Background/Aims: Chronic hepatitis C virus (HCV) infection constitutes a substantial healthcare concern in Türkiye. The clinical application of direct-acting antiviral medications (DAAs) has transformed its management. The goal is to assess the efficacy and safety of DAAs in the real-world setting in Turkish patients with chronic HCV. Materials and Methods: Thirty-seven centers from Türkiye recorded 1807 patients to the database. Patients aged >18 years were enrolled to the study. Their demographics, clinical information, DAAs used, efficacy, and safety information were evaluated. Efficacy and safety results were reported for patients with 12-week post-treatment (SVR12) data. Results: Among the patients, 919 (50.9%) were female with a mean of age 56 Å} 15 years (range:18-97 years) and 238 (13%) were cirrhotic. Liver biopsy was performed in 296 patients. Mean histologic activity index score was 7.68 and fibrosis score was 2.58. Baseline mean viral load was 4.11Å~106 copies/mL. Patients received the following treatments: Paritaprevir+Ritonavir+Ombitasvir+Dasabuvir (PrOD):706, Ledipasvir+Sofosbuvir:490, Sofosbuvir+Ribavirin:176, PrOD+Ribavirin:175, Ledipasvir+Sofosbuvir+Ribavirin:156, PrO+Ribavirin:32, and PrO:10. Response at the end of treatment was 99.2% (1454/1465) and SVR12 was 97.8% (1289/1318). The DAAs were generally well tolerated. Ten and 13 patients discontinued therapy because of drug-related and unrelated adverse side effects, respectively. Conclusion: This real-world study demonstrated that DAA treatment for HCV is both safe and highly effective. In two-thirds of the patients, the hepatic inflammation is moderate to severe, and fibrosis is moderate to advanced in half of them. Patients’ characteristics suggest that HCV infection is often not diagnosed or treated until patients present with moderate-to-severe stage, indicating that diagnostic and therapeutic approaches should be used more effectively. Cite this article as: Gunduz A, .ztoprak N., Sarı ND, et al. Efficacy and safety of direct-acting antivirals in patients with hepatitis Cinfection: nationwide real-life data from Türkiye. Turk J Gastroenterol. Published online April 10, 2026. doi:10.5152/tjg.2026.25287

AIM:This study aimed to determine the important features and cut-off values after demonstrating the detectability of cirrhosis using routine laboratory test results of chronic hepatitis C (CHC) patients in machine learning (ML) algorithms. METHODS:This retrospective multicenter (37 referral centers) study included the data obtained from the Hepatitis C Turkey registry of 1164 patients with biopsy-proven CHC. Three different ML algorithms were used to classify the presence/absence of cirrhosis with the determined features. RESULTS:The highest performance in the prediction of cirrhosis (Accuracy = 0.89, AUC = 0.87) was obtained from the Random Forest (RF) method. The five most important features that contributed to the classification were platelet, αlpha-feto protein (AFP), age, gamma-glutamyl transferase (GGT), and prothrombin time (PT). The cut-off values of these features were obtained as platelet < 182.000/mm3, AFP > 5.49 ng/mL, age > 52 years, GGT > 39.9 U/L, and PT > 12.35 s. Using cut-off values, the risk coefficients were AOR = 4.82 for platelet, AOR = 3.49 for AFP, AOR = 4.32 for age, AOR = 3.04 for GGT, and AOR = 2.20 for PT. CONCLUSION:These findings indicated that the RF-based ML algorithm could classify cirrhosis with high accuracy. Thus, crucial features and cut-off values for physicians in the detection of cirrhosis were determined. In addition, although AFP is not included in non-invasive indexes, it had a remarkable contribution in predicting cirrhosis. TRIAL REGISTRATION:Clinicaltrials.gov identifier: NCT03145844.

