PURPOSE:Effective antiretroviral therapy has significantly reduced mortality rates among people living with HIV (PWH) and has altered the distribution of causes of death. We aimed to investigate trends in causes of death among PWH over time. METHODS:We investigated all reported deaths in the Turkish Clinical Microbiology and Infectious Diseases Society HIV Cohort. Causes of death were categorized and analyzed across four time periods: 1997-2006, 2007-2014, 2015-2019, and 2020-2023. Factors associated with HIV/AIDS-related causes of death were compared to other causes of death. RESULTS:A total of 9,334 PWH were followed, of which 414 deaths (4.4%) occurred, including 44 (11.6%) among individuals assigned female at birth. The most common causes of death were AIDS-related illnesses (57.7%), non-AIDS-related cancers (11.1%), and cardiovascular diseases (9.9%). Among causes of death, the rate of AIDS-related diseases has declined over the years (p<0.001). Rates of non-AIDS-related cancers (p=0.013) and non-AIDS-related infections (p=0.008) have increased, and deaths due to comorbid conditions such as cardiovascular diseases have remained stable (p=0.193). In multivariate analysis, AIDS-related deaths were significantly associated with an increased risk in individuals who had an AIDS-defining illness at baseline. The rate of AIDS-related deaths declined in later periods compared to 1997-2006. AIDS-related deaths decreased with older age at HIV diagnosis. The rate of AIDS-related deaths was less frequent among men who have sex with men, smokers, and ex-smokers, individuals on antiretroviral therapy, those with higher CD4 counts, and individuals with comorbid diseases. CONCLUSIONS:Among all deaths, AIDS-related deaths have declined. In contrast, the proportion of deaths attributed to non-AIDS-related cancers has increased, and the mortality rate from cardiovascular disease has remained unchanged over the years. Therefore, it is crucial to implement interventions that address comorbid conditions, particularly by enhancing the management of cardiovascular disease and cancer.

Objective: Axillary lymph node changes are frequently observed in patients with HIV, yet their radiological characteristics and clinical significance remain underexplored. This study aimed to evaluate the association between axillary lymph node computed tomography (CT) features and clinical markers of immune function, including CD4 lymphocyte count and plasma viral load, in HIV-positive patients. Materials and Methods: In this retrospective study, 113 HIV-positive patients who underwent contrast-enhanced chest CT were included. Patients were stratified by CD4 count (<200, 200–500, >500 cells/μL) and plasma viral load (<100,000 or >100,000 copies/mL). Axillary lymph node parameters—including maximum and minimum diameters, cortical thickness, hilar width, and density (Hounsfield units, HU)—were measured on multiplanar reconstructed CT images. Group differences were assessed using the Kruskal–Wallis and Mann–Whitney U tests, and Spearman’s correlation was used to evaluate associations between imaging and laboratory findings. Receiver operating characteristic (ROC) curve analysis identified optimal density thresholds. Results: Lymph node diameters, cortical thickness, and hilar width did not significantly differ between CD4 groups. However, mean lymph node density was higher in patients with CD4 < 200 cells/μL (p = 0.024). A density threshold of 84.5 HU distinguished impaired from preserved immune function (sensitivity 61.1%, specificity 71.2%). Patients with viral load >100,000 copies/mL showed increased lymph node density, minimal diameter, and cortical thickness. Conclusions: Elevated axillary lymph node density correlates with immune suppression and high viral load, suggesting its potential as a non-invasive prognostic imaging biomarker in HIV infection.

