Objective: Infective endocarditis is a serious disease with high morbidity and mortality due to serious embolic complications. The follow-up of the patients requires multidisciplinary evaluation. We aimed to share the experience of the infective endocarditis team in our hospital and to guide the work of the teams to be formed in the future. Methods: Our study was planned as descriptive, cross-sectional, and observational. The patients were diagnosed by the modified Duke criteria. The National Infective Endocarditis Consensus Report was considered during the diagnosis, follow-up, and treatment process. Results: Fifty (45.4%) of 110 patients followed by the team were diagnosed with endocarditis. Thirty of the patients (51.8%) were male, the median age was 63.5 (18-87) days, and the median duration of symptoms was 35.7 (1-180) days. 76% of the diagnoses were definite endocarditis, 46% of the cases had an acute course, aortic valve involvement was 38%, and native valve involvement was 60%; the most isolated agent was Stapyhylococcus aureus. Community-acquired infection was 46%. The most common predisposing factors were prosthetic heart valve (38%) and hemodialysis (46%). Fever was observed in 64% of the patients and dyspnea in 58%. The rate of detection of vegetation by transesophageal echocardiography was 68%. Brain, pulmonary embolisms, and spondylodiscitis were the most common complications. The median time for blood culture to become negative was 3 (3-15) days, the operation time for 15 patients was 8 (1-30) days, and the 30-day hospital mortality was 28%. A statistically significant correlation was found between mortality and the presence of previous endocarditis, ejection fraction below 50%, complication development, hospitalization in the intensive care unit, presence of thrombocytopenia, Charlson comorbidity index ≥5, and vegetation size ≥1 cm (p<0.05). We determined that the presence of previous endocarditis increased the risk of mortality 14 times (p=0.025). Conclusion: Mortality and morbidity rates can be reduced by detecting underlying diseases, controlling complications, applying early effective antibiotic and anticoagulant treatment, surgical interventions at the right time, and rapid supportive treatments for sepsis by teams formed with a multidisciplinary approach.
{"title":"Three Years’ Experience of the Infective Endocarditis Team in a University Hospital","authors":"Nuran Sari, Emir Karacaglar, Elif Ates, Bahadir Gultekin, Seda Kabiroglu, Zeynep Kendi-Celebi, Aysen Terzi, Feride Rahatli-Kural, Ayse Aktas, Meric Yavuz-Colak, Ozlem Kurt-Azap, Atilla Sezgin, Caner Incekas","doi":"10.36519/kd.2023.4725","DOIUrl":"https://doi.org/10.36519/kd.2023.4725","url":null,"abstract":"Objective: Infective endocarditis is a serious disease with high morbidity and mortality due to serious embolic complications. The follow-up of the patients requires multidisciplinary evaluation. We aimed to share the experience of the infective endocarditis team in our hospital and to guide the work of the teams to be formed in the future. Methods: Our study was planned as descriptive, cross-sectional, and observational. The patients were diagnosed by the modified Duke criteria. The National Infective Endocarditis Consensus Report was considered during the diagnosis, follow-up, and treatment process. Results: Fifty (45.4%) of 110 patients followed by the team were diagnosed with endocarditis. Thirty of the patients (51.8%) were male, the median age was 63.5 (18-87) days, and the median duration of symptoms was 35.7 (1-180) days. 76% of the diagnoses were definite endocarditis, 46% of the cases had an acute course, aortic valve involvement was 38%, and native valve involvement was 60%; the most isolated agent was Stapyhylococcus aureus. Community-acquired infection was 46%. The most common predisposing factors were prosthetic heart valve (38%) and hemodialysis (46%). Fever was observed in 64% of the patients and dyspnea in 58%. The rate of detection of vegetation by transesophageal echocardiography was 68%. Brain, pulmonary embolisms, and spondylodiscitis were the most common complications. The median time for blood culture to become negative was 3 (3-15) days, the operation time for 15 patients was 8 (1-30) days, and the 30-day hospital mortality was 28%. A statistically significant correlation was found between mortality and the presence of previous endocarditis, ejection fraction below 50%, complication development, hospitalization in the intensive care unit, presence of thrombocytopenia, Charlson comorbidity index ≥5, and vegetation size ≥1 cm (p<0.05). We determined that the presence of previous endocarditis increased the risk of mortality 14 times (p=0.025). Conclusion: Mortality and morbidity rates can be reduced by detecting underlying diseases, controlling complications, applying early effective antibiotic and anticoagulant treatment, surgical interventions at the right time, and rapid supportive treatments for sepsis by teams formed with a multidisciplinary approach.","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":"135082268","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}