Objective: It has been reported that carnitine deficiency is observed in various viral infections and in the follow-up of the prognosis of some diseases. In this cross-sectional study, we aimed to determine how carnitine ester derivatives change in HIV-positive patients. Material and Method: In this study, 25 HIV-infected patients who applied to Harran University Faculty of Medicine Education Research and Practice Hospital Infectious Diseases and Clinical Microbiology Outpatient Clinic and who did not receive any antiretroviral treatment, as well as 25 healthy volunteers were included in the study. Carnitine ester levels in serum samples were measured by Liquid Chromatography-Mass Spectrometry/Mass Spectrometry (LC-MS/MS) method (Shimadzu North America, Columbia, MD, USA). Results: While suberoylcarnitine (C8DC), myristoleylcarnitine (C14:1), tetradecadienoylcarnitine (C14:2), palmitoleylcarnitine (C16:1), and linoleylcarnitine (C18:2) levels in HIV(+) patients were quite low compared to the control group, tiglylcarnitine (C5:1) levels were high (p ≤ 0.05). In addition, C5:1 and C14:2 index parameters according to VIP score, and C5:1 and C14:1/C16 index parameters according to ROC analysis were determined as markers with high potential to distinguish HIV(+) patients from healthy volunteers. Conclusion: This study showed that levels of acylcarnitine derivatives might be altered in HIV(+) patients, and the results obtained may contribute to a better understanding of carnitine metabolism.

In our study, we aimed to detect amino acid changes, if any, by comparing the levels of amino acids in cerebrospinal fluid (CSF) samples of patients with aseptic, bacterial, and tuberculous meningitis and control groups.Patients diagnosed with aseptic meningitis (n=41), tuberculous meningi tis (n=21), bacterial meningitis (n=41) and a control group consisting of 64 individuals with similar gender and age characteristics were included in the study.2 mL of cerebrospinal fluid specimens were obtained from all patients and control group and sto red at -80 °C until the study day.The amino acid measurements were performed using commercially available liquid chromatography -tandem mass spectrometry method (LC-MS / MS) kits.When we investigated amino acids levels in all groups, the levels of 1 -methyl histidine, alanine, asparagine, histidine, isoleucine, lysine, methionine, norvaline, ornithine, phenylalanine, proline, sarcosine, threonine, tyrosine, valine in the aseptic, tuberculosis and bacterial meningitis groups were statistically higher than t hose of the control group.The levels of all amino acids except cystine, glutamic acid, homo-citrulline, and taurine in the patients with aseptic meningitis were statistically significantly higher than in the control group.The levels of all amino acids ex cept homocitrulline, and tryptophan were statistically significantly higher in the patient group with tuberculous meningitis than in the control group.The levels of all amino acids except glutamic acid were statistically significantly higher in the patient group with bacterial meningitis than in the control group.

BACKGROUND:The aim of this study was to determine how the levels of peptide and protein-based biomarkers in cerebrospinal fluid change in bacterial, tuberculous, and aseptic meningitis, and to determine the success of these agents in distinguishing between different types of infectious meningitis. METHODS:The levels of arachidonate-5-lipoxygenase, S100 calcium-binding protein B, defensin-α 1, and glial fibrillary acidic protein in cerebrospinal fluid samples from 20 tuberculosis, 40 bacterial, 25 aseptic meningitis patients, and 55 control groups were measured and compared using an enzyme-linked immunosorbent assay. RESULTS:The mean age of the patients was 37.9 ± 14.4 years. The parameter that contributed the most to the differential diagnosis of the infectious meningitis groups was S100 calcium-binding protein B. The S100 calcium-binding protein B levels were significantly higher in the tuberculous meningitis group than in the other groups, and arachidonate-5-lipoxygenase levels were significantly higher in the tuberculous meningitis and bacterial meningitis groups (P < .05). CONCLUSION:This study showed that cerebrospinal fluid arachidonate-5-lipoxygenase, and S100 calcium-binding protein B levels may differ in bacterial, aseptic, and tuberculous meningitis, and the results obtained may be quite effective as important potential biomarkers in the differential diagnosis of different types of meningitis.

