Klimik Dergisi/Klimik Journal最新文献

{"title":"Cryptococcus neoformans Meningitis With Renal Involvement in an HIV-Positive Patient: A Case Report","authors":"Figen Sarigul, Ulku User, N. Oztoprak","doi":"10.5152/kd.2018.36","DOIUrl":"https://doi.org/10.5152/kd.2018.36","url":null,"abstract":"In this report, we present a case of cryptococcal meningitis with acute onset and multiple organ involvement. A 44-yearold male was hospitalized with complaints of nausea, vomiting, headache and deterioration in general condition one month after the initiation of antiretroviral therapy (ART) for HIV infection. Empirical antibiotic treatment was started for the diagnosis of pneumonia, retinitis and meningitis according to the clinical findings and examination results. India ink preparation of cerebrospinal fluid (CSF) revealed budding capsulated yeast cells. Cryptococcal antigen test was positive in CSF and C. neoformans was isolated from CSF culture. Liposomal amphotericin B and fluconazol was added to the treatment schedule. Histopathologic examination of the tissue obtained with renal biopsy revealed extensive parenchymal cryptococcal involvement. Antifungal therapy was continued as oral fluconazole after 40 days. Fluconazol was discontinued when CD4+ T cell count increased over 100/mm3 after 12 months. The patient had persistently elevated creatinin levels under ART without antifungal therapy. Last creatinine value was 2.4 mg/dL after a one-year follow-up. Especially in newly diagnosed HIV-positive cases, cryptococcal antigen test should be performed in CSF as stated in the guidelines, if the CD4+ T cell count is <100/mm3 and the serum cryptococcal antigen is positive. In addition, cryptococcal infection should be considered in differential diagnosis of HIV-positive patients with impaired renal function and kidney biopsies should be performed as soon as possible. Early diagnosis will help to reduce mortality and morbidity. It should be kept in mind that cryptococcal infections in HIV-infected patients may be present with multiple organ involvement. Klimik Dergisi 2018; 31(2): 153-6.","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80507380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Invasive Fungal Infections in Haematology-Oncology Patients","authors":"S. Tekin","doi":"10.5152/kd.2019.62","DOIUrl":"https://doi.org/10.5152/kd.2019.62","url":null,"abstract":"Immunocompromised patients, those with cancer or haematological malignancies and allogeneic bone marrow/haematopoietic stem cell transplant recipients carry a high risk of invasive fungal infection (IFI), which is frequently life threatening. The most common causes of IFIs are Aspergillus and Candida species. Patients who receive long-term corticosteroids or broadspectrum antimicrobial treatment or total parenteral nutrition; patients with central venous catheters, neutropenia, malignancies, or burns and low-weight premature infants are at highest risk of IFI. Early start of antifungal therapy is mandatory, but clinical findings often do not provide clear evidence of IFI. Antifungal agents preferentially used for systemic therapy of IFIs are amphotericin B preparations, fluconazole, voriconazole, posaconazole, caspofungin, anidulafungin, micafungin, and isavuconazole. Local epidemiological data, current resistance profile against antifungal agents, and their pharmacological and economic aspects together with clinical experience must be considered for clinical management of patients with IFI. Klimik Dergisi 2019; 32(Suppl. 2): 168-73.","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83198923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measles Seroprevalence in Yozgat City Hospital Employees","authors":"H. Köse, Fatih Temoçin","doi":"10.5152/kd.2018.34","DOIUrl":"https://doi.org/10.5152/kd.2018.34","url":null,"abstract":"Objective: We aimed to determine the relationship between the measles immunity status of the employees of Yozgat City Hospital and their age, gender, occupation, and work unit. Methods: The results of the measles serology of the 623 health care workers together with information on their age, gender, occupation and work unit were recorded retrospectively and analyzed by using SPSS for Windows. Version 15.0 (Statistical Package for the Social Sciences, SPSS Inc., Chicago, IL, USA) program. Results: The measles immunity in all health care workers was 88.1%. A statistically significant difference was found between the measles immunity and the age of health care workers (p<0.05). Immunity was 72% in ages 