Demographic, Clinical and Radiological Features of Healthcare Workers and Two Index Cases That Were Infected with COVID-19 (SARS-Cov-2)

To evaluate the index cases leading to the transmission of healthcare workers (HCWs) in Rize/Turkey Recep Tayyip Erdogan University Faculty of Medicine Education and Research Hospital with COVID-19 infection and the clinical features of infected HCWs. The first two COVID-19 test positive patients treated at Rize/Turkey between 10.03.2020 and 12.04.2020 and HCWs those who examined these two patients whose COVID-19 PCR test results were positive were included in this study. In Rize/Turkey, the first and second cases of positive COVID-19 which was recorded on 13.03.2020 on 25.03.2020, 27 HCWs (female, 63%, n = 17 and male, 37%, n = 10 and the mean age was 33.2 ± 6.9 years) who contacted during the treatment of these cases and became COVID-19 positive were examined. The median of symptom duration (days) of the HCWs was 5 days (range: 0–17 days). Fever, 55.6% (n = 15); malaise, 44.4% (n = 12); cough, 40.7% (n = 11); sore throat, 33.3% (n = 9); myalgia, 33.3% (n = 9); dyspnea, 14.8% (n = 4); diarrhea, 22.2% (n = 6); vomiting, 14.8% (n = 4); anosmia, 18.5% (n = 5); ageusia, 22.2% (n = 6) and headache, 37% (n = 10) of the cases. The rates of headache in female HCWs infected with COVID-19 were found to be significantly higher compared to men (52.9%). None of them had severe clinical situation requiring intensive care follow-up or acute respiratory distress syndrome (ARDS). Laboratory measurements of HCWs were carried out at the first when they had symptoms and when they recovered, and results were compared accordingly. The thorax computerized tomography (CT) findings of HCWs were normal in 74.1% (n = 20) of total. HCWs were initially affected by the COVID-19 pandemic. Early measures provided by the Health authorities, access to diagnosis and treatment, and the young age average in HCWs prevented severe outcomes such as severe clinical course and mortality at the beginning of the outbreak

Rational Antibiotic Use: How Much Can Duration of Antibiotic Therapy Be Shortened?

KOSTAKOGLU, UGUR/0000-0002-4589-0962WOS: 000463053800009Infectious diseases are conditions with significant consequences in terms of public health while associated mortality, morbidity, and complications can be prevented. Disease severity and duration can be shortened by means of rational antimicrobial therapy. It is important to obey main rational antibiotic use rules ie. to collect and examine appropriate culture specimens before treatment, identify potential microbial agents, consider the pharmacological properties of the antibiotic, determine whether combined antibiotics are indicated, review the host factors and indications for antibiotic therapy modification, and monitor response to antibiotic therapy while planning antibiotic therapy. Once correct diagnosis has been made, the correct antibiotic must be administered via the correct route, at an effective dose, at optimum intervals, and for an appropriate length of time for rational antimicrobial therapy. However, knowledge concerning the optimal duration of treatment is limited. Patients generally receive antibiotic therapy for 10-14 days. Prolonged treatment is also common. Duration of antimicrobial therapy may be a confusing issue for clinicians due to problems of resistance and toxicity. A healthy bacterial ecosystem (i.e. a normal flora) is essential to remain healthy. Antibiotic use can alter the normal bacterial flora in humans, which generally leads to the emergence of multidrug-resistant (MDR) bacteria and side effects such as diarrhea. Infections caused by MDR bacteria result in increased disease and mortality rates and extended hospital stays, as well as increased costs. Studies aimed at shortening the duration of treatment have reported that a 3-5 day treatment period in some of the community-acquired infections and one-week period in some of the nosocomial infections may be sufficient. Based on the patients' individual characteristics and clinical responses to treatment, short-term antibiotic therapy may be administered in selected patient groups both in community-acquired and healthcare-associated infections. Rational antibiotic therapy, together with observation of response to treatment and optimal treatment durations (which remain to be determined) can prevent adverse outcomes associated with long-term antibiotic use such as antibiotic-related side effects and development of MDR bacteria

An assessment of ventilator-associated pneumonias and risk factors identified in the Intensive Care Unit