Mehmet Okan Yildirim, Gonca Demirbuken, Elif Doruk-Kartal
Objective: We aimed to evaluate risk factors for bacteremia and mortality in patients with nosocomial Acinetobacter bacteremia in a university hospital’s Anesthesia and Reanimation Intensive Care Unit (ICU) between 2013-2016. Methods: This study was designed as a retrospective case-control study; the case group consisted of patients older than 18 years, with Acinetobacter species growth in blood cultures taken 48 hours after hospitalization, with clinical bacteremia findings, followed until death or at least 30 days after culture. Patients in the control group consisted of cases without Acinetobacter bacteremia and showed similar characteristics to the case group. Patients were evaluated regarding demographic characteristics, underlying diseases, carbapenem use before blood culture was taken, appropriate empirical treatment, 30-day mortality, nutritional status, Pittsburgh Bacteremia Score (PBS), and interventional procedures. Results: Among case and control groups each consisting of 51 patients, carbapenem use (63.2% and 34.8%, respectively, odds ratio (OR)=3.67; 95% confidence interval (CI)=1.49-9.04, p=0.005) and chest tube placement (23.5% and 7.8%, respectively, OR=7.31; 95% CI=1.43-37.22, p=0.005) were independent risk factors for Acinetobacter bacteremia. Among cases with or without mortality in the case group, there was a significant difference in terms of endotracheal intubation (100%, 76.9%, respectively, p=0.023), PBS (6.6±1.08, 5.0±2.29, respectively, p=0.003), nutritional status (total parenteral nutrition [TPN] or enteral nutrition +TPN) (%28, %0 and %72, %100, respectively, p=0.004) and hypertension (HT) (%52, %19.2, respectively, p=0.03) and also HT [52% and 19.2%, respectively, OR=4.61; 95% CI=1.08-19.57, p=0.038], inappropriate empirical therapy [69.6% and 30.8%, respectively, OR=6.46; 95% CI=1.55-26.94, p=0.01] and albumin level [2.32±0.50 and 2.57±0.44 g/dL, respectively, OR=0.196; 95% CI=0.045-0.847, p=0.029] were independent mortality risk factors. Conclusion: Previous carbapenem use and chest tube insertion are important risk factors for Acinetobacter bacteremia in ICU. Inappropriate empirical treatment, HT, and low albumin levels are important mortality risk factors in Acinetobacter bacteremia in ICU. High PBS scores should be carefully evaluated for mortal Acinetobacter bacteremia.
{"title":"Evaluation of Risk Factors Causing Nosocomial Acinetobacter Bacteremia and Mortality in the Intensive Care Unit","authors":"Mehmet Okan Yildirim, Gonca Demirbuken, Elif Doruk-Kartal","doi":"10.36519/kd.2023.4392","DOIUrl":"https://doi.org/10.36519/kd.2023.4392","url":null,"abstract":"Objective: We aimed to evaluate risk factors for bacteremia and mortality in patients with nosocomial Acinetobacter bacteremia in a university hospital’s Anesthesia and Reanimation Intensive Care Unit (ICU) between 2013-2016. Methods: This study was designed as a retrospective case-control study; the case group consisted of patients older than 18 years, with Acinetobacter species growth in blood cultures taken 48 hours after hospitalization, with clinical bacteremia findings, followed until death or at least 30 days after culture. Patients in the control group consisted of cases without Acinetobacter bacteremia and showed similar characteristics to the case group. Patients were evaluated regarding demographic characteristics, underlying diseases, carbapenem use before blood culture was taken, appropriate empirical treatment, 30-day mortality, nutritional status, Pittsburgh Bacteremia Score (PBS), and interventional procedures. Results: Among case and control groups each consisting of 51 patients, carbapenem use (63.2% and 34.8%, respectively, odds ratio (OR)=3.67; 95% confidence interval (CI)=1.49-9.04, p=0.005) and chest tube placement (23.5% and 7.8%, respectively, OR=7.31; 95% CI=1.43-37.22, p=0.005) were independent risk factors for Acinetobacter bacteremia. Among cases with or without mortality in the case group, there was a significant difference in terms of endotracheal intubation (100%, 76.9%, respectively, p=0.023), PBS (6.6±1.08, 5.0±2.29, respectively, p=0.003), nutritional status (total parenteral nutrition [TPN] or enteral nutrition +TPN) (%28, %0 and %72, %100, respectively, p=0.004) and hypertension (HT) (%52, %19.2, respectively, p=0.03) and also HT [52% and 19.2%, respectively, OR=4.61; 95% CI=1.08-19.57, p=0.038], inappropriate empirical therapy [69.6% and 30.8%, respectively, OR=6.46; 95% CI=1.55-26.94, p=0.01] and albumin level [2.32±0.50 and 2.57±0.44 g/dL, respectively, OR=0.196; 95% CI=0.045-0.847, p=0.029] were independent mortality risk factors. Conclusion: Previous carbapenem use and chest tube insertion are important risk factors for Acinetobacter bacteremia in ICU. Inappropriate empirical treatment, HT, and low albumin levels are important mortality risk factors in Acinetobacter bacteremia in ICU. High PBS scores should be carefully evaluated for mortal Acinetobacter bacteremia.","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":"135081620","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}
