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Öğe Acute Acalculous Cholecystitis due to Viral Hepatitis A(Hindawi Ltd, 2013) Kaya, Safak; Eskazan, Ahmet Emre; Ay, Nurettin; Baysal, Birol; Bahadir, Mehmet Veysi; Onur, Arzu; Duymus, RecaiInflammation of the gallbladder without evidence of calculi is known as acute acalculous cholecystitis (AAC). AAC is frequently associated with gangrene, perforation, and empyema. Due to these associated complications, AAC can be associated with high morbidity andmortality. Medical or surgical treatments can be chosen according to the general condition of the patient, underlying disease and agent. Particularly in acute acalculous cholecystitis cases, early diagnosis and early medical treatment have a positive effect on the patient and protect them from surgical trauma. ACC is a rare complication of acute viral hepatitis A. Herein, we present an adult patient of acalculous cholecystitis due to acute viral hepatitis A. She responded to the conservative management.Öğe Analysis of antimicrobial consumption and cost in a teaching hospital(Elsevier Science London, 2014) Bozkurt, Fatma; Kaya, Safak; Tekin, Recep; Gulsun, Serda; Deveci, Ozcan; Dayan, Saim; Hosoglu, SalihBackground: The aim of this study is to compare the periods before and after the intervention applied using the ATC/DDD method in order to ascertain the rational use of antibiotics in a newly established hospital. Method: The appropriateness of the hospital's antibiotic use, consumption rates and the costs were calculated and compared with other hospitals. Based on these data, an intervention has been planned in order to raise the quality of antibiotic use. The periods before and after the intervention were compared. Between 16 May 2011 and 23 May 2012, data were collected from all hospital units by the infectious diseases specialists and a point prevalence survey was conducted. Anatomical therapeutic chemical classification and the defined daily dose (DDD) methodology were used to calculate the antibiotic consumption. Results: On two specific days in 2011 and 2012, 194 out of 307 patients (63.2%) and 224 out of 412 patients (54.4%) received antibiotic treatment, respectively. In 2011 and 2012, the percentage of appropriate antibiotic use was 51% and 64.3%, respectively. Both in 2011 and 2012, inappropriate antibiotic use was found to be significantly higher in surgical clinics in comparison to the internal diseases clinics and the ICU. This was caused by the high rates of inappropriate perioperative antimicrobial prophylaxis observed in surgical clinics. During both years, approximately one-third of the antibiotics were prescribed for the purposes of perioperative prophylaxis, while 88.5% and 43.7% of these, respectively, were inappropriate and unnecessary. Cephalosporins, fluoroquinolones, combinations of penicillins (including ii-lactamase inhibitors) and carbapenems were the most frequently prescribed antibiotics during the study periods. The mean total antibiotic consumption was 93.6 DDD/100 bed-days and 63.1 DDD/100 bed-days, respectively. The cost of total antibacterial consumption was (sic) 7901.33 for all the patients ((sic) 40.72 per infected patient) and sic 6500.26 ((sic) 29.01 per infected patient), respectively. Conclusion: Each hospital should follow and assess their antibiotic use expressed in DDD in order to compare their antibiotic use with national and international hospitals (WHO, 2009 [14]). (C) 2013 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.Öğe Antibiotic Resistance in Gram-Negative Bacteria Isolated From Blood Cultures(Doc Design Informatics Co Ltd, 2014) Temiz, Hakan; Temiz, Sevim; Kaya, Safak; Celen, Mustafa KemalObjective: The aim of this study was to retrospectively determine the antimicrobial susceptibilities of Gram-negative bacteria isolated from blood cultures of hospitalized patients in 2012. Methods: Antibiotic resistance rates of isolated Gram-negative bacteria were evaluated retrospectively from patients' files. In this study, 106 Gram-negative bacteria isolated from patients' blood culture samples in intensive care units and clinical services were evaluated. Blood samples inoculated into BacT/Alert (R) FA Plus aerobic bottles and were followed in a fully automated blood culture device, BacT/Alert (R) 3D (bioMerieux, Marcy