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.

Effects of cytokine hemadsorption as salvage therapy on common laboratory parameters in patients with life-threatening COVID-19.

BACKGROUND: The COVID-19 pandemic has led to emergency approval of treatment modalities unusual for viruses, such as therapeutic cytokine Hemadsorption(HA). This study aims to investigate the experience of salvage HA therapy and the effect of HA on routine laboratory tests. METHODS: Life-threatening COVID-19 patients followed up between April 2020 and October 2022 who underwent HA salvage therapy were retrospectively enrolled. Data derived from the medical records were evaluated to meet the assumptions of statistical tests, and those that met the relevant statistical rules were selected for further analysis. Tests of Wilcoxon, Paired-T, and repeated measures-ANOVA were used to analyse the laboratory tests performed before and after HA among the surviving and nonsurviving patients. P < 0.05 was selected for the statistical significance of the alpha. RESULTS: A total of 55 patients were enrolled in the study. Fibrinogen (p = 0.007), lactate dehydrogenase (LDH) (p = 0.021), C-reactive protein (CRP) (p < 0.0001), and platelet (PLT) (p = 0.046) levels showed a significant decrease with the HA effect. WBC (p = 0.209), lymphocyte (p = 0.135), procalcitonin (PCT) (p = 0.424), ferritin (p = 0.298), and D-dimer (p = 0.391) levels were not affected by HA. Ferritin level was significantly affected by survival status (p = 0.010). All patients tolerated HA well, and 16.4 % (n = 9) of the patients with life-threatening COVID-19 survived. CONCLUSION: HA is well tolerated even when used as a last option. However, HA may not affect WBC, lymphocyte, and D-dimer levels. In contrast, the effect of HA could limit the benefits of LDH, CRP, and fibrinogen in various clinical assessments. This study suggests that HA treatment could be beneficial even if selected as a salvage therapy.

[A Histopathologically Diagnosed Neurocysticercosis Case from Türkiye]. / Türkiye'de Histopatolojik Olarak Tanisi Konulmus Bir Nörosistiserkoz Olgusu.

Cysticercosis is a parasitic tissue infection caused by larval cysts of Taenia solium. Although the disease affects many tissues, it primarily affects the brain and muscles. The most common form is neurocysticercosis, a term used for human central nervous system involvement with T.solium cysts. Neurocysticercosis is an important public health problem in many parts of the world. Its prevalence is particularly high in places where T.solium tapeworms are common, such as Mexico, Central America, South America, Southeast Asia, Africa, China, India, and Nepal. Its incidence has been increasing rapidly in recent years in non-endemic countries, due to both import and local cases, while in some highly endemic areas, numbers appear to have decreased, possibly due to better sanitation and increased public awareness. It is extremely rare in Türkiye. Cysticercosis is usually caused by drinking water or eating food containing tapeworm eggs. Clinical manifestations can range from completely asymptomatic infection to severe illness or death. Although the infection can involve any part of the central nervous system, symptomatic patients mostly have spinal cord involvement, intracerebral lesion, intraventricular cyst or subarachnoid lesion. An intraparenchymal cerebral cyst typically grows slowly and causes minimal symptoms for years or decades after the onset of infection. The site of involvement and the symptoms experienced determine the diagnosis and treatment method. The current general consensus supports antihelmintic and corticosteroid therapy for viable parenchymal lesions. In this report, a neurocysticercosis case with a single brain lesion that was surgically removed and histologically examined was presented. The patient had complaints of lisp in the tongue, numbness in the lips and left face. The patient had no concomitant chronic disease. The patient did not have a travel history or a history of eating pork but had a history of contact with a dead pig two months ago. Upon detection of a central mass in the brain computed tomography examination, surgical procedure was performed on the patient. Based on the identification of a larval stage of T.solium in biopsy material neurocysticercosis was diagnosed. However, histopathologically demonstration of the parasite is not possible in most cases. The patient received an antiparasitic treatment with albendazole 1000 mg/d in combination with dexamethasone. The patient was successfully treated and is still being followed up by calling for controls.

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.

Efficacy and Safety of Direct-Acting Antivirals in Elderly Patients with Chronic Hepatitis C: A Nationwide Real-Life, Observational, Multicenter Study from Turkey.

