Alev Çetin Duran

Objective: Influenza-like illness (ILI) is a major cause of hospitalization during respiratory virus seasons. This study aimed to investigate the pathogens detected in patients presenting with ILI symptoms and to analyze the results in conjunction with clinical, laboratory, and radiological findings. Materials and Methods: This retrospective, single-center study included 446 hospitalized adults with ILI between epidemiological week 40 of 2024 and week 20 of 2025. Respiratory pathogens were identified using a multiplex real-time polymerase chain reaction (PCR) assay detecting 18 viral and 5 bacterial pathogens. Demographic, clinical, laboratory, and radiological data were retrieved from electronic medical records. Disease severity was assessed using the CURB-65 score. Patients with Streptococcus pneumoniae detected by PCR were further evaluated according to radiological evidence of pneumonia. Results: At least one respiratory pathogen was detected in 184/446 patients (41.2%), whereas no pathogen was identified in 262 patients (58.8%). The most frequently detected pathogens were S. pneumoniae, influenza viruses, and seasonal coronaviruses. The most common coinfection was influenza A plus S. pneumoniae. Among patients with pneumococcal PCR positivity, those with radiologically confirmed pneumonia were significantly older, had higher CURB-65 scores, and more frequently had concomitant influenza infection than patients without radiological evidence of pneumonia. Conclusion: Multiplex molecular assays provide valuable information for respiratory pathogen detection, but molecular results, especially for bacterial pathogens such as S. pneumoniae, should be interpreted together with clinical and radiological findings.

Sistemik otoimmün romatizmal hastalıklar, tanı, prognoz, hasta yönetimde kritik rol oynayan çeşitli otoantikorlarla ilişkilidir. Bazı otoantikorların klinik önemi iyi tanımlanmıştır, fakat henüz çok iyi karakterize edilememiş, araştırma aşamasında olan otoantikorlar da mevcuttur. Otoantikorların uygun laboratuvar yöntemi ile tanımlanması, standart bir şekilde raporlanması, klinik olarak ilişkilerinin ortaya konması, hastalığın tanısı, prognozu ve tedavi takibinde doğru bir şekilde kullanılması hasta yönetiminde son derece önemlidir. Bu noktada laboratuvar uzmanı ve klinisyen işbirliği son derece önemlidir. Bu bölümde, artrite neden olan sistemik otoimmün romatizmal hastalıklar ve immünolojik tanısında kullanılan otoantikorlar özetlenmiştir. Systemic autoimmune rheumatic diseases are associated with various autoantibodies that play a critical role in diagnosis, prognosis, and patient management. The clinical significance of some autoantibodies is well defined, but there are also autoantibodies that have not yet been fully characterized and are still under investigation. The identification of autoantibodies using appropriate laboratory methods, their standardized reporting, the establishment of their clinical correlations and their accurate use in disease diagnosis, prognosis, and treatment monitoring are extremely important in patient management. In this regard, collaboration between laboratory specialists and clinicians is crucial. This section provides an overview of systemic autoimmune rheumatic diseases that cause arthritis and the autoantibodies used in their immunological diagnosis.

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.

The human microbiome is increasingly recognized as a key determinant of health and disease, yet methodological variability continues to limit reproducibility and clinical translation of findings. This review synthesizes current approaches in microbiome research, critically evaluating each step from sampling to sequencing and downstream bioinformatics. Pre-analytical factors such as sample type, collection method, preservation, and storage conditions profoundly affect microbial community profiles and remain a major source of bias. Nucleic acid extraction protocols and quality assessment strategies are discussed with emphasis on optimized lysis techniques, contamination controls, and DNA yield evaluation. Advances in sequencing technologies are highlighted, including 16S rRNA amplicon sequencing, shotgun metagenomics, third-generation long-read platforms, and emerging single-cell and minimal-input methods, each with specific advantages and limitations in taxonomic and functional resolution. Bioinformatics pipelines for taxonomic profiling, variant detection, phylogenetic inference, and functional annotation are compared, with attention to widely used reference databases such as RefSeq, GTDB, and SILVA. Integrative multi-omics approaches, including metatranscriptomics, metabolomics, and genome-scale metabolic modeling, are presented as powerful tools for linking microbial community structure to host physiology and disease mechanisms. Despite these advances, the lack of standardized workflows across pre-analytical, sequencing, and computational steps continues to hinder inter-study comparability and biomarker validation. This review aims to provide a methodological framework that highlights both strengths and limitations of current technologies while underlining the need for harmonized protocols to ensure reproducibility and accelerate the translation of microbiome research into clinical practice.