BACKGROUND:Cardiovascular disease (CVD) is a major cause of mortality among people living with HIV (PLWH). We aimed to assess the prevalence of diagnosed CVD and the risk of CVD among PLWH using 5 different tools. METHODS:This retrospective, cross-sectional study was conducted in 20 tertiary centers in Türkiye between October 2021 and March 2022, among 1425 PLWH aged 40-75 years. About 82.7% were male, with a median age of 51. Web-based tools for each score were used for CVD risk calculations. RESULTS:Of 1425 PLWH enrolled, 10.8% had confirmed CVD, and 1132 had their risk scores evaluated. Of those participants, 42.8% had a higher risk of CVD (10-year risk of atherosclerotic CVD risk score (ASCVD) above 7.5%), and according to the European Society of Cardiology systemic coronary risk evaluation 2 (SCORE2), 71.7% had a high- to very high-risk rate. The agreement between various CVD risk tools varied, with Framingham heart study risk score (FRS), modified FRS, data collection on adverse effects of anti-HIV drugs (DAD), and SCORE2 for high-risk countries showing overall agreement rates of 82%, 94%, 91%, and 36%, respectively, compared to ASCVD. According to the 2021 European and 2019 American Cardiology guidelines, 75.3% and 47.1% of PLWH would be eligible for lipid-lowering agents, respectively. CONCLUSION:The diagnosed CVD prevalence highlighted the importance of monitoring cardiovascular health and comorbidities in this population. SCORE2 identified a greater number of individuals at high/very high risk compared to other prediction tools. The implementation of CVD prevention through lipid-lowering therapy was far from desired levels in our cohort.

Aim: Bloodstream infections present a significant healthcare challenge, causing substantial morbidity and mortality despite advancements in antimicrobial therapy. This study, conducted at the Infectious Diseases and Clinical Microbiology Clinic at Ondokuz Mayis University (OMU), aimed to evaluate epidemiological characteristics, risk factors, infectious agents, and resistance profiles in hospitalized patients with bloodstream infections. Material and Methods: This cross-sectional prospective analysis encompassed adult patients admitted to OMU between 2015 and 2019. Data included susceptibility tests, infection focus, treatments, and patient survival. Patients were categorized as having bacteremia or sepsis. Blood culture samples were collected with strict sterile procedures. Results: Of the 100 patients, 47 had community -acquired infections, and 53 had nosocomial infections. The most common community -acquired focus was the urinary system (42.6%), and the most common nosocomial focus was intravenous catheters (43.4%). Escherichia coli (E. coli) was the most common causative microorganism, with 23% prevalence. Extended -spectrum beta-lactamase (ESBL) was detected in E. coli (34.7%) and multi -drug resistance in 47.8%. Klebsiella spp. exhibited ESBL (61.5%), multi -drug resistance (38.4%), carbapenem resistance (23%), and other resistances. Staphylococcus aureus had 28.5% methicillin resistance. Discussion: This study offers vital insights into bloodstream infections, revealing their prevalence, causes, and resistance patterns. The challenge of drugresistant organisms, especially ESBL and carbapenem-resistant bacteria, emphasizes the need for tailored treatment strategies and collaborative efforts. The increasing prevalence of MRSA and VRE underscores the importance of prudent antibiotic use and rigorous infection control. In conclusion, this study calls for a collective approach to address evolving risks in bloodstream infections, improving patient outcomes and public health.

Objective: Extrapulmonary tuberculosis (EPTB) can be easily missed due to challenges in diagnosis or overlooked in the differential diagnosis. Therefore, EPTB should be considered in endemic regions, especially in the differential diagnosis of fever of unknown origin. Methods: Adult patients diagnosed and treated for EPTB at Ondokuz Mayıs University School of Medicine Hospital between 2005 and 2018 were analyzed retrospectively. Results: One hundred and nineteen patients with a mean age of 48.4±17.8 years, including 75 (63%) females and 44 (37%) males, were included in the study. The mean age of female patients was 51.8±16.7, and the mean age of male patients was 42.6±18.4. Female patients were significantly older than male patients (p<0.05). Urban and rural residency rates were 45.4 and 40%, respectively. EPTB involved lymph nodes in 60 (50.4%), the central nervous system in 15 (12.6%), the vertebral column in 14 (11.8%), bone in 7 (5.9%), the urogenital system in 7 (5.9%), peritoneum in 6 (5%), the gastrointestinal system in 6 (5%), pleura in 3 (2.5%) and eye in 1 (0.8%) patient. Acid-fast bacilli were seen in 4 (8.1%) of 49 samples; Mycobacterium tuberculosis grew in cultures of 29 (48.3%) of 60 samples; and the polymerase chain reaction was positive for tuberculosis in 24 (52%) of 46 samples. In the histopathologic examination, caseous granulomatous inflammation was the most reported finding (41.2%). The most common adverse event related to antituberculosis drugs was hepatotoxicity. Conclusion: EPTB can involve various organ systems and should be included in the differential diagnosis.