l'Etoile, France). The identification and antibiotic sensitivity tests of the isolated microorganisms were performed using automated VITEK (R) 2 (bioMerieux, Marcy l'Etoile, France) system and the results were evaluated according to the standards of Clinical and Laboratory Standards Institute (CLSI). Results: The most frequently isolated Gram-negative bacteria were Escherichia coli (37.7%), Klebsiella pneumoniae (22.6%), Pseudomonas aeruginosa (12.3%) and Acinetobacter baumannii (13.2%). Extended-spectrum beta-lactamase (ESBL) production was detected in 52.5% of E. coli and 83.3% of K. pneumoniae strains. The most effective antibiotics in vitro for ESBL producing and non-producing strains of both types were found as imipenem and meropenem. Resistance to antibiotics tested in ESBL-producing strains of E. coli was found to be significantly higher than non-ESBL-producing strains (p<0.05). In our study, aminoglycosides, particularly amikacin, was found to be the most effective agents for P. aeruginosa and A. baumannii strains. Imipenem and amikacin were found as most effective antibiotics for the Enterobacter spp. isolated in this study. Conclusions: All institutions should determine their microbial agent and antibiotic resistance profiles and establish their own antibiotic treatment policies and follow current guidelines for empirical antibiotherapy.Öğe Association Between the Rh Blood Group and the Covid-19 Susceptibility(Akad Doktorlar Yayinevi, 2020) Arac, Esref; Solmaz, Ihsan; Akkoc, Hasan; Donmezdil, Suleyman; Karahan, Zulkuf; Kaya, Safak; Mertsoy, YilmazWe aimed to investigate whether there is a predisposition to COVID-19 with ABO and Rh blood group systems. This study was a retrospective study that investigate the patients admitted to our hospital between March 16 -May 20 due to Covid-19 pandemic and conducted with data revealed from the hospital Information Management System A total of 392 patients were included in this study, including 227 PCR test positive patients with blood group information in the system and 165 possible patients with CT findings in favor of Covid-19. Data from a blood group study conducted with 127091 people in our province in 2019 were used as a control group. In our study, a significant increase was observed in the blood group A in patients diagnosed with Covid-19, and a decrease was found in the blood groups B, AB and especially O. However, statistical analysis showed no significant difference between Covid-19 patients and healthy individuals in terms of ABO blood group system. When analyzed in terms of Rh blood group system, it was found that Rh positivity was statistically significantly higher in patients with Covid-19 (p= 0.000). Our study suggests that the Rh (-) blood group is protective and the Rh (+) blood group is predisposed to Covid 19 significantly. We think that it is valuable because it is the first study to reveal the relationship between Covid-19 and blood type in our country and the only one to reveal the relationship between Covid-19 and Rh (+) in the world literature.Öğe Brucellar pericarditis: a report of four cases and review of the literature(Elsevier Sci Ltd, 2013) Kaya, Safak; Eskazan, Ahmet Emre; Elaldi, NazifBackground: Brucellosis, a disease endemic in many countries including Turkey, is a systemic infectious disease. Cardiovascular complications are not frequent, and endocarditis is the main cardiac manifestation of brucellosis. Pericarditis in the absence of concomitant endocarditis is extremely rare. Methods: In this report, we present four patients with pericarditis caused by brucellosis in the absence of concomitant endocarditis, along with a review of the published literature on brucellar pericarditis. We also searched for clinically silent pericardial effusion among patients with brucellosis. We performed routine transthoracic echocardiography (TTE) on 72 consecutive patients with newly diagnosed brucellosis in the absence of any signs and symptoms of pericarditis over a period of 6 months. Results: Three of our patients with brucellar pericarditis recovered fully after antibiotics. The other patient received 6 days of antibiotic treatment, and her signs and symptoms regressed, but after this the patient was lost to follow-up. We did not detect pericarditis among the 72 newly diagnosed patients. Conclusions: Brucellar pericarditis is a rare clinical entity, and the morbidity and mortality in patients with brucellar pericarditis is low. Pericardiocentesis should only be performed in patients with cardiac tamponade. Moreover, the choice of antibiotics and the duration of treatment do not differ between brucellosis cases with or without isolated pericarditis. Although the prevalence of pericarditis in brucellosis is low, brucellar pericarditis should always be kept in mind in patients with acute or chronic pericarditis, especially in areas where brucellosis is endemic. (C) 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.