Predictive epidemiological, clinical and laboratory parameters in the diagnosis of Crimean-Congo hemorrhagic fever.

Background: The aim of this study is to determine predictive parameters that can be used in the differential diagnosis of Crimean-Congo Hemorrhagic Fever (CCHF) and other diseases with similar clinical and laboratory findings. Materials & methods: In this study, epidemiological, clinical and laboratory parameters of 107 CCHF-positive and 71 CCHF-negative patients were compared. Results: Alanine amino transferase, aspartate aminotransferase, creatine kinase, lactate dehydrogenase, red blood cell, hemoglobin and hematocrit were significantly higher in CCHF-positive patients, whereas total and direct bilirubin, alkaline phosphatase, prothrombin time, international normalization ratio, white blood cell, C-reactive protein and procalcitonin were higher in CCHF-negative patients. In binary logistic regression analysis, an increase in activated partial thromboplastin time level was identified as an independent predictor of having CCHF, while alanine amino transferase, white blood cell and C-reactive protein elevations were identified as independent predictors of not having CCHF. Conclusion: In endemic areas where PCR and serological tests are delayed, knowing the predictive parameters may be of vital importance in the early diagnosis of CCHF.

What is the role of prognostic indexes in COVID-19 patients with diabetes mellitus? Data of patients from Turkey.

Aim: We aimed to determine the prognostic performance of the Glasgow Prognostic Score (GPS), systemic immune-inflammation index and early warning score (the 'ANDC' system) in patients with diabetes mellitus who had COVID-19. Patients & methods: Patients were divided into two groups: with and without diabetes mellitus. Results: In the diabetic patient group, the rates of in-hospital mortality, intensive care unit hospitalization and corticosteroid treatment were higher compared with the nondiabetic patient group (p < 0.05). A GPS of 2 was useful for predicting in-hospital mortality in diabetic patients (p < 0.05). The ANDC score was significantly higher in diabetic patients (p < 0.05) and in diabetic patients with mortality and those who needed ICU hospitalization (p < 0.05). Conclusion: The presence of a GPS of 2 at the time of admission and a high ANDC value were associated with poor prognosis in diabetic COVID-19 patients.

Crimean-Congo Hemorrhagic Fever in Differential Diagnosis During the Coronavirus Disease-2019 Pandemic

Objective: Crimean-Congo Hemorrhagic Fever (CCHF) is a disease of the viral hemorrhagic fever group and is endemic in certain regions in Turkey. Here, the demographic, clinical, and laboratory findings of patients diagnosed with CCHF during the Coronavirus disease-2019 (COVID-19) pandemic were examined, and differential diagnosis was stressed. Methods: This study comprised 12 patients over the age of 18 who were admitted to our clinic after the onset of the COVID-19 pandemic on March 11, 2020 and whose CCHF diagnosis was confirmed by reverse transcription-polymerase chain reaction with viral-RNA or enzyme-linked immunosorbent assay with immunoglobulin M antibodies. Epidemiological, clinical, and laboratory findings as well as treatment and prognosis of the patients were investigated. Results: Of the 12 cases, 10 (83.3%) were men and 2 (16.7%) were women. The median (interquartile range) age was 51 (27-64) years. Eleven (91.7%) patients lived in rural regions, and seven (58.3%) had a history of tick contact. Five patients were hospitalized in an external center with a preliminary diagnosis of COVID-19 and transferred to our center due to clinical and laboratory deterioration. Loss of appetite, headache, fever, weakness, and muscle-joint pain were the most common complaints of the patients. Following the suspicion of COVID-19, thoracic computed tomography (CT) was performed in six patients, five of whom were transferred to an external center. None of the patients had any pathological findings following thoracic CT. Conclusion: Although it is thought that the COVID-19 pandemic will end in the following months owing to vaccine applications, it can be predicted that sporadic cases will still occur for a long time. Therefore, clinicians should take CCHF into consideration in their differential diagnosis. Also, it should be remembered that co-infections can be observed in endemic areas.