Objective To evaluate the effect of olfactory dysfunction on the course and severity of COVID-19 and its prognostic and predictive significance for COVID-19. Study Design Prospective case-control study. Setting Ondokuz Mayıs University School of Medicine. Methods Reverse transcription polymerase chain reaction (PCR)–positive patients, patients with COVID-19–related symptoms who had a negative PCR result, and healthy controls were included in the study. Clinicodemographic characteristics, inflammatory markers, and computed tomography stages were recorded. Disease progression and intensive care unit admission were registered. The visual analog scale (0, worst; 10, best) was used to evaluate subjective olfactory, taste, and nasal breathing ability, and the Sniffin’ Sticks identification (SS-ID) test was used for psychophysical olfactory assessment. Results Mean SS-ID scores were significantly lower in the positive group (8.77) than in the negative (10.43) and healthy control (12.17) groups. VAS-smell scores were significantly lower and anosmia was more prevalent in PCR-positive patients (P < .01). SS-ID and VAS-smell scores were significantly correlated (r = 0.681, P < .001). The inflammatory parameters, pulmonary infiltration stage, disease progression, and ICU admission were not associated with SS-ID scores. A cutoff SS-ID score <9 resulted in 55.56% sensitivity in predicting COVID-19 positivity, and a cutoff VAS-smell score <8 yielded 72.22% sensitivity. Conclusion Olfactory dysfunction was detected objectively and subjectively in the PCR-positive group, and no difference was found in terms of taste function and nasal breathing. The severity and prognosis of COVID-19 are not exclusively dependent on olfactory dysfunction. The degree of olfactory dysfunction can be useful in predicting PCR positivity.

PURPOSE:This study aims to test the validity and reliability of the Turkish version of the HIV/AIDS-related Stigma Scale.DESIGN AND METHODS:The study has a methodological design. The sample included a total of 428 participants. of the participants, 198 were HIV/AIDS patients, 230 were HIV-negative individuals. The data were analyzed using the Exploratory and Confirmatory Factor Analysis.FINDINGS:The Turkish version of the HIV/AIDS-related Stigma Scale was found to be valid and reliable for the Turkish society. Cronbach's α was 0.93 for the community perspectives subscale and 0.89 for the patient perspectives subscale, and all the model fit indices were acceptable.PRACTICE IMPLICATIONS:The level of stigmatization revealed by the scale helps gain an insight into the community and patient perspectives on HIV/AIDS.

Introduction/Aim: Hyponatremia (serum sodium 0.001) were the independent predictors of hyponatremia at the time of admission. The median length of hospital stay (LOS) was longer in patients with hyponatremia than patients with normonatremia (10 days vs. 8 days, p < 0.001). In multivariate analysis, hyponatremia was significantly associated with ICU admission or the need for mechanical ventilation (adjusted OR, 1.72; 95% confidence interval [95% CI], 1.03 to 2.85; p = 0.036). The severity of pneumonia, hemoglobin and lactate dehydrogenase levels, neutrophil-to-lymphocyte ratio (NLR), and body temperature were also associated with ICU admission or the need for mechanical ventilation. The oxygen saturation, male sex, serum albumin, NLR, and the ICU admission but not the hyponatremia on admission were significantly related to mortality. Conclusion: Hyponatremia on admission, even when mild, predicts a worse outcome in COVID-19 patients, and it should be considered in risk stratification.