Objective: We aimed to determine an appropriate anti-HCV test cut-off value for the HCV-RNA study and contribute to the development of correct algorithms by evaluating our hospital’s anti HCV and HCV-RNA test results between 2017-2019. Methods: Available HCV-RNA test results of patients who were found to have reactivity in anti-HCV were analyzed. Patients with anti-HCV reactivity were analyzed by dividing into age groups 0-20 years, 21-40 years, 41-60 years, and ≥61 years. HCV-RNA results were also evaluated within the same age groups. Patients with anti-HCV reactivity were divided into three groups according to their S/Co values as 1-5 mLU/mL, 5.1-10 mLU/mL, and ≥10.1 mLU/mL, and statistical analysis was performed. Results: Anti-HCV reactive results were divided into groups of 1.0-3.8 mLU/mL and ≥3.9 mLU/mL according to S/Co values, and HCV-RNA positivity was 2% and 44.4% respectively. When divided into three groups as 1-5 mLU/mL, 5.1-10 mLU/mL, and ≥10.1 mLU/mL according to S/Co values, the HCV RNA positivity rate was 1.8%, 25%, and 55.2%, respectively. The difference between the groups was statistically significant. Conclusion: Countries should carry out comprehensive studies to represent their populations to determine cut-off values for widely used kits and to make this applicable with algorithms.
{"title":"Retrospective Evaluation of Serological and Molecular Tests for Determination of Anti-HCV Screening Test Cut-Off","authors":"Digdem Ozer-Yildirim, Begüm Nalca-Erdin, Tugba Kula-Atik","doi":"10.36519/kd.2023.4453","DOIUrl":"https://doi.org/10.36519/kd.2023.4453","url":null,"abstract":"Objective: We aimed to determine an appropriate anti-HCV test cut-off value for the HCV-RNA study and contribute to the development of correct algorithms by evaluating our hospital’s anti HCV and HCV-RNA test results between 2017-2019. Methods: Available HCV-RNA test results of patients who were found to have reactivity in anti-HCV were analyzed. Patients with anti-HCV reactivity were analyzed by dividing into age groups 0-20 years, 21-40 years, 41-60 years, and ≥61 years. HCV-RNA results were also evaluated within the same age groups. Patients with anti-HCV reactivity were divided into three groups according to their S/Co values as 1-5 mLU/mL, 5.1-10 mLU/mL, and ≥10.1 mLU/mL, and statistical analysis was performed. Results: Anti-HCV reactive results were divided into groups of 1.0-3.8 mLU/mL and ≥3.9 mLU/mL according to S/Co values, and HCV-RNA positivity was 2% and 44.4% respectively. When divided into three groups as 1-5 mLU/mL, 5.1-10 mLU/mL, and ≥10.1 mLU/mL according to S/Co values, the HCV RNA positivity rate was 1.8%, 25%, and 55.2%, respectively. The difference between the groups was statistically significant. Conclusion: Countries should carry out comprehensive studies to represent their populations to determine cut-off values for widely used kits and to make this applicable with algorithms.","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":"135081623","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}
Objective: Chronicity of acute HBV infection is higher in people living with HIV (PLWH) than in the general population. HIV/HBV coinfection has a higher risk of rapid progression to cirrhosis and liver-related death than in solely HBV-infected patients. Therefore, vaccination against HBV is recommended. In this study, we aimed to evaluate hepatitis B vaccination rates and the factors affecting response to the vaccine in PLWH. Methods: Outpatient follow-up files and laboratory test results at the hospital information system of 1394 patients aged >18 years diagnosed with HIV/AIDS and followed between January 1, 2007, and January 1, 2022, were evaluated retrospectively. Results: Of the PLWH, 81 (5.8%) had chronic hepatitis B infection, 114 (8.2%) had isolated anti-HBc IgG positivity, and 274 (19.6%) had a previous condition. 