Kadriye Kart Yaşar

Background: Rabies is a fatal viral zoonotic disease. Despite Türkiye’s integrated human, domestic animal, and wildlife vaccination programs alongside post-exposure prophylaxis (PEP) services, human rabies cases continue to occur annually. Aim: This review systematically examines the current state of Post-Exposure Prophylaxis (PEP) following suspected rabies exposure in Türkiye, evaluating rabies control practices and prophylaxis data from the literature. Method: Following PRISMA 2020 guidelines, a descriptive evidence synthesis was conducted using data from 43 observational studies on rabies prophylaxis in Türkiye published between 2010 and 2024, retrieved from databases including PubMed, Web of Science, TR Dizin, and local repositories. Results: All included studies were retrospective and reported 111,677 presentations; among the 110,094 individuals with available prophylaxis data, 92.5% received PEP. Contact with stray animals accounted for 67.8%, while contact with owned but unvaccinated animals was 18.3%. The 4-dose vaccine regimen was the most common, and rabies immunoglobulin (RIG) was administered in 36.2% of cases. Notably, 81.5% of individuals sought PEP within 24 h. Side effects, including fever, local swelling, and erythema, were reported in 3.84% of cases. Conclusion: Although rabies control measures in Türkiye have achieved substantial progress, regional disparities in PEP administration remain evident. Observed variations in prophylaxis completion, delayed presentation (> 24 h), and inconsistent RIG administration highlight ongoing public health challenges. As the included studies did not directly assess the causes of these patterns, factors such as guideline adherence, public awareness, and regional service organization warrant further investigation. Continuous professional training, public health outreach, and stray animal population management may help optimize rabies prophylaxis strategies.

Background: Candida species are major causes of hospital-acquired bloodstream infections associated with high mortality in critically ill patients. This study aimed to evaluate temporal changes in species distribution, antifungal resistance, clinical outcomes, and mortality predictors in ICU patients with candidemia. Methods: This retrospective study included 250 ICU patients with candidemia between January 2018 and January 2022. The study period was divided into two cohorts (2018–2020, n = 80; 2020–2022, n = 170). Clinical, laboratory, and microbiological characteristics were compared. Multivariable analysis was performed to identify independent predictors of mortality. Results: The incidence density of candidemia significantly decreased from 4.32 to 3.10 per 1,000 ICU patient-days (IRR: 0.72; %95 CI: 0.55–0.94; p = 0,014). A shift toward non-albicans Candida species was observed, while antifungal resistance rates remained stable. Candida score values and empirical antifungal therapy rates were lower in the later period. Despite increased central venous catheter use, catheter-related candidemia decreased. Overall mortality was similar between periods; however, during the second period, mortality was higher in patients with SARS-CoV-2 infection than in those without infection [100/105 (95.2%) vs. 43/65 (66.2%), p < 0.001]. In multivariable analysis, SOFA score was independently associated with mortality in the early period (OR: 1.20, 95% CI: 1.01–1.43; p = 0.043), whereas SARS-CoV-2 infection (OR: 20.43, 95% CI: 3.53–118.14; p = 0.001), Candida score (OR: 0.19, 95% CI: 0.06–0.50; p = 0.003), lactate level at ICU admission (OR: 5.23, 95% CI: 1.55–17.57; p = 0.007), and urea level at ICU admission (OR: 1.01, 95% CI: 1.00–1.02; p = 0.030) were independent predictors in the later period. Conclusion: The high mortality observed among patients with SARS-CoV-2–associated candidemia underscores the need for heightened diagnostic awareness in deteriorating ICU patients. Early diagnostic work-up, timely initiation of antifungal therapy, and reassessment of treatment according to microbiological findings are important in this setting. Hospital-specific identification of preventable risk factors may also help optimize candidemia management and infection control strategies.

Background/Objectives: The accurate evaluation of the fibrosis stage is critical for improving chronic hepatitis B (CHB) management and patient outcomes. This study aimed to compare the diagnostic accuracy of non-invasive fibrosis markers with liver biopsy for detecting significant, advanced fibrosis and cirrhosis. We further investigated the diagnostic performance of non-invasive markers according to HBeAg status to provide further insight into their clinical utility across patient subgroups. Methods: This single-center retrospective study included 536 treatment-naive patients with CHB who underwent liver biopsy. Patients were categorized into four groups according to the fibrosis stage: “no significant fibrosis” (F0–F2), “significant fibrosis” (F3–F6), “advanced fibrosis” (F4–F6), and “cirrhosis” (F5–F6). AAR, AAPRI, APRI, API, FIB-4, GPR, and S–index were compared among these groups. Results: In total, 536 treatment-naïve patients were analyzed (63.2% male; mean age 44.8 ± 12.9 years), of whom 25.4% were HBeAg-positive. API, FIB 4, GPR, and S-Index showed good performance (area under the curve [AUC] ≥ 0.8–0.9) in defining advanced fibrosis (≥F4), AAPRI, AAR, API, and APRI showed good performance ([AUC] < 0.700) in defining cirrhosis. The analysis showed that GPR had the highest AUC for ≥F3 (0.719) and ≥F4 (0.838), while FIB 4 had the highest AUC for cirrhosis (0.865). Conclusions: These findings highlight the value of non-invasive markers as inexpensive and easily applicable methods for clinicians in assessing the stage of liver fibrosis. The integration of these scores into the routine monitoring of chronic hepatitis B patients is expected to expand, enhancing clinical decision-making and reducing the necessity for liver biopsies.