Objective: The late diagnosis of human immunodeficiency virus (HIV) infection and, therefore, initiation of antiretroviral therapy (ART) in the advanced stages of the disease is still a significant problem in many countries. This study aimed to define the prevalence of late presentation and advanced HIV disease among newly diagnosed HIV infected patients. Patients and Methods: The medical records of HIV-infected patients aged 18 and over, diagnosed between January 2011 and December 2019, were analysed retrospectively. The patients were grouped into three-year periods according to the date of diagnosis. Results: Of the 280 patients with HIV infection, 44 (15.7%) were female and 236 (84.3%) were male. It was found that 50.7% of the patients were late presenters, and 28.5% had advanced diseases. There was no statistical difference in the prevalence of late presentation and advanced HIV disease between the three-year periods. While there was no relationship between gender and late presentation, a statistically significant relationship was found between advanced age and late presentation. Conclusion: Despite advances in the diagnosis and treatment of HIV infection, the frequency of late presentation is still quite high, in Turkey. This situation highlights the importance of broad-based HIV screening programs to control the disease more effectively.

Background Coexisting fibromyalgia syndrome (FMS) to the chronic diseases and its negative impact on global health status in these diseases has been identified. Recent treatment strategies have changed HIV from a terminal disease to a chronic condition that requires great effort because of regular treatment and periodic medical screenings. The prevalence of fibromyalgia has been reported in HIV patients as 1-17%. It was reported that greater illness perceptions are associated with dysfunctional coping strategies in HIV patients with detectable or high viral load. There are no data on illness perceptions and coping strategies in HIV patients with FMS. Objectives The aim of this study was to evaluate the impact of the presence of fibromyalgia on illness perceptions and coping strategies in HIV infected patients. Methods Data about illness perceptions by The Brief Illness Perception Questionnaire (Brief-IPQ) and coping strategies by the COPE questionnaire were collected from 79 HIV patients. FMS was determined according to 2010 American College of Rheumatology criteria. CD4+ cell counts, viral load, and disease duration were also noted. Kolmogorov Smirnov test, chi-square test, Mann Whitney- U test, Spearman correlation analysis, and Univariate analysis of variance were used for statistical analyses. Results Patients were aged between 22 and 77 years, with a mean age of 44.63±10.7 years. Thirteen patients (16.5%) were diagnosed with FMS and of those 4 (30.8%) were women. Cognitive illness representations and emotional representations scores were higher in HIV patients with FMS than those without FMS (p<0.05). Disease duration, HIV-progression biomarkers (CD4+ and viral load), COPE questionnaire scores, and illness comprehensibility sub scores of Brief-IPQ were not different between the HIV patients with and without FMS (p>0.05). The significant effect of the presence of FMS on cognitive illness representations (p<0.001) and emotional representations (p<0.05) was found by univariate analysis of variance in patients with HIV. Conclusion According to the preliminary results of this study, FMS was detected 16.3% of 79 HIV patients and coexisting FMS was associated with increased cognitive and emotional representations in patients with HIV. Coping strategies were not affected by the comorbid FMS. The presence of FMS may adversely affect perceptions of the disease in HIV infected patients. Since the patients’ beliefs about their illness have great importance in the patients’ health outcomes and the understanding of the disease, physicians should be aware of the possibility of concomitant FMS in patients with HIV. References [1]Demirdal US, Bilir N, Demirdal T. The effect of concomitant fibromyalgia in HIV infected patients receiving antiretroviral therapy: a prospective cross‑sectional study. Ann Clin Microbiol Antimicrob 2019; 18(1):31. [2]Fitzcharles MA, Perrot S, Hauser W. Comorbid fibromyalgia: A qualitative review of prevalence and importance. Eur J Pain 2018; 22(9):1565-76. [3]Fox C, Walker-Bone K. Evolving spectrum of HIV-associated rheumatic syndromes. Best Pract Res Clin Rheumatol. 2015; 29(2): 244-58. [4]Pala AN, Steca P. Illness perceptions and coping strategies among individuals diagnosed with HIV. J Behav Med. 2015; 38(4):620-31. Disclosure of Interests None declared

