A retrospective analysis of individuals living with HIV/AIDS

Aim: The objective of this study was to assess the general characteristics, transmission routes and sociodemographic, clinical, and laboratory data of individuals living with human immunodeficiency virus (HIV) infection during the course of their follow-up. Material and Methods: The study population consisted of 80 individuals diagnosed with HIV/acquired immunodeficiency syndrome (AIDS) who were aged 18 or above. These individuals were followed up in the infectious diseases and clinical microbiology outpatient clinic. A retrospective analysis was conducted on the epidemiological data pertaining to the patients. Results: Of the 80 patients, 72 were male, and the mean age was 44.98 +/- 12.76 years (range: 18-71 years). In the majority of patients (57.5%), the diagnosis was established through the analysis of routine blood tests. The most prevalent mode of transmission was heterosexual intercourse, accounting for 75% of cases. In accordance with the criteria established by the Centers for Disease Control and Prevention (CDC), 66 cases were classified as stage A, one case was designated as stage B, and 13 cases were categorized as stage C. The most frequently utilized antiretroviral therapy (ART) regimens were tenofovir alafenamide + emtricitabine + cobicistat + elvitegravir in 28.75% of cases and tenofovir disoproxil fumarate + emtricitabine + dolutegravir in 21.25% of cases. The most prevalent opportunistic infections were oral candidiasis (6.25%) and tuberculosis (5%). Two cases of Kaposi's sarcoma and one case of non-Hodgkin's lymphoma were identified as AIDS-related malignancies. Discussion: The global prevalence of HIV/AIDS remains a significant public health concern. It is therefore recommended that people living with HIV be followed up on a regular basis, with their sociodemographic characteristics analyzed and recorded

Access to treatment of acute hepatitis b and chronic hepatitis b acute exacerbation

Objectives: Acute hepatitis B (AHB) and chronic hepatitis B acute exacerbation (CHBAE) can lead to liver failure, necessitating careful monitoring and urgent intervention. This study aimed to evaluate patients diagnosed with AHB and CHBAE, the antivirals initiated, and the methods of accessing these treatments. Materials and Methods: This study included patients monitored at our hospital over a 5 year period with diagnoses of AHB and CHBAE. Clinical symptoms of the patients, potential etiologies leading to infection or exacerbation, laboratory values, possible diagnoses, indications for antiviral treatment, methods of treatment access, and disease course were retrospectively evaluated. Results: Seven patients diagnosed with AHB and 12 with CHBAE were included in the study. Antiviral therapy was initiated in nine patients (47.4%). Among these patients, four began antivirals for coagulopathy, one for pregnancy, one for cessation of previously used antivirals for CHB, and three for ongoing liver function test abnormalities and hepatitis B virus-DNA positivity. Only two patients had swift access to treatment through health insurance coverage, while others pursued alternative routes, such as off-label drug approval. None of the patients developed fulminant hepatitis. Conclusion: The treatment indications for AHB are clearly established based on the guidelines. Some studies recommend initiating treatment for all CHBAE cases, whereas others suggest treatment only when signs of liver failure are present. Access to treatment for patients who require urgent intervention may be delayed due to non-compliance with healthcare reimbursement regulations. Adjustments in health insurance coverage for antiviral therapies are necessary to mitigate such delays

Predicting mechanical ventilation, intensive care unit admission, and mortality in COVID-19 patients: Comparison of seven different scoring systems