KOSTAKOGLU, UGUR/0000-0002-4589-0962WOS: 000383112000005PubMed: 27648020Objectives: Ventilator-associated pneumonia (VAP) is a significant cause of hospital-related infections, one that must be prevented due to its high morbidity and mortality. the purpose of this study was to evaluate the incidence and risk factors in patients developing VAP in our intensive care units (ICUs). Methods: This retrospective cohort study involved in mechanically ventilated patients hospitalized for more than 48 hours. VAP diagnosed patients were divided into two groups, those developing pneumonia (VAP(+)) and those not (VAP(-)). Results: We researched 1560 patients in adult ICUs, 1152 (73.8%) of whom were mechanically ventilated. the MV use rate was 52%. VAP developed in 15.4% of patients. the VAP rate was calculated as 15.7/1000 ventilator days. Mean length of stay in the ICU for VAP(+) and VAP(-) patients were (26.7 +/- 16.3 and 18.1 +/- 12.7 days (p<0.001)) and mean length of MV use was (23.5 +/- 10.3 and 12.6 +/- 7.4 days (p<0.001)). High APACHE II and Charlson co-morbidity index scores, extended length of hospitalization and MV time, previous history of hospitalization and antibiotherapy, reintubation, enteral nutrition, chronic obstructive pulmonary disease, cerebrovascular disease, diabetes mellitus and organ failure were determined as significant risk factors for VAP. the mortality rate in the VAP(+) was 65.2%, with 23.6% being attributed to VAP. Conclusion: VAPs are prominent nosocomial infections that can cause considerable morbidity and mortality in ICUs. Patient care procedures for the early diagnosis of patients with a high risk of VAP and for the reduction of risk factors must be implemented by providing training concerning risk factors related to VAP for ICU personnel, and preventable risk factors must be reduced to a minimum

The Prognostic Significance of Serum Troponin T Levels in Crimean-Congo Hemorrhagic Fever Patients

KOSTAKOGLU, UGUR/0000-0002-4589-0962;WOS: 000393892900004PubMed: 26693839Crimean-Congo Hemorrhagic Fever (CCHF) is a disease transmitted by the Crimean-Congo hemorrhagic fever virus (CCHFV), characterized by severe fever and hemorrhage and with a reported fatality level of 3-30%. Cerebral hemorrhage, gastrointestinal hemorrhage, severe anemia, shock, myocardial infarction, pulmonary edema, and pleural effusion may be seen as causes of death. Cardiac troponin T (cTn-T) is a biochemical marker with high sensitivity and specificity in myocardial injury. the purpose of this study was to determine the prognostic significance of serum troponin T levels in CCHF patients. Patients hospitalized with a diagnosis of CCHF and whose serum cTn-T was investigated were examined retrospectively. Patients were divided into two groups on the basis of presence or absence of hemorrhage. Data were subjected to statistical analysis. One hundred thirty-five CCHF patients and 72 control subjects were included. Hemorrhage was present in 48 (35.6%) patients. Mean serum cTn-T level was 17.3 +/- 28.0 ng/L in the patients with hemorrhage, 9.98 +/- 5.97 ng/L in the non-hemorrhage patients (P = 0.001) and 6.6P = 2.6 ng/L in the control samples (P < 0.001). At a cTn-T level cut-off point of 9 ng/L, area under the ROC curve was 0.797 (95% CI: 0.730-0.854), sensitivity 83.0%, specificity 87.5%, PPD 95.7%, and NPV 60.3%. At logistic regression analysis, a rise in cTn-T level above 14 ng/L increased the probability of hemorrhage in CCHF patients approximately threefold. An increased troponin T level may be a prognostic risk factor for hemorrhage in CCHF patients. This marker should therefore be borne in mind in determining treatment strategy in these patients. (C) 2015 Wiley Periodicals, Inc

The protective effects of angiotensin-converting enzyme inhibitor against cecal ligation and puncture-induced sepsis via oxidative stress and inflammation

