Şebnem Çalık

Objective: Varicella zoster virus (VZV), a member of the Herpesviridae family, is known as the causative agent of chickenpox (varicella). Following primary infection, VZV can remain latent for life and may reactivate over time to cause herpes zoster (shingles). Advanced age, immunodeficiency, and certain chronic illnesses are major risk factors for the development of herpes zoster. To prevent herpes zoster, a live zoster vaccine was licensed in 2006, followed by a recombinant zoster vaccine with higher efficacy in 2018. In Türkiye, the recombinant zoster vaccine was licensed in 2024. Raising awareness among healthcare workers is important both for their own health and the safety of vulnerable patients. This study aimed to evaluate healthcare workers’ knowledge and awareness of herpes zoster infection and zoster vaccines across the country, as well as to determine the prevalence of prior herpes zoster infection among them. Methods: After obtaining ethical approval, a nationwide multicenter survey was conducted. A questionnaire was distributed to healthcare workers via an online link. Participation was entirely voluntary. The survey collected demographic information (age, sex, profession, years of experience) and included questions on knowledge of herpes zoster, history of zoster infection, symptoms and severity (if applicable), awareness of the zoster vaccine, and vaccination attitudes. Results: A total of 5180 healthcare workers participated, of whom 3505 were female. The participants ranged in age from 18 to 79 years (mean age: 34.24 ± 11.52). Regarding professions: 47.9% were physicians, 21.3% were nurses or midwives, 0.8% were dentists or dental technicians, and 30% were from other healthcare professions. Among participants, 54.4% had ≤10 years of professional experience, 20% had comorbidities, and 10.5% were using immunosuppressive medications. It was found that 9.6% had previously had herpes zoster, 8.8% had no knowledge of the disease, 39.6% were aware of the vaccine, and 20.1% were unwilling to pay for vaccination. Multivariate binary logistic regression analysis revealed that being a physician significantly increased the likelihood of having correct knowledge by 1.961 times compared to other professions (p < 0.001, CI: 1.608–2.392). Similarly, those who had heard of herpes zoster were 3.191 times more likely to answer correctly than those who had not (p = 0.011, CI: 1.650–6.172). Male gender was significantly associated with a lower likelihood of having accurate knowledge compared to females (p = 0.001, OR = 0.720, CI: 0.594–0.874). Conclusions: This study revealed that healthcare workers’ knowledge and awareness regarding herpes zoster and its vaccines are generally insufficient. The recent licensing of the vaccine in Türkiye may explain this, but it is critical for healthcare professionals to be more informed about risk groups and vaccination indications in order to enhance the effectiveness of preventive healthcare services. Given the potential for serious complications of herpes zoster in elderly and immunocompromised individuals, the importance of vaccination should be emphasized more strongly to healthcare workers. Furthermore, the finding that 20.1% of those aware of the vaccine were deterred by its cost highlights the need to improve vaccine accessibility. Economic barriers preventing healthcare workers from being vaccinated emphasize the importance of making the vaccine widely available through public support to protect both healthcare workers and patient safety.