Objective: Healthcare professionals taking care of COVID-19 patients are considered to be at high risk for acquir-ing infection, and the protection of healthcare professionals is one of the top priorities. Inadequate knowledge of the disease by healthcare professionals and their inability to access or use personal protective equipment (PPE) required for protection may cause rapidly spreading of infection. In this study, we aimed to evaluate the knowledge levels of healthcare professionals regarding COVID-19 and PPE use.Methods: The prepared questionnaire was filled in face-face or electronically, ensuring that 502 healthcare profession-als who volunteered to participate in the study remained anonymous. chi 2 test was used for data analysis, and p <0.005 was considered significant.Results: Five hundred two healthcare professionals participated in the study. The average age of the participants was 30.23 +/- 6.02 years. Two hundred six of the participants were men, and 296 were women. Of the participants, 265 (52.8%) were physician, 168 (35.5%) nurse, 30 (6.0%) caregivers / cleaning staff, 24 (4.8%) emergency medical technician, and 5 (1.0%) were dialysis technician. Three hundred eighty of the participants (75.7%) had received training on COVID-19 and the use of personal protective equipment in the institution where they worked. 79.5% of the participants knew the causative agent of the disease, 91.0% the incubation period, and 97.6% the symptoms correctly. Hand washing rates were lower in physicians than in nurses and cleaning staff in indicated places. The rate of those who put on PPE in the correct order was 48.7%, and the rate of those who put off in the correct order was 38.9%.Conclusions: As the global COVID-19 pandemic continues to affect the world, increasing the knowledge level of healthcare professionals is critical. Protection of healthcare professionals from infection can be provided by the avail-ability of adequate information and protective equipment.

Objective:As the Coronavirus disease 2019 (COVID-19) pandemic spread globally, more human immunodeficiency virus (HIV) positive patients began to appear infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to evaluate the clinical course of HIV and SARS-CoV-2 co-infected patients from a local perspective.Methods:HIV and SARS-CoV-2 co-infected patients diagnosed between March 2020 to June 2021 at a tertiary hospital in Turkey were analyzed retrospectively.Results:Thirty HIV and SARS-CoV-2 co-infected patients were included. Five patients were female, 25 were male, and the mean age was 44.5 ±10.2 years. Twenty-three (76.7%) patients were known to be HIV-positive before their admission to the hospital, and seven (23.7%) patients, were detected by screening after the diagnosis of COVID-19. All patients were known to be HIV-positive; they were on antiretroviral therapy (ART) and virologically suppressed. Twenty-seven patients had a mild course. Three patients were hospitalized, and of them, two patients had died. All hospitalized patients were male and were ART-naïve.Conclusion:HIV infection alone did not increase the severity of the course of COVID-19 and did not increase the mortality in COVID-19.

The objective of this study is to evaluate smell and taste dysfunction (STD) in coronavirus disease 2019 (COVID-19) positive and negative patients, and to assess the factors associated with STD in COVID-19 positive patients. Patients who had been tested with the real-time reverse transcriptase-polymerase chain reaction (RT-PCR) for COVID-19 were identified, and according to the RT-PCR test results, patients were separated into Positive and Negative Groups. A telephone-based assessment was applied to both groups using the American Academy of Otolaryngology–Head and Neck Surgery Anosmia Reporting Tool. Patients in Positive Group were also asked to rate STD, nasal breathing, and anxiety in three different time periods (pre-/during-/post-COVID) using the visual analog scale (VAS). A total of 53 COVID-19 positive and 51 negative patients completed the surveys. STD was eightfold more frequent (OR 8.19; CI 95% 3.22–20.84) in the Positive Group. Of the 53 COVID-19 positive patients, 32 reported STD and 21 did not. ‘Ground-glass appearance’ on chest-computed tomography was more frequent and median lymphocyte count was significantly lower in COVID-19 positive patients with STD. During-COVID STD and nasal breathing VAS scores were significantly lower than the pre- and post-COVID scores. During-COVID STD scores were significantly correlated with anxiety scores (Spearman’s rho-0.404, p = 0.022) but not correlated with nasal breathing scores. STD may be related to increased inflammatory response as well as damage of olfactory neuronal pathway or non-neuronal olfactory mucosa. Understanding the exact cause of chemosensory impairment in COVID-19 can be helpful in explaining the pathophysiology of the disease.