248 (17.7%) of the PLWH had been vaccinated before HIV/AIDS diagnosis. HBsAg, anti-HBc IgG and anti-HBs were negative in 673 PLWH. A total of 352 (44.7%) PLWHs were vaccinated, consisting of 63 (55.2%) of 114 PLWHs with isolated anti-HBc IgG positivity and 289 (42.9%) of 673 PLWHs with negative HBV serology. Immunity developed in 282 (84.1%) of those vaccinated. We found that the main factor determining the immune response was the CD4+ T lymphocyte count at the time of diagnosis, and there was a significant increase in immune response since 2015 when the recommendation of antiretroviral therapy independent of the CD4+ T lymphocyte level was implemented. We observed that comorbidities, age, gender, and sexual orientation did not significantly affect the vaccine response. Conclusion: Vaccination is critical in PLWH, and we observed that the ideal time for vaccination in those with negative HBV serology is when the CD4+ T lymphocyte count is >200 cells/mm³ and the viral load is suppressed. It should be considered that the vaccination rate and immune response will increase with the support of vaccination outpatient clinics, where vaccination status is closely monitored by healthcare personnel. Keywords: HIV/AIDS, hepatitis B vaccine, vaccination, vaccine respons
{"title":"Evaluation of Hepatitis B Vaccination Status and Factors Affecting Response to Vaccination in HIV/AIDS Patients","authors":"Esra Zardali, Hatice Kubra Karanalbant, Melike Nur Ozcelik, Inci Yilmaz-Nakir, Filiz Pehlivanoglu","doi":"10.36519/kd.2023.4602","DOIUrl":"https://doi.org/10.36519/kd.2023.4602","url":null,"abstract":"Objective: Chronicity of acute HBV infection is higher in people living with HIV (PLWH) than in the general population. HIV/HBV coinfection has a higher risk of rapid progression to cirrhosis and liver-related death than in solely HBV-infected patients. Therefore, vaccination against HBV is recommended. In this study, we aimed to evaluate hepatitis B vaccination rates and the factors affecting response to the vaccine in PLWH. Methods: Outpatient follow-up files and laboratory test results at the hospital information system of 1394 patients aged >18 years diagnosed with HIV/AIDS and followed between January 1, 2007, and January 1, 2022, were evaluated retrospectively. Results: Of the PLWH, 81 (5.8%) had chronic hepatitis B infection, 114 (8.2%) had isolated anti-HBc IgG positivity, and 274 (19.6%) had a previous condition. 248 (17.7%) of the PLWH had been vaccinated before HIV/AIDS diagnosis. HBsAg, anti-HBc IgG and anti-HBs were negative in 673 PLWH. A total of 352 (44.7%) PLWHs were vaccinated, consisting of 63 (55.2%) of 114 PLWHs with isolated anti-HBc IgG positivity and 289 (42.9%) of 673 PLWHs with negative HBV serology. Immunity developed in 282 (84.1%) of those vaccinated. We found that the main factor determining the immune response was the CD4+ T lymphocyte count at the time of diagnosis, and there was a significant increase in immune response since 2015 when the recommendation of antiretroviral therapy independent of the CD4+ T lymphocyte level was implemented. We observed that comorbidities, age, gender, and sexual orientation did not significantly affect the vaccine response. Conclusion: Vaccination is critical in PLWH, and we observed that the ideal time for vaccination in those with negative HBV serology is when the CD4+ T lymphocyte count is >200 cells/mm³ and the viral load is suppressed. It should be considered that the vaccination rate and immune response will increase with the support of vaccination outpatient clinics, where vaccination status is closely monitored by healthcare personnel. Keywords: HIV/AIDS, hepatitis B vaccine, vaccination, vaccine respons","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":"135082095","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}
Pub Date : 2023-07-31eCollection Date: 2023-09-01DOI: 10.36519/idcm.2023.241
Amanda J Bastien, Gene C Liu, Dennis M Tang, Abhita Reddy, Kyohei Itamura, Jack Green, Priya R Soni
A retropharyngeal abscess (RPA) in early childhood is not uncommon due to at-risk lymph nodes in this deep neck space and is typified by fever, odynophagia, and a constellation of respiratory manifestations. However, RPA is exceedingly rare in the neonatal subpopulation and not part of the usual differential diagnosis algorithm in this age range. Herein, we present a unique case of a previously healthy 5-week-old male infant with protracted "congestion" and difficulty in oral feeding, whose clinical course is confounded by intermittent, positional bradycardia and subsequent apnea. He was eventually diagnosed with a methicillin-resistant Staphylococcus aureus (MRSA) RPA, leading to concurrent vascular and airways compromise in the form of baroreceptor-mediated bradycardia from mass-effect carotid body compression. This clinical case is an important reminder that any infant with positional vital sign changes should prompt urgent and thorough investigation for extraordinary and otherwise uncommon pathophysiologic states. The case also highlights the power of multidisciplinary collaboration across multiple specialties and parental advocacy in unifying a diagnosis for rare pediatric illnesses.
