Gülnur Kul

Background/Objectives: Cardiac implantable electronic device (CIED) infections range from localized pocket infection to systemic disease. This study evaluated clinical, laboratory, microbiological, and imaging findings associated with the final classification of systemic CIED infection and described device management and in-hospital outcomes. Methods: This retrospective single-center study included 75 adults with definite CIED infection after case-by-case diagnostic re-adjudication, comprising 61 patients with localized pocket infection and 14 with systemic infection. Exploratory univariable and Firth penalized logistic regression analyses were used to examine associations with systemic infection. Results: Of 75 patients with definite CIED infection, 14 (18.7%) had systemic infection and 61 (81.3%) had localized pocket infection. Fever was observed in 5/14 (35.7%) patients with systemic infection and 3/61 (4.9%) patients with localized infection (p = 0.005). Procalcitonin was available for 70 patients and was higher in systemic than in localized infection (0.23 [0.06–1.57] vs. 0.05 [0.03–0.12] ng/mL; p = 0.025). Chronic kidney disease stage G3a–G5 was more frequent in systemic infection (3/14 [21.4%] vs. 2/61 [3.3%]; p = 0.042), and estimated glomerular filtration rate was lower (64 [45–83] vs. 89 [73–99] mL/min/1.73 m²; p = 0.014). Among 33 culture-positive episodes, coagulase-negative staphylococci were recovered in 12/22 localized episodes, whereas Staphylococcusaureus was recovered in 6/11 systemic episodes. Complete system removal was documented in 12/14 (85.7%) systemic and 46/61 (75.4%) localized infections; the median interval from admission to first removal attempt was 10 [6–17] and 5 [3–8] days, respectively. In the exploratory Firth model including age, fever, and log₂-transformed procalcitonin, fever (aOR 6.17, 95% CI 1.02–37.52) and procalcitonin per doubling (aOR 1.35, 95% CI 1.02–1.81) were associated with systemic infection. In the kidney-function sensitivity model, the procalcitonin estimate was attenuated (aOR 1.31, 95% CI 0.99–1.74). Two in-hospital deaths occurred, both among patients with systemic infection. Conclusions: In this small retrospective cohort, fever and higher procalcitonin concentrations were exploratory correlates of the systemic-infection classification. The study did not evaluate diagnostic accuracy, clinical prediction, calibration, or external validity. Larger prospective studies with standardized diagnostic work-up and external validation are needed before biomarker-based clinical decisions can be considered.

Background: In recent years, with the aging population worldwide, the number of elderly undergoing solid organ transplantation has been steadily increasing. However, data on the effects of advanced age on infection characteristics and clinical outcomes in transplant recipients are limited. This study aimed to evaluate the effects of advanced age on infections and clinical outcomes in solid organ transplant recipients. Methods: This retrospective multicenter cohort study included patients who underwent solid organ transplantation at different transplant centers in Türkiye between 2003 and 2023 and were followed up for at least 1 year. Patients were divided into two age groups: ≥ 60 years and < 60 years. Demographic characteristics, laboratory parameters, infection episodes, and clinical outcomes were compared between the two age groups. Results: The study included 273 (27.7%) patients aged ≥ 60 years and 712 (72.3%) patients aged < 60 years, totaling 985 recipients. Male sex and liver transplantation were more common in the older age group ( p < 0.001). Hospital stay was significantly longer in patients aged ≥ 60 years ( p = 0.002). However, there was no difference between the two age groups in terms of time to first infection or number of infection episodes. The mortality rate in patients aged ≥ 60 years was 21.6%. The most common cause of death was bacterial infection, with carbapenem‐resistant pathogens detected in a substantial proportion of cases. Conclusions: Although infection incidence was similar across age groups, solid organ transplant recipients aged ≥ 60 years had higher mortality and longer hospital stays, highlighting the need for careful clinical monitoring in older transplant recipients. image