Background: The number and proportion of elderly patients living with chronic hepatitis C are expected to increase in the coming years. We aimed to compare the real-world efficacy and safety of direct-acting antiviral treatment in elderly and younger Turkish adults infected with chronic hepatitis C. Methods: In this multicenter prospective study, 2629 eligible chronic hepatitis C patients treated with direct-acting antivirals between April 2017 and December 2019 from 37 Turkish referral centers were divided into 2 age groups: elderly (>= 65 years) and younger adults (<65 years) and their safety was compared between 2 groups in evaluable population. Then, by matching the 2 age groups for demographics and pretreatment risk factors for a non-sustained virological response, a total of 1516 patients (758 in each group) and 1244 patients (622 in each group) from the modified evaluable population and per-protocol population were included in the efficacy analysis and the efficacy was compared between age groups. Results: The sustained virological response in the chronic hepatitis C patients was not affected by the age and the presence of cirrhosis both in the modified evaluable population and per-protocol population (P =.879, P =.508 for modified evaluable population and P =.058, P =.788 for per-protocol population, respectively). The results of the per-protocol analysis revealed that male gender, patients who had a prior history of hepatocellular carcinoma, patients infected with non-genotype 1 hepatitis C virus, and patients treated with sofosbuvir + ribavirin had a significantly lower sustained virological response 12 rates (P <.001, P =.047, P =.013, and P =.025, respectively). Conclusion: Direct-acting antivirals can be safely used to treat Turkish elderly chronic hepatitis C patients with similar favorable efficacy and safety as that in younger adults.

Background: Increasing the sensitivity and availability of liquid chromatography tandem mass spectrometry (LC-MS/MS) devices may provide advantages in terms of revealing the changes in metabolic pathways in HIV-positive patients and elucidating the physiopathology. Introduction: The aim of this study was to determine the difference in amino acid levels between HIV-positive patients and healthy individuals by using LC-MS / MS and investigate its relationship with HIV infection. Material and Methods: Concentrations of 36 different amino acids and their derivatives were measured and compared in venous plasma samples from 24 HIV-positive patients and 24 healthy individuals by using the LC-MS/MS method (Shimadzu North America, Columbia, MD, USA). Results: HIV-positive subjects had significantly lower alanine, 1-methyl-L-histidine, valine, aspartate, cysteine, cystine, methionine, lysine, glutamine, imino acid, tyrosine, tryptophan, threonine, sarcosine, and argininosuccinic acid and significantly higher 3-methyl-L -histidine, asparagine, glutamate, and carnosine levels as compared to healthy controls. No significant differences were detected in other amino acids. Conclusion: The significant differences in amino acid profile between HIV-positive and healthy subjects may represent an auxiliary biomarker of cellular damage in asymptomatic HIV-positive patients that may be examined in more detail in further studies. It may also provide guidance for symptomatic cases in terms of the association between symptoms, clinical manifestations, and deficiency or excess of certain amino acids in the context of the complete metabolomics record of HIV-positive patients.

Introduction: People who inject drugs (PWID) should be treated in order to eliminate hepatitis C virus (HCV) in the world. Aims: The aim of this study was to compare direct acting antivirals (DAAs) treatment of HCV for PWID and non-PWID in real life setting. Materials and methods: We performed a prospective, non-randomized, observational multi-center cohort study in 37 centers. All patients treated with DAAs therapy between April 1, 2017 to February 28, 2019 were included. In total, 2,713 patients were included in the study among which 250 were PWID and 2,463 were non-PWID. Besides patient characteristics, treatment response, follow-up and side effects of treatment were also analyzed. Results: Genotype 1a and 3 were more prevalent in PWID infected patients (20.4% vs 9.9% and 46.8% vs 5.3%). The number of naïve patients was higher in PWID (90.7% vs 60.0%), while the number of patients with cirrhosis was higher in non-PWID (14.1% vs 3.7%). The loss of follow up was higher in PWID (29.6% vs 13.6%). There was no difference in the sustained virologic response at 12 weeks after treatment (98.3% vs 98.4%), but the end of treatment response was lower in PWID (96.2% vs 99.0%). In addition, the rate of treatment completion was lower in PWID (74% vs 94.4%). Conclusion: DAAs were safe and effective in PWID. Primary measures should be taken to prevent the loss of follow-up and poor adherence in PWID patients in order to achieve World Health Organization’s objective of eliminating viral hepatitis.

