Klimik Journal最新文献

{"title":"Fourth-year Results of HBeAg Negative Chronic Hepatitis B Patients Discontinuing Nucleos(t)ide Analogue Therapy","authors":"Alper Tahmaz, Figen Sarigul-Yildirim, Ulke User","doi":"10.36519/kd.2023.4568","DOIUrl":"https://doi.org/10.36519/kd.2023.4568","url":null,"abstract":"Objective: There is not a definitive virological treatment for chronic hepatitis B . Withdrawal of nucleos(t)ide analogue (NA) therapy frequently results in viral recurrence, necessitating lifetime treatment. We aimed to look into the results of discontinuation of nucleos(t)ide analogue therapy in HBeAg negative patients. Methods: Treatment of HBeAg-negative patients without cirrhosis who had suppressed HBV DNA for a mean of ≥7 years and underwent nucleos(t)ide analogue therapy for a mean of ≥7 years were stopped according to the EASL guideline stopping rule. Standard laboratory tests, such as HBV DNA viral load, HBsAg, alanine aminotransferase, and adverse events, were monitored for more than four years during therapy and afterwards. Results: HBsAg loss was not observed in any of the patients during the four-year follow-up period. After the first 12 weeks, HBV-DNA was detected in all patients whose nucleos(t)ide analogue treatment was discontinued. The percentage of patients with HBV DNA >2000 IU/mL was 70% at 6 months, 74% at 12 months, 78% at 24 months, and 79.7% at 36 months, HBV DNA >2000 IU/mL was not detected in remaining patients over a four-year period. In the first year, 26% (n=18) of patients were started treatment for relapse, 46% (n=32) in the second year, 49% (n=34) in the third year, and 55% (n=38) in the fourth year. 45% (n=31) of the patients were still being followed without treatment at the end of the fourth year. Conclusion: Although the follow-up of hepatitis B e antigen-negative CHB patients on NA therapy was longer than in the literature, our recurrence rates were similar to other studies, and no patient lost HBsAg. The most significant benefit was that we were able to follow half of the patients without therapy for more than four years, eliminating the need for the patients to use drugs.","PeriodicalId":44309,"journal":{"name":"Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135081314","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":"Correlation of Real-Time PCR Cycle Threshold Values and Clinical Progress, Mortality, and Laboratory Parameters of COVID-19 Patients","authors":"Ayse Alici, Samet Cam, Mustafa Kilic, Meryem Vural, Ozgur Pasa","doi":"10.36519/kd.2023.4579","DOIUrl":"https://doi.org/10.36519/kd.2023.4579","url":null,"abstract":"Objective: The cycle threshold value was used to predict disease severity, disease progression, determine transmissibility, and differentiate active viral replication from prolonged virus shedding. In this study, we aimed to evaluate the relationship between rRT-PCR cycle threshold and clinical course, mortality and laboratory parameters in COVID-19 patients. Methods: The patients included in the study were grouped according to how they were followed; as outpatients, service and intensive care unit patients. Data of age, gender, length of hospital stay, survival status and comorbidities of the patients were obtained from the hospital information system. In addition, CRP, ferritin, albumin, lactate dehydrogenase, procalcitonin and iron values of inpatients were reviewed retrospectively. Cycle threshold values of the patients were compared with each parameter separately. Results: 1339 patients with positive SARS-CoV-2 rRT-PCR test were included in the study. Of the patients, 774 (58%) were outpatients, 548 (41%) were in the ward, and 17 (1%) were in the intensive care unit. No significant difference was found between any of the groups when the cycle threshold values of the groups were compared statistically. Fifty (3.7%) of the patients included in the study died. Cycle threshold values of deceased patients were found to be significantly lower than those who survived (p=0.019). 