A multi-center retrospective analysis of healthcare workers after COVID-19: Epidemiological and clinical features

Objective: Concerns regarding the high-level risk of infection among healthcare workers (HCWs) increased after COVID19 was declared as a pandemic in March 2020. Inadequate infection control owing to a shortage of personal protective equipment or an inconvenient usage of infection control measures may play a significant role in transmission to/among healthcare personnel. The study aimed to determine the characteristics and outcomes of COVID-19 patients who are healthcare workers along with possible transmission routes of COVID-19 in four different healthcare facilities in Istanbul. Methods: All hospital records were reviewed retrospectively. Demographic and clinical characteristics of HCWs were documented, and all infected HCWs were subjected to a phone-based mini-questionnaire and three-dimensional test (TDT). All statistical analyses were done using statistical packages SPSS Demo Ver 22 (SPSS Inc. Chicago, IL, USA).Results: Clinical features of COVID-19 were similar to the general public's characteristics. The most frequent symptoms were cough, fever, and headache. HCWs with the O blood group tend to have asymptomatic COVID-19 infection. Hospital workers other than medical professionals have a lack of convenience of infection control measures. The median duration of PCR negativity was 9 days. HCWs who had a sore throat at the beginning of COVID-19 have a longer PCR-positive duration.Conclusion: Understanding the clinical features or characteristics of asymptomatic COVID-19 carriers may aid in the implementation of a feasible screening program for early detection. It is strongly advised that proper infection control precautions, education, and auditing of nonclinical staff be implemented. As a result, transmission among healthcare workers can be avoided

The effect of antimicrobial policy implementation on carbapenem resistance: A university hospital experience

Objective: The resistance of Gram-negative bacteria to antibiotics is a global issue that leads to increased mortality and treatment costs. The aim of this study is to see how a newly formed carbapenem control team affected the prevalence of carbapenem-resistant Gram-negative rods and antibiotic consumption expenses in 2017 compared to the year before.Methods: The rate of carbapenem antibiotic usage in Intensive Care Units and Bone Marrow Transplantation services, as well as the findings of culture materials obtained from various body parts of the same patients, between January 1, 2016, and December 31, 2017 were assessed.Results: While there was an ordinary restriction on carbapenem consumption in 2016, carbapenem consumption has been more restricted in 2017. The carbapenem-resistant Gram-negative bacteria patterns of culture materials are examined and compared with Defined Daily Dose data of carbapenems. After the restriction, a significant decrease in the consumption of carbapenems was detected. The decline in carbapenem-resistant Gram-negative bacteria and decreasing antibiotic consumption were found to have a moderately positive correlation (r=0.641, p=0.02). A 60.9% decrease was observed in carbapenem costs after carbapenem restriction, on the other hand, an increase in other unrestricted antibiotics was apparent.Conclusion: Antimicrobial restriction policies can help minimize the rate of carbapenem-resistant Gram-negative rods, which is a serious problem in healthcare. We demonstrated that a decrease in carbapenem-resistant Gram-negative rods isolation rates can lead to a decrease in healthcare-associated infections. Although there is no decrease in the direct antibiotics cost, a drop in carbapenem-resistant may lower the expenses of drastic consequences of infections with carbapenem-resistant and its cost. we can conclude that the Antibiotic Control Policy should be modified based on this new information

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

Regio frontalis'teki anatomik yapıların topografik ilişkisinin değerlendirilmesi; bu ilişkilerin ilgili bilim alanlarındaki öneminin ortaya konması