Öğe Community acquired infections among refugees leading to Intensive Care Unit admissions in Turkey(Elsevier Sci Ltd, 2017) Turktan, Mediha; Ak, Oznur; Erdem, Hakan; Ozcengiz, Dilek; Hargreaves, Sally; Kaya, Safak; Karakoc, EmreObjectives: Data on the impact of refugees on Intensive Care Units (ICUs) are lacking in the literature, in particular for community-acquired (CA) infectious diseases, for which they are known to be at higher risk. We did a descriptive, multicenter study to analyze CA infections among refugee patients requiring ICU admission. Methods: Inclusion criteria were adult refugee patients admitted to an ICU due to CA infections. Anonymized data were collected between January 1, 2010 and December 30, 2015 across 10 referral centers. Results: 29.885 patients were admitted to the ICUs in the study period. 37 patients were included the study, the majority were from Syria (n = 31, 83.8%). Mean (SD) age of the patients was 45.92 +/- 20.16 years. The 5-year prevalence rate was 123.8 per 100.000 patients in the ICUs. All patients had at least one comorbid condition. Forty-nine CA infections were diagnosed. The most common CA infection was pneumonia (49%) followed by urinary-tract infections (16.3%). 21 patients (56.7%) hospitalized in the ICU had trauma history. Mortality rate was high at 22 patients (59.5%) with 5 (22.7%) deaths directly attributed to CA infections. Conclusions: Refugees presented to ICUs with CA infections similar to the host populations (pneumonia and urinary-tract infections) but had high mortality rates (59.5%). It seems that Turkish ICUs were not congested with the refugee patients' influx for CA infections. More research needs to be done to better understand how to deliver preventative and timely health care services to this group of patients. (C) 2017 International Society for Infectious Diseases. Published by Elsevier Ltd.Öğe Comparison of anti-reflux mechanism between Double-J-Stent and standart Double-J-Stent use for risk of BK nephropathy and urinary tract Infection in kidney transplantation(E-Century Publishing Corp, 2015) Ay, Nurettin; Bahadir, Mehmet Veysi; Anil, Melih; Alp, Vahhac; Kaya, Safak; Sevuk, Utkan; Gul, MesutObjectives: There are studies that show that double J stenting (DJS) increase BK nephropathy (BKN) 4 fold. DJS may cause vesicoureteral reflux (VUR) with normal bladder contraction. The aim of this study is to comparison risk of BKN, urinary tract infections (UTI) and postoperative urologic complications with the use DJS with anti-reflux device (ARD-DJS) and standart double J stent (St-DJS). Matherial and methods: Ninety patients (male/female: 50/40) that had undergone kidney transplantations in Diyarbakir Training and Research Hospital and Dicle University, Faculty of Medicine Hospital between January 2012 and April 2015 were enrolled in the study. Demographic data, immunosuppression protocols, presence of rejection, graft loss, postoperative urologic complications, UTI, plasma BK levels of the patients were evaluated retrospectively. Results: Median and IQR follow up time for ARD-DJS and St-DJS patients were 14 (12-18) months and 25 (16-30) months respectively. Five cases (5.5%) had BK viremia (P=0.025). All 5 cases with BK viremia were St-DJS users. Conclusion: As a result for postoperative UTI and postoperative urinary complication risk there were no statistically significant difference between ARD-DJS use and St-DJS use during ureteral anastomosis. BKN univariate analysis were significantly less than those st-DJS used. Risc factors were evaluated. But results were not statistically significant in the logistic regression analysis. We think that to demonstrate this benefit, we need randomized controlled studies with more patients and longer follow up.