Background: The comparative effectiveness and safety of leflunomide and methotrexate in elderly rheumatoid arthritis (RA) patients remain understudied despite the growing prevalence of RA in this population. Objective: To compare the efficacy, drug survival, and safety of leflunomide and methotrexate in disease-modifying antirheumatic drugs (DMARD)-naive RA patients aged ⩾65 years. Design: Retrospective cohort study. Methods: Patients aged ⩾65 years with RA who were treated initially with either leflunomide or methotrexate were analyzed. Patients with DMARD-naive RA were selected according to the 2010 American College of Rheumatology/European League Against Rheumatism criteria. Patients received at least 6 months of treatment and were followed up for 24 weeks. Disease activity was assessed using the Disease Activity Score 28 (DAS28)-CRP (remission: DAS28-CRP < 2.6 and low disease activity (LDA): DAS28-CRP 2.6–3.2). Drug survival and adverse events were also recorded. Results: This study included 167 patients (80 on leflunomide and 87 on methotrexate). Methotrexate led to a greater reduction in DAS28-CRP (median reduction 1.9 vs 0.7, p < 0.001). By contrast, remission (37.9% vs 31.3%, p = 0.229) and LDA rates (82.8% vs 73.8%, p = 0.110) were not significantly different. In both groups, swollen joint count was associated with remission ( p < 0.001). Drug survival rates were comparable in the unadjusted analysis (74.7% vs 66.3%, p = 0.152). After adjusting for baseline disease activity, methotrexate was associated with a 73% lower hazard of discontinuation (adjusted hazard ratio 0.27, 95% confidence interval [CI] 0.13–0.54, p < 0.001). The adverse event-related discontinuation rate was low and similar between the groups (10% for leflunomide vs 8% for methotrexate, p = 0.431). Conclusion: Both leflunomide and methotrexate are effective and safe in elderly RA patients. Methotrexate was associated with a greater reduction in disease activity and better adjusted drug survival. However, given the baseline differences in disease activity and the lack of statistically significant differences in remission and low disease activity rates at week 24, methotrexate remains a reasonable first-line option in the absence of contraindications for elderly RA patients. Leflunomide is a viable alternative when methotrexate is not tolerated.

İmmün sistemin önemli özelliklerinden biri, değişik çok sayıda mikroorganizmaya karşı vücudu savunurken, öz antijenlerimize, doku ve organlarımıza karşı yanıtsız kalmasıdır. Öz antijenlere yanıtsızlık durumu immünolojik tolerans olarak da tanımlanmaktadır. Öz antijenleri tanıyabilen lenfositler, öz antijenlere yönelik immün yanıtları önleyecek mekanizmalar ile ortadan kaldırılmaktadır. Bu mekanizmalardaki bir aksaklık, immün sistemin öz antijenlere, doku ve organlara saldırmasına neden olmaktadır. Bu tür yanıtlara otoimmünite ve oluşturdukları hastalıklara da otoimmün hastalıklar denilmektedir.

Edinsel immünite birçok enfeksiyonlara yol açabilen mikroorganizmalara karşı konak savunmasında oldukça önemli fonksiyonlar kazanmasına rağmen öz antijenlerimize karşı çoğu zaman yanıtsız kalmaktadır. İmmunolojik tolerans olarak tanımlanan bu yanıtsızlık durumu öz antijenlerimize yanıt veren lenfositlerin farklı mekanizmalarla ortadan kaldırılması ile sağlanır. Bu mekanizmalardaki aksaklık otoimmüniteyi neden olmaktadır. Otoimmün romatolojik hastalıklar diye tanımlanan ve otoimmünitenin başlıca hastalık grubuna ait semptom ve bulguların yanında hastalığa özgü otoantikoların varlığı tanıda önemli yer tutmaktadır. Although acquired immunity gains very important functions in host defense against microorganisms that can cause many infections, it often remains unresponsive to our own antigens. This unresponsiveness, defined as immunologic tolerance, is achieved by eliminating lymphocytes that respond to our own antigens by different mechanisms. Failure in these mechanisms causes autoimmunity. The presence of disease-specific autoantibodies in addition to the symptoms and signs of the main disease group of autoimmunity, defined as autoimmune rheumatologic diseases, plays an important role in the diagnosis.