Headaches are one of the most common complaints in the community. The rate of people experiencing headache at least once in their lifetime is 93% in men and 99% in women; it is over 90% in the general population. (2nd). According to the classification made by the International Headache Society; They are classified as primary headaches, secondary headaches, and other types of headaches. In this classification, primary headaches are not related to the central nervous system; Secondary headaches are due to a central nervous system or a systemic disease. Although it is stated in the studies that the most common cause of primary headache is tension headache; In the study of the Turkish Headache Study Group, it is said that most of them are combined with migraine headache. Migraine headaches; It may be located in Regio frontalis, Regio temporalis or Regio occipitalis. The pathogenesis of migraine concerns many cortical and subcortical structures in the brain parenchyma, as well as the meninges and blood vessels, which are pain-sensitive structures. Determination of entrapment neuropathies, detection of trap points in Regio frontalis, and relief of these points are invasive treatment methods. Another treatment method is Botulinum toxin A injection. Due to the increasing level of well-being and the amount of personal care, people are increasingly interested in their faces. One of the areas of most interest is Regio frontalis. In this region, aesthetic applications are becoming widespread as well as reconstructive surgeries performed due to tumors, traumas, etc. In the thesis study, using 20 human heads fixed with 10% Formalin in the Department of Anatomy of Ege University Faculty of Medicine; Topographical dissection of the structures in the Regio frontalis was performed. The determined measurements were made and analyzed statistically. The measurements in the literature and the measurements made by us were compared and evaluated. Statistical analyzes were carried out using the IBM SPSS Statistics 25.0 package program. Whether the data were normally distributed on the basis of gender and variable was evaluated with the Shapiro Wilk Test. As a result of the evaluation made on the basis of P value 0.05 as the significance value; whether they are compatible with the normal distribution or not. Mann Whitney U test, one of the non-parametric tests, was applied to those suitable for normal distribution. T test, one of the parametric tests, was used for those who were not suitable for normal distribution. As a result of the measurements made, it has been observed that the structures in Regio frontalis can show a lot of variation, and these variations can only be detected by different studies. The measurements found will be beneficial in surgical and aesthetic approaches; During the treatment, it was understood again how important it is to know the anatomy of the structures in this region.Başağrıları, toplumda en yaygın yakınmalardan biridir. Ömür boyu en az bir kez başağrısı yaşayan kişi oranı, erkeklerde % 93, kadınlarda % 99 olmak üzere; genel popülasyonda %90'ın üzerindedir. (2). Baş ağrıları, Uluslararası Baş Ağrısı Topluluğu tarafından yapılan sınıflandırmaya göre; primer baş ağrıları, sekonder baş ağrıları ve diğer tip baş ağrıları olarak sınıflandırılmıştır. Bu sınıflandırmada, primer baş ağrılarının merkezi sinir sistemi ile ilişkisi yoktur; sekonder baş ağrılarıysa merkezi sinir sistemi ya da sistemik bir rahatsızlığa bağlıdır. Yapılan çalışmalarda, primer başağrısının en sık nedeninin gerilim tipi baş ağrısı olduğu söylense de; Türk Başağrısı Çalışma Grubu'nun araştırmasında, bunların çoğunluğunun migren başağrısı ile kombine olduğu söylenmektedir. Migren baş ağrıları; Regio frontalis, Regio temporalis veya Regio occipitalis yerleşimli olabilir. Migren patogenezi, ağrıya duyarlı yapılar olan meninksler ve kan damarlarının yanı sıra, beyin parankimindeki kortikal ve subkortikal birçok yapıyı ilgilendirir. Tedavi yöntemlerinden biri olan Tuzak nöropatilerinin belirlenmesi, Regio frontalis'deki tuzak noktalarının tespit edilmesi, ve bu noktaların rahatlatılması invazif tedavi yöntemlerindendir. Bir diğer tedavi yöntemi de, Botilinum toksini A enjeksiyonudur. Artan refah düzeyi ve kişisel bakım miktarına bağlı olarak, gün geçtikçe kişiler yüzleriyle daha fazla ilgilenmektedir. En fazla ilgilenilen alanlardan birisi de, Regio frontalis'dir. Bu bölgede tümörlere, travmalara vb nedenlere bağlı yapılan rekonstrüktif cerrahiler kadar, estetik uygulamalar da yaygınlaşmaktadır. Yapılan tez çalışmasında, Ege Üniversitesi Tıp Fakültesi Anatomi Anabilim Dalı'ndaki % 10 formalin ile fikse edilmiş 20 adet insan kafası kullanılarak; Regio frontalis'deki yapıların topografik olarak diseksiyonu yapıldı. Belirlenen ölçümler yapıldı ve istatistiksel olarak analiz edildi. Literatürdeki ölçümlerle, tarafımızdan yapılan ölçümler karşılaştırılarak değerlendirildiİstatistiksel analizler, IBM SPSS Statistics 25.0 paket programı kullanılarak gerçekleştirilmiştir. Verilerin cinsiyet bazında ve değişken bazında normal dağılıp dağılmadıkları, Shapiro Wilk Testi ile değerlendirilmiştir. Anlamlılık değeri olarak, P değeri 0.05 baz alınarak yapılan değerlendirme sonucunda; normal dağılıma uyumlu olup olmadıkları incelenmiştir. Normal dağılıma uygun olanlara, non parametrik testlerden biri olan Mann Whitney U testi uygulanmıştır. Normal dağılıma uygun olmayanlar için ise, parametrik testlerden birisi olan T testi kullanılmıştır. Yapılan ölçümler sonucunda, Regio frontalis'teki yapıların çok fazla varyasyon gösterebileceği, ve bu varyasyonların ancak, yapılan farklı çalışmalar ile tespit edilebileceği görülmüştür. Cerrahi ve estetik yaklaşımlarda, bulunan ölçümlerin faydalı olacağı; tedavi esnasında, bu bölgedeki yapıların anatomisinin iyi bilinmesinin ne kadar önemli olduğu yeniden anlaşılmıştı