Öğe Cutaneous anthrax in Southeast Anatolia of Turkey(Taylor & Francis Ltd, 2015) Tekin, Recep; Sula, Bilal; Deveci, Ozcan; Tekin, Alicem; Bozkurt, Fatma; Ucmak, Derya; Kaya, SafakContext: Anthrax is a rare disease cause by Bacillus anthracis, a Gram-positive, rod-shaped endospore-forming capsuled bacterium. Anthrax is manifest in three primary forms: cutaneous, respiratory, and gastrointestinal. Cutaneous anthrax accounts for approximately 95% of all cases of anthrax in humans. Objective: In the present study, we evaluated the clinical diagnosis and treatment of cutaneous anthrax, a rare disease that nonetheless remains a serious healthcare problem in developing countries. Methods: The complete medical records of patients diagnosed with cutaneous anthrax between January 2001 and December 2012 were examined in a retrospective manner. Cutaneous anthrax was diagnosed by the identification of typical antrax lesions and/or the presence of Gram-positive-capsuled bacillus after staining with Gram stain and methylen blue in pathology samples obtained from these lesions and the presence of characteristic scarring with a history of severe swelling, black eschar, and positive response to treatment form the basis of diagnosis in cases where cultures were negative for the presence of bacillus. Results: A total of 58 patients were admitted to the hospital with cutaneous anthrax between January 2001 and December 2012. This included 32 (55.2%) males and 26 (44.8%) females, with an age range of 15-82 years and a mean age of 38 +/- 13.8 years. The incubation period for the infection ranged between 1 and 20 d (mean 3.7 +/- 1.4 d). The most common symptoms at the time of hospital referral were swelling, redness, and black eschar of the skin. The most common lesion site was the hand and fingers (41.3%). Isolated of bacteria was used to diagnose the disease in six cases (23.8%), detection of Gram-positive bacillus in samples of characteristic lesion material was used in seven (28.5%) cases, and the presence of a characteristic lesion was the sole diagnositc criteria in 45 (77.6%) cases. Treatment consisted of penicillin G (12 cases), ampicillin-sulbactam (30 cases), Cefazolin (12 cases), or ciprofloxacin (4 cases). Conclusion: Although the prevalence of anthrax is a decreasing worldwide, it remains a significant problem in developing countries. Rapid identification of the signs and symptoms of cutaneous anthrax is essential for effective treatment. Early supportive treatment and appropriate antimicrobial measures are necessary to address this potentially life-threatening disease.Öğe Cytopenia in adult brucellosis patients(Medknow Publications & Media Pvt Ltd, 2018) Kaya, Safak; Elaldi, Nazif; Deveci, Ozcan; Eskazan, Ahmet Emre; Bekcibasi, Muhammed; Hosoglu, SalihBackground & objectives: Brucellosis can lead to haematological abnormalities including cytopenia confusing with haematological malignancies. The aim of this study was to compare the main characteristics of brucellosis patients without cytopenia (Group 1) and with cytopenia (Group 2). Methods: This five-year period study which was performed in two referral hospitals in Turkey, included all adult brucellosis patients. Abnormally, low counts of leucocyte or haemoglobin or platelets in a patient were considered as cytopenia. The demographics, clinical, laboratory, treatment and outcome data were analyzed. Results: A total of 484 brucellosis patients were enrolled. Among the cases, 162 (33.5%) of them had cytopenia. One hundred and four (21.5%) had anaemia, 88 (18.8%) had thrombocytopenia, 71 (14.6%) had leucopenia and 28 (5.8%) had pancytopenia. The mean age of group 2 was 35.01 +/- 16.05 yr and it was 33.31 +/- 14.39 yr in group 1. While there was no difference between the groups in terms of duration of treatment, the median length of hospital stay (LOS) was significantly longer in group 2 (9 vs 10 days; P<0.001). The most frequently applied combination therapy consisted of doxycycline plus rifampicin and doxycycline plus streptomycin regimens. No significant difference was observed in terms of duration of treatment, LOS and restoration time of cytopenia between the patients who received either of these combinations. Interpretation & conclusions: Our findings suggested that the patients with cytopenia should be investigated for brucellosis, especially if living in, or with a history of travel to, endemic areas, in view of the increase in world travel.