Background: Sepsis remains a major cause of morbidity and mortality in intensive care units (ICUs). Although various scoring systems and biomarkers have been studied, the prognostic significance of early dynamic changes in laboratory parameters remains unclear. This study aimed to investigate the prognostic value of 48 h changes in routinely monitored biomarkers for in-hospital mortality in septic patients. Methods: This retrospective, single-center study was conducted in the Anesthesiology and Reanimation ICU of a tertiary teaching hospital. A total of 174 adult patients (≥18 years) diagnosed with sepsis according to SEPSIS-3 criteria between January 2017 and December 2022 were included. Laboratory data were recorded at ICU admission and after 48 h. Patients who died within 48 h or had missing follow-up data were excluded. Receiver operating characteristic (ROC) analysis and logistic regression models were used to assess the prognostic performance of clinical and laboratory parameters. Results: The median age was 71 years, and 58% of patients were male. Comorbidities were present in 76% patients, and malignancy was associated with higher mortality (p = 0.012). The overall in-hospital mortality rate was 58.6%. Inappropriate empirical antibiotic therapy significantly increased mortality risk (p = 0.001). Non-survivors had higher baseline SOFA and APACHE II scores. At 48 h, mortality was associated with increased procalcitonin, lactate, and CRP/albumin ratio and greater albumin decline. ROC analysis identified procalcitonin ≤ 28% decrease, lactate > 23% increase, albumin > 7% decrease, and CRP/albumin ratio > 31% increase as optimal cutoffs. Multivariate analysis revealed SOFA score > 6, inappropriate antibiotic therapy, procalcitonin ≤ 28% decrease, lactate > 23% increase, and platelet > 37% decrease as independent mortality predictors. The change in albumin level was included in the model but was not statistically significant. Conclusions: Forty-eight–hour biomarker changes, particularly in lactate and platelet count, may provide complementary prognostic information to baseline SOFA scores and may support early risk stratification in sepsis. These findings should be considered exploratory and require confirmation in prospective multicenter studies before clinical implementation.

Background: The Omicron variant of SARS-CoV-2 exhibits higher transmissibility compared to previous variants. This retrospective, single-center study aimed to evaluate the relationship between vaccination status and mortality among patients infected with the Omicron variant. Methods: This retrospective analysis included 584 patients diagnosed with the Omicron variant of SARS-CoV-2 between January and March 2022 at Bozyaka Training and Research Hospital, Türkiye. Demographic characteristics, comorbidities, laboratory findings, computed tomography (CT) severity scores, vaccination status, and mortality outcomes were assessed. Multivariate logistic regression was used to adjust for potential confounding factors, including age, sex, and comorbidities. Results: Among the 584 patients, 280 were unvaccinated and 304 vaccinated. Mortality was 21% in unvaccinated patients (mean age 56±17) and 10% in vaccinated patients (mean age 62±15). After adjustment for age and Charlson Comorbidity Index, vaccination remained independently associated with reduced mortality (p<0.05). Unvaccinated patients demonstrated higher inflammatory markers, elevated CT severity scores, and greater ICU admission rates (34% vs. 16%). Conclusion: Vaccination significantly reduced mortality and lung involvement among patients infected with the Omicron variant. Despite reports of milder disease, Omicron remains clinically significant, particularly in unvaccinated individuals.

Staphylococcus aureus bacteremia (SAB) is associated with significant morbidity and mortality despite advancements in antimicrobial therapies. Timely risk stratification is critical to optimize patient outcomes. This study aimed to evaluate the prognostic value of clinical (Pitt bacteremia score [PBS]), combined clinical and laboratory (Sequential Organ Failure Assessment [SOFA]), and laboratory-based parameters (neutrophil-to-lymphocyte ratio [NLR] and platelet-to-lymphocyte ratio [PLR]) in patients with SAB. We conducted a retrospective observational study of 150 adult patients diagnosed with monomicrobial SAB between November 2023 and November 2024 at a tertiary care center. The predictive value of PBS, SOFA, NLR, and PLR for in-hospital mortality was assessed using ROC analysis and logistic regression. The overall in-hospital mortality rate was 46%. PBS >4 and NLR >21 were independently associated with increased mortality (OR 11.72 and 6.36, respectively; p < 0.001). Absence of fever (OR 0.11) and presence of central venous catheter (OR 4.11) were also significant predictors. ROC analysis demonstrated good predictive performance for both PBS (AUC: 0.82) and SOFA (AUC: 0.795) scores with no statistically significant difference between them. Community-acquired SAB and primary bacteremia were associated with worse prognosis. Methicillin resistance did not significantly affect mortality. Fever response was significantly blunted in older adults but not in immunosuppressed patients. High PBS and NLR are strong and independent predictors of mortality in SAB. As this study was conducted in a high-risk cohort with a considerable proportion of critically ill and immunocompromised patients, the findings are particularly relevant to this vulnerable population. External validation in larger, multicenter cohorts is required to confirm their generalizability.

