Hepatit B enfeksiyonu olan hastalarda yaşanılan zorlukların değerlendirilmesi

Objectives: Although stigma is well defined in people with a chronic disease or condition, it has not been studied much in individuals infected with hepatitis B virus (HBV). The study is one of the first descriptive individual studies conducted on this subject in our country. Our aim in this study was to evaluate the stigma experiences and concerns of individuals living with HBV, their sharing of their illness with the environment, and the state of being affected by their social relationships. Materials and Methods: Patients with hepatitis B surface antigen positivity who were admitted to the infectious diseases outpatient clinic were surveyed through face-to-face interviews. Epidemiological data, stigma experiences and anxiety states, people with whom they shared their illness, the reasons for not sharing, the impairment of social relations were questioned. Results: It was found that 19.5% of 390 individuals infected with HBV who participated in our study were "exposed" to stigma in various ways, and 27.4% were "worried" about experiencing this condition. In research, 19.9% of women, 41.4% of university graduates, and 34.8% of divorced or widowers were found to experience higher stigma (p=0.002, p=0.02 and p<0.001, respectively). It was determined that 56.7% of the participants did not share their illnesses, and this need increased with stigma experiences and anxiety. It was found that individuals mostly shared their disease status with their first-degree relatives (p<0.001). Conclusion: The fact that individuals infected with HBV experience different forms of stigma or experience anxiety suggests that there is a need to investigate these conditions and develop treatment interventions

Is liver biopsy necessary in patients with chronic hepatitis B with normal alanine aminotransferase level?

Objectives: If not treated early, morbidity and mortality will remain high in hepatitis B virus infection. In this study, it was aimed to analyze the liver biopsy results of patients with chronic hepatitis B with normal alanine aminotransferase (ALT) levels. Materials and Methods: The study was conducted retrospectively. The patients who were admitted in the infectious diseases and clinical microbiology outpatient clinic, had liver biopsy and received treatment between 01.09.2019 and 01.12.2019, were included. Results: A total of 169 patients were included in the study. Of the individuals, 95 (56.2%) were female, with a mean age of 42.4 +/- 11.15 years. The rates of having an histological activity index (HAI) score of 6/18 and above and a fibrosis stage of 2/6 or more (90%, 100%, respectively) in patients with ALT level above upper limit of normal (ULN) were higher than in patients with ALT level below ULN (63.6% and 79.1%, respectively) (p=0.001 and p=0.002, respectively). When 129 patients with ALT level below ULN were evaluated in subgroup analyses. HAI score was 6 or higher in 59 (58.4%) of the hepatitis B e antigen (HBeAg) negative patients, and fibrosis stage was 2 or higher in 76 (75.2%) patients. In patients with ALT below ULN and HBeAg positivity, the rates of HAI score of 6 and above and fibrosis stage of 2 and above were found to be statistically significantly higher than in HBeAg negative patients. Conclusion: Liver fibrosis and necroinflammation may develop in patients with normal ALT levels. In making the biopsy decision, ALT level should be considered together with other factors that may affect liver damage

COVID 19 disease independently predicted endothelial dysfunction measured by flow-mediated dilatation

The systemic effects of COVID-19 disease are still largely uncertain and needs to be scrutinized with further trials. Endothelial dysfunction (ED) is responsible for the majority of adverse cardiovascular events. Flow-mediated dilation (FMD) is easily obtainable method to assess ED accurately. It is aimed to evaluate ED by measuring FMD following COVID-19 disease. Patients diagnosed with COVID-19 disease were recruited to the hospital two month after the discharge. Sex and age-matched healthy subjects were determined as the control group. Blood samples and FMD measurements were obtained from each participant. All subjects were divided into two groups according to the presence of ED determined by FMD measurements. These two groups were compared in terms of demographic features and the presence of recovered COVID-19 disease. A total of 92 subjects consisting of 59 without ED and 33 with ED were included in the study. ED (+) group was older (p = 0.015) and more likely to have hypertension (p = 0.044) and COVID-19 rate was higher in ED (+) group (p = 0.009). While neutrophil count (p = 0.047) and CRP (p = 0.036) were higher, eGFR (p = 0.044) was lower in ED (+) group. In the backward multivariable regression analysis, COVID-19 disease [OR = 3.611, 95% CI 1.069-12.198, p = 0.039] and BMI [OR = 1.122, 95% CI 1.023-1.231, p = 0.015] were independent predictors of ED. COVID-19 disease may cause ED which is the major underlying factor of cardiovascular diseases. Furthermore, COVID-19 disease may deteriorate the existing cardiovascular disease course. Detecting ED in the early phase or preventing by new treatment modalities may improve short and long-term outcome