Öğe Efficacy and Safety of Telbivudine in Chronic Hepatitis B Treatment Throughout the Entire Pregnancy(Galenos Yayincilik, 2016) Baysal, Birol; Kaya, Safak; Aksoz, Seluk; Comoglu, Senol; Cabalak, Mehmet; Arslan, Eyup; Colak, HabibeObjective: Women of childbearing potential treated for chronic hepatitis B virus (HBV) infection may experience exacerbations during or after pregnancy. Infants may also acquire HBV infection through perinatal route. Currently, there is no antiviral agent approved for use in pregnancy. This makes it difficult to decide whether treatment should be withdrawn immediately or continued in women who become pregnant while on HBV antiviral therapy. The present study aims to establish the safety and, as a second measure, the efficacy of telbivudine in patients who became pregnant while they were on telbivudine treatment for chronic HBV infections and were maintained on the treatment throughout pregnancy. Materials and Methods: Between 2010 and 2013, twenty-one patients, who became pregnant while receiving telbivudine treatment for chronic HBV infection and continued the treatment, were evaluated retrospectively. Results: The mean age of the patients was 28.9 +/- 6.3 years (range: 18-41 years). All patients were hepatitis B envelope antigen-negative. The mean pre-treatment hepatic activity index was 9.4 +/- 1.6 (range: 7-13), and fibrosis and serum HBV, DNA measurements were 3.2 +/- 0.8 (range: 2-5) and 3.5x10(5)+/- 2.8x10(5) IU/mL, respectively. No drug-related side effects were seen in any of the patients. All infants had normal birth weights and no abnormalities were observed in any of them. At the end of week 28, none of the infants was hepatitis B surface antigen-positive. Conclusion: The use of telbivudine from the first trimester of pregnancy appears to be safe both for the mother and fetus and to be efficient in preventing mother-to-child transmission of HBV infection. However, randomized, controlled studies involving a higher number of subjects are needed.Öğe Efficacy and safety of tenofovir disoproxil fumarate in pregnancy for the prevention of vertical transmission of HBV infection(Baishideng Publishing Group Inc, 2013) Celen, Mustafa Kemal; Mert, Duygu; Ay, Muzeyyen; Dal, Tuba; Kaya, Safak; Yildirim, Necmettin; Gulsun, SerdaAIM: To evaluate the effects of tenofovir disoproxil fumarate (TDF) use during late pregnancy to reduce hepatitis B virus (HBV) transmission in highly viremic mothers. METHODS: This retrospective study included 45 pregnant patients with hepatitis B e antigen (+) chronic hepatitis B and HBV DNA levels > 10(7) copies/mL who received TDF 300 mg/d from week 18 to 27 of gestation (n = 21). Untreated pregnant patients served as controls (n = 24). All infants received 200 IU of hepatitis B immune globulin (HBIG) within 24 h postpartum and 20 mu g of recombinant HBV vaccine at 4, 8, and 24 wk. Perinatal transmission rate was determined by hepatitis B surface antigen and HBV DNA results in infants at week 28. RESULTS: At week 28, none of the infants of TDF-treated mothers had immunoprophylaxis failure, whereas 2 (8.3 %) of the infants of control mothers had immunoprophylaxis failure (P = 0.022). There were no differences between the groups in terms of adverse events in mothers or congenital deformities, gestational age, height, or weight in infants. At postpartum week 28, significantly more TDF-treated mothers had levels of HBV DNA < 250 copies/mL and normalized alanine aminotransferase compared with controls (62% vs none, P < 0.001; 82% vs 61%, P = 0.012, respectively). CONCLUSION: TDF therapy during the second or third trimester reduced perinatal transmission rates of HBV and no adverse events were observed in mothers or infants. (C) 2013 Baishideng Publishing Group Co., Limited. All rights reserved.