Background: Objectives: The main aim of this study was to compare, by a new automated colorimetric method, oxidant and anti-oxidant status of those who fast during Ramadan and those who do not. For this purpose, total oxidant status (TOS), total anti-oxidant capacity (TAC) levels and oxidative stress index (OSI) were analysed. By doing this, we hope to examine whether fasting has any beneficial effect on human health. Materials and methods: Fifty seven people were included in this study. Of these, 30 people had been fasting during the month of Ramadan for at least ten years, but 27 had never fasted in their life. On the 15th day of Ramadan, blood samples were obtained from both groups after 12 hours of fasting. Results: The TAC levels of the fasting group (1.29 +/- 0,19) was quite higher than the non-fasting group (1,09 +/- 0,16) [EIC2][ICD3] [ICD4](p< 0.001). Similarly, in the fasting group TOS level and the OSI (respectively 12,77 +/- 2,23 and 1,01 +/- 0,25) was quite lower [EIC5][ICD6][ICD7] than in the non-fasting group (respectively 14,15 +/- 2,04 and 1,33 +/- 0,30), (p<=0.019 and p<0.001, respectively). These findings show that the TOS level of non-fasting group was high. This oxidative stress might cause various illnesses. Therefore, fasting could play a significant part in health-protection by increasing total anti-oxidant capacity.

Objective: The aim of this study is to assess the epidemiology of foodborne botulism cases which were seen and published in Turkey. Material and Methods: This study covers the cases and outbreaks of botulism that have been identified and published in any region of Turkey, between 1983 and 2017. This systematic review was performed in accordance with the guidelines for performing and reporting systematic reviews and meta-analyses. The search was done on PubMed and Google in English and Turkish languages. Demographic features of the cases, nutritional sources, the development process of the disease, clinical symptoms and signs, the duration of hospitalization, treatment and mortality rates were analyzed. Results: Totally 95 patients (57 female and 38 male) were assessed from the published. The food which caused the majority of intoxication cases was canned green beans, and all the foods were home-canned goods. There cords showed that botulism antitoxin was given to 56 patients. The time from exposure to illness onset was 26.9 h. While 18 patients died at the end of follow-up and treatment (mortality 19%), 77 patients were discharged with full recovery. Conclusion: Among 95 botulism cases, spread in Turkey over the last 35 years, the predominant source of toxin was home-canned food and green beans, in particular. Since community and emergency room physicians may be the first to treat patients with any type of botulinum intoxication, they must know how to diagnose and treat this rare but potentially lethal disease.

INTRODUCTION: Genotypes 2 and 3 chronic hepatitis C (CHC) patients are less frequently seen than genotype 1 in Turkey. While these genotypes have had favorable treatment outcomes with interferon-based regimens, response rates are lower with direct acting antivirals (DAAs). We aimed to evaluate efficiency and safety of DAAs in CHC patients infected with genotype 2 and 3. METHODS: Between April 2017 and September 2018, 37 centers recorded 2230 patients. All patients >18 years with CHC under DAAs were enrolled in this observational study. Those infected with genotype 2 and 3 were analyzed for end of treatment response (EoTR) and response at week 12 (SVR12). RESULTS: Among 2230 patients recorded into the database; 267 (12%) were infected with genotype 2 or 3, 73 (27%) were female and mean age was 41.7±17 years (range 18-84 years). The genotypes were 3 in 189 (71%) and 2 in 78 (29%). 25 (9.4%) had cirrhosis; 24 had compensated (Child-Pugh A) and 1 had decompensated (Child-Pugh B-C) cirrhosis. Liver biopsy was available in 151 (57%, G3: 107, G2: 44) patients; mean histologic activity index (HAI) was 7.4 and fibrosis score was 2.4. HAI was mild (1-6) in 37%, moderate (7-12) in 59%, and severe (13-18) in 4%. Fibrosis was mild in 49%, moderate in 47%, and advanced in 4%. While 200 (79%) patients were treatment-naive, 57 (21%) were previously treated with pegylated interferon+ribavirin: 74% relapse and 26% non-responder. Baseline viral load was 5.3x106 copies/mL. Ledipasvir + Sofosbuvir, Ledipasvir + Sofosbuvir + Ribavirin and Sofosbuvir + Ribavirin were given to 8, 15, and 154 patients, respectively. The drugs were tolerated well. Severe adverse events were not reported. SVR was evaluated in 134 patients, shown in Table 1. Response rate at week 4 was 119/147 (81%), EoTR 143/144 (%99.3%) and SVR12 128/134 (95.5%). CONCLUSION: This study represents the largest study of genotypes 2 and 3 CHC in Turkey. Genotype 3 is much commoner than genotype 2 (71% vs 29%). Rate of male gender was higher (73%) and mean age was 42 years. Liver histology showed moderate to higher activity in more than half of the patients and fibrosis was moderate to severe in half. Sofosbuvir and ribavirin containing regimens provided a SVR of more than 90%. The response rate in genotype 2 (94%) was lower than that in genotype 3 (96.5%). DAAs containing sofosbuvir and ribavirin have found efficient and safe among genotype 2 and 3 CHC patients in Turkey. *This study was supported by Gilead Sciences İlaç Ltd. Şti. (İstanbul, Turkey). Company was not involved to the content of the study/publication; no involvement to the decision to submit for publication.