Investigation of atypical agents in respiratory tract infections

Bu prospektif çalışmada, yaklaşık 1 yıllık bir sürede (Ocak 1999-Mayıs 2000) solunum yolu infeksiyonlarının etyolojik tanısı için 7 viral ve 3 atipik bakteriye ait antijenler immünfloresan yöntemle araştırılmıştır. Solunum yolu infeksiyonu semptomu olan pediatrik (grup l, 76 olgu) ve erişkin (grup II, 135 olgu) yaş grubundaki hastalarda, solunum yolu sekresyonları elde edilmiştir. Etyolojik tanı; pediatrik olgularda %45.4, erişkin olgularda ise %67.3 oranında konulmuştur. Grup l ve grup ll'de sırasıyla; Chlamydia pneumoniae %17.8, %13.3; Mycoplasma pneumoniae %0, %9.6; influenza A virüsü %3.9, %16.3; adenovirüs %3.9, %14.8; parainfluenza virüs tip 1 %5.3, %7.4; respiratuar sinsityal virüs %9.2, %1.5; parainfluenza virüs tip 2 %3.9, %3.0 ve influenza B virüs %1.3, %1.5 oranlarında tespit edilmiştir. Hastaların %2.6 ve %3.9'unda birden fazla etken bulunurken, parainfluenza virüs tip 3 ile Legionella pneumophila'ya ait antijen tespit edilmemiştir. Kullanılan immünfloresan yöntemin etyolojik tanıya katkısı ve sonuçların rasyonel antibiyotik kullanımına etkisi tartışılmıştır.In this prospective study, 7 viral and 3 atypical bacteria antigens were investigated by immunofluorescence method during January 1999-May 2000 for the etiological diagnossis of respiratory tract infections. Respiratory tract secretions were obtained from children (group I, 76 cases) and adults (group II, 135 cases) who had symptoms of respiratory tract infections. Etiological diagnosis was reported as 45.4% in pediatric cases and 67.3% in adults. In group I and group II; the rates of Chlamydia pneumoniae was 17.8%, 13.3%; Mycoplasma pneumoniae 0%, 9.6%; influenza A virus 3.9%, 16.3%; adenovirus 3.9%, 14.8%; parainfluenza virus type 1 5.3%, 7.4%; respiratory syncytial virus 9.2%, 1.5%; parainfluenza virus type 2 3.9%, 3.0%; and influenza B virus 1.3%, 1.5% respectively. In 2.6% and 3.9% of the patients in two groups two or more etiological agents were identified. Parainfluenza virus type 3 and Legionella pneumophila antigens could not be determined in any of the patients. The advantage of immunofluorescence method for the etiological diagnosis and the effect of results to the rational antibiotic use were discussed

