that the fatality rate of Acinetobacter infection in ICU was 56%. Advanced age, carbapenem resistance and Acinetobacter isolation from respiratory secretions were significantly related with fatality.  We found that carbapenem resistance increased steadily during a 5 year period, fatality rates significantly decreased with combination therapies including aminoglycosides. There wasn’t significant relation between colistin therapy and survival in patients with Acinetobacter infections.Conclusion: The patients should be well-assessed in terms of fatality risk factors in case of Acinetobacter infections that occur in the intensive care units. The empirical antibiotic treatment started earlier based on such risk factors may decrease fatality. The antimicrobial combinations including aminoglycoside may be considered more in order to the local resistance data

Extrapulmonary tuberculosis: 7 year-experience of a tertiary center in Istanbul

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Background: Although a decreasing trend of tuberculosis (TB) was reported in Turkey, higher proportion of extrapulmonary tuberculosis (EPT) was revealed. Material and methods: In this retrospective study, clinical and laboratory data of 141 EPT patients were evaluated for a seven-year period by using descriptive statistics, and parametric and non-parametric tests where appropriate. Results: The most frequent types of EPT were meningeal TB (23%) and TB lymphadenitis (21%), respectively. Other types of EPT were skeletal, miliary, peritoneal, abscess, genitourinarial, cutaneous and gastrointestinal involvement which ranged between 18% and 1%. Mean age was 42 and female/male ratio was almost equal. All patients were born in Turkey. Although all of them were permanent residents of Istanbul, 73% of the patients came from East and Southeast Region of Turkey. For the patients, being older than 40 years old (p < 0.01), having miliary TB (p < 0.05) and high CRP levels (p < 0.05) were found to be associated with mortality. Conclusions: EPT still remains as a significant morbidity and mortality reason in lower income populations and developing countries. In our study, although all patients were residents of Istanbul approximately two thirds of them have migrated from East and Southeast parts of the country. The relatively high prevelance of tuberculosis cases in Istanbul may be due to the permanent migration from other parts of the country. Early diagnosis and initiation of appropriate treatment are the keys for reducing morbidity and mortality in patients with EPT, particularly in the cases of older age

Extrapulmonary tuberculosis: 7 year-experience of a tertiary center in Istanbul

WOS: 000327765300035PubMed ID: 24028930Background: Although a decreasing trend of tuberculosis (TB) was reported in Turkey, higher proportion of extrapulmonary tuberculosis (EPT) was revealed. Material and methods: In this retrospective study, clinical and laboratory data of 141 EPT patients were evaluated for a seven-year period by using descriptive statistics, and parametric and non-parametric tests where appropriate. Results: The most frequent types of EPT were meningeal TB (23%) and TB lymphadenitis (21%), respectively. Other types of EPT were skeletal, miliary, peritoneal, abscess, genitourinarial, cutaneous and gastrointestinal involvement which ranged between 18% and 1%. Mean age was 42 and female/male ratio was almost equal. All patients were born in Turkey. Although all of them were permanent residents of Istanbul, 73% of the patients came from East and Southeast Region of Turkey. For the patients, being older than 40 years old (p < 0.01), having miliary TB (p < 0.05) and high CRP levels (p < 0.05) were found to be associated with mortality. Conclusions: EPT still remains as a significant morbidity and mortality reason in lower income populations and developing countries. In our study, although all patients were residents of Istanbul approximately two thirds of them have migrated from East and Southeast parts of the country. The relatively high prevelance of tuberculosis cases in Istanbul may be due to the permanent migration from other parts of the country. Early diagnosis and initiation of appropriate treatment are the keys for reducing morbidity and mortality in patients with EPT, particularly in the cases of older ages. (C) 2013 European Federation of Internal Medicine. Published by Elsevier B. V. All rights reserved

Ertapenem for the treatment of complicated urinary tract ınfections caused by extended-spectrum β-lactamase-producing bacteria: A case series report

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Urinary tract infections with extended-spectrum beta-lactamases (ESBL) are an increasing public health concern. We evaluated our experience with the use of ertapenem for complicated urinary tract infections (cUTI) caused by ESBL- producing bacteria. Sixty-four patients aged >18 years who had a cUTI caused by ESBL- producing microorganisms that were treated with ertapenem at Sisli Etfal Training and Research Hospital, from January 1st, 2010 to December 31st, 2011, were included in this study. Data on patients demographic, clinical and laboratory results were collected. The median age was 65.8 years (range, 30 to 95). All patients had at least one risk factor complicating factor except two of them. The most common underlying problem was prior antibiotic exposure. The pathogens isolated from urine samples were ESBL-producing E. coli in 49, ESBL-producing K. pneumoniae in 12 and ESBL-producing K. oxytoca in 2 patients. All were susceptible to ertapenem in vitro. The average duration of ertapenem therapy was 14+/-4 days for upper UTI and 11+/-2 days for lower UTI. All patients achieved clinical cure and bacteriological eradication in urine. One patient had relapse and six of them had reinfection. Only one case had diarrhea which did not require discontinuation of therapy. Our results demonstrate that ertapenem is suitable for the treatment of cUTI cause by ESBL-producing bacteria