OBJECTIVES A new type of coronavirus outbreak has emerged in China and caused a pandemic. World Health Organization (WHO) announced the official name of this disease 'COVID-19'. The main purpose of this study is to evaluate pain in COVID-19 patients. METHODS Patients who were followed in the ward of an infectious diseases department because of possible or confirmed COVID-19 between May and September of 2020 were included in the study. The Turkish version of the Brief Pain Inventory (BPI) was applied. Demographic features, frequency, location, the intensity of pain, and response to analgesics were analyzed. RESULTS A total of 178 participants were included in the study. Ninety-one (51.1%) of patients had pain complaints and the mean pain score (MPS) was 2.28±2.81 over 10. Fifty-nine (56.0%) of participants with pain required analgesic therapy and 41 (80.3%) of them showed ≥50% pain relief with simple analgesics. Twelve of the remaining 18 who did not get enough pain relief with simple analgesic were taking their analgesics pro re nata (PRN) rather than around the clock (ATC). Pain frequency and intensity and mean hospitalization duration (MHD) were similar between confirmed and possible cases. CONCLUSION Regarding the results, we conclude that pain is not one of the challenging symptoms and easily manageable in patients with a mild-moderate intensity of COVID-19. Our results were not enough to make a correlation between pain and the clinical course of the disease. Further studies are required for the evaluation of pain including patients in intensive care units.

In December 2019, several cases of pneumonia of unknown origin were reported in the city of Wuhan, province of Hubei, China. The pathogen was named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease was named coronavirus disease 2019 (COVID-19). Acute phase reactans (APRs) are critical in the early diagnosis, treatment, and for monitoring the progression of COVID-19. Seventy two patients were included in the study and infections confirmed by real-time reverse transcription polymerase chain reaction. Clinical parameters, the level of APFs and D-dimer were assessed and results were retrived from the patients' medical records. Chest computed tomography (CT) findings were described for each patient and they were divided into two groups, with or without COVID-19 pneumonia. The correlation between APRs and CT findings and the patients' prognosis were evaluated. Twenty eight (38.8%) of the 72 patients were female and 44 (61.2%) were male. The most common symptom was cough (43%) and the most common associated chronic disease was hypertension (12.5%). Thirty (41.6%) patients had completely normal chest CT, while 42 (58.4%) patients had typical findings in terms of COVID-19 pneumonia. C reactive protein (CRP), lactate dehydrogenase (LDH), erythrocyte sedimentation rate (ESR), ferritin, procalcitonin and D-Dimer levels were statistically significantly higher in patients with pneumonia than in those without pneumonia and these parameters were also statistically significantly higher in patients with severe illness. In conclusion, CRP, LDH, ESR, ferritin, and D-Dimer were associated with severe COVID-19 pneumonia. These biomarkers can be used to evaluate the prognosis to predict the clinical course of disease, allowing a proper management and treatment of the patients.

Vitamin D deficiency affects bone mineral density and immune function and thus may confer adverse outcomes in HIV infected patients. We aimed to determine plasma 25-OH Vit D-3 for evaluation of vitamin D status among HIV infected patients. Medical records were searched retrospectively and data were collected with ethical committee approval. One hundred twenty HIV infected patients who plasma 25-OH Vit D-3 level was determined by liquid chromatography tandem mass spectrophotometer enrolled into the study. Plasma 25-OH Vit D-3 levels of the patients ranged between 4.26 and 68.57 mu g/L (mean: 21.71 +/- 13.08 mu g/L). Normal plasma level (>30 mu g/L) was determined only in 26 (21.6%) patients. Female patients had lower plasma level (11.29 +/- 4.53 vs 24.19 +/- 13.24 mu g/L). There was also negative moderate correlation between age and plasma 25-OH Vit D-3 level (r:-0.42). Correlation between CD4 count and plasma 25-OH Vit D-3 level (r:-0.04) was not determined. In conclusion, majority of HIV infected patients (78.3%) had low level of plasma 25-OH Vit D-3. Therefore, it is important to determine vitamin D status of patients and give replacement therapy for its deficiency during care of HIV infected patients.