Investigation of atypical agents in respiratory tract infections

Bu prospektif çalışmada, yaklaşık 1 yıllık bir sürede (Ocak 1999-Mayıs 2000) solunum yolu infeksiyonlarının etyolojik tanısı için 7 viral ve 3 atipik bakteriye ait antijenler immünfloresan yöntemle araştırılmıştır. Solunum yolu infeksiyonu semptomu olan pediatrik (grup l, 76 olgu) ve erişkin (grup II, 135 olgu) yaş grubundaki hastalarda, solunum yolu sekresyonları elde edilmiştir. Etyolojik tanı; pediatrik olgularda %45.4, erişkin olgularda ise %67.3 oranında konulmuştur. Grup l ve grup ll'de sırasıyla; Chlamydia pneumoniae %17.8, %13.3; Mycoplasma pneumoniae %0, %9.6; influenza A virüsü %3.9, %16.3; adenovirüs %3.9, %14.8; parainfluenza virüs tip 1 %5.3, %7.4; respiratuar sinsityal virüs %9.2, %1.5; parainfluenza virüs tip 2 %3.9, %3.0 ve influenza B virüs %1.3, %1.5 oranlarında tespit edilmiştir. Hastaların %2.6 ve %3.9'unda birden fazla etken bulunurken, parainfluenza virüs tip 3 ile Legionella pneumophila'ya ait antijen tespit edilmemiştir. Kullanılan immünfloresan yöntemin etyolojik tanıya katkısı ve sonuçların rasyonel antibiyotik kullanımına etkisi tartışılmıştır.In this prospective study, 7 viral and 3 atypical bacteria antigens were investigated by immunofluorescence method during January 1999-May 2000 for the etiological diagnossis of respiratory tract infections. Respiratory tract secretions were obtained from children (group I, 76 cases) and adults (group II, 135 cases) who had symptoms of respiratory tract infections. Etiological diagnosis was reported as 45.4% in pediatric cases and 67.3% in adults. In group I and group II; the rates of Chlamydia pneumoniae was 17.8%, 13.3%; Mycoplasma pneumoniae 0%, 9.6%; influenza A virus 3.9%, 16.3%; adenovirus 3.9%, 14.8%; parainfluenza virus type 1 5.3%, 7.4%; respiratory syncytial virus 9.2%, 1.5%; parainfluenza virus type 2 3.9%, 3.0%; and influenza B virus 1.3%, 1.5% respectively. In 2.6% and 3.9% of the patients in two groups two or more etiological agents were identified. Parainfluenza virus type 3 and Legionella pneumophila antigens could not be determined in any of the patients. The advantage of immunofluorescence method for the etiological diagnosis and the effect of results to the rational antibiotic use were discussed

COVID-19 infection in pregnancy: A single-center experience in Rize in the Eastern Black Sea Region

Aim: In this study, it was aimed to share the clinical experiences of mothers and their babies (perinatal, natal) who encountered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy. Material and Methods: The study was carried out retrospectively, 62 pregnant individuals were diagnosed with the 2019 coronavirus disease (COVID-19). Demographic characteristics, clinical course, laboratory and radiological findings and clinical results of the baby were evaluated by examining electronic and file records. Results: The average age of the 62 pregnant women included in the study was 29.8 +/- 4.7 (19-42) years, and the average gestational week at the time of admission was 28.5 +/- 10.4 (5-40) weeks. More than half of the patients (80,6%) on admission were in their third trimester. The most common initial symptoms were cough (45.2%), myalgia (43.5%),) fever (21%). In total, 15 of the pregnant women had evidence of COVID-19 pneumonia in lung involvement. The PCR test results of all pregnant women were positive. There were three cases admitted to the intensive care unit, one of whom was due to gestational diabetes. No maternal mortality was recorded. One gestation ended in a miscarriage and two women gave birth prematurely. One stillbirth occurred at the 33h week of gestation. Among 22 neonates, two were admitted to the neonatal intensive care unit. Neonatal mortality, congenital malformation, and mother- to- child transmission were not observed in newborns. Discussion: The results of our study suggest that the clinical course of COVID-19 infection in pregnant women was mostly asymptomatic/mild

Distribution and antimicrobial susceptibilities of stenotrophomonas maltophilia strains ısolated from various clinical samples: an 8-year study