Objective: In this study, we investigated whether scoring systems determine coronavirus disease-2019 (COVID-19) severity. Materials and Methods: COVID-19 patients hospitalized between 01.09.2020 and 31.04.2021 were retrospectively assessed. The national early warning score (NEWS), modified early warning score, rapid emergency medicine score, quick sequential organ failure assessment score (q-SOFA), CURB65, MuLBSTA, and ISARIC-4C scores on admission day were calculated. Scoring systems' ability to predict mechanical ventilation (MV) need, intensive care unit (ICU) admission, and 30-day mortality were assessed. Results: A total of 292 patients were included; 137 (46.9%) were female, and the mean age was 62.5 +/- 15.4 years. 69 (23.6%) patients required ICU admission, 45 (15.4%) needed MV, and 49 (16.8%) died within 30 days. No relationship was found between q-SOFA and MV need (p=0.167), but a statistically significant relationship was found between other scoring systems and MV need, ICU admission, and 30-day mortality (p5.5) and NEWS (optimal cut-off >3.5) had the highest area under the curve in receiver operating characteristic curve analyses, whereas q-SOFA had the lowest. Conclusion: The severity of COVID-19 could be estimated by using these scoring systems, especially ISARIC-4C and NEWS, at the first admission. Thus, mortality and morbidity would be reduced by making the necessary interventions earlier. Keywords: COVID-19, ISARIC-4C, mortality, NEWS, scoring system

Nosocomial infection and antimicrobial resistance in intensive care units: comparison of secondary and tertiary hospital

Antibiyotik direnci, sağlık hizmetiyle ilişkili enfeksiyonlarda (SHIE) önemli bir sorun olarak karşımıza çıkabilmektedir. Çalışmada aynı il içinde bulunan ikinci basamak hastane (2.BH) ile üçüncü basamak hastane (3.BH) yoğun bakım ünitelerindeki (YBÜ) SHİE hızlarının ve antimikrobiyal direnç oranlarının karşılaştırılması amaçlanmıştır. 2.BH ve 3.BH’deki YBÜ’lerde, 1 Ocak 2017 – 31 Aralık 2019 tarihleri arasında, Centers for Disease Control and Prevention (CDC) kriterlerine göre SHİE tanısı almış 18 yaş ve üzerindeki hastalar çalışmamıza dahil edilmiştir. SHİE insidans hızı, insidans dansitesi ve Klebsiella spp., Pseudomonas spp. ve Acinetobacter spp.’de karbapenem direnç oranları karşılaştırılmıştır. YBÜ’lerde 2.BH’de 158, 3.BH’de 519 SHİE gelişmiştir. SHİE insidans hızı 3.BH’deki YBÜ’lerde 2.BH’dekilerden daha yüksek bulunmuştur. 2.BH YBÜ’lerinde 2017-2019 yılları arasındaki karbapenem dirençli Klebsiella spp. oranları 3.BH’ye kıyasla istatistiksel açıdan anlamlı olarak daha yüksek saptanmıştır (p=0.001). Hastaneler arasında Pseudomonas spp. ve Acinetobacter spp.türlerinde karbapenem direnç oranları açısından istatistiksel açıdan anlamlı bir fark bulunamamıştır (sırasıyla p=0.723, p=0.267). Her iki hastanede de yıllar arasında karbapenem direnci oranlarında anlamlı bir değişiklik saptanmamıştır (p>0.05). 3.BH YBÜ’lerde SHİE hızı daha yüksek saptanmasına rağmen direnç oranları 2.BH’ye kıyasla daha düşük veya benzer bulunmuştur. Bu farkı inceleyen ileri çalışmalar antimikrobiyal direncin azalmasında yardımcı olabilir.Antibiotic resistance can be an important problem in healthcare-associated infections (HAI). The aim in this study was to compare HAI rates and antimicrobial resistance rates in the intensive care units (ICU) of a secondary hospital (SH) and a tertiary hospital (TH) in the same province. Patients aged 18 years and older who were diagnosed with HAI according to Centers for Disease Control and Prevention (CDC) criteria in ICUs of SH and TH between January 1st 2017 to December 31st 2019 were included. HAI incidence rate, incidence density, and carbapenem resistance rates in Klebsiella spp., Pseudomonas spp. and Acinetobacter spp. were compared. In the ICUs, 158 HAIs developed in the SH and 519 in the TH. HAI incidence rate were higher in the ICUs of TH than in the SH. Carbapenem-resistant Klebsiella spp. rates in ICUs of SH between 2017 and 2019 were statistically significantly higher than in TH (p=0.001). No statistically significant difference in carbapenem resistance rates of Pseudomonas spp. ve Acinetobacter spp. was found (p=0.723, p=0.267, respectively). There was no significant change in carbapenem resistance rates between years in both hospitals. (p>0.05). Although HAI rates were higher in the ICUs of TH, resistance rates were lower or similar compared to SH. Further studies examining this difference may be helpful in reducing antimicrobial resistance