Background: Infective endocarditis (IE) is a serious and potentially life-threatening infection with high morbidity and mortality. Early risk identification is critical for enabling timely treatment and preventing adverse outcomes. Recently, several low-cost and accessible inflammatory markers, such as the neutrophil-to-lymphocyte ratio (NLR), prognostic nutritional index (PNI), and systemic immune-inflammation index (SII), have gained attention for their potential prognostic value in infectious diseases. Methods: This retrospective study evaluated patients diagnosed with definite IE between May 2014 and May 2024 at Bakırköy Dr. Sadi Konuk Training and Research Hospital. Clinical characteristics, laboratory parameters, complications, and outcomes were compared between survivors and non-survivors. The predictive value of NLR, PNI, and SII for in-hospital mortality was assessed. Results: A total of 78 patients with IE were included, with an overall mortality rate of 52.5%. Non-survivors were significantly older (p = 0.001) and had higher rates of cardiac complications (p < 0.05). PNI values were significantly lower in non-survivors (p = 0.014). Undergoing cardiac surgery was associated with a lower mortality rate (p = 0.024). Conclusion: PNI, a simple, inexpensive, and readily available marker, may provide valuable prognostic information in patients with infective endocarditis. This index could help in early risk stratification and clinical decision.

Background/Aim: Vitamin K is vital for numerous physiological functions, particularly in coagulation and inflammation. This research investigates the relationship between VK1 and VK2 levels and the severity and mortality of COVID-19 Methods: This prospective study analyzed VK1 and VK2 levels using ELISA in 165 hospitalized COVID-19 patients. Statistical analyses, including logistic regression, were performed to evaluate associations with clinical outcomes, including ICU admission and mortality. Results: VK2 levels were significantly higher in patients with severe disease (P<0.01) and deceased patients (P<0.05). Logistic regression identified CT severity and VK1 levels as risk factors for ICU admission and mortality, with odds ratios of 10.65 and 6.43, respectively. Conclusion Elevated VK2 levels correlated with severe COVID-19 outcomes, suggesting a potential role as a biomarker for disease severity and risk of mortality. These findings underscore the potential clinical utility of VK2 as a biomarker for disease severity and prognosis.

This study investigated the resistance patterns to aminoglycosides among 137 bacterial isolates derived from various clinical specimens submitted to the Microbiology Laboratory at XXX Training and Research Hospital in the year 2005. The bacterial isolates were Escherichia coli (n=34), Klebsiella pneumoniae (n=30), Pseudomonas aeruginosa (n=30), Acinetobacter baumannii (n=23), and Staphylococcus aureus (n=20). Staphylococcus aureus was further classified into methicillin-susceptible strains (MSSA, n=13) and methicillin-resistant strains (MRSA, n=7). We examined the susceptibility against eight distinct aminoglycosides. Isepamicin exhibited the lowest overall resistance rates within Gram-negative bacilli, particularly among isolates of P. aeruginosa and A. baumannii derived from intensive care units (ICUs). Streptomycin presented the highest levels of resistance. Statistically significant differences in resistance rates were observed between ICU and non-ICU isolates for gentamicin (χ² = 11.19, p = 0.0037), amikacin (χ² = 8.82, p = 0.0121), and isepamicin (χ² = 9.67, p = 0.0079). This suggests an increased resistance rate in intensive care units. MRSA strains were more resistant to various aminoglycosides, including gentamicin, tobramycin, and isepamicin, in comparison to MSSA strains. These observed differences were not statistically significant. These resistance patterns highlight the limitations of older drugs like streptomycin and kanamycin. The sustained efficacy of isepamicin and netilmicin positions them as viable treatment alternatives, particularly for infections caused by multidrug-resistant organisms. The results point to the necessity for routine susceptibility testing, careful antimicrobial stewardship, and judicious antibiotic selection to enhance patient outcomes and address resistance in high-risk environments such as the ICU.