Amaç: Hastane enfeksiyonları ve buna bağlı mortalitenin artması çoklu ilaç direncine sahip fırsatçı patojenleri her zamankinden daha fazla gündeme getirmiştir. Bunlar arasında yer alan stenotrophomonas maltophilia önemi giderek artan fırsatçı bir patojendir. Bu çalışmanın amacı,sekiz yıllık süre boyunca hastanemizde çeşitli klinik örneklerden izole edilmiş S. maltophilia izolatlarının dağılımını ve antimikrobiyal duyarlılıklarını araştırmaktır. Yöntemler: Ocak 2011-Aralık 2019 tarihleri arasında çeşitli klinik örneklerden izole edilen toplam 149 S. maltophilia suşunun antimikrobiyallere direnç oranları araştırıldı. Bakteri identifikasyonu ve antibiyotik duyarlılığı rutin konvansiyonel mikrobiyolojik yöntemler ve VİTEK 2 kompakt otomatize sistem (BioMerieux, France) ile yapılmıştır. Bulgular: S. maltophilia en sık yoğun bakım ünitelerinde izole edilirken 50 (%33,5), en az 1 örnekle ( %0,6) Kardiyovasküler cerrahi servisi, Pediatri servisinden izolasyon gerçekleşmiştir. Örneklerin 85’i (%57,) solunum yolu izolatları olurken (trakeal aspirat, lavaj, balgam), en az 1 örnek ( %0,6) ile plevra ve eklem sıvısı olmuştur. Karbapenemlere doğal direnç gösteren S. maltophilia’da levofloksasin direnci % 6 iken, trimetoprim/sulfametoksazol’de %12, seftazidim’de %45 olarak tespit edilmiştir. Tartışma ve Sonuç: Çalışmada saptanan yüksek direnç oranları nedeniyle, S. maltophilia suşlarının etken olduğu nozokomiyal enfeksiyonların tedavisinde mümkün olduğunca in vitro duyarlılık testlerinin yapılması gerekir. Bunun yapılamadığı durumlarda ise tedavi planlamasında trimetoprim-sulfametoksazol ve levofloksasin iyi birer tedavi seçeneğidir. Ayrıca tedaviye başlamadan önce kolonizasyon - etken ayrımı klinik bulgularda göz önünde tutularak birlikte karar verilmelidirObjective: Hospital infections which associated with increased mortality have brought opportunistic pathogens like Stenotrophomonas maltophilia, with multiple drug resistance into focus. The aim of this study was to investigate the distribution and antimicrobial susceptibility of S. maltophilia isolates obtained from various clinical samples in our hospital for a period of eight years. Method: Antimicrobial resistance rates of 149 strains of S. maltophilia isolated from various clinical samples between January 2011 and December2019 were investigated. Bacterial identification and antibiotic susceptibility were performed with routine conventional microbiological methods and the VITEK 2 compact automated system (BioMerieux, France). Results: While S. maltophilia was most frequently isolated in intensive care units, from a total of 50 samples (33.5%), the rate was 0.6% (1 sample) the cardio vascular surgery service and pediatrics services. 85 (57%) of the samples were respiratory tract isolates (tracheal aspirate, lavage, sputum) with at least 1 (0.6%) pleural and joint fluid. Among these isolates of S maltophilia, which shows natural resistance to carbapenems, resistance for levofloxacin was 6% and for trimethoprim/ sulfamethoxazole was 12%. Conclusion: Due to the high resistance rates observed in the study, in vitro susceptibility tests should be used as much as possible in the treatment of nosocomial infections caused by S. maltophilia strains. In cases where this is not possible and empirical treatment is required, trimethoprim-sulfamethoxazole and levofloxacin are reasonable treatment options. Also, before starting treatment, the separation between colonization and agent should be decided in accordance with the clinical findings

Diagnostic value of Chest CT and Initial Real-Time RT-PCR in COVID-19 Infection

Objectives: To evaluate the diagnostic value of the rtRT-PCR test and CT in patients presenting with typical clinical symptoms of COVID-19. Methods: The study with the participation of four center in Turkey was performed retrospectively from 20 March-15 April 2020 in 203 patients confirmed for COVID-19. The initial rtRT-PCR test was positive in 142 (70.0%) of the patients (Group-I) and negative in 61 patients (Group-II). Results: The mean age of the patients in Group-I was 49.718.0 years and the time between the onset of symptoms and admission to the hospital was 3.6 +/- 2.0 days; whereas the same values for the patients in Group-II were 58.1 +/- 19.9 and 5.3 +/- 4.2, respectively (p=0.004; p=0.026). Initial rtRT-PCR was found positive with 83.5% sensitivity and 74.1% PPV in patients with symptom duration of less than five days. It was found that rtRT-PCR positivity correlated negatively with the presence of CT findings, age, comorbidity, shortness of breath, and symptom duration, while rtRT-PCR positivity correlated positively with headache. Presence of CT findings was positively correlated with age, comorbidity, shortness of breath, fever, and the symptom duration. Conclusions: It should be noted that a negative result in the rtRT-PCR test does not rule out the possibility of COVID-19 diagnosis in patients whose symptom duration is longer than five days, who are elderly with comorbidities and in particular who present with fever and shortness of breath. In these patients, typical CT findings are diagnostic for COVID-19. A normal chest CT is no reason to loosen up measures of isolation in patients with newly beginning symptoms until the results are obtained from the PCR test