Serologic tests for brucellosis aim to detect antibodies produced against membranous lipopolysaccharide of bacteria. Diagnostic use of this method is limited due to false positiveness. This study evaluates an alternative antigen to lipopolysaccharides (LPS), outer membrane 28-precursor-protein, of Brucella melitensis Rev1 for its diagnostic value. Omp28 precursor of B. melitensis Rev1 was cloned, expressed, and purified. 6-His and sumo epitope tags were used to tag the protein at N-termini. Omp28 gene was amplified based on the ORF sequence and cloned into a pETSUMO vector. The recombinant construct was propagated in Escherichia coli One Shot® Mach1™ cells then transformed into E. coli BL21(D3) cells for protein expression. The purified protein was studied in an indirect ELISA for diagnosis of brucellosis. Sera samples from 60 patients were screened by ELISA and the results were compared to Rose Bengal plate test. Recombinant antigen-based iELISA has given a successful outcome with the sensitivity, specificity, positive predictive value, and negative predictive value of 87.8%, 96.2%, 96.6%, and 78.78%, respectively. In conclusion, recombinant production and purification of the immunodominant Omp28 precursor protein has been achieved successfully in a one-step process with efficient yield and can be used for diagnosis of brucellosis in humans.

Amac: Amacimiz, anti viral tedavi ile remisyona giren kronik hepatit B (KHB) hastalarinda persistan ALT yuksekliginin nedenini arastirmaktir. Materyal Metod: Persistan ALT yuksekligi olan 10 hasta calismaya alinarak tedavi oncesi HBV-DNA degerleri, serolojik testleri, ALT, AST duzeyleri, histopatolojik olarak fibroz derecesi, ultrasonografisi, kullanmakta oldugu anti viral ilaclar incelendi. Bu hastalarda tedavi baslangicindan itibaren gecen sure degerlendirildigi sirada hastalarin yine HBV-DNA, seroloji, biyokimyasal testler, diger karaciger fonksiyon testleri, serum kolesterol ve trigliserid duzeyleri, karaciger ultrasonografisi, otoimmun tetkikleri ve muhtemel diger hepatit nedenleri arastirildi. Bulgular: Tamami erkek 10 hastanin tedavi basinda HBV-DNA degerleri 104 -108 kopya/ml arasinda ve hastalarin besinde HBeAg serokonversiyonu vardi. Tedavi ile virolojik yanita bakildiginda hastalardan sadece birisinde HBV-DNA 244 IU/ml iken, geri kalan kisminda negatiflesti. Ve hastalarin tumunde HBeAg serokonversiyonu olustu. Hastalarin besinde ALT degerlerinde tedavi oncesine gore yukselme oldugu; bir hastada ALT degerinin ayni kaldigi, geri kalan 4 hastada da ALT degerlerinde dusme olmakla beraber normale gelmedigi gorulmektedir. Karaciger USG incelendiginde iki hastada grade I hepatosteatoz disinda baska bir patoloji tespit edilmedi. Diger viral hepatit etkenleri ve otoimmun hepatit markerlari negatif olup karaciger fonksiyon testleri ve alfa feto protein (AFP) de normal idi. Hastalarin hikâyesinde ilaci birakma, alkol ve madde (drug use) kullanimi veya neden olabilecek baska bir ilac kullanimi da soz konusu degildi.Hastalarin kullandigi antiviral ilaclara bakildiginda dort hastanin entekavir, dort hastanin tenofovir, bir hastanin entekavir + tenofovir, bir hastanin telbivudin ve bir hastanin da pegile interferon alfa kullandigi goruldu. Sonuc: KHB hastalari, tedavi ile virolojik ve serolojik olarak remisyonda olsalar bile ALT yuksekligi devam edebilir. Bu durum, nedeni tam olarak bilinmeyen ve aydinlatilmasi gereken bir sorun olarak karsimizda durmaktadir