BACKGROUND: The number and proportion of elderly patients living with chronic hepatitis C are expected to increase in the coming years. We aimed to compare the real-world efficacy and safety of direct-acting antiviral treatment in elderly and younger Turkish adults infected with chronic hepatitis C. METHODS: In this multicenter prospective study, 2629 eligible chronic hepatitis C patients treated with direct-acting antivirals between April 2017 and December 2019 from 37 Turkish referral centers were divided into 2 age groups: elderly (≥65 years) and younger adults (<65 years) and their safety was compared between 2 groups in evaluable population. Then, by matching the 2 age groups for demographics and pretreatment risk factors for a non-sustained virological response, a total of 1516 patients (758 in each group) and 1244 patients (622 in each group) from the modified evaluable population and per-protocol population were included in the efficacy analysis and the efficacy was compared between age groups. RESULTS: The sustained virological response in the chronic hepatitis C patients was not affected by the age and the presence of cirrhosis both in the modified evaluable population and per-protocol population (P = .879, P = .508 for modified evaluable population and P = .058, P = .788 for per-protocol population, respectively). The results of the per-protocol analysis revealed that male gender, patients who had a prior history of hepatocellular carcinoma, patients infected with non-genotype 1 hepatitis C virus, and patients treated with sofosbuvir+ribavirin had a significantly lower sustained virological response 12 rates (P < .001, P = .047, P = .013, and P = .025, respectively). CONCLUSION: Direct-acting antivirals can be safely used to treat Turkish elderly chronic hepatitis C patients with similar favorable efficacy and safety as that in younger adults.

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.

An Unusual Cause of Acute Isolated Hepatitis in a Cancer Patient Post-COVID Pneumonia: HSV-2.

Herpes simplex virus is a rare cause of hepatitis in immunosuppressed and immunocompetent individuals. It can cause clinical pictures in patients ranging from an asymptomatic course to fatal acute fulminant hepatitis. Early diagnosis and treatment may be delayed if it is not suspected because of the patients' nonspecific clinic. This study presents a case of isolated HSV-2 hepatitis in a patient with a history of cancer chemotherapy and a recent diagnosis of COVID-19 who received steroid therapy.

Association Between Dermcidin, Salusin-α, Salusin-ß Molecules and Diabetic Foot Infections.

Dermcidin, salusin-α, and salusin-ß are three recently discovered molecules that confer antimicrobial properties. The present study aims to investigate the association between dermcidin, salusin-α, and salusin-ß in the etiopathology of patients with diabetic foot infection. The study included three groups: Group 1 - diabetic foot infection; Group 2 - diabetes without history of diabetic foot; and Group 3 - the control group. Plasma dermcidin, salusin-α, and salusin-ß levels were compared across the groups. Median (Q1-Q3) values of plasma dermcidin levels in Groups 1, 2, and 3 were 3.45 (0.8-4.4), 5.2 (3.7-6.4), and 5.8 (3.1-10) ng/mL, respectively. Diabetic foot infection group had significantly lower plasma dermcidin levels compared to diabetes only group and control group (P = .000, ANOVA), whereas there was no statistically significant difference between the Group 2 and Group 3 (P = .163, ANOVA). Salusin-α and salusin-ß levels were significantly higher in the Group 3 compared to the other groups. Based on our findings, diabetic foot infection group had significantly lower plasma dermcidin levels and salusin-α and salusin-ß levels were significantly higher in the control group. These molecules (dermcidin specifically) can be researched as an adjuvant therapeutic agent in addition to conventional treatments in diabetic foot diabetic foot infections. Also, it can be searched this may prevent many complications including amputation.

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).

The diagnostic utility of the "Thwaites' system" and "lancet consensus scoring system" in tuberculous vs. non-tuberculous subacute and chronic meningitis: multicenter analysis of 395 adult patients.