{"title":"A Near Miss of a Retropharyngeal Abscess with MRSA in a 5-Week-Old Boy Due to an Unusual Presentation.","authors":"Amanda J Bastien, Gene C Liu, Dennis M Tang, Abhita Reddy, Kyohei Itamura, Jack Green, Priya R Soni","doi":"10.36519/idcm.2023.241","DOIUrl":"10.36519/idcm.2023.241","url":null,"abstract":"<p><p>A retropharyngeal abscess (RPA) in early childhood is not uncommon due to at-risk lymph nodes in this deep neck space and is typified by fever, odynophagia, and a constellation of respiratory manifestations. However, RPA is exceedingly rare in the neonatal subpopulation and not part of the usual differential diagnosis algorithm in this age range. Herein, we present a unique case of a previously healthy 5-week-old male infant with protracted \"congestion\" and difficulty in oral feeding, whose clinical course is confounded by intermittent, positional bradycardia and subsequent apnea. He was eventually diagnosed with a methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) RPA, leading to concurrent vascular and airways compromise in the form of baroreceptor-mediated bradycardia from mass-effect carotid body compression. This clinical case is an important reminder that any infant with positional vital sign changes should prompt urgent and thorough investigation for extraordinary and otherwise uncommon pathophysiologic states. The case also highlights the power of multidisciplinary collaboration across multiple specialties and parental advocacy in unifying a diagnosis for rare pediatric illnesses.</p>","PeriodicalId":44309,"journal":{"name":"Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11020011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46824113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Z. Keleş, Buse Aslan, Zeynep Kubra Kav, Helin Destina Tutus
Objective: Transport of blood and saliva-contaminated materials such as impressions and prostheses between clinics and laboratories increases the risk of cross-infection. This study evaluates dental technicians knowledge, attitudes, and behaviors about infection control practices. Methods: This cross-sectional study was conducted through an online questionnaire for dental technicians working in Istanbul between July 03, 2021, and January 31, 2022. The questionnaire comprised 38 multiple-choice questions on demographic information, infection control awareness, disinfection practices, personal protective equipment use, and Hepatitis B vaccination. Results: In the research, 256 dental technicians took part, and 73% of them graduated from were graduates of dental lab technician school. The rate of those who received infection control training was 60.2%. 72.3% of the participants were vaccinated against hepatitis B, and 8.6% were not vaccinated due to their immunity. 59.4% of dentists did not inform the laboratories about the sent materials disinfection status. Although 97.3% of the technicians thought there was a risk of infectious disease transmission from impressions and prostheses delivered from dental clinics, they disinfected 88.7% of the alginate impressions and 87.5% of the silicone and polyether impressions. The rate of those who used all the equipment, gloves, masks, and eye protection during disinfection was 31.7%. Medical wastes were separated in 40.6% of the laboratories. 69.9% of technicians thought the infection control procedures were adequate in their laboratories, whereas 20.7% did not. Conclusion: It would be beneficial for dental technicians to receive infection control training to increase their knowledge about disinfection practices and the use of personal protective equipment. We suggest that contaminated materials be transported to laboratories after being disinfected at dental clinics, infection control guidelines for dental prosthesis laboratories should be established, and regular inspections should be conducted to reduce the risk of cross-infection.
{"title":"Evaluation of Awareness and Attitude Regarding Infection Control Practices in Dental Prosthesis Laboratories","authors":"Z. Keleş, Buse Aslan, Zeynep Kubra Kav, Helin Destina Tutus","doi":"10.36519/kd.2023.4370","DOIUrl":"https://doi.org/10.36519/kd.2023.4370","url":null,"abstract":"Objective: Transport of blood and saliva-contaminated materials such as impressions and prostheses between clinics and laboratories increases the risk of cross-infection. This study evaluates dental technicians knowledge, attitudes, and behaviors about infection control practices.\u0000\u0000Methods: This cross-sectional study was conducted through an online questionnaire for dental technicians working in Istanbul between July 03, 2021, and January 31, 2022. The questionnaire comprised 38 multiple-choice questions on demographic information, infection control awareness, disinfection practices, personal protective equipment use, and Hepatitis B vaccination.\u0000\u0000Results: In the research, 256 dental technicians took part, and 73% of them graduated from were graduates of dental lab technician school. The rate of those who received infection control training was 60.2%. 72.3% of the participants were vaccinated against hepatitis B, and 8.6% were not vaccinated due to their immunity. 