OZET AMAC: Bu calismanin amaci osteomyelit tanisi alan eriskin hastalarda prokalsitoninin duyarlilik, ozgulluk ve prediktif degerini olcmektir. MATERYAL VE METOD: Calismaya osteomiyelitli 30 hasta ve 30 saglikli kontrol grubu alindi. Her iki grubun lokosit sayisi, eritrosit sedimantasyon hizi, C-reaktif protein ve prokalsitonin (PCT) duzeyleri saptandi. Prokalsitonin, Enzyme-Linked Immunosorbent Assay (Ray Bio ® Human Procalcitonin LISA Kit, Norcross GA, USA) yontemi ile olculdu. PCT’nin 0,5 ng/ml'nin uzerinde olan degeri, normalden yuksek olarak kabul edildi. BULGULAR : Calismaya dahil edilen 30 hastanin 4'u subakut osteomyelit iken; 26'si kronik osteomyelitti. Hastalarin ve kontrol grubundaki toplam kadinlarin erkeklere orani 10/20'ydi. Hastalarin yas ortalamasi 31,16 ± 15,32 iken, kontrol grubunda ise 32,22 ± 14,32 idi. Hastalarin 26'sinda (% 86,7) klinik bulgular ve osteomyelit semptomlari vardi. 5 (% 16.6) hastada lokosit sayisi yuksek, 20 (% 66.6) hastada eritrosit sedimantasyon hizi yuksek, 15 (% 50) hastada C-reaktif protein pozitif iken 30 (% 100) hastanin tumunde PCT duzeyleri (PCT> 0.5 ng / mL) yuksek bulundu. Calismamizda, PCT testinin cut-off degeri 0.5 ng/mL olarak degerlendirildiginde, duyarliligi % 100, ozgullugu % 56 ve pozitif prediktif degeri ise % 100 idi. PCT’nin cut-off degeri 0.57 ng/mL degerlendirildiginde, duyarliligi % 87, ozgullugu % 86 ve pozitif prediktif degeri ise % 87 idi. Bu cut-off degeri (0.57 ng/mL), osteomyelit hastalari icin daha uygun goruldu. SONUC: Osteomyelitli hastalarda, PCT testinin duyarliligi, ozgullugu ve pozitif prediktif degeri diger akut faz reaktanlarina gore daha iyi ayirici taniya goturebilmektedir. Bu nedenle PCT testi, osteomyelitin teshisinde yararli bir belirtec olarak kullanilabilir.