Objective: Chronic hepatitis B (CHB) represents a major contributor to fibrosis and cirrhosis worldwide. In this study, we aimed to investigate the relationship and predictive value of the gamma-glutamyl transferase (GGT)-to-platelet ratio (GPR) with liver fibrosis and steatohepatitis. Materials and Methods: This retrospective cohort study included 100 patients with CHB and 100 healthy controls. Fibrosis indices were calculated and compared with ultrasound results for fibrosis status and steatohepatitis identified on liver biopsy. The diagnostic performance of these parameters was assessed using receiver operating characteristic (ROC) curve analysis. Results: The body mass index, liver enzyme levels, and fibrosis indices were higher in patients with chronic hepatitis B than in healthy individuals, while platelet counts were lower in these patients (all p<0.05). ROC analysis showed that GPR had the highest discriminative performance in distinguishing CHB patients from healthy controls, with an AUC of 0.960, sensitivity of 96%, and specificity of 80%, and it outperformed both APRI and FIB-4. GGT and FIB-4 exhibited the strongest discriminatory performance. Although GPR showed a strong correlation with APRI and FIB-4, only FIB-4 was independently associated with Ishak fibrosis stages (OR≈1.8, p=0.037). None of the indices significantly predicted hepatic steatosis severity. Conclusion: GPR demonstrates high accuracy in distinguishing CHB patients from healthy individuals. FIB-4 was found to be more valuable than GPR for staging fibrosis progression, indicating that GPR should be interpreted primarily as a disease discrimination index, rather than as a fibrosis staging tool. The combined use of these indices could provide a cost-effective, noninvasive diagnostic tool for the diagnosis and follow-up of patients with CHB and serve as a useful biomarker for clinicians.

Aslı Haykır Solay, Gülnur Kul. Gut and Liver -0001;0:. https://doi.org/10.5009/gnl250132

Amaç: Sağlık çalışanları aşıyla önlenebilir hastalıklar için risk altında olan kişilerdir. Çalışmamızın amacı; bu kişilerde hepatit A ve B, kızamık, kızamıkçık, kabakulak ve suçiçeği virüslerine karşı bağışıklık durumlarını belirlemek, yaş ve cinsiyete göre değerlendirmektir. Gereç ve Yöntemler: Çalışmaya Kasım 2023- Mayıs 2024 tarihleri arasında Ankara Etlik Şehir Hastanesi Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji polikliniği’ne, aşıyla önlenebilen bulaşıcı hastalıkların taranması amacıyla başvuran, semptom tariflemeyen, 18 yaş üstü, 2409 sağlık çalışanı dahil edilmiştir. Bulgular: Anti HBs %74,17, anti HAV %31,48, kızamık IgG %64,36, kızamıkçık IgG %95,9, kabakulakIgG %72,22, su çiçeği IgG %86,28 pozitif bulunmuştur. HBsAg, anti HAV, kabakulak Ig G ve kızamık Ig G pozitif olanların yaş ortancası daha yüksek saptanmıştır (p

Objective: Our aim is to assess the knowledge, attitude, and behaviors of pregnant women about COVID-19. Material and Method: This cross-sectional survey study was performed on pregnant women in their second and third trimester between the November-December 2020. The participants completed a questionnaire consisting of 5 parts. Demographic data of pregnant women, their knowledge, attitude, and risk perceptions toward COVID-19, their practices and worries about COVID-19, and what they knew about pregnancy were assessed. The answers were calculated as a percentile and mean. Results: A total of 1011 participants were included in the statistical analysis. Of the participants, 98.5% knew that COVID-19 was transmitted through close contact. Of the participants, 47.5% extremely trusted healthcare workers in fighting against the COVID-19 pandemic. Affection and respect for healthcare workers during the pandemic increased by 89.1% of the participants. Of the participants, 50.6% were intending to decrease their antenatal visits during the COVID-19 pandemic and 39.4% thought that their baby may be infected after birth. Conclusion: The measures taken can be applied with high awareness of COVID-19. Sufficient training, in that case, can be done through communication routes such as information and public service announcements.