Five-Years Tigecycline Experience an Analysis of Real-Life Data

Aim: Tigecycline has been approved by the Food and Drug Administration for the treatment of complicated intra-abdominal infections, skin and soft tissue infections and community-acquired pneumonia. In our study, we examined the efficacy of tigecycline in clinical practice and reported real life data from our hospital over a period of five years. Methods: The study was conducted between 2008 and 2013 on patients who received tigecycline for longer than 48 hours in Ankara Training and Research Hospital. Clinical success was defined as clinical recovery and microbiological cure in patients who used tigecycline. Any reason for discontinuation of tigecycline treatment was considered a clinical failure. Results: In our hospital, 320 patients were administered tigecycline between 2008 and 2013. Tigecycline was mainly used for pneumonia and skin and soft tissue infections. Tigecycline was used as monotherapy in 174 patients (54.1%). The most frequently isolated agent in tigecycline-treated patients was Acinetobacter baumannii (43.4%) followed by Enterococcus (6.9%). A change in treatment was not considered necessary in 243 (75.9%) patients who received tigecycline, while it was changed in 77 patients (24.1%). Conclusion: In conclusion, the use of tigecycline can be an effective treatment choice, either as monotherapy or as a combination antibiotic therapy

Treatment response to oral antivirals in chronic hepatitis B patients: assessment of polymorphism in the IL-28B gene (rs809991)

Objectives: Chronic hepatitis C treatment response is strongly associated with interleukin 28B (IL-28B) single nucleotide gene polymorphism (SNP). In this study, we aimed to investigate the association of the IL-28B rs8099917 SNP with the first-year virological response in chronic hepatitis B (CHB) patients receiving antiviral treatment.Materials and Methods: We enrolled 100 CHB patients over the age of 18 years who had been on oral antiviral treatment for at least a year. IL-28B rs8099917 SNP was analyzed from the blood samples by polymerase chain reaction. The first-year virological response was investigated retrospectively.Results: No statistically significant association was found between the IL-28B rs8099917 SNP and first-year virological response (p=1.000). The mean age of patients who did not obtain a first-year virological response was significantly lower than that of those who did (p=0.022), and the median values of alanine aminotransferase (xULN) and hepatitis B virus (HBV)-DNA log(10)IU/ mL were higher (p<0.001 and p<0.001, respectively). The first year virologic response rate was significantly lower in hepatitis B e antigen-positive patients than in negative patients (p<0.001). In the multivariate model, it was found that having a high HBVDNA level was strongly linked to not having a first-year virological response (risk ratio: 1.995, 95% confidence interval 1.311-3.036, p=0.001).Conclusion: An association between IL-28B SNP and first-year virological response was not found in patients with CHB. Studies assessing different IL-28B SNPs are warranted to understand the factors affecting treatment response

Türkiye'ye İnternetin gelişi ve ilk kullanım alanları

Ankara : İhsan Doğramacı Bilkent Üniversitesi İktisadi, İdari ve Sosyal Bilimler Fakültesi, Tarih Bölümü, 2012.This work is a student project of the The Department of History, Faculty of Economics, Administrative and Social Sciences, İhsan Doğramacı Bilkent University.by Selim Tezcan.Tezcan, Selim. HIST 203-05TEZCAN HIST 203-05/3 2011-1

The Effect of Clinical, Laboratory and Radiological Findings on Mortality in Patients with Severe COVID-19