KOSTAKOGLU, UGUR/0000-0002-4589-0962; Mercantepe, Tolga/0000-0002-8506-1755WOS: 000506211900002PubMed: 31733315Aims: Sepsis is a severe public health problem affecting millions of individuals, with global mortality rates caused by lower respiratory tract infections are approximately 2.38 million people a year die from respiratory failure caused by infection. Although ACE is known to contribute to damage in septicemia, the pathophysiological mechanisms of sepsis remain unclear. While mortality can be significantly reduced through effective and sensitive antibiotic therapy, antibiotic resistance restricts the use of these drugs, and the investigation of novel agents and targets is therefore essential. Our aim was to determine whether Perindopril (PER) has anti-inflammatory and antioxidant capable of preventing these adverse conditions resulting in injury in previous studies. Main methods: Sprague Dawley rats were randomly assigned into the control group, received oral saline solution alone for four days. the cecal ligation and puncture (CLP) group, underwent only cecal ligation and puncture induced sepsis, while the CLP + PER (2 mg/kg) underwent cecal ligation and puncture-induced sepsis together with oral administration of 2 mg/kg PER for four days before induction of sepsis. Key findings: Malondialdehyde (MDA), tumor necrosis factor-alpha (TNF-alpha), Caspase-3 and nuclear factor kappa B (NF-k beta/p65) levels increased in the CLP group. on the other hand, PER (2 mg/kg) oral administration to septic rats decreased MDA, TNF-alpha and increase glutathione (GSH) in the lung tissue. in addition, PER administration also decreased the lung tissue NF-kappa B and Caspase-3 immunopositivity against sepsis. Significance: PER treatment may represent a promising means of preventing sepsis-induced lung injury via antioxidant and anti-inflammation effects

The relationship between diagnostic value of chest computed tomography imaging and symptom duration in COVID infection

WOS: 000546364200008PubMed: 32831937OBJECTIVES: Severe acute respiratory syndrome-coronovirus-2 is a global public health problem, in which early diagnosis is required to prevent the spread of infection. in this study, we aimed to reveal the diagnostic value of chest computed tomography (CT) imaging with respect to symptom duration. METHODS: This retrospective study involved patients from five centers, who were admitted with typical COVID-19 symptoms and found to be positive for COVID-19 real-time reverse transcription-polymerase chain reaction (rtRT-PCR) test. RESULTS: One hundred and five patients with positive COVID-19 rtRT-PCR test were involved in the study. Sixty percent of these patients had chest CT imaging findings consistent with COVID-19 pneumonia. the most common chest CT finding was bilateral and subpleural ground-glass opacity in middle-lower lobes of the lungs. Chest CT findings were detected in 85.1% of the patients with a symptom duration of more than 2 days. in receiver operating characteristic analysis of this parameter, area under the curve (AUC) was 0.869, while sensitivity and specificity were 90.5% and 76.2%, respectively. It was notable that chest CT findings were 7.17 times more common among the patients aged 60 years and older, with AUC, specificity, and positive predictive value of 0.768, 88.1%, and 84.8%, respectively. CONCLUSION: Chest CT imaging is a quite valuable tool in patients with longer than 2 days' duration of symptoms, in whom clinical and epidemiological data support the diagnosis of COVID-19 infection. We suggest that the diagnosis of COVID-19 pneumonia should be made with chest CT imaging when rtRT-PCR test cannot be performed or gives a negative result, which is important for public health and to prevent the spread of infection

Fever of Unknown Origin: Tuberculosis and HIV Coinfection

KOSTAKOGLU, UGUR/0000-0002-4589-0962; ERTURK, AYSE/0000-0001-6413-9165WOS: 000481718600022Infections are the most common causes of fever of unknown origin (FUO). Both human immunodeficiency virus (HIV) itself and its concomitant opportunistic infections cause FUO. Clinically, the symptoms and findings are often elusive and difficulties are encountered in diagnosis and treatment. A 40-year-old male was admitted to our outpatient clinic with fever, shortness of breath, dry cough increasing at night and weight loss. the patient was hospitalized with FUO and was diagnosed as HIV and tuberculosis coinfection. the HIV RNA level of the patient was 3 892 819 copy/mL and the CD4 count was 97/mm(3). Antitetroviral therapy was postponed for 8 weeks in the light of current guidelines and antituberculosis treatment was started. As this patient showed that HIV status of patients with tuberculosis should be established. Furthermore, both the drug-drug interactions and development of immune reconstitution inflammatory syndrome should be considered in the treatment of HIV-infected patients with tuberculosis coinfection