59.4% of dentists did not inform the laboratories about the sent materials disinfection status. Although 97.3% of the technicians thought there was a risk of infectious disease transmission from impressions and prostheses delivered from dental clinics, they disinfected 88.7% of the alginate impressions and 87.5% of the silicone and polyether impressions. The rate of those who used all the equipment, gloves, masks, and eye protection during disinfection was 31.7%. Medical wastes were separated in 40.6% of the laboratories. 69.9% of technicians thought the infection control procedures were adequate in their laboratories, whereas 20.7% did not.\u0000\u0000Conclusion: It would be beneficial for dental technicians to receive infection control training to increase their knowledge about disinfection practices and the use of personal protective equipment. We suggest that contaminated materials be transported to laboratories after being disinfected at dental clinics, infection control guidelines for dental prosthesis laboratories should be established, and regular inspections should be conducted to reduce the risk of cross-infection.","PeriodicalId":44309,"journal":{"name":"Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42430308","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}
Ceren Atasoy-Tahtasakal, D. Sevgi, Ahsen Oncul, H. Diktas, I. Dokmetas
Objective: We aimed to determine the frequency, type, and mortality rate of central nervous system infections (CNSI) in patients infected with the human immune deficiency virus (HIV). Methods: A total of 353 HIV/AIDS cases hospitalized in our clinic between January 2014 and March 2020 were retrospectively analyzed. Patients diagnosed with CNSI were included in the study. Epidemiological data, diagnoses, clinical, and laboratory information, and clinical progress data of the cases were collected from patient files and recorded. Variables were analyzed. Results: Thirty-four (9.6%) of 353 inpatients diagnosed with HIV/AIDS were followed with CNSI diagnosis. 88.2% of the cases were male, and the median age was 43.5 [interquartile range (IQR)= 26-62) ]. Toxoplasma encephalitis (n=7, 20.6% ), neurosyphilis (n=7, 20.6%), tuberculous meningitis (n=4, 11.8%), cryptococcal meningitis (n=4, 11.8%), HIV encephalopathy (n =3, 8.8%), progressive multifocal leukoencephalopathy (PML) (n=3, 8.8%), and bacterial meningitis (n=2, 5.9%), and 1 case of herpes simplex virus (HSV) encephalitis, varicella zoster virus (VZV) encephalitis, chronic encephalitis, cytomegalovirus (CMV) meningoencephalitis were seen. The median CD4+ T lymphocyte count of the cases was 44.5 /uL (IQR=5-627), HIV RNA level was 215 000 copies/mL (IQR=20-617 000) in patients under antiretroviral therapy (ART), 227 500 (IQR=32 000-4 500 000) copies/ml in patients not receiving ART. CD4+ T lymphocyte count of 25 (73.4%) patients was <200/uL. Twenty-one patients (61.8% ) were simultaneously diagnosed with HIV/AIDS and CNSI, and 14 were in the AIDS stage. The mortality rate was 32.4 % (n=11), and all fatal cases had CD4+ T lymphocyte counts below 200/uL. Conclusion: Central nervous system infections continue to cause severe mortality and morbidity in HIV-infected individuals. We observed that the frequency and mortality rate of CNSI is higher in patients who do not know their HIV status, late-presenters, and those who are not under treatment and/or do not adhere to treatment. Facilitating access to diagnostic tests, rapid treatment initiation, and counseling on treatment compliance is essential to prevent CNSI and, thus, reduce mortality.
{"title":"Evaluation of Central Nervous System Infections in HIV/AIDS Patients: A Seven-Year Retrospective Analysis","authors":"Ceren Atasoy-Tahtasakal, D. Sevgi, Ahsen Oncul, H. Diktas, I. Dokmetas","doi":"10.36519/kd.2023.4174","DOIUrl":"https://doi.org/10.36519/kd.2023.4174","url":null,"abstract":"Objective: We aimed to determine the frequency, type, and mortality rate of central nervous system infections (CNSI) in patients infected with the human immune deficiency virus (HIV).\u0000\u0000Methods: A total of 353 HIV/AIDS cases hospitalized in our clinic between January 2014 and March 2020 were retrospectively analyzed. Patients diagnosed with CNSI were included in the study. Epidemiological data, diagnoses, clinical, and laboratory information, and clinical progress data of the cases were collected from patient files and recorded. Variables were analyzed.\u0000\u0000Results: Thirty-four (9.6%) of 353 inpatients diagnosed with HIV/AIDS were followed with CNSI diagnosis. 88.2% of the cases were male, and the median age was 43.5 [interquartile range (IQR)= 26-62) ]. Toxoplasma encephalitis (n=7, 20.6% ), neurosyphilis (n=7, 20.6%), tuberculous meningitis (n=4, 11.8%), cryptococcal meningitis (n=4, 11.8%), HIV encephalopathy (n =3, 8.8%), progressive multifocal leukoencephalopathy (PML) (n=3, 8.8%), and bacterial meningitis (n=2, 5.9%), and 1 case of herpes simplex virus (HSV) encephalitis, varicella zoster virus (VZV) encephalitis, chronic encephalitis, cytomegalovirus (CMV) meningoencephalitis were seen. The median CD4+ T lymphocyte count of the cases was 44.5 /uL (IQR=5-627), HIV RNA level was 215 000 copies/mL (IQR=20-617 000) in patients under antiretroviral therapy (ART), 227 500 (IQR=32 000-4 500 000) copies/ml in patients not receiving ART. CD4+ T lymphocyte count of 25 (73.4%) patients was <200/uL. Twenty-one patients (61.8% ) were simultaneously diagnosed with HIV/AIDS and CNSI, and 14 were in the AIDS stage. The mortality rate was 32.4 % (n=11), and all fatal cases had CD4+ T lymphocyte counts below 200/uL.\u0000\u0000Conclusion: Central nervous system infections continue to cause severe mortality and morbidity in HIV-infected individuals. We observed that the frequency and mortality rate of CNSI is higher in patients who do not know their HIV status, late-presenters, and those who are not under treatment and/or do not adhere to treatment. Facilitating access to diagnostic tests, rapid treatment initiation, and counseling on treatment compliance is essential to prevent CNSI and, thus, reduce mortality.","PeriodicalId":44309,"journal":{"name":"Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41884844","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}