Öğe Evaluation of cutaneous palpebral anthrax(Taylor & Francis Ltd, 2013) Tekin, Recep; Ari, Seyhmus; Dal, Tuba; Kaya, Safak; Kortak, Mehmet Zeki; Dursun, Birgul; Dayan, SaimContext: Anthrax is a rare disease caused by Bacillus anthracis. Antrax is zoonotic disease and is often encountered in persons engaged in animal husbandry. Cutaneous anthrax is approximately 95% of anthrax in humans. Palbebral involvement is rare. Objective: In this study, we aimed to evaluate the clinical presentation, diagnosis and treatment of cases with cutaneous palpebral anthrax. Methods: In this study, the patients diagnosed of cutaneous palpebral anthrax between January 2000 and December 2012, were investigated and evaluated, retrospectively. Cutaneous palpebral anthrax was diagnosed by the presence of typical anthrax lesion and/or observation of gram-positive encapsulated bacilli in gram prepations and/or culture positive of samples taken from lesions. In the cases who were culture-negative and without bacilli in gram-staining, the diagnosis was based on the presence of characteristic clinical presentation with a history of severe scarring formation, swelling, black eschar and positive response to the treatment. Results: A total of 21 patients with cutaneous palpebral anthrax admitted to the two hospitals between January 2000 and December 2012. Eight patients were male (38.1%) and 13 patients were female (61.9%), and the mean age was 31 +/- 21.2 (range 1-82 years). The most common symptoms on admission to the hospital were swelling and redness on the skin. Periorbital lesions were in the right eye in 14 cases and the most common eyelid involvement was seen in upper eyelid with 15 cases. The diagnosis was based on isolation of bacteria in five (23.8%) cases, detection of gram-positive bacilli in direct examination of characteristic lesion material in six (28.5%) cases. Ten (47.7%) cases were diagnosed by the characteristic appearance of the lesion. Malignant pustule was seen in all of our patients and seven cases (33.4%) had malignant edema. In the treatment, penicilin was used for 10 (47.7%) cases, ampicillin-sulbactam for five (23.8%) cases and, ciprofloxacin for three (14.3%) cases. Cicatricial ectropion was observed in 10 (47.7%) patients, lagophthalmos developed in four (19%) patients, and corneal scar in two (9.5%) patients. The distribution of the cases did not differ by the year but showed a density in the months from July to September (62.7%). Conclusion: Early diagnosis and high dose antibiotic treatment can facilitate the treatment and prevent development of eyelid complications including cicatricial ectropion, corneal scars and palpebral symphysis. Prolonged follow-up is necessary in patients who develop complications and surgical intervention.Öğe Evaluation of Infections in Intensive Care Units: A Multicentre Point-Prevalence Study(Ankara Microbiology Soc, 2019) Arac, Esef; Kaya, Safak; Parlak, Emine; Buyuktuna, Seyit Ali; Baran, Ali Irian; Akgul, Fethiye; Gokler, Mehmet EnesInfection control is a top priority for hospitals, especially in intensive care units (ICU). In intensive care units, prevalence of infection is estimated to be 30% worldwide, which is a major cause of morbidity and mortality. Many factors are known to increase the risk of infection in ICU patients. Since each of these may lead to different infections, it is important to recognize and identify predisposing factors for early diagnosis and treatment. The regional health care-associated infections (HCAI) prevalence and distribution of risk factors are important strategies in infection control. In this regard, the aim of this point prevalence study was to obtain data related to infections, the prevalence of HCAI among these infections, the epidemiology, agents and antibiotics used among adult ICU patients in the university hospitals, training and research hospitals and public hospitals located in eight of the cities of our region. In the light of these data, we aimed to review and emphasize the guidelines on HCAI prevention. The study included adult ICU patients followed up in nine hospitals in the Eastern and South-eastern Anatolia Regions of eight different cities (Sivas, Erzurum, Mardin, Batman, Diyarbakir Elazig, Van, Adiyaman) in Turkey. Of the hospitals six were university hospitals, one was training and research hospital, and two were public hospitals. The number of beds ranged from 358 to 1418. A specific day was determined on which the researchers concurrently carried out a prospective surveillance in all adult intensive care unit patients. The researchers collected data and recorded the demographic characteristics (age, gender), underlying diseases, length of hospital stay, presence of invasive intervention (urinary catheter, central venous catheter, external ventricular drainage, mechanical ventilator, presence of risk factors such as burn, trauma and surgery, number of infection cases, type of infection (hospital-acquired, community-acquired), type of microorganisms and whether polymicrobial or monomicrobial, which antibiotics were administered, and duration of antibiotic treatment. Our study assessed data of 429 inpatients in the adult ICU of nine hospitals in eight different cities. There were a total of 881 intensive care beds in these hospitals, and 740 (84%) beds were occupied. Of the study group 49.7% was male with a mean age (min-max) of 64.08 +/- 18.78 (2-97) years. The point prevalence of HCAI was 21.7% (n= 93). Of the patients who were followed-up 182 (42.4%) presented infections. Of these infections, 21.4% were diagnosed as community-acquired pneumonia, 18.6% were ventilator-associated pneumonia (VAP), 16.3% were community-acquired urinary tract infection (UTI), and 16.3% were bloodstream infection. In addition, the most commonly administered antibiotics in the study group were piperacillin/tazobactam, carbapenem, quinolone and ceftriaxone, respectively. The most common types of HCAI were community-acquired pneumonia (10.7%), ventilator-associated pneumonia (8.9%) and bloodstream infections (8.2%). The mean length of hospital stay was 32.05 +/- 66.85 (1-459) days and the mean duration of antibiotic therapy in patients with HCAls was 7.76 +/- 7.11 (1-41) days. The most widely accepted method to handle infection is to carry out active, prospective and patient-based surveillance studies on a regular basis, and to take control measures and arrange appropriate treatment in the light of the data obtained. We attribute the high prevalence of HCAI in our region to lack of personnel, lack of materials, inappropriate use of antibiotics, insufficiency of physical conditions, and little support for infection control committees. In conclusion, we emphasize that it is of importance to work closely with the hospital administration to take measures and that necessary assistance is provided.Öğe Evaluation of liver fibrosis in chronic hepatitis B patients with 2D shear wave elastography with propagation map guidance: a single-centre study(Bmc, 2022) Kavak, Seyhmus; Kaya, Safak; Senol, Ayhan; Sogutcu, NilgunBackground The aims of this study were to evaluate liver fibrosis with two-dimensional (2D) shear wave elastography (SWE) in patients with chronic hepatitis B (CHB), to compare 2D-SWE with histopathology and to determine the change in liver stiffness values after antiviral therapy. Material and methods A total of 253 patients with CHB were included in this prospective study. 2D-SWE with propagation map guidance to measure liver stiffness, fibrosis-4 index (FIB-4) and aspartate aminotransferase to platelet ratio index (APRI) scoring and additional liver biopsy were performed in patients with CHB. Liver stiffness was measured again at 24 and 48 weeks in all patients. The Spearman rank correlation test was used to analyse the correlation between variables, and receiver operating curve analysis was used to evaluate the diagnostic performance in terms of fibrosis. Results Liver stiffness measurements made with 2D-SWE demonstrated a significant positive correlation with the fibrosis stage and FIB-4 score (r(s) = 0.774 and 0.337, respectively, p < 0.001 for both). The area under the curve value for kPa for the prediction of significant fibrosis was 0.956 (95% CIs) (0.920-0.991), and the optimal cut-off value was 8.2 kPa (sensitivity: 92.7% and specificity: 78.9%); these values were 0.978 (95% CIs, 0.945-1.000) and 10.1 kPa (sensitivity: 92.9% and specificity: 96.4%) for the prediction of severe fibrosis. After antiviral treatment, a decrease in liver stiffness values measured by 2D-SWE was detected (mean kPa values at 0 and 48 weeks; 9.24 and 7.36, respectively, p < 0.001). Conclusion In conclusion, the measurement of liver stiffness with 2D-SWE has high diagnostic performance in the determination of hepatic fibrosis and can be used to evaluate the response to treatment in patients receiving antiviral therapy.