Amac: Amacimiz, potansiyel olarak fatal ve oldukca nadir gorulen Capillaryleaksyndrome (CLS) tanisi koydugumuz hastalari literatur esliginde tartisarak klinisyenlerin dikkatine sunmaktir. Materyal ve Metod: Calismaya 2010-2016 yillari arasinda CLS tanisi alan6 vaka alindi. Hastalarin tanisi, hipotansiyon (sistolik kan basinci ≤90 mmHg veya mevcut kan basincinin ≥40 mmHg dusmesi), hemokonsantrasyon, hipoalbuminemi (albumin duzeyinin ≥0.5 gr /dL dusmesi) ve odem (lokal veya anazarka tarzinda) klinik bulgulariyla konuldu. Hastalarin bilgileri, retrospektif hasta dosyalari incelenerek elde edildi. Bu calisma,universitemiz enfeksiyon hastaliklari klinigi ve yogun bakim unitesinde yapildi. Bulgular: Hastalarin ucu erkek, ucu kadin olup yaslari 22-80 arasindaydi. Hastalardan biri bruselloz, biri tuberkuloz, biri derin ventrombozu ve pulmoneremboli nedeniyle yogun bakima alinan, biri hipoglisemik koma nedeniyle yogun bakimda takip edilen, biri akut myeloid losemi (AML) nedeniyle kemoterapi alan digeri buyuk cerrahi girisim uygulanan hastalardan olusuyordu. AML hastasi haric diger hastalarda birden fazla bakteri superpoze olarak hastalarin sepsise girmelerine neden oldu. Hastalarin tumu entube edildiginden kan kulturu yani sira alinan derin trakealaspiratta da ureme oldu. Bu enfeksiyonlar, hem CLS gelismesine hem de mortaliteyle sonuclanmasina neden oldu. Takip ve tedavi sonunda butun cabamiza ragmen hastalarimizin tamami exitus oldu. Sonuc: CLS oldukca nadir, mortalitesi hala yuksek, tedavisi hala belirsiz gizemli bir hastalik olarak kalmaya devam etmektedir. Klinisyenlerin ozellikle septik durumlarda hastalarin CLS’ye gidisi konusunda uyanik olmalari gerekir. Zira erken tani ve tedavi donguyu hastanin lehine cevirecekbilecektir

Background: Our objective is to discuss the cases of patients diagnosed with capillary leak syndrome (CLS) that is a potentially fatal and extremely rare condition, in the light of literature, and present them to clinicians’ attention. Material and Method: Six cases diagnosed with CLS between 2010 and 2016 were included in the study. The patients were diagnosed with clinical findings including hypotension (systolic blood pressure ≤90 mmHg, or a decline of ≥40 mmHg in immediate blood pressure), hemoconcentration, hypoalbuminemia (a decrease of ≥0.5 gr /dL in albumin level) and edema (local or anasarca). Information about the patients was elicited through the analysis of patient files retrospectively. The present study was carried out at the Infectious Diseases Clinic and Intensive Care Unit of Harran University Hospital. Results: Of the six patients, three were males and three were females, and their ages ranged between 22-80. The patients’ diagnoses were one patient brucellosis and one patient tuberculosis, one patient monitored in intensive care unit because of deep vein thrombosis along with pulmonary embolism and the other monitored due to hypoglycemic coma, one patient who received chemotherapy due to acute myeloid leukemia (AML), and the other one who have undergone a critical surgical intervention. Except for the patient with AML, multiple bacterial species became superposed in the patients and caused them to progress into sepsis. As all patients were intubated, culture growth was detected in deep tracheal aspirates apart from blood culture. These infections gave rise to both the development of CLS and increased mortality. All of the patients died, despite our all efforts of treatment and follow-up interventions Conclusion: CLS remains to be a mysterious illness which is extremely rare. It still has high mortality and does not have a certain treatment. Clinician needs to be alert about the patients’ progress to CLS, partic