Peritonitis presents an inflammation of the peritoneal cavity that can develop because of infectious (bacteria, viruses, parasites, etc.) and non-infectious (chemical agents, foreign substances, etc.) causes. Infectious peritonitis is divided into three classes based on

Objective: To evaluate the long-term outcomes of hepatitis delta patients, including cirrhosis and hepatocellular carcinoma (HCC), based on clinical and laboratory data. Methodology: A retrospective evaluation was conducted on patients diagnosed with hepatitis delta. The patients were formed into four groups: no-treatment, pegylated interferon, oral antiviral, and combined treatment. Results: A total of 93 patients, 48 women and 45 men, were evaluated in the study. The mean follow-up time was 4.38 ± 2.7 years. Of those, 43 were in the no-treatment group, 22 received combination therapy including pegylated interferon and oral antiviral treatment for chronic hepatitis B (the combined treatment group), 19 received only oral antiviral treatment for chronic hepatitis B (the oral antiviral group), and nine received pegylated interferon (the pegylated interferon group). HDV-RNA negativity was observed in 67% (6/9) of patients in the pegylated interferon group and 33% (5/15) of patients in the combined treatment group. HDV-RNA became spontaneously negative in one of the two patients in the no-treatment group, while no patient in the oral antiviral group became HDV-RNA negative. Seven patients were diagnosed with cirrhosis and one with HCC. Three patients had undergone liver transplants. There were no fatalities among patients. Conclusions: Pegylated interferon therapy has been demonstrated to have partial efficacy in the treatment of delta hepatitis, while oral antivirals have been shown to offer no additional benefit. Although negative HDV-RNA was achieved in some patients treated with pegylated interferon, pegylated interferon treatment could not eliminate the risk of cirrhosis and HCC.

Objective: It is difficult to distinguish cytomegalovirus (CMV) infection and disease since CMV is a latent virus and can cause recurrent infections. Positive CMV tests may not necessarily be indicative of active disease. There is no clear threshold value for plasma CMV-DNA polymerase chain reaction (PCR) levels to distinguish disease from viral reactivation. In this study, we aimed to determine a numerical value to identify CMV-related clinical syndromes and to differentiate between CMV infection and disease in HIV/AIDS patients. Methods: HIV/AIDS patients aged ≥18 years with a positive CMV viral load in plasma of any titer were included in the study. Sociodemographic, clinical, and laboratory data were extracted from patient files. Cytomegalovirus-related disease was defined as the isolation or detection of viral proteins or nucleic acid in a tissue sample or any body fluid in the presence of clinical signs related to the organ involved. CMV infection was diagnosed based on evidence of CMV replication without CMV symptoms or signs. A ROC curve was created to determine a cut-off value to distinguish CMV infection and disease. Results: Eighteen patients had CMV-related disease, and 18 had CMV infection. Clinical and laboratory parameters were compared between the two groups. The end organs’ involvement was detected in the CMV disease group, and gastrointestinal involvement was the most common. The CMV-DNA PCR threshold level among patients with CMV disease and infection was determined as 3154 copies/mL. The risk of CMV disease increased with decreasing CD4⁺ T lymphocytes count and increasing HIV viral load. Conclusion: Since CMV illness can have life-threatening effects, a precise and prompt diagnosis is essential. Antiviral therapy can reduce the morbidity and mortality of CMV infection. The CMV-DNA PCR threshold level determined in this study will guide clinicians in the early diagnosis of CMV disease. Keywords: CMV, HIV, polymerase chain reaction, antiretroviral therapy

Introduction: Mpox virus is an orthopoxvirus that causes the zoonotic infectious disease known as mpox. The disease can also spread from humans to humans. It can be transmitted through contact with bodily fluids, lesions on the skin, or internal mucosal surfaces. Method: The number of mpox cases increased during the COVID-19 pandemic. Early diagnosis and prompt management of mpox are critical in people living with HIV (PLHIV). In this study, a cross-sectional survey was conducted among PLHIV followed at the outpatient clinic between 20 April–20 August 2023. A questionnaire was used to assess the knowledge and anxiety levels of patients as well as their opinions about vaccination against mpox. The severity of symptoms in the past two weeks was assessed using the Generalised Anxiety Disorder 7-item scale. A total of 203 PLHIV were interviewed for this survey study. Result: The mean age was 39.37±11.93. The majority of them were male (86.7%), and 41.4% were men who have sex with men (MSM). Only 21 of the surveyed participants (10.4%) had a “good knowledge” score about mpox. The mean knowledge score on human Mpox was 2.05 (min:0-max:8), and 107 (52.7%) had a score of 0. Conclusion: The future study should focus on continuous education, promoting awareness through programs and establishing measures to successfully overcome identified variables that contribute to mpox pandemic understanding and attitudes. Applying the lessons learned from the COVID-19 pandemic will help the management of mpox virus.