Nurhan Bakir-Keser, N. E. Luleci, S. Hıdıroğlu, Canseli Acil, E. Aksoy, R. Ozturk, Zeynep Az, M. Karavuş
Objective: The study aimed to investigate whether 6th-grade students in a medical school have sufficient knowledge about general and COVID-19 vaccine types at the end of the first year of the COVID-19 pandemic. Methods: In this qualitative study, the sample was selected by snowball method among 6th-year medical students in February 2021. The data were collected in-depth by using a semi-structured question guide with 10 participants who agreed to be interviewed. Results: Most of the participants stated that they did not feel knowledgeable enough about the general vaccine types, the newly produced COVID-19 vaccines, the mechanisms of action of COVID-19 vaccines, and the efficacy and safety of these vaccines. All participants agreed to have the recommended vaccine before the phase studies were completed. Conclusion: It is invaluable for the participants to report that they had decided to be vaccinated with the inactivated vaccine, which was Turkey’s first recommended and current vaccine. Although they thought their COVID-19 vaccine knowledge was insufficient, they agreed to get vaccinated to protect themselves and society. Furthermore, it is remarkable that most participants also reported recommending the new vaccines to society. Therefore, we suggest that general and current vaccine information, including the COVID-19 vaccine, should be part of the medical school core education curriculum. In addition, it will be essential to repeat similar and qualitative research on available vaccine types and COVID-19 vaccines after the pandemic and compare the results with the data in the middle of the pandemic.
{"title":"Evaluation of Vaccine Knowledge of Sixth-Year Medical Students During the Pandemic: A Qualitative Study","authors":"Nurhan Bakir-Keser, N. E. Luleci, S. Hıdıroğlu, Canseli Acil, E. Aksoy, R. Ozturk, Zeynep Az, M. Karavuş","doi":"10.36519/kd.2023.4372","DOIUrl":"https://doi.org/10.36519/kd.2023.4372","url":null,"abstract":"Objective: The study aimed to investigate whether 6th-grade students in a medical school have sufficient knowledge about general and COVID-19 vaccine types at the end of the first year of the COVID-19 pandemic.\u0000\u0000Methods: In this qualitative study, the sample was selected by snowball method among 6th-year medical students in February 2021. The data were collected in-depth by using a semi-structured question guide with 10 participants who agreed to be interviewed.\u0000\u0000Results: Most of the participants stated that they did not feel knowledgeable enough about the general vaccine types, the newly produced COVID-19 vaccines, the mechanisms of action of COVID-19 vaccines, and the efficacy and safety of these vaccines. All participants agreed to have the recommended vaccine before the phase studies were completed.\u0000\u0000Conclusion: It is invaluable for the participants to report that they had decided to be vaccinated with the inactivated vaccine, which was Turkey’s first recommended and current vaccine. Although they thought their COVID-19 vaccine knowledge was insufficient, they agreed to get vaccinated to protect themselves and society. Furthermore, it is remarkable that most participants also reported recommending the new vaccines to society. Therefore, we suggest that general and current vaccine information, including the COVID-19 vaccine, should be part of the medical school core education curriculum. In addition, it will be essential to repeat similar and qualitative research on available vaccine types and COVID-19 vaccines after the pandemic and compare the results with the data in the middle of the pandemic.","PeriodicalId":44309,"journal":{"name":"Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48373505","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}
Burak Ezer, Huma Gokmen, M. Oz, Ozge Metin-Akcan, Metin Dogan, M. Ozdemir
Pasteurella multocida is a gram-negative, non-motile, oxidase positive, catalase positive, indole positive, urease negative, non-spore-forming coccobacillus. Animal bites, scratching, and licking are the most critical risk factors for Pasteurella infections, but it may also occur without any contact. Data about the prevalence of these infections in Turkey is limited because most cases apply to primary healthcare institutions where bacterial culture cannot be performed, and infections are treated empirically. This report aims to analyze a soft-tissue infection caused by P. multocida following an animal bite and is reported for the first time from Konya.