306 (22.8%) of the patients had comorbidities. When the cycle threshold values of patients with and without comorbid disease were compared, no significant difference was found between any of the groups (p=0.850). In addition, no significant correlation was found between the length of hospital stay, age, CRP, LDH, ferritin, procalcitonin, albumin and iron values and the cycle threshold value. Conclusion: In conclusion, we did not find a significant difference between the cycle threshold values of outpatients, ward patients and intensive care patients. No significant correlation was found between the laboratory parameters, length of hospital stay and age, and the cycle threshold: however, deceased patients were found to have lower cycle thresholds than surviving patients.","PeriodicalId":44309,"journal":{"name":"Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135081455","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":"Retrospective Evaluation of Patients with Brucellosis: Five Years of Experience","authors":"Emine Turkoglu-Yilmaz, Zeliha Arslan","doi":"10.36519/kd.2023.4470","DOIUrl":"https://doi.org/10.36519/kd.2023.4470","url":null,"abstract":"Objective: We aimed to evaluate the epidemiological, clinical features, laboratory findings, and treatment regimens of patients with brucellosis in the Tokat region. Methods: In this cross-sectional study, the data of 236 adult patients followed with brucellosis in Tokat Gaziosmanpaşa University Medical Faculty Hospital between January 2016 and December 2021 were evaluated retrospectively. Diagnostic criteria of brucellosis were determined as culture positivity, or positivity in the Wright test at ≥ 1/160 titration, or a 4-fold increase in titer of the Wright test repeated at 2 – 3 week intervals. Demographic data, symptoms, physical examination findings, and laboratory results of the patients were evaluated. Results: 72% (n=170) of the patients were male, and the mean age was 44.47±16.64. 53% (n=125) were engaged in animal husbandry, 21.6% (n=51) consumed unpasteurized dairy products, and 13.1% (n=31) had a family member with brucellosis. Seven (2.9%) patients with a prediagnosis of Crimean-Congo hemorrhagic fever (CCHF) were diagnosed with acute brucellosis. The most common symptoms were muscle-joint pain (70.3%), fever (50.8%), and sweating (43.2%). Spondylodiscitis was observed in 13.6%, epididymal-orchitis in 8.2%, and neurobrucellosis in 0.4% of the patients. Blood culture positivity was detected in 7.2% of the cases. 91.5% had elevated C-reactive protein (CRP) levels, and 48.3% had elevated erythrocyte sedimentation rates. The most common hematological findings were anemia (28%), leukopenia (10.6%), and thrombocytopenia (8.5%). As a therapy doxycycline + rifampicin combination was started at 36%, doxycycline + gentamicin to 5.8%, doxycycline + streptomycin to 5.4%, and doxycycline + rifampicin + gentamicin to 29.7% of the patients. Alternative treatment regimens were given to 22.9% (n=54) of the patients. Conclusion: Brucellosis is still a critical zoonotic disease in our region. It should be kept in mind when diagnosing patients with fever, muscle-joint pain, and sweating, with epidemiological histories, have elevated acute phase reactants and cytopenia. It should also be remembered that brucellosis can be confused with CCHF in endemic areas.","PeriodicalId":44309,"journal":{"name":"Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135082261","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":"Morbidity and Mortality in Immunocompromised COVID-19 Patients: Which Factors Are Responsible?","authors":"Ridvan Karaali, Kevser Sak, Abdulkerim Uygur, Fatma Sena Hakyemez, Sibel Yildiz-Kaya, Fehmi Tabak","doi":"10.36519/kd.2023.4721","DOIUrl":"https://doi.org/10.36519/kd.2023.4721","url":null,"abstract":"Objective: The COVID-19 pandemic has caused significant morbidity and mortality and has challenged health systems worldwide. Immunosuppression is considered a risk factor for development of severe COVID-19. In this study, we aimed to determine the factors affecting morbidity and mortality in immunocompromised patients diagnosed with COVID-19. Methods: In this retrospective, cross-sectional study, laboratory findings and outcomes of 340 COVID-19 patients with secondary immunosuppression in a university hospital in Turkey from March 2020 to April 2022 were analyzed according to the 28-day clinical outcomes. Mortality-related factors were investigated in 3 patient groups with different forms of immunodeficiency: 1) malignancy (hematologic/solid), 2) organ transplantation, and 3) rheumatological diseases. Results: 172 (51%) of the patients were female, and the mean age was 61±15 years. A total of 122 (35.8%) patients died during hospitalization. The mortality rate (73.4%) in patients admitted to the intensive care unit (ICU) was significantly higher than those not admitted (p<0.001). The highest laboratory median values of urea, lactate dehydrogenase (LDH), D-dimer, ferritin, C-reactive protein (CRP), and fibrinogen values were found to be significantly higher, and the first measurement lymphocyte value was found to be considerably lower compared to the surviving patients (p<0.001) in the 28-day follow-up, ICU admission increased the mortality risk 13.6 (p<0.001) times. Anticoagulant treatment (p=0.029) and nasal oxygen support (p<0.001) led to a decrease in the risk of mortality. Conclusion: Immunocompromised patients are at risk for serious COVID-19 complications. LDH, D-dimer, CRP, and lymphocyte values can be used as markers to evaluate survival, and standard treatment is essential in immunosuppressive COVID-19 patients.","PeriodicalId":44309,"journal":{"name":"Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135082263","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":"A Case of Acute Q Fever Presenting with Abdominal Pain and Developing Myocarditis","authors":"Caglayan Bozkurt, Asim Gurbanov, Burcu Yagmur, Sukriye Miray Kilincer-Bozgul, Devrim Bozkurt","doi":"10.36519/kd.2023.4369","DOIUrl":"https://doi.org/10.36519/kd.2023.4369","url":null,"abstract":"Coxiella burnetii is the cause of Q fever, which is a zoonosis. Although the disease is mostly asymptomatic, it can progress to different clinical forms. Myocarditis is rarely seen in acute Q fever. In this report, we present a 40-year-old male patient who applied to the emergency department with complaints of abdominal pain and fever and was followed with the diagnosis of cholangitis. He was later transferred to the intensive care unit after developing heart failure and was diagnosed with Q fever myocarditis. We present this case to bring attention to the severe clinical course and the unusual onset of Q fever.","PeriodicalId":44309,"journal":{"name":"Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135082264","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":"The Incidence and Factors Affecting the 28-day Hospital Admission Among Adult Ambulatory COVID-19 Patients","authors":"Huseyin Bilgin, Ahmet Topuzoglu, Uluhan Sili, Cigdem Alaydin-Kaya, Rabia Can-Sarinoglu, Volkan Korten, Pinar Ay","doi":"10.36519/kd.2023.4510","DOIUrl":"https://doi.org/10.36519/kd.2023.4510","url":null,"abstract":"Objective: This study aimed to determine the 28-day hospital admission incidence and risk factors related to the hospitalization of COVID-19 patients who were followed as outpatients in a university hospital. Methods: A retrospective cohort study was designed in which the sociodemographic characteristics, symptoms on the first visit, presence of comorbidities, and viral load predictor cycle threshold (Ct) value were defined as independent variables and hospital admission in the first 28 days after the first visit was defined as dependent variable. Factors related to hospital admission were evaluated with univariate and multivariate analyses. Cox regression analysis was used for multivariate analyses, and the effect size was determined with a hazard ratio (HR). Statistical significance was defined as p<0.05. Results: 368 patients were included in this study. The median (25-75th percentile) age was 36 (28-45) years, and 46.1% of the patients were female. Sixty-five patients (17.7%) were hospitalized in the first 28 days. When age ≤29 referenced, age≥50 (HR=4.1, 95% confidence interval [CI]=1.7-9.6), 40-49 (HR=3.0, 95% CI=1.3-6.6) and 30-39 (HR=1.6, 95% CI=0.6-3.6), fever or chills, (HR=2.3, 95% CI=1.3-4.1), dyspnea (HR=2.0, 95% CI=1.1-3.4), fatigue (HR=1.9, 95% CI=1.0-3.5), vomiting (HR=3.0, 95% CI=1.5-5.8), and sore throat (HR=0.4, 95% CI=0.2-0.8) were defined as independent risk factors according to multivariable analysis. Hypertension was the only comorbidity independently predicting hospital admission (HR=2.2, 95% CI=1.0-4.4). Conclusion: Advanced age, systemic and lower respiratory tract infection signs, and hypertension independently increased the 28-day hospital admission. The presence of a sore throat was not a factor for hospital admission. A lower risk of hospital admission in patients with sore throats may indicate that the patient will have a mild upper respiratory tract infection and will not progress to severe disease. Due to missing data, this study could not fully evaluate the hospital admission risk factors. Studies that include clinical, laboratory, and radiological findings are needed to generate a more accurate model predicting hospital admission risk.","PeriodicalId":44309,"journal":{"name":"Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135081450","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":"After the HIV/AIDS Congress 2022 (24-27 November 2022, Antalya): Gains, Challenges and Recommendations for the Future Response to HIV Infection in Türkiye","authors":"Suda Tekin, Hayat Kumbasar-Karaosmanoglu, Asuman Inan, Halis Akalin, Behice Kurtaran, Fehmi Tabak, Yesim Tasova, Canberk Harmanci, Arda Karapinar, Cigdem Simsek, Deniz Gokengin","doi":"10.36519/kd.2023.4548","DOIUrl":"https://doi.org/10.36519/kd.2023.4548","url":null,"abstract":"The