Introduction: COVID-19 can range from asymptomatic to critical illness and may result in mortality. In our study, we aimed to evaluate the effect of clinical, laboratory, and radiological findings on mortality in patients diagnosed with severe COVID-19. Materials and Methods: We included SARS-CoV-2 polymerase chain reaction (PCR) positive patients followed up in infectious diseases pandemic and chest diseases pandemic departments at Rize State Hospital in 01.01.2020-31.03.2021. Epidemiological data, chronic diseases, admission symptoms, laboratory findings, and radiological findings of the patients were recorded retrospectively from the patient files. Patients were grouped as survivors and non-survivors. We defined severe disease as patients with pneumonia on radiological imaging, oxygen saturation < 0.05. Results: 135 patients, 110 of whom were survivors and 25 non-survivors, were included in the study. The mean age was 65.5 ± 15.45 years and 61.5% (n= 83) of patients were male. The mean age of the non-survivors was higher compared to survivors (p= 0.007). The mortality rates in patients with coronary artery disease (CAD) and chronic kidney disease (CKD) were statistically higher in non-survivors (p= 0.032, p= 0.032). The rate of tachypnea was found to be statistically higher in the non-survivors (p= 0.001). During the follow-up period, chest X-rays were taken every other day for assessment. The rate of progression was found to be statistically significantly higher in non-survivors (p= 0.004). According to the results of the multivariate logistic regression analysis, the presence of CAD, tachypnea at hospital admission, and progression in chest X-ray were considered independent risk factors for mortality. Conclusion: In this study, the factors that may worsen the disease in the severe COVID-19 disease course were estimated and the presence of CAD, tachypnea, and progression in chest X-ray was found to be independent risk factors for mortality. In addition to chronic diseases and symptoms at presentation, the detection of progression in chest X-ray in the clinical follow-up of patients is a risk factor for mortality, which shows us that radiological follow-up should be kept in mind during the course of the disease

A Case of Enterobacter cloacae Meningitis Secondary to Urinary Tract Infection

Gram-negatif bakterilere bağlı menenjit, genellikle yenidoğanlarda ve yaşlı hastalarda, prostat biyopsisi, beyin cerrahisi gibi girişimlerden sonra veya kafa travmasından sonra gelişebilmektedir. Bu hastalarda akut bakteriyel menenjitin ateş, baş ağrısı ve meninks iritasyonu gibi tipik bulguları görülmeyebilmektedir ve mortalitesi yüksektir. Bu yazıda üriner sistem infeksiyonuna bağlı bakteriyemiye sekonder geliştiği düşünülen bir Gram-negatif bakteri menenjiti olgusu sunulmuştur. Uygun antibiyotik tedavisine rağmen hasta eksitus olmuştur. Özellikle yaşlı ve komorbid hastalığı olan hastalar antibiyotik tedavisine yanıt vermediğinde ve bilinç bozukluğu geliştiğinde santral sinir sistemi infeksiyonu mutlaka akılda tutulmalıdır.Gram-negative bacterial meningitis can usually be seen in neonates and elderly patients, after head trauma or interventions such as prostate biopsy and brain surgery. Typical findings of acute bacterial meningitis such as fever, headache and meningeal irritation signs may not be observed, and mortality rate is high in these patients. In this report, we present a case of Gramnegative bacterial meningitis secondary to bacteremia probably due to urinary tract infection. The patient died despite appropriate antibiotic therapy. Central nervous system infection should be kept in mind especially when elderly patients with comorbid diseases do not respond to antibiotic treatment and changes in mental status develop

A Case of Enterobacter cloacae Meningitis Secondary to Urinary Tract Infection

WOS: 000464106200018Gram-negative bacterial meningitis can usually be seen in neonates and elderly patients, after head trauma or interventions such as prostate biopsy and brain surgery. Typical findings of acute bacterial meningitis such as fever, headache and meningeal irritation signs may not be observed, and mortality rate is high in these patients. In this report, we present a case of Gram-negative bacterial meningitis secondary to bacteremia probably due to urinary tract infection. The patient died despite appropriate antibiotic therapy. Central nervous system infection should be kept in mind especially when elderly patients with comorbid diseases do not respond to antibiotic treatment and changes in mental status develop