Prognostic value of hematological parameters

KOSTAKOGLU, UGUR/0000-0002-4589-0962;WOS: 000435652100002Aim: Acute bacterial and viral infections are usually associated with elevations of the mean platelet volume. We correlated infection with influenza changes in mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), to determine whether these might be predictors for the duration of hospitalization or mortality. Material and Method: A total of 122 influenza patients (54 males and 68 females), including 87 children and 35 adults, and 42 age-gender-matched healthy individuals (18 males and 24 females) including 25 children and 17 adults were included in the study. Hematologic tests were conducted on the patients and controls. Linear regression analysis was used to determine independent predictors of hospitalization. Results: the MPV was significantly higher in influenza patients [10.7 (min/max 7.5-15) fL] than in the healthy control group [7.8(min/max 5.7-10.8) fL, p<0.001]. the NLR and PLR were similar in both groups. There was no correlation between MPV, NLR, or PLR and mortality. Predictors of hospitalization were determined to be neutrophil level (NL) and NLR and PLR ratios (p = 0.00, p = 0.035 and p = 0.041, respectively). Discussion: Neutrophil, MPV, NLR, and PLR were significantly higher in the influenza group. While the MPV was not determined to correlate with the length of stay and mortality in the patient group, the higher levels of NLR and PLR and increased neutrophil levels predicted the duration of hospitalization

Determination of the staphylococcal cassette chromosome in methicillin-resistant Staphylococcus aureus strains isolated from various clinical samples

KOSTAKOGLU, UGUR/0000-0002-4589-0962; SANDALLI, Cemal/0000-0002-1298-3687WOS: 000408494600002Aim - the present study aimed to detect mecA and staphylococcal cassette chromosome mec (SCCmec) types in methicillin-resistant Staphylococcus aureus (MRSA) isolates obtained from various clinical samples in two university hospitals. It was also aimed to make comparison amongst the isolates. Materials and Methods - A total of 99 MRSA strains isolated from various clinical samples between 2011-2015 were included in the study. Bacterial deoxyribonucleic acid (DNA) was extracted from Staphylococcus aureus strains using GF-1 DNA extraction Kit (Vivantis, Malaysia). mecA gene were detected, and SCCmec cassette types were determined by multiplex polymerase chain reaction (PCR) first, and following specific PCR. Specific MRSA strains such as COL type I, PER3 type Ia, and HU25 type IIIa were used as the quality control strains for optimization of multiplex PCR. the amplification products were electrophoresed using agarose gel electrophoresis in TAE buffer (mixture of tris base, acetic acid and ethylenediaminetetraacetic acid). Results - mecA gene was detected in 60 Staphylococcus aureus isolates, and these were identificated as MRSA. Amongst the MRSA strains, SCCmec type III was the most frequent cassette type (42 isolates, 70.0%). SCCmec type I was detected in 27 isolates (45.0%), type II was in 26 isolates (43.3%), and type V in 23 isolates (38.3%). Conclusion - in the present study, the most frequent cassette was detected as SCCmec type III in concordance with the studies conducted in Turkey and in some regions in the world. in conclusion, determination of epidemiological and molecular characteristics of MRSA strains has critical importance because of the difficulties in the treatment and of the nosocomial infections and epidemics they caused. the data obtained would contribute to the preventions in terms of epidemiology

Carbonic anhydrase I-II autoantibodies and oxidative status in long-term follow-up of patients with Crimean-Congo haemorrhagic fever

KOSTAKOGLU, UGUR/0000-0002-4589-0962; Demir, Selim/0000-0002-1863-6280WOS: 000425063500009PubMed: 28796539Context: Crimean-Congo haemorrhagic fever (CCHF) is a life-threatening acute febrile haemorrhagic disease. Objective: This study was to measure levels of the oxidative stress biomarkers malondialdehyde (MDA), total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) and of CA I-II autoantibodies as biomarkers for autoimmunity and course of disease in patients with CCHF. Methods: Seventy CCHF patients and 39 healthy control volunteers were included in the study. Results: Serum MDA and TAS levels were significantly higher (p < .0001) and serum TOS and OSI levels were significantly lower (p < .0001) in both the acute period and at 6th-month follow-up in the CCHF patients compared to the healthy volunteers. CA II levels were significantly higher in the acute period compared to the healthy volunteers (p < .005) and were significantly lower at 6th-month follow-up (p < .05). Conclusion: Serum MDA and CA II autoantibodies appear to reflect oxidative stress status and disease progression in CCHF and may be used as biomarkers for oxidative stress and disease progression