National HIV/AIDS Congress, organized every year by the Turkey HIV/AIDS Platform, which was formed by the five physician associations operating in the field of HIV infection in Turkey, was held in Antalya on 24-27 November 2022. This congress, AIDS and Sexually Transmitted Diseases Association (AIDS and STD Association), HIV/AIDS Prevention and Education Association (HAKED), HIV Infection Association (HIVEND), Turkish Infectious Diseases and Clinical Microbiology Specialist Association (EKMUD) and Turkish Clinical Microbiology and Infectious Diseases (KLİMİK) Association. In addition, the Red Ribbon Association, Positive-iz Association, and Positive Living Association, three subject associations operating in the field, contributed. This report aims to summarize the data presented by the health professionals, health authorities, and non-governmental organizations working at the forefront of the response to the HIV/AIDS epidemic in our country, their shares and discussions during the congress, and to determine the needs by analyzing the current situation in our country in the light of these.","PeriodicalId":44309,"journal":{"name":"Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135082433","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":"A Case of Infective Endocarditis Complicated with an Acute Coronary Syndrome, Cerebral Septic Infarction, and Sepsis","authors":"Mustafa Serhat Sahinoglu, Sevil Alkan","doi":"10.36519/kd.2023.4445","DOIUrl":"https://doi.org/10.36519/kd.2023.4445","url":null,"abstract":"Infective endocarditis (IE) is a rare and highly mortal infectious disease. A 41-year-old male patient who was being followed with the diagnosis of acute coronary syndrome, acute cerebrovascular disease, meningitis and sepsis, was diagnosed with IE with the presence of vegetation on the mitral valve and Staphylococcus aureus growth in his blood culture. The patient was treated with cefazolin plus vancomycin. We present this case to remind that IE can cause various complications and careful examination may be required for the diagnosis.","PeriodicalId":44309,"journal":{"name":"Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135082258","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":"The Error in the Infectious Period of Measles in the Circular Concerning Measles Elimination Program","authors":"Ahmet Abbasoglu","doi":"10.36519/kd.2023.4626","DOIUrl":"https://doi.org/10.36519/kd.2023.4626","url":null,"abstract":"","PeriodicalId":44309,"journal":{"name":"Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135082267","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":"Trimethoprim-Sulfamethoxazole and Ciprofloxacin Resistance Rates in Escherichia coli and Klebsiella spp. in Urinary Tract Infections: A 10-Year Evaluation","authors":"Pinar Samlioglu, Ilknur Kilic","doi":"10.36519/kd.2023.4558","DOIUrl":"https://doi.org/10.36519/kd.2023.4558","url":null,"abstract":"Objective: Urinary tract infections are the most common bacterial infections among community-acquired infections in all age groups. In this study, we aimed to evaluate the distribution of Escherichia coli and Klebsiella spp. in community-acquired urinary tract infections by years and the resistance rates to trimethoprim-sulfamethoxazole (TMP-SXT) and ciprofloxacin antibiotics, which are used as the first choice in community-acquired urinary tract infections. Methods: All urine culture samples from all age groups admitted to the medical microbiology laboratory from outpatient clinics and emergency services between January 2011 and August 2021 were retrospectively analyzed. Samples with E. coli and Klebsiella spp. detected as causative agents in urine cultures were included in the study. Conventional methods and automated systems were used to identify bacteria and for antibiotic susceptibility tests. Results: E. coli (n=50 430) and Klebsiella spp. (n=7763) isolated from urine cultures between January 2011 and August 2021 were evaluated. The lowest and highest resistance rates for ciprofloxacin and TMP-SXT for E. coli were 25-40% and 35-51%, respectively. Ciprofloxacin and TMP-SXT resistance rates for Klebsiella spp. were the lowest and highest at 17-43% and 31-43%, respectively. Conclusion: Knowing the resistance rates of antibiotics used as the first choice against common agents such as E. coli and Klebsiella spp. in treating community-acquired urinary tract infections may guide the empirical antimicrobial therapy.","PeriodicalId":44309,"journal":{"name":"Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135081446","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}