Amaç: Toksoplazma gondii (T. gondii), Rubella ve Cytomegalovirüs (CMV)etkenlerinin neden olduğu TORCH grubu enfeksiyonları sağlıklı yetişkinlerde asemptomatik seyrederken, gebelik döneminde vertikal bulaşla fetal morbidite ve mortalite ile sonuçlanabilir. Günümüzde gebelik sırasında bu enfeksiyon etkenlerinin rutin taraması konusunda net bir fikir birliği yoktur. Çalışmamızda ülke genelinde toxoplazma gondii, rubella ve sitomegalovirus enfeksiyonlarının gebelik dönemindeki seroprevelans durumunun belirlenmesi ve diğer ülkelerin verileriyle karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Çalışma çok merkezli, retrospektif, tanımlayıcı kesitsel bir araştırma olarak planlanmıştır. Çalışmamıza 2011-19 yılları arasında, ikinci basamak devlet hastanesi, üçüncü basamak eğitim araştırma hastanesi ve üniversite hastanelerine o yıl kuruma başvuran gebe sayısı, o yıl toksoplazma, rubella ve sitomegalovirus tetkiki yapılan gebe sayısı, IgM ve IgG sonuçları ve ulaşılabilirse toksoplazma ve sitomegalovirus avidite test sonuçları kaydedilmiştir. Rubella IgG negatif olan hastaların yaşları dahil edilmiştir. Bulgular: Türkiye’nin on farklı ilindeki ikinci ve üçüncü basamak sağlık kuruluşlarından toplam 15 merkezin katıldığı bu çalışmada, bu merkezlere başvurmuş ve gebelik durumu olan toplam 354526 kişiden elde edilen veriler sonucunda; anti toksoplazma IgG seropozitifliği %21, anti rubella IgG seropozitifliği %96.5, anti CMV Ig G seropozitifliği %56.2 bulunmuştur. Çalışmamızda anti rubella IgG negatif gebelerin yaşları değerlendirilmiştir. Rubella IgG negatif 2024 gebenin yaş ortalaması 30.6 yıl (18-54) bulunmuştur. Yaş aralıklarına göre incelendiğinde seronegatifliğin en çok 30-39 yaş aralığında olduğu görülmüştür. Sonuç: Gebelerde toksoplazma, rubella ve sitomegalovirus enfeksiyonu sıklığı ve yaygınlığı hakkında bilgi sahibi olmak, hastalık yükünün belirlenmesinde, tarama programlarının planlanmasında ve birinci basamak sağlık hizmetlerinin aktif kullanımında kritik bir rol oynamaktadır. Aşılama ile bağışıklığın sağlanabildiği rubella enfeksiyonu için seronegatif bireylerin tespit edilip gebelik öncesi aşılanması önemlidir.

It is an important issue in terms of drawing attention to the vaccination of health workers, who constitute an important group in terms of vaccination. Suggestions were made in a short and concise way. however, the lack of information on hepatitis A...

Amaç: Bu çalışmada iki farklı merkezdeki COVID-19 tanılı hastaların demografik, klinik, laboratuvar ve radyolojik özelliklerini belirlemeyi amaçladık. Gereç ve Yöntem: Çalışmamız iki merkezli, retrospektif bir çalışmadır. Çalışmaya 1 Eylül – 30 Kasım tarihlerinde hastanede yatırılarak tedavi edilen kesin COVID-19 tanısıyla izlenen SARS-CoV-2 gerçek zamanlı polimeraz zincir reaksiyon testi pozitif olarak sonuçlanan hastalar dahil edildi. Hastaların demografik, klinik, laboratuvar ve toraks bilgisayarlı tomografisi verileri retrospektif olarak değerlendirildi. Bulgular: Çalışmamıza 157’si erkek 304 COVID-19 hastası dahil edildi. En sık görülen komorbid hastalıklar arasında %38,3 hipertansiyon, %36,3 diyabetes mellitus, %23,8 astım vardı. En sık görülen semptomlar öksürük (77,3), dispne (63,2) Miyalji (29,9) olarak bulundu. Akciğer tutulumlarının hafif-orta ve ağır tutulumlu pnömoni olarak değerlendirdiğimizde 83 hastada hafif pnömoni, 151 hastada orta pnömoni ve 69 hastada ağır tutulum olan pnömoni gözlenmiştir. Ağır Covid-19 pnömonisi olan hastalarının beyaz küre, nötrofil, aspartat aminotransferaz, laktat dehidrogenaz, ferritin, CRP, D-Dimer ve INR seviyeleri ile yatış sürelerinin istatistiksel olarak anlamlı şekilde yüksek olduğu, buna karşın lenfosit düzeylerinin ise anlamlı şekilde düşük olduğu belirlendi (p