Real-world data on the efficacy and safety of trastuzumab emtansine in patients with metastatic breast cancer previously treated with pertuzumab: Turkish oncology group multicenter study

We aimed to evaluate the efficacy and safety of trastuzumab emtansine in patients with metastatic breast cancer previously treated with pertuzumab plus trastuzumab and taxane. We reviewed the medical records of patients who were diagnosed with Human Epidermal Growth Factor Receptor 2 (HER-2) positive metastatic breast cancer and received pertuzumab and then TDM-1 between January 2014 and January 2021 from twenty- five cancer centers. The Kaplan- Meier method estimated progression-free survival (PFS) and overall survival (OS). Additionally, objective response rate (ORR), clinical benefit rate (CBR), and safety were evaluated. One hundred fifty-three patients were included,79.1% of the patients received TDM-1 in the second line, 90.8% had visceral metastasis, and 30.7% had central nervous system involvement. The PFS and OS of TDM-1 were evaluated according to the number of previous lines (on the 2nd line or more than two lines) metastatic sites (visceral and non-visceral) and the presence of central nervous metastasis. In TDM-1 therapy, PFS in second line therapy was ten months (95% CI: 7.7 - 12.2); this was statistically higher than later-line PFS, which was six months (95% CI: 3.3 to 8.6) (p = 0.004). The median OS time was 25 months (95% CI: 21.0 to 28.9) in patients treated with TDM-1 in the second line and 19 months (95% CI: 12.3 to 25.6) in patients who received later than the second line(p = 0.175). There were no significant differences in PFS time of patients with and without visceral and central nervous metastases. Our study showed that TDM-1 was also effective in patients using pertuzumab, contributes significantly to PFS when used in the second line compared to its use in the later line, and does not make any difference in OS

Real-world outcomes of pazopanib in metastatic soft tissue sarcoma: a retrospective Turkish oncology group (TOG) study

AimDescription of patient characteristics, effectiveness and safety in Turkish patients treated with pazopanib for metastatic soft tissue sarcoma (STS).Patients and methodsThis multicenter study is based on retrospective review of hospital medical records of patients (>= 18 years) treated with pazopanib for non-adipocytic metastatic STS at 37 Oncology clinics across Turkey. Objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS) and overall survival (OS) were evaluated with further analysis of data on the three most common histological subtypes (leiomyosarcoma [LMS], undifferentiated pleomorphic sarcoma [UPS], synovial sarcoma [SS]) in the cohort.ResultsData of 552 adults (57.6% women, median age: 52 years) were analyzed. DCR and ORR were 43.1% and 30.8%, respectively. Median PFS was 6.7 months and OS was 13.8 months. For LMS, UPS and SS, median PFSs were 6.1, 5.9 and 7.53 months and median OSs were 15.03, 12.87 and 12.27 months, respectively. ECOG >= 2 was associated with poor PFS and OS. Liver metastasis was only a factor for progression. Second-line use of pazopanib (vs. front-line) was associated with better PFS, its use beyond third line predicted worse OS. Adverse events (AE) occurred in 82.7% of patients. Most common AEs were fatigue (58.3%) and anorexia (52.3%) which were graded as >= 3 in 8.2% and 7.4% of patients, respectively.ConclusionPazopanib is effective and well-tolerated in treatment of non-adipocytic metastatic STS. Its earlier use (at second-line), good performance status may result in better outcomes. Worldwide scientific collaborations are important to gain knowledge on rarer STS subtypes by conducting studies in larger patient populations

Real-world outcomes of pazopanib in metastatic soft tissue sarcoma: a retrospective Turkish oncology group (TOG) study

Aim: Description of patient characteristics, effectiveness and safety in Turkish patients treated with pazopanib for metastatic soft tissue sarcoma (STS). Patients and methods: This multicenter study is based on retrospective review of hospital medical records of patients (≥ 18 years) treated with pazopanib for non-adipocytic metastatic STS at 37 Oncology clinics across Turkey. Objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS) and overall survival (OS) were evaluated with further analysis of data on the three most common histological subtypes (leiomyosarcoma [LMS], undifferentiated pleomorphic sarcoma [UPS], synovial sarcoma [SS]) in the cohort. Results: Data of 552 adults (57.6% women, median age: 52 years) were analyzed. DCR and ORR were 43.1% and 30.8%, respectively. Median PFS was 6.7 months and OS was 13.8 months. For LMS, UPS and SS, median PFSs were 6.1, 5.9 and 7.53 months and median OSs were 15.03, 12.87 and 12.27 months, respectively. ECOG ≥ 2 was associated with poor PFS and OS. Liver metastasis was only a factor for progression. Second-line use of pazopanib (vs. front-line) was associated with better PFS, its use beyond third line predicted worse OS. Adverse events (AE) occurred in 82.7% of patients. Most common AEs were fatigue (58.3%) and anorexia (52.3%) which were graded as ≥ 3 in 8.2% and 7.4% of patients, respectively. Conclusion: Pazopanib is effective and well-tolerated in treatment of non-adipocytic metastatic STS. Its earlier use (at second-line), good performance status may result in better outcomes. Worldwide scientific collaborations are important to gain knowledge on rarer STS subtypes by conducting studies in larger patient populations