Sibel Altunisik Toplu

Objective: Sleep problems are common among people with HIV, but prospective data on sleep quality early after antiretroviral therapy (ART) initiation are limited. This pilot study evaluated changes in sleep quality during the first month after ART initiation. Methods: In this pilot cohort study, sleep quality was prospectively assessed using the Pittsburgh Sleep Quality Index (PSQI) at ART initiation and 1 month later in an ART-initiation. A separate group receiving virologically suppressive ART for at least 1 year was assessed cross-sectionally. Continuous variables are presented as median [interquartile range (IQR)]. Results: Nine participants were included in the ART-initiation group and 39 in the long-term suppressive ART group. In the ART-initiation group, median global PSQI scores were 4 [IQR 3–7] at baseline and 4 [IQR 4–6] at month 1, with no significant change ( p = 0.915). Poor sleep quality (PSQI >5) was present in 33% at both assessments. In the long-term suppressive ART group, the median PSQI score was 6 [IQR 4–8], and 51% had poor sleep quality. Neither PSQI scores ( p = 0.247) nor the prevalence of poor sleep quality ( p = 0.466) differed significantly between baseline and the long-term suppressive ART group. Conclusion: No detectable change in sleep quality was observed during the first month after ART initiation. Approximately half of participants receiving long-term suppressive ART had poor sleep quality. These findings suggest that sleep quality may be a clinically relevant patient-reported outcome to consider during routine HIV care.

BackgroundHealthcare-associated infections (HAIs) remain a major cause of morbidity and healthcare burden in liver transplant recipients. However, long-term surveillance data from dedicated liver transplant intensive care units (ICUs) are limited. This study evaluated decade-long trends in healthcare-associated and device-associated infections in a high-volume liver transplant ICU undergoing substantial expansion.MethodsThis retrospective observational study analyzed prospectively collected surveillance data from the Liver Transplant ICU of Inonu University between January 2015 and December 2024. Overall HAI incidence rates were calculated per 1,000 patient-days, while ventilator-associated pneumonia (VAP), catheter-associated urinary tract infection (CAUTI), and central line-associated bloodstream infection (CLABSI) rates were calculated per 1,000 device-days. Temporal trends were assessed using Poisson regression analysis.ResultsA total of 7,717 adult liver transplant recipients accounting for 48,001 patient-days were included. During the study period, ICU capacity increased from 12 to 36 beds and annual patient volume increased from 612 to 961 admissions. Overall, 285 HAI episodes were recorded. HAI incidence decreased from 14.37 to 2.98 per 1,000 patient-days, representing a 79.3% reduction. Poisson regression demonstrated a significant annual decline in HAI incidence (incidence rate ratio [IRR], 0.85; 95% confidence interval [CI], 0.82–0.89; p<0.001). Significant reductions were also observed for VAP (IRR, 0.86; p=0.003), CAUTI (IRR, 0.78; p<0.001), and CLABSI (IRR, 0.84; p<0.001). Device utilization ratios remained relatively stable throughout the study period.ConclusionsMarked reductions in healthcare-associated and device-associated infections were achieved despite stable device utilization, increasing patient volume, and a threefold expansion in ICU capacity. Importantly, infection rates continued to decline throughout this period, suggesting that institutional growth need not compromise infection control performance when supported by robust surveillance and continuously reinforced prevention strategies.

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