BACKGROUND: Tuberculous meningitis (TBM) represents a diagnostic and management challenge to clinicians. The "Thwaites' system" and "Lancet consensus scoring system" are utilized to differentiate TBM from bacterial meningitis but their utility in subacute and chronic meningitis where TBM is an important consideration is unknown. METHODS: A multicenter retrospective study of adults with subacute and chronic meningitis, defined by symptoms greater than 5 days and less than 30 days for subacute meningitis (SAM) and greater than 30 days for chronic meningitis (CM). The "Thwaites' system" and "Lancet consensus scoring system" scores and the diagnostic accuracy by sensitivity, specificity, and area under the curve of receiver operating curve (AUC-ROC) were calculated. The "Thwaites' system" and "Lancet consensus scoring system" suggest a high probability of TBM with scores ≤4, and with scores of ≥12, respectively. RESULTS: A total of 395 patients were identified; 313 (79.2%) had subacute and 82 (20.8%) with chronic meningitis. Patients with chronic meningitis were more likely caused by tuberculosis and had higher rates of HIV infection (P < 0.001). A total of 162 patients with TBM and 233 patients with non-TBM had unknown (140, 60.1%), fungal (41, 17.6%), viral (29, 12.4%), miscellaneous (16, 6.7%), and bacterial (7, 3.0%) etiologies. TMB patients were older and presented with lower Glasgow coma scores, lower CSF glucose and higher CSF protein (P < 0.001). Both criteria were able to distinguish TBM from bacterial meningitis; only the Lancet score was able to differentiate TBM from fungal, viral, and unknown etiologies even though significant overlap occurred between the etiologies (P < .001). Both criteria showed poor diagnostic accuracy to distinguish TBM from non-TBM etiologies (AUC-ROC was <. 5), but Lancet consensus scoring system was fair in diagnosing TBM (AUC-ROC was .738), sensitivity of 50%, and specificity of 89.3%. CONCLUSION: Both criteria can be helpful in distinguishing TBM from bacterial meningitis, but only the Lancet consensus scoring system can help differentiate TBM from meningitis caused by fungal, viral and unknown etiologies even though significant overlap occurs and the overall diagnostic accuracy of both criteria were either poor or fair.

NS5A resistance - associated substitutions in chronic hepatitis C patients with direct acting antiviral treatment failure in Turkey.

OBJECTIVES: Chronic hepatitis C (CHC) is now a more curable disease with new direct acting antivirals (DAA). Although high sustained virologic response rates, failures still occur in DAA regimens. Our objective in this study was to characterize the real-life presence of clinically relevant resistance - associated substitutions (RASs) in the HCV NS5A gene in CHC patients whose DAA regimen has failed. METHODS: The study enrolled 53 CHC patients who experienced failure with DAA regimen as the prospective longitudinal cohort between 2017-2019. Genotypic resistance testing was performed via the viral population sequencing method and The Geno2pheno HCV tool was used for RAS analysis. RESULTS: The most frequent failure category was relapse (88%) followed by non-responder (12%). For a total of 36% of patients, RASs was detected in NS5A, Y93H was the most detected RAS in GT1b infected patients (89%). CONCLUSIONS: This study establishes an HCV failure registry for Turkey in which samples were combined with clinical, virologic and molecular data of adult patients whose DAA therapy failed. RASs can occur in CHC patients with DAA treatment failures. Evaluation of RAS after DAA failure is very important before re-treatment is initiated to prevent virologic failure.

Self-Esteem and Defense Mechanisms in HIV-Positive and AIDS Patients.

Objective: To investigate the self-esteem and defense mechanisms in patients diagnosed with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Methods: This prospective, cross-sectional study included 29 patients diagnosed with HIV/AIDS admitted to inpatient or outpatient clinics between March 2018 and January 2019 and 29 healthy subjects. Participants were assessed using a sociodemographic and clinical data form, the Rosenberg Self-Esteem Inventory (RSEI), the Defense Style Questionnaire (DSQ), and the Beck Anxiety Inventory (BAI). Results: Patients with HIV/AIDS had significantly higher scores on the fantasy, psychosomatic symptoms, and parental interest subscales of the RSEI. There was no significant difference between the groups on the other subscales, including the self-esteem subscale. There was no correlation between the duration of the disease and self-esteem. The neurotic defense mechanism and immature defense mechanism subscale scores of the DSQ were significantly higher in the HIV/AIDS group compared to the control group (P < .01). Undoing and reaction formation scores in neurotic defense mechanisms and projection, devaluation, autistic fantasy, and splitting scores in immature defense mechanisms were significantly higher in the HIV/AIDS group compared to controls (P < .05). There was no significant difference between the groups based on the mature defense mechanisms subscale scores. Conclusions: No difference was found in the self-esteem scores of the HIV/AIDS and control groups, and this finding could be associated with the stability of the self-esteem concept. It was also determined that patient group members utilized neurotic and immature defense mechanisms more often compared to the healthy group, and there was no difference between the groups based on mature defense mechanisms.