Objective: Staphylococcus aureus causes infections ranging from mild skin conditions to life-threatening diseases such as endocarditis. The incidence of S. aureus infections is increasing due to the rise in invasive procedures and immunosuppression. Inflammatory markers such as C-reactive protein level, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio are useful for monitoring disease severity. This study aimed to identify the clinical and laboratory predictors of mortality in patients with S. aureus infections. Methods: This retrospective observational study included patients aged >18 years with S. aureus growth who were treated at a tertiary hospital between 1 November 2013 and 1 February 2022. Infections were classified as pneumonia or infections of the bloodstream, bone and joint, and skin and soft tissue. Results: Univariate analysis revealed that age >73 years, emergency department admission, and methicillin resistance were significant mortality risk factors. Multivariate analysis showed that age >73 years, pneumonia, and C-reactive protein level >86 mg/L increased the mortality rate by 3.5-, 7.6-, and 4.4-fold, respectively. Conclusion: C-reactive protein level, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio are accessible, cost-effective markers that aid in predicting mortality. Integrating these biomarkers with clinical parameters such as advanced age and pneumonia can improve early risk stratification in patients with S. aureus infections.

Background: This study aimed to examine the relationship between microbiological features and mortality in hematological malignancy patients who develop febrile neutropenia using machine learning algorithms. Methods: Patients with hematological malignancies who developed febrile neutropenia between 2011 and 2015 in a training and research hospital were included. The PyCaret low-code Python library was used to streamline the machine-learning workflow. Two separate models were developed to predict early and late mortality. The following machine learning algorithms were evaluated during the modeling process: Ridge Classifier, Random Forest Classifier, Linear Discriminant Analysis, Light Gradient Boosting Machine, Logistic Regression, Gradient Boosting Classifier, and Extra Trees Classifier. Accuracy and area under the receiver operating characteristic curve (AUC-ROC) metrics were calculated to evaluate the models’ predictive capability for both early and late mortality predictions. All analyses were performed using Python 3.12 and the PyCaret 3.0 library. Results: The dataset used in this study consisted of 159 patients. For early mortality prediction, the Ridge Classifier demonstrated the best performance with a test set accuracy of 0.92 and an AUC of 0.94. For late mortality prediction, the Random Forest Classifier achieved the highest accuracy of 0.94 and an AUC of 0.98. For both models, ICU admission was identified as the most important feature, with a relative importance of 23.6% for early mortality prediction and 25.3% for late mortality prediction. Other key variables included pneumonia, renal function, and the duration of neutropenia. Conclusion: Machine learning models can be applied and improved on more patient data, helping traditional statistical methods in medical research.