Purpose: To investigate the frequency of concurrent drug use and drug interactions in patients with human immunodeficiency virus (HIV) infection. Methods: The medical records of HIV-infected patients followed up at Ondokuz Mayis University Hospital in the last six months were retrospectively reviewed to assess the antiretroviral therapy (ART) regimens used, the prescribed concurrent drugs, and their interactions Results: The records of 268 patients were evaluated; of these, 43 (16 %) were women, and 225 (84 %) were men. The mean age of the patients was 43.8 ± 12.1 years. Concurrent drugs were prescribed to 210 (78.3 %) patients. Drug interactions were detected in 115 (42.9 %) patients. Of the 210 drug interactions detected, 168 (80 %) were potential interactions, 39 (18.6 %) were weak interactions, and 3 (1.4 %) were contraindicated. A statistically significant relationship was not observed in gender, age, and rate of concurrent drug prescription. Increased nephrotoxicity was the most common potential drug interaction. Non-steroidal anti-inflammatory drugs were the most commonly prescribed class of drugs along with ART. Conclusion: Physicians treating HIV-infected patients should be conscious of, and careful about the concurrent use of drugs and their potential drug interactions.

Crimean-Congo haemorrhagic fever (CCHF) is a severe form of haemorrhagic fever identified in parts of Africa, Asia, Eastern Europe and the Middle East. CCHF continues to be a justifiable cause of concern for people in rural areas where the disease is endemic. A total of 151 patients, diagnosed with CCHF, were evaluated retrospectively. The demographic characteristics of these patients and the relationship between the neutrophil-lymphocyte ratio (NLR) at admission and survival were examined. There were 21 (13.9%) deaths. There was no relationship between age, gender and mortality, but elevated neutrophil-lymphocyte ratio (NLR) on admission was statistically associated with mortality. NLR is a laboratory marker that can be studied even in medical centres with limited facilities and may be helpful in predicting the clinical course of the disease.

Introduction: Tuberculosis (TB) still continues to be the leading cause of death for Human Immunodeficiency Virus (HIV) infected patients, and it accounts for approximately one of three acquired immunodeficiency syndrome (AIDS) related deaths. The study aimed to analyze clinical and laboratory data of Mycobacterium tuberculosis infection in HIV infected patients. Materials and Methods: Medical records of adult (aged≥ 18 years) HIV infected patients diagnosed and under medical care between January 2005 and November 2018 were obtained and analyzed retrospectively by searching hospital database system. Results: Fifteen patients (4.5%) had TB among the 336 HIV infected patients. There was no statistically significant difference between the age of HIV-infected patients with and without TB disease (38.07 ± 8.48 vs 39.26 ± 11.67; p: 0.697). Diagnosis of TB disease and HIV infection were concurrent during presentation in 9 (60%) patients, while six (40%) patients had a previous history of HIV infection and treatment. Five (83.3%) of 6 patients receiving antiretroviral therapy (ART) had no viral suppression due to non-adherence. Median CD4 T lymphocyte count was 114/mm3 (0-436) at the time of TB diagnosis whereas it was 408/mm3 (1-1734) in those without TB disease at the time of initial HIV infection diagnosis, and the difference was statistically significant (p< 0.05). Odds ratio for CD4 T lymphocyte count less than 200 in HIV infected patients with TB disease was 14.89 (confidence interval 95%: 4.08-54.34). While ten (66.7%) patients had pulmonary involvement, five (33.3%) patients had extrapulmonary involvement. There was no statistically significant difference between the median CD4 T lymphocyte counts of patients with pulmonary involvement (107/mm3, range:0-436) and extrapulmonary involvement (140/mm3, range: 86-259) (p= 0.391). Conclusion: Tuberculosis disease should be considered in patients who have applied at advanced stages of HIV infection or whose virological suppression could not be achieved due to incompatibility with ART treatment.