Pentraxin-3: A Novel Marker for Indicating Liver Fibrosis in Chronic Hepatitis B Patients?

BACKGROUND/AIMS: PTX-3 is an important marker that plays a role in suppressing inflammation and tissue repair. The aim of this study is to investigate the diagnostic and prognostic characteristics of PTX-3 in CHB patients and the relationship between PTX-3 levels and fibrosis. MATERIALS AND METHODS: A total of 52 CHB patients and 40 healthy subjects were included in the study. All of the CHB patients underwent liver biopsy and were then scored using a Ishak histologic scoring system. Blood samples were collected to evaluate the PTX-3 levels. RESULTS: Of the subjects who participated in the study, 53% were female. PTX-3 levels were determined as 5.63ng/mL in the control group, and as 0.88ng/mL in the CHB patient group. PTX-3 levels were found to be 1.19ng/mL in stage 1, 0.89ng/mL in stage 2, 0.68ng/mL in stage 3 and 0.55ng/mL in stage 4. Of the CHB patients, 44.2% had significant fibrosis, while 55.7% were identified as not having significant fibrosis. PTX-3 values were 0.64 and 1.0ng/mL in patients with and without significant fibrosis, respectively. The cut-off value for PTX-3 in predicting the absence of significant fibrosis was estimated as 0.9ng/mL. CONCLUSION: CHB patients were found to have lower serum PTX-3 levels compared to the control group, and these levels decreased even further as the fibrosis stage progressed in these patients. In addition, the significant decrease in PTX-3 levels in patients with stage 1 fibrosis compared to the control group shows that PTX-3 can be used as a non-invasive marker for the early detection of fibrosis (p<0.001).

Procalcitonin levels among patients with fever secondary to severe intracerebral infection. A cross-sectional study.

BACKGROUND: Making the differential diagnosis between central fever and infectious fever is critically important among intracerebral hemorrhage patients followed up in intensive care units (ICUs). Serum procalcitonin (PCT) has been found to be a promising biomarker for the initial diagnosis of infection, even before culturing results. OBJECTIVES: To investigate the relationship between PCT and both fever etiologies and C-reactive protein (CRP) levels among critically ill patients with suspected intracerebral hemorrhage. DESIGN AND SETTING: Cross-sectional study in a public university hospital in Elazig, Turkey. METHODS: ICU patients diagnosed with intracerebral hemorrhage and normal procalcitonin levels were included in this study. From clinical assessments and cultures, they were classified as presenting either infectious or central fever. The sensitivity and specificity of PCT and CRP for predicting infection were calculated using a receiver operating characteristic (ROC) curve. RESULTS: There were 98 ICU patients with diagnoses of intracerebral hemorrhage. The median (interquartile range) PCT levels of patients with infectious and central fever were 4 (0.9-11) and 0.1 (0.1-0.4) ng/ml, respectively, with a statistically significant intergroup difference (P < 0.001). The areas under the ROC curve for predicting infectious or central fever PCT and CRP were 0.958 (P < 0.001) and 0.816 (P < 0.001), respectively. A statistically significant positive correlation was detected between PCT and CRP levels in patients with infectious fever (rho: 0.461; P = 0.003), but not in patients with central fever. CONCLUSIONS: PCT can possibly be used as a biomarker to differentiate between infectious and central fever among ICU patients.

Crimean Congo Hemorrhagic Fever in Eastern Turkey: Epidemiological and Clinical Evaluation