Introduction: Since there is no standard treatment regimen and duration in brucellosis spondylodiscitis cases, management of brucellosis spondylodiscitis cases is difficult. This study aimed to evaluate the risk factors, clinical features and follow-up results of brucellosis spondylodiscitis cases followed up in a tertiary healthcare institution. Methods: In this retrospective study, data from 60 patients with brucellosis spondylodiscitis who were followed up in a training and research hospital between 2009-2019 were evaluated from the electronic data recording system. All statistical analyses were performed using the SPSS 26 program. Comparison of the distributions of variables in the compared groups was made using the chi-square test or Fisher's exact test for categorical variables and the Mann-Whitney U test for continuous variables. Results: A total of 212 patients were followed up with a diagnosis of brucellosis. Spondylodiscitis was detected in 60 (28.30%) cases. In cases developing brucella spondylodiscitis, the duration of symptoms was longer (p=0.007), lower back pain (p=0.000), muscle pain (p=0.023) were more common and sedimentation values were higher (p=0.044). Three (5%) cases had single vertebra involvement, 34 (56.70%) cases had two vertebra involvement and 23 (38.30%) cases had ≥3 vertebra involvement. The most common involvement was in the lumbar region (23 cases, 38.30%), followed by the thoracic region (13 cases, 21.70%) and lumbosacral region (11 cases, 18.33%). Abscess was detected in 21 (35%) cases. Seventeen (28.30%) cases were given a treatment regimen containing two antibiotics and 43 (71.70%) cases were given a treatment regimen containing three antibiotics. Treatment regimens containing three antibiotics were found to be more successful (p=0.001). The mean treatment duration of the cases was 19.7±12 weeks (minimum 12-maximum 66 weeks). Relapse occurred in five (8.30%) cases. While muscle weakness and neurological deficits developed in three (5%) cases, two of them underwent surgery. Conclusion: Brucella spondylodiscitis is a not uncommon manifestation of the disease. In most cases, more than one vertebral involvement was affected. Treatment regimens containing three antibiotics were found to be more successful than regimens containing two antibiotics. Cases with muscle weakness and neurological deficits as complications were detected. A team consisting of infectious diseases, radiologists, neurosurgeons and physical therapy specialists may be useful for the treatment of spondylodiscitis.

Objective: We aimed to compare scoring systems and peripheral inflammatory biomarkers in estimating mortality among Fournier's gangrene (FG) patients. Background: Multiple scoring systems and biomarkers are utilized to assess FG severity and predict mortality. However, these indices have complexities, limitations, and inconsistencies. Therefore, alternative methods and parameters are investigated. Materials and Methods: Each patient’s clinical and laboratory data are well documented at hospitalization, Fournier's gangrene severity index (FGSI), Uludag FGSI (UFGSI), simplified FGSI (SFGSI), and age-adjusted Charlson comorbidity index (ACCI) scores and peripheral blood parameters and ratios were calculated. Patients were compared in two groups as deceased and survived ones. Results: Among the 160 patients, 35 (21.9%) died. Diabetes was the most prevalent comorbidity. Deceased patients had significantly higher FGSI, UFGSI, ACCI, and SFGSI scores compared to the survivors (p < 0.001). Among the prognostic parameters, only the red cell distribution width (RDW) value was statistically significantly higher in the non-surviving group (p < 0.05). Multivariate analysis identified age, elevated blood urea nitrogen, symptom duration, disease extent, and malignancy as independent prognostic factors. Conclusion: FGSI, UFGSI, SFGSI, and ACCI are reliable prognostic scores in FG and aren’t superior to each other. Age, blood urea nitrogen levels, duration of symptoms, disease extent, and coexisting malignancy were found to be independent prognostic factors. Given its rapid and cost-effective nature, RDW should be considered alongside other established parameters in future prognostic models. A new scoring method that includes these variables would be practical and worth testing.

Objectives: Acute leukemia often leads to severe complications such as febrile neutropenia. Mortality rates remain high, underscoring the need for novel prognostic markers. Regulatory T cells (Tregs) have not been extensively studied in this context. Methods: This prospective observational, single-center study included 114 patients diagnosed with acute leukemia. Tregs percentages were measured using flow cytometry. Statistical analyses involved logistic regression to identify factors significantly associated with survival. Results: Of the 114 patients, 78 recovered, while 36 died. The median Treg percentages were 5.9% in patients under 65 years and 5.38% in those 65 and older. A lower percentage of Tregs was associated with higher mortality in the older group (p = 0.04). Multivariate analysis highlighted the presence of comorbidities, documented infections, and day seven C-reactive protein levels as significant predictors of survival. Conclusion: This study supports the importance of monitoring chronic diseases and infection foci alongside traditional markers like C-reactive protein. Future research should explore the mechanistic roles of Tregs in immunosuppression and survival in this vulnerable population.