18-25 years, 88.8% in ages 26-35 years, 95.2% in ages 36-45 years, and 91.8% over 46 years. Measles immunity status increased as the age of the health care worker increased and the difference between the age groups was statistically significant (p<0.05). There was no statistically significant relationship between the measles immunity, gender (p=0.36), occupation and work unit (p>0.05). Conclusions: We concluded that measles immunity is inadequate among health care workers in general, especially in younger ages, and therefore health care workers should be vaccinated for measles regularly. Klimik Dergisi 2018; 31(2): 144-7.","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76091789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invasive Fungal Infections: Diagnosis and Management","authors":"S. Tekin","doi":"10.5152/kd.2019.52","DOIUrl":"https://doi.org/10.5152/kd.2019.52","url":null,"abstract":"","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84049647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antifungal Prophylaxis in Haematological Patients","authors":"Burak Deveci, R. Saba","doi":"10.5152/kd.2019.61","DOIUrl":"https://doi.org/10.5152/kd.2019.61","url":null,"abstract":"Invasive fungal infections remain as important issues in immunosuppressed patients, especially in patients with haematological malignancies. Difficulty of diagnosis and treatment and increased mortality in the presence of delayed diagnosis has led to the widespread use of antifungal prophylaxis. The cost and side effects resulting from this widespread use are against this approach. In this article, current practices and recommendations on antifungal prophylaxis have been reviewed. Klimik Dergisi 2019; 32(Suppl. 2): 163-7.","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75708328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of Invasive Fungal Infections","authors":"Z. Karakoç","doi":"10.5152/kd.2019.53","DOIUrl":"https://doi.org/10.5152/kd.2019.53","url":null,"abstract":"Invasive fungal infection (IFI) is still one of the leading causes of morbidity and mortality in immunosupressed hosts. Although Candida species are the most common cause of IFIs and Candida albicans still remains the predominant cause of invasive candidiasis, emergence of non-albicans species has increased with the decreasing fluconazole sensitivity in the world. There is also an increase in the incidence of Aspergillus, new species such as Candida auris, and rare moulds. Many factors have likely contributed to this situation including the number of patients with increased immunosuppression and aggressive chemotherapy, increased use of invasive devices and antimicrobial prophylaxis or treatment approaches. Species and resistance distribution of IFI agents can vary between hospitals and even within different units in the same hospital as in the whole world and may vary according to predisposing factors of patients. Due to these reasons, understanding the changing epidemiology of IFIs is important in developing effective therapeutic and prophylactic approaches for these infections expected to increase in the next decade. Klimik Dergisi 2019; 32(Suppl. 2): 118-23.","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87516513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge Levels of Students, Trainees and Faculty Members About Hand Hygiene at a University Hospital","authors":"Nazlım Aktug-Demir, S. Sumer, L. Demir, O. Ural","doi":"10.5152/kd.2018.26","DOIUrl":"https://doi.org/10.5152/kd.2018.26","url":null,"abstract":"","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76918271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Needle Stick Injuries and Hand Hygiene Practices in Hospitals","authors":"H. Eraksoy","doi":"10.5152/kd.2018.21","DOIUrl":"https://doi.org/10.5152/kd.2018.21","url":null,"abstract":"Yazışma Adresi / Address for Correspondence: Haluk Eraksoy, İstanbul Üniversitesi, İstanbul Tıp Fakültesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Çapa, İstanbul, Türkiye E-posta/E-mail: haluk.eraksoy@gmail.com DOI: 10.5152/kd.2018.21 Sağlık çalışanları için en önemli mesleki risklerden biri, bir kesici ve delici alet yaralanması (KDAY)’na maruz kalmaktır. Her yıl dünyada en az 16 milyar injeksiyon uygulandığı bildirilmektedir. Bunların çok büyük bir çoğunluğu, tedavi edici işlemler için uygulanır. Bu uygulamaların güvenli olması, özellikle kanla bulaşan viruslar açısından önemlidir (1). Dünya üzerinde sağlık çalışanlarındaki hepatit B ve hepatit C olgularından %40 kadarının, HIV infeksiyonlarından %2.5’inin mesleki iğne kazalarına bağlı olduğu hesaplanmıştır (2). Klimik Dergisi’nin bu sayısında Karacaer ve arkadaşları (3)’nın, bir ikinci basamak hastanedeki KDAY sıklığını, türlerini, bunu etkileyen risk faktörlerini ve personelin bu konudaki bilgi ve tutumlarını değerlendirdikleri bir anket çalışmasının sonuçları yer alıyor. Anket çalışması bazı yönlerden ilginç sonuçlar vermiş. Örneğin, çalışanların yarıdan fazlasının son iki yıl içinde bir KDAY öyküsü tanımlamış olması ve bunların %85’ten fazlasının bir iğne kazası biçiminde ortaya çıkmış olması dikkati çekiyor. Çalışmaya katılan personelin %80’e yakınının mesleki yaralanmalar konusunda eğitim aldığı bildiriliyor. Buna karşılık, şaşırtıcı bir biçimde, eğitim alanlarda eğitim almayanlardan daha sık KDAY görülmüş. Bu durum, bir sağlık kuruluşunda eğitimle verilen bilgiler uygulamaya yansımadığı takdirde, aşılması gereken başka engellerin olduğunu düşünmek ve bunlara eğilen çalışmalar planlamak gerektiğini gösteriyor. Sakallı Celal’in ünlü özlü sözlerinden biri buraya adeta denk düşüyor. Aktuğ-Demir ve arkadaşları (4)’nın el hijyenine ilişkin farkındalığı ve bilgi düzeyini değerlendirdikleri bir araştırma da Klimik Dergisi’nin bu sayısında bir başka anket çalışması olarak yer alıyor. Çalışma, bir üniversite hastanesinde öğrencilerin, araştırma görevlilerinin ve öğretim üyelerinin üzerinde yapılmış. Son beş yıl içerisinde öğrencilerin %91’inin, araştırma görevlilerinin %73’ünün el hijyeni eğitimi aldığı; öğretim üyelerinin ise hiçbirinin el hijyeni eğitimi almadığı saptanmış. Son bir yıl içerisinde eğitim alma oranı ise araştırma görevlilerinde %23, öğrencilerde %39 olarak saptanmış. Öğrencilerin bilgi düzeyinin, araştırma görevlisi ve öğretim üyelerinden daha yüksek olarak saptanması, araştırmanın en ilginç bulgusunu oluşturuyor. Uygun indikasyonda el hijyeni sağlama oranını ≥%85 olarak bildiren katılımcı hiç olmamış; bu oranı %70-85 arasında bildirenler ise çalışmaya katılanların dörtte birinden bile azını oluşturmaktaymış. \"Eldiven giymek el hijyeni yerine geçer\" bilgisinin katılımcılar tarafından en yanlış bilinen bilgi olduğu saptanmış ki bu durumda el hijyenine uyumsuzluğa başka bir “mazeret” aranması gereği kalmıyor. İnfeksiyon kontrolüyle uğraşan bir komitenin böyle ","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77406351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Candida Infections in Intensive Care Unit: How to Treat?","authors":"E. Kazak","doi":"10.5152/kd.2019.60","DOIUrl":"https://doi.org/10.5152/kd.2019.60","url":null,"abstract":"The number of fungal infections observed in hospitalized patients has been gradually increasing in recent years. Bloodstream infections due to Candida spp. constitute the majority of hospital-acquired fungal infections. Two-thirds of all candidemias occur in patients in the intensive care units. Early initiation of appropriate treatment decreases high mortality in these cases. On the other hand, difficulty in diagnosis, economic cost of drug treatments, development of resistance, and effect of unnecessary drug use on ecology are major obstacles to the initiation of treatment. The recommendations on which conditions, in which patients, and when and which antifungal therapy should be initiated are discussed in this review. Klimik Dergisi 2019; 32(Suppl. 2):154-62.","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90577100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Features of Invasive Fungal Infections: Aspergillosis, Candidiasis and Mucormycosis","authors":"M. Alan","doi":"10.5152/kd.2019.54","DOIUrl":"https://doi.org/10.5152/kd.2019.54","url":null,"abstract":"Invasive fungal infection (IFI) is an important cause of morbidity and mortality especially in immunosupressed patients. They can range widely in severity; while mucocutaneous infections are more frequent, fungal infections can be life threatening in some patients. Candida and Aspergillus species are the most common causes of IFIs. Candida spp. have become important causes of sepsis in hospitals, with incidence constantly growing over the last 20 years. Invasive aspergillosis is the second most common IFI, with increasing incidence over the last two decades along with the advances in the treatment of hematological malignancies. Mucormycosis is the second most common invasive mould infection. Agents like Mucor spp. can cause devastating infections. Klimik Dergisi 2019; 32(Suppl. 2): 124-7.","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83591531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}