Coxiella burnetii’ye bağlı bir endokardit olgusu

A 36-year-old male patient, who was an agricultural farmer and had a diagnosis of bicuspid aortic valve and coarctation, was admitted with symptoms of fever, fatigue, and shortness of breath that lasted for a month, in March 2017. Examination revealed dyspnea and bilateral rales and rhonchi in lung auscultation. A 3/6 systolic murmur was heard in the mesocardiac focus. The laboratory tests showed a white blood cell count of 15.14x10(3)/mu l, erythrocyte sedimentation rate of 36 mm/h, and C-reactive protein of 26 mg/l. An echocardiogram showed mobile vegetation (30x10 mm) on the aortic valve and severe aortic and tricuspid valve insufficiency. All blood cultures that are taken from the patient with the diagnosis of infective endocarditis were negative and C. burnetii phase I IgG antibody was positive at 1/32768 titer. As far as we know, herein, we present a case of endocarditis due to C. burnetii, which is the third case that is reported in Turkey.Q ateşi, Coxiella burnetii ’nin neden olduğu zoonotik bir hastalıktır. Çiftlik hayvanları insan enfeksiyonları için birincil rezervuarlardır. Akut Q ateşi genellikle grip benzeri bir hastalık olarak ortaya çıkar. Kronik formda ana klinik tablo endokardittir. Otuz altı yaşında erkek hasta, biküspit aort kapağı ve koarktasyon tanısı alan bir tarım çiftçisi, Mart 2017’de bir aydır devam eden ateş, yorgunluk ve nefes darlığı şikayetleri ile başvurdu. Fizik muayenede hasta dispneik olup, akciğer seslerinde bilateral ral ve ronküs mevcuttu. Mezokardiyak odakta 3/6 sistolik üfürüm duyuldu. Laboratuvar testlerinde lökosit 15,14x103 /µl, eritrosit sedimentasyon hızı 36 mm/saat, C-reaktif protein 26 mg/l idi. Ekokardiyogramda aort kapağında hareketli bir vejetasyon (30x10 mm), şiddetli aort ve triküspit kapak yetmezliği saptandı. Enfektif endokardit tanısıyla hastadan alınan tüm kan kültürleri negatif sonuçlandı. C. burnetii faz I IgG antikoru 1/32768 titrede pozitif geldi. Bu makalede bildiğimiz kadarıyla Türkiye’de bildirilen üçüncü olgu olan C. burnetii’ye bağlı endokardit vakasını sunduk

Rifampicin-induced fever in a patient with brucellosis: A case report

We present a 35-year-old female patient who was started on rifampicin (900 mg orally once daily) and trimethoprim/sulfamethoxazole (TMP/SMX) (160/800 mg orally twice daily) after being diagnosed with brucellosis. Following defervescence and improvement in her general condition, fever recurred on the 12th day of treatment. A re-challenge drug test lead to causality assessment and treatment was switched to a combination of streptomycin (1 g intramuscularly) for 10 days and TMP/SMX (160/800 mg orally twice daily) for 4 weeks. Our patient is doing well after 12 months of follow-up