Öğe Seroprevalence of Hepatitis B and C among Patients Admitted to a Tertiary Hospital(Galenos Yayincilik, 2014) Kaya, Safak; Baysal, Birol; Temiz, Hakan; Karadag, Omer; Ozdemir, Kevser; Bilman, FulyaObjectives: To evaluate seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) among patients admitted to a tertiary hospital in southeast Turkey. Materials and Methods: A retrospective study of patients admitted to the Diyarbakir Training and Research Hospital during February 2010 and July 2011. The study population consisted of patients who gave blood and tested for HBV and HCV. Data were collected from the database of our hospital. Data were analyzed using SPSS program. Results: A total of 43.131 patients tested for hepatitis B surface antigen (HBsAg) were included in this study. 4.472 patients (10.4%) were positive for HBsAg (6.8% male, 3.6% female, p<0.05). 323 (1.2%) of 28.276 patients, who underwent anti-HCV testing, were positive for anti-HCV. 381 (13.1%) of 2.899 HBsAg-positive patients were positive for hepatitis B e antigen (HBeAg). Conclusion: Although similar to that in the other regions of Turkey, the seroprevalence of hepatitis B is still high. Community awareness about the transmission and prevention of hepatitis B infection should be strengthened by health education.Öğe Tigecycline in the treatment of multidrug-resistant Acinetobacter baumannii meningitis: Results of the Ege study(Elsevier Science Bv, 2018) Sipahi, Oguz Resat; Mermer, Sinan; Demirdal, Tuna; Ulu, Ashhan Candevir; Fillatre, Pierre; Ozcem, Selin Bardak; Kaya, SafakObjectives: In this study we retrospectively reviewed A. baumannii meningitis cases treated with tigecycline including regimens and evaluated the efficacy of tigecycline in the therapy. Patients and Methods: Study was performed in seven tertiary-care educational hospitals from five cities of Turkey and one center from France. We extracted data and outcomes of all adult (aged > 18) patients with culture proven A. baumannii meningitis treated with tigecycline including antibiotic therapy until April 2016. Results: A total of 23 patients (15 male and eight female) fulfilled our inclusion criteria. All Acinetobacter strains were carbapenem-resistant and susceptible to tigecycline. Six cases received tigecycline monotherapy while 17 received tigecycline including combination therapy (10 with colistin, 4 with netilmicin, 3 with amikacin, 4 with meropenem). Seven of 23 cases (30%) died during the tigecycline including therapy (1 in monotherapy, 4 in colistin, 2 in netilmicin, 1 amikacin, one case received tigecycline + netilmicin followed by tigecycline + colistin). Hence, overall end of treatment (EOT) success was 70%. However, since further 27% died due to additional nosocomial infections, overall clinical success (relieved symptoms at the EOT and one-month post therapy survival without any relapse or reinfection) decreased to 43%. Conclusion: We conclude that tigecycline may be an alternative in the salvage treatment of nosocomial multi drug-resistant Acinetobacter spp. meningitis. Acinetobacter spp. Meningitis.Öğe Two Cases of Autoimmune Hemolytic Anemia Secondary to Brucellosis: A Review of Hemolytic Disorders in Patients with Brucellosis(Japan Soc Internal Medicine, 2014) Eskazan, Ahmet Emre; Dal, Mehmet Sinan; Kaya, Safak; Dal, Tuba; Ayyildiz, Orhan; Soysal, TeomanBrucellosis is a worldwide zoonotic disease associated with hemolytic complications, including thrombotic microangiopathy (TMA) and hemolytic anemia. Autoimmune hemolytic anemia (AIHA) is a rare clinical presentation of this disease. In this report, we describe the cases of two patients with brucellosis who presented with Coombs-positive AIHA. We also include a review of the literature on the hemolytic complications of brucellosis. Both patients were successfully treated with a combination of doxycycline and rifampicin in addition to steroids. In the medical literature, there are several cases of TMA associated with brucellosis, although only a few cases of Coombs test-positive AIHA have been reported. Antibiotic therapy is the mainstay of treatment, and the selection of antibiotics and duration of treatment do not differ between brucellosis patients with and without hemolysis. Although rare, the potential for brucellosis should always be kept in mind in patients who present with hemolysis, especially those living in areas where brucellosis is endemic.