Molecular Identification of HIV-1 in the Presence of Hepatitis B Virus and Hepatitis C Virus Co-infections

Background: Because of their similar modes of transmission, the simultaneous infection of viral hepatitis and human immunodeficiency virus are increasingly seen as a big problem related to human health. Aims: To determine the drug mutations in hepatitis B virus and/or hepatitis C virus co-infected human immunodeficiency virus-1 patients in Turkey. Study Design: Retrospective cross-sectional study. Methods: The present study was conducted between 2010 and 2017. HBsAg, anti-hepatitis C virus, and anti-human immunodeficiency virus were tested with ELISA. All anti-human immunodeficiency virus positive results by ELISA were verified for anti-human immunodeficiency virus positivity by a Western blot test, and Anti-human immunodeficiency virus positive patients with HBsAg and/or anti-hepatitis C virus positivity were included in the study. Subtyping and genotypic resistance analyses were performed by population sequencing of the viral protease and reverse transcriptase regions of the human immunodeficiency virus-1 pol gene. Results: We detected 3896 human immunodeficiency virus-1 positive patients whose sera were sent from numerous hospitals across the country to our polymerase chain reaction unit for detection of drug resistance mutations and whose molecular laboratory tests were completed. Viral hepatitis co-infections were detected in 4.3% (n=170) of patients. Hepatitis B virus and hepatitis C virus co-infection were observed in 3.2% and 0.5% of all human immunodeficiency virus-1 infected patients, respectively. The major human immunodeficiency virus-1 subtype detected was group M, subtype B (62.9%). However, 13.5% of drug resistance mutation motifs were found in human immunodeficiency virus-1 genomes of patients included in the study. Conclusion: Due to similar transmission routes, HIV1 patients are at risk of hepatitis B and C virus co-infection. However, antiretroviral drug resistance mutation model is similar to patients with hepatitis negative.

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.

Current status of HIV/AIDS-syphilis co-infections: a retrospective multicentre study.

OBJECTIVE: Treponema pallidum and HIV are transmitted frequently through sexual contact, these agents with epidemiological similarities co-infect the same host. The current number of HIV-infected cases in Turkey is increasing. For this reason, we aimed to reveal the characteristics of syphilis in HIV/AIDS cases. METHODS: A retrospective longitudinal cohort study was performed, patients were followed up at 24 clinics in 16 cities from all seven regions of Turkey between January 2010 to April 2018. We examined the socio-demographic characteristics, laboratory parameters and neurosyphilis association in HIV/AIDS-syphilis co-infected cases. RESULTS: Among 3,641 patients with HIV-1 infection, 291 (8%) patients were diagnosed with syphilis co-infection. Most patients were older than 25 years (92%), 96% were males, 74% were working, 23% unemployed, and 3% were students. The three highest prevalence of syphilis were in Black Sea (10.3%), Mediterranean (8.4%) and Marmara Regions (7.4%). As for sexual orientation, 46% were heterosexuals, 42% men who have sex with men (MSM), and no data available for 12%. Patients with the number of CD4+ ≤ 350 mm3 reached 46%, 17% of the patients received antiretroviral therapy and neurosyphilis association reached 9%. CONCLUSION: Although HIV/AIDS-syphilis co-infection status appeared high in heterosexuals, MSM had a moderate level increase in cases. Our results suggested syphilis co-infection in HIV/AIDS cases should be integral part of monitoring in a national sexual transmitted diseases surveillance system. However, our data may provide base for HIV/syphilis prevention and treatment efforts in the future.

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

ABSTRACT 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.