Objective: The present study aimed to evaluate Crimean-Congo Haemorrhagic Fever (CCHF) in patients hospitalized in our hospital. Methods: A total of 61 adult patients who were diagnosed as having CCHF between January 2011 and August 2018, in whom the diagnosis was confirmed by detecting virus-specific IgM by ELISA and/or by showing viral RNA by RT-PCR and who were managed at our clinic were evaluated retrospectively for their epidemiological and clinical findings, treatment and prognosis. Results: Of the 61 cases, 41 (67.2%) were male and 20 (32.8%) female. The mean age of the patients was 45.31±2.12 years. Sixty (98.4%) patients were living in rural area. Forty four patients (72.1 %) had a tick-bite history. According to months, most of the cases were seen in June, July and May, respectively. Fever, weakness and loss of appetite were the most common complaints of the patients. Treatment of ribavirin was started on the day of admission in all patients. One patient who was admitted in the late period died. The other 60 patients were discharged after being healed. Conclusions: Especially during summers when the disease is seen frequently, the history of tick contact should be questioned and tick should be searched in the examination in the patients with suspected clinical findings. A significant number of the patients do not have a known tick contact. Therefore, training meetings should be organized about the symptoms and findings of the disease in the endemic areas and awareness should be raised among the community and the doctors working in emergency services and primary care.

A Case of Severe Plasmodium falciparum Malaria Co-Infected with HIV Improved with Exchange Transfusion.

In our country, within years, despite a dramatic drop in the number of patients with malaria, a dramatic increase in the number of patients with import malaria is noteworthy. A 32-year-old male patient presented with fever, shivering, malaise, and loss of appetite. He had travelled to West Africa. Laboratory findings were as follows: hemoglobin: 8.8 g/dL and anti-HIV: positive. Microscopic examinations of thin blood smears and thick blood preparations revealed widespread trophozoites. The presence of double-dotted ring forms and banana-shaped gametocytes resulted in Plasmodium falciparum malaria being diagnosed. The patient was started treatment with oral artemether 20 mg/ lumefantrine 120 mg 2×4 tablets and trimethoprim-sulfamethoxazole. During his follow-up, hemoglobin levels regressed to 5.8 g/dL. The patient was diagnosed as having severe malaria. He visited our hematology unit, and exchange transfusion (EET) was recommended. Using an EET apheresis device, eight units of erythrocyte suspension was transfused. The cured patient was discharged. This case was found to be interesting and reminds us the possible presence of comorbid conditions associated with malaria in patients who have a history of travelling abroad. Although its effectiveness has not been proved thus far, as a striking result, EET was used as an alternative treatment in a patient with severe malaria.

High genetic diversity of hepatitis delta virus in eastern Turkey.

INTRODUCTION: Hepatitis delta virus (HDV) is a serious cause of liver-related mortality in patients infected with hepatitis B virus (HBV). Determination of genotypes of HDV and phylogenetic analysis are important for better understanding the pathogenesis of the liver diseases associated with HBV infection. The aim of this study was to determine the genotype or genotypes of HDV among chronically infected patients with HBV in eastern Turkey. METHODOLOGY: A group of 113 patients infected with HBV and HDV were included in this study. The samples taken from the patients were analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR) and restriction enzyme cleavage. RESULTS: According to the results of the restriction enzyme analysis, all of the RT-PCR products were determined to be HDV genotype I. Furthermore, for phylogenetic analysis and genotyping, 40 of HDV RT-PCR positive products were sequenced. Phylogenetic analysis of the sequences showed that all of the samples were infected with HDV genotype I. In addition, the results of the alignment analysis showed that the sequences of clinical samples were 82%-95% similar. CONCLUSION: These results indicate that high genetic diversity of the virus is possible in endemic areas such as Turkey.

Toxocara seroprevalence in schizophrenic patients in Turkey.

PURPOSE: To investigate the seroprevalence of toxocariasis in patients diagnosed as schizophrenia. PATIENTS AND METHODS: Ninety-eight schizophrenic patients hospitalized at The Elazig Psychiatric Hospital were included in the study. Anti-Toxocara IgG and/or IgM antibodies were determined by using commercial Toxocara canis IgG and/or IgM ELISA kit. RESULTS: Seropositivity for T. canis was detected in 45 (45.9%) of 98 patients and 2 (2.0%) of 100 control subjects the difference was statistically significant (p<0.001). The seroprevalence was 40.4% (19 cases) and 51.0% (26 cases) for female and male subjects, respectively (p=0.3). When the seropositive and seronegative schizophrenic patients were compared with respect to the age group environment they were living in, occupation period of follow up and number of hospitalizations, there were no differences between the two groups (all, p>0.05). CONCLUSION: In conclusion, the schizophrenic state seems to present a high risk for Toxocara infection in Turkey.