Comparison of two pandemics: H1N1 and SARS-CoV-2

OBJECTIVE: We aimed to compare the clinical, epidemiological, and prognostic features of the H1N1 pandemic in 2009 and the severe acute respiratory syndrome coronavirus 2 pandemic in 2020. METHODS: This retrospective study involved subjects from seven centers that were admitted and found to be positive for H1N1 or COVID-19 real-time polymerase chain reaction test. RESULTS: A total of 143 patients with H1N1 and 309 patients with COVID-19 were involved in the study. H1N1 patients were younger than COVID-19 ones. While 58.7% of H1N1 patients were female, 57.9% of COVID-19 patients were male. Complaints of fever, cough, sputum, sore throat, myalgia, weakness, headache, and shortness of breath in H1N1 patients were statistically higher than in COVID-19 ones. The duration of symptoms until H1N1 patients were admitted to the hospital was shorter than that for COVID-19 patients. Leukopenia was more common in COVID-19 patients. C-reactive protein levels were higher in COVID-19 patients, while lactate dehydrogenase levels were higher in H1N1 ones. The mortality rate was also higher in H1N1 cases. CONCLUSIONS: The severe acute respiratory syndrome coronavirus 2 pandemic is a major public health problem that continues to affect the world with its high rate of contagion. In addition, no vaccines or a specific drug for the benefit of millions of people have been found yet. The H1N1 pandemic is an epidemic that affected the whole world about ten years ago and was prevented by the development of vaccines at a short period. Experience in the H1N1 pandemic may be the guide to prevent the COVID-19 pandemic from a worse end

Naiv hepatit C enfeksiyonlu hastaların on-altı yıllık prognozu

Objectives: In this study, we aimed to evaluate the clinical course of treatment-naive patients infected with hepatitis C virus (HCV) who were followed up in various centers in Turkey. Materials and Methods: This was a retrospective study performed with the participation of 15 centers. Patients aged 18 years and older with HCV infection were included. Results: A total of 391 treatment-naive patients infected with HCV were included in this study. During the follow-up period, the final values of alanine aminotransferase, aspartate transaminase, and total protein were significantly decreased when compared to the initial values (p<0.001, p<0.001, and p=0.005, respectively). In the study group, 19.2% of the patients underwent liver biopsy and 4.1% underwent transient elastography (FibroScan). An increased histological activity index (HAI) score and fibrosis in the second biopsy were observed in one patient, only increased HAI in two patients and increased fibrosis in one patient, as shown on the FibroScan. In the 16 years of the study period, cirrhosis was radiologically detected in only one patient. Conclusion: Even if rapid progression is not observed, close monitoring of the clinical findings related to liver failure and fibrosis with invasive or non-invasive methods may be useful.Amaç: Bu çalışmada ülkemizin çeşitli merkezlerinde takip edilen naiv hepatit C virüs (HCV) ile enfekte hastaların klinik seyrini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Bu çalışma retrospektif olarak 15 merkezin katılımıyla gerçekleştirilmiştir. Çalışmaya 18 yaş üstü, HCV enfeksiyonu olan hastalar dahil edilmiştir. Bulgular: Çalışmada 391 tedavi-naiv HCV enfeksiyonlu hasta yer almıştır. Hastaların takip süresinde son alanine aminotransferase, aspartate transaminase ve total protein değerleri ilk düzeyine göre önemli düzeyde azalmıştır (sırasıyla p<0,001, p<0,001, p=0,005). Çalışma grubunda hastaların %19,2’sine karaciğer biyopsisi, %4,1’ine elastografi (FibroScan) uygulanmıştır. Takip esnasında bir hastada ikinci biyopside histolojik aktivite indeksi (HAI) ve fibroziste artma, iki hastada sadece HAI’da artma, birinde FibroScan ile fibrozis değerinde artma olduğu gözlenmiştir. Bir hastada 16 yıl içinde radyolojik olarak siroz saptanmıştır. Sonuç: Hızlı progresyon gözlenmemekle birlikte hastaların izleminde karaciğer yetmezliği ile ilgili klinik bulguların ve invaziv veya noninvaziv yöntemlerle fibrozisin yakın takibi yararlı olabilir