There have been many studies pertaining to the management of herpetic meningoencephalitis (HME), but the majority of them have focussed on virologically unconfirmed cases or included only small sample sizes. We have conducted a multicentre study aimed at providing management strategies for HME. Overall, 501 adult patients with PCR-proven HME were included retrospectively from 35 referral centres in 10 countries; 496 patients were found to be eligible for the analysis. Cerebrospinal fluid (CSF) analysis using a PCR assay yielded herpes simplex virus (HSV)-1 DNA in 351 patients (70.8%), HSV-2 DNA in 83 patients (16.7%) and undefined HSV DNA type in 62 patients (12.5%). A total of 379 patients (76.4%) had at least one of the specified characteristics of encephalitis, and we placed these patients into the encephalitis presentation group. The remaining 117 patients (23.6%) had none of these findings, and these patients were placed in the nonencephalitis presentation group. Abnormalities suggestive of encephalitis were detected in magnetic resonance imaging (MRI) in 83.9% of the patients and in electroencephalography (EEG) in 91.0% of patients in the encephalitis presentation group. In the nonencephalitis presentation group, MRI and EEG data were suggestive of encephalitis in 33.3 and 61.9% of patients, respectively. However, the concomitant use of MRI and EEG indicated encephalitis in 96.3 and 87.5% of the cases with and without encephalitic clinical presentation, respectively. Considering the subtle nature of HME, CSF HSV PCR, EEG and MRI data should be collected for all patients with a central nervous system infection.

Giris: Kaza denilince beklenmedik bir zamanda ve beklenmedik sekilde olusan yaralanmalara, mal ve/veya can kayiplarina neden olan olaylari anlariz. Bu calismada ev ici kaza sikâyetiyle basvuran 80 hasta degerlendirildi. Materyal ve Metod:Arastirma, orneklem yapilmaksizin Agustos 2007 – Aralik 2007 arasinda Acil Dahiliye ve Acil Cerrahi polikliniklerine basvuran 80 vakaya yuz yuze gorusme teknigi uygulanarak anket formu doldurulmasiyla yapildi. Bu calisma, kesitsel tipte bir arastirma olup; calismamizda capraz karsilastirmali tablo metodu kullanildi. Bulgular: Hastalarin 50'si (% 62,5) kadin, 30'u (%37,5) erkek olup, yas ortalamasi ise 39,55±24,70'idi. Kaza tipleri kadinlarda fazla oranda bulunmaktaydi (P<0,05). Egitim durumuna gore inceledigimizde en fazla ilkokul mezunlarinin maruz kaldigini goruyoruz. Kaza tipleriyle ev ici fiziki risk faktorleri arasindaki farkliliklarin istatistiksel olarak anlamli oldugu anlasilmaktadir (P<0,05). Kazalarin en gerceklestigi yer ise salon ve oturma odasi idi ( %43). Sonuc: Kazalarin buyuk bir kisminin bilgisizlik, tedbirsizlik, ihmal gibi onlenebilir insan hatalarindan kaynaklandigi gorulmektedir. Hem ev kazalarinin onlenmesine yonelik hem de olusan zararin azaltilmasina yonelik pratik ve kolay onlemler icin insanlara egitim verilebilir.

AIM:To examine the variables associated with mortality in patients with Acinetobacter baumannii-related central nervous system infections treated with intrathecal colistin. MATERIALS AND METHODS:This multi-centre retrospective case control study included patients from 11 centres in Turkey, as well as cases found during a literature review. Only patients with CNS infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii treated with intrathecal colistin were included in this study. The variables associated with mortality were determined by dividing the patients into groups who died or survived during hospitalisation, and who died or survived from Acinetobacter meningitis. RESULTS:Among the 77 cases enrolled in the study, 35 were found through a literature review and 42 were cases from our centres. Forty-four cases (57.1%) were male and the median age was 48 years (range: 20-78 years). Thirty-seven patients (48%) died during hospitalisation. The variables associated with increased all-cause mortality during hospitalisation included old age (odds ratio, 1.035; 95% confidence interval (CI), 1.004-1.067; p=0.026) and failure to provide cerebrospinal fluid sterilisation (odds ratio, 0.264; 95% confidence interval, 0.097-0.724; p=0.01). There is a trend (P=0.062) towards higher mortality with using of meropenem during meningitis treatment. Fifteen cases (19%) died from meningitis. There were no significant predictors of meningitis-related mortality. CONCLUSIONS:The mortality rate for central nervous system infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii is high. Old age and failure to provide CSF sterilisation are associated with increased mortality during hospitalisation.