TNF-alpha and leptin in experimental liver fibrosis models induced by carbon tetrachloride and by common bile duct ligation.

In this study we investigated TNF-alpha and leptin levels in two different liver fibrosis models induced by carbon tetrachloride (CCl(4)) and common bile duct ligation (CBDL). A total of 36 male rats of Albino-Wistar strain were allocated to three groups. One of the groups was the control. The second group received 0.15 ml 100 g(-1) CCl(4) subcutaneously for 6 weeks, 3 days per week. The third group underwent common bile duct ligation (CBDL) and was monitored for 4 weeks. Histopathological investigation included fibrosis, steatosis and inflammation. Serum IL-6 and TNF-alpha levels were analysed by ELISA methods and leptin was analysed by RIA. Fibrosis and steatosis increased significantly in the CCl(4) group in comparison with the CBDL group (p < 0.01; p < 0.001). Leptin and TNF-alpha levels in CCl(4) group were higher than those in the CBDL and control groups (p < 0.05). TNF-alpha and leptin levels were not related to each another in either the CCl(4) group or the CBDL group (r=0.22, p > 0.05; r=0.19, p > 0.05). The IL-6 level was higher in the CCl(4) group in relation to severity of inflammation (p < 0.05). TNF-alpha and leptin levels were higher in animals with liver fibrosis induced by CCl(4), than they were in those whose liver fibrosis was induced by common bile duct ligation. Leptin and TNF-alpha may be less effective on the development of liver fibrosis in the group which underwent common bile duct ligation.

Role of L-carnitine in the prevention of acute liver damage induced by carbon tetrachloride in rats.

BACKGROUND AND AIM: Lipid peroxidation is the most important mechanism in the pathogenesis of acute liver damage with carbon tetrachloride (CCl4). L-carnitine may prevent lipid peroxidation and thus may protect against liver damage. In the present study we investigated the protective effect of L-carnitine in experimental acute liver damage induced by CCl4. METHODS: Fifty rats were allocated to five equal groups. The first group was the control (group 1), the second group received an intraperitoneal CCl4 injection for 3 days (group 2), and the third group received a 50 mg/kg subcutaneous L-carnitine injection for 4 days, beginning a day before CCl4 injection. The CCl4 injection was continued for 3 days in the concerned group (group 3). Group 4 was given a CCl4 injection for 7 days and group 5 received a 50 mg/kg subcutaneous L-carnitine injection for 8 days, beginning a day before CCl4 injection. This group continued to receive a CCl4 injection for 7 days. Rats in groups 2 and 3 were killed on the fifth day. Rats in groups 1, 4 and 5 were killed on the ninth day. Plasma and liver tissue malondialdehyde (MDA) levels, glutathione peroxidase (GSH-Px) activity and liver enzyme levels were studied. Histopathological investigations were conducted. RESULTS: Liver tissue MDA levels decreased significantly in group 3 compared to group 2 (P<0.001). Liver tissue MDA levels in group 5 decreased significantly in comparison to those of group 4 (P<0.001). Liver tissue GSH-Px activity in group 5 was significantly lower than that in group 4 (P<0.05). There were no significant differences between groups 3 and 4 regarding GSH-Px activity (P>0.05). Steatosis, inflammation and necrosis in group 3 were significantly reduced when compared to group 2 (P<0.01). Fibrosis development was not identified in groups 2 and 3. Steatosis in group 5 was significantly lower than that in group 4 (P<0.05) and there were no significant differences between groups 4 and 5 with regards to inflammation and necrosis (P>0.05). Mild fibrosis development was identified in groups 4 and 5 but the difference between the groups was not significant. CONCLUSION: It appears that L-carnitine has a protective effect in the early stage of experimental acute liver damage induced by CCl4. As the toxic effect or damage continues, its effect lessens.