{"title":"Soft Tissue Infection Caused by Pasteurella multocida: A Rare Case","authors":"Burak Ezer, Huma Gokmen, M. Oz, Ozge Metin-Akcan, Metin Dogan, M. Ozdemir","doi":"10.36519/kd.2023.4430","DOIUrl":"https://doi.org/10.36519/kd.2023.4430","url":null,"abstract":"Pasteurella multocida is a gram-negative, non-motile, oxidase positive, catalase positive, indole positive, urease negative, non-spore-forming coccobacillus. Animal bites, scratching, and licking are the most critical risk factors for Pasteurella infections, but it may also occur without any contact. Data about the prevalence of these infections in Turkey is limited because most cases apply to primary healthcare institutions where bacterial culture cannot be performed, and infections are treated empirically. This report aims to analyze a soft-tissue infection caused by P. multocida following an animal bite and is reported for the first time from Konya.","PeriodicalId":44309,"journal":{"name":"Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48491616","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}
S. Şimşek-Yavuz, Selcuk Ozger, Aysun Benli, C. Ateş, M. Aydın, G. Aygun, A. Azap, S. Başaran, N. Demirturk, O. Ergonul, Aysel Kocagul-Celikbas, Ferit Kuşçu, E. M. Saricaoğlu, S. Sayın-Kutlu, N. Turker, Emine Turkoglu-Yilmaz, O. Kurt-Azap
Although brucellosis is very common in the world and Türkiye, there are no evidence-based guidelines to guide the diagnosis and treatment of the disease. This guide has been prepared by the Turkish Society of Clinical Microbiology and Infectious Diseases to provide evidence-based recommendations to physicians from different specialties interested in the diagnosis and treatment of brucellosis. The recommendations of the Clinical Practice Guide Development Guide of the Infectious Diseases Society of America (IDSA) were taken as the basis for preparing this guide. The guideline preparation group determined 20 questions considered to be important in the diagnosis and treatment of brucellosis, and the publications that could answer these questions prepared in PICO (Population/Patient [P], Intervention [I], Comparison [C], Outcome [O]) format, were searched in ULAKBİM Tr Dizin, PubMed, Cochrane databases without date restrictions. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group method was used to rank the evidence and determine the strength of the recommendations for each PICO question and for each individual outcome. Meta-analyses of comparative clinical studies were performed to answer the PICO questions. Individual participant data (IPD) meta-analyses with data obtained from case reports and case series were conducted in the absence of comparative clinical studies. It is planned to update the recommendations at regular intervals in line with the results of new studies.
{"title":"The Turkish Clinical Microbiology and Infectious Diseases Society (KLİMİK) Evidence-Based Guideline for the Diagnosis and Treatment of Brucellosis, 2023","authors":"S. Şimşek-Yavuz, Selcuk Ozger, Aysun Benli, C. Ateş, M. Aydın, G. Aygun, A. Azap, S. Başaran, N. Demirturk, O. Ergonul, Aysel Kocagul-Celikbas, Ferit Kuşçu, E. M. Saricaoğlu, S. Sayın-Kutlu, N. Turker, Emine Turkoglu-Yilmaz, O. Kurt-Azap","doi":"10.36519/kd.2023.4576","DOIUrl":"https://doi.org/10.36519/kd.2023.4576","url":null,"abstract":"Although brucellosis is very common in the world and Türkiye, there are no evidence-based guidelines to guide the diagnosis and treatment of the disease. This guide has been prepared by the Turkish Society of Clinical Microbiology and Infectious Diseases to provide evidence-based recommendations to physicians from different specialties interested in the diagnosis and treatment of brucellosis.\u0000\u0000The recommendations of the Clinical Practice Guide Development Guide of the Infectious Diseases Society of America (IDSA) were taken as the basis for preparing this guide. The guideline preparation group determined 20 questions considered to be important in the diagnosis and treatment of brucellosis, and the publications that could answer these questions prepared in PICO (Population/Patient [P], Intervention [I], Comparison [C], Outcome [O]) format, were searched in ULAKBİM Tr Dizin, PubMed, Cochrane databases without date restrictions. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group method was used to rank the evidence and determine the strength of the recommendations for each PICO question and for each individual outcome. Meta-analyses of comparative clinical studies were performed to answer the PICO questions. Individual participant data (IPD) meta-analyses with data obtained from case reports and case series were conducted in the absence of comparative clinical studies. It is planned to update the recommendations at regular intervals in line with the results of new studies.","PeriodicalId":44309,"journal":{"name":"Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44759120","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}
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