Çetin Kılınç

Giriş: Steril vücut sıvılarında saptanan enfeksiyonlar, özellikle yoğun bakımda izlenen veya immünsüprese hastalarda yüksek morbidite ve mortalite ile ilişkilidir. Beyin omurilik sıvısı (BOS), plevra, periton ve eklem sıvılarında gelişen enfeksiyonlar sistemik yayılım gösterebilir ve ciddi klinik tablolara yol açabilir. Bu çalışmada, üçüncü basamak bir sağlık merkezine beş yıllık dönemde gönderilen steril vücut sıvısı örneklerinde mikrobiyal üreme oranlarının; örnek türüne, demografik özelliklere, klinik birimlere, mikroorganizma dağılımına ve antimikrobiyal direnç profillerine göre değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Bu retrospektif kesitsel çalışmada, 2020–2025 yılları arasında laboratuvarımıza gönderilen BOS, plevra, periton ve eklem sıvısı örnekleri incelenmiştir. Toplam 1.956 örnek değerlendirilmiş olup 168’i (%8,6) pozitif üreme göstermiştir. Mikroorganizma tanımlama ve antimikrobiyal duyarlılık testleri VITEK-2 otomatik sistemi (bioMérieux, Fransa) ile gerçekleştirilmiştir. Veriler örnek türü, klinik birim, cinsiyet ve izole edilen mikroorganizmalar temelinde sınıflandırılmış; direnç oranları ulusal ve uluslararası verilerle karşılaştırılmıştır. Bulgular: Değerlendirilen örneklerin %41,9’u plevra, %28,1’i eklem sıvısı, %21,3’ü BOS ve %8,5’i periton sıvılarından oluşmuştur. Genel pozitiflik oranı %8,6 bulunmuştur. En sık izole edilen Gram-pozitif etkenler Staphylococcus aureus (%24,4), koagülaz negatif stafilokoklar (%10,7), Streptococcus agalactiae (%4,2) ve Enterococcus faecium (%2,3) olmuştur. Gram-negatif izolatlar arasında Acinetobacter baumannii (%13,7), Klebsiella pneumoniae (%12,5), Escherichia coli (%8,3) ve Pseudomonas aeruginosa (%7,8) ön planda yer almıştır. Örneklerin en büyük kısmının yoğun bakımlardan gönderildiği (%43) belirlenmiştir. Karbapenem direnci A. baumannii için %95’in üzerinde, K. pneumoniae için %75’in üzerinde, P. aeruginosa için ise %65’in üzerinde saptanmış; E. coli izolatlarında karbapenem direncine rastlanmamıştır. Sonuç: Steril vücut sıvılarından izole edilen patojenler ve antimikrobiyal direnç profilleri, özellikle yoğun bakım hastalarında ampirik tedavi yaklaşımlarının yeniden gözden geçirilmesi gerektiğini göstermektedir. Çalışmada saptanan yüksek karbapenem direnç oranları, Avrupa verilerinin üzerinde olup bölgesel antibiyotik yönetimi ve enfeksiyon kontrol uygulamalarının güçlendirilmesi gerektiğine işaret etmektedir. Bu veriler, bölgesel direnç haritalarının oluşturulmasına katkı sağlayarak ampirik tedavi protokollerinin güncellenmesine yol gösterici olabilir.

Amaç: Bu çalışmada, bir yıllık dönemde hastanemizde saptanan kandidemi olgularında Candida türlerinin dağılımının, antifungal duyarlılık profillerinin ve 30 günlük mortalite oranlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: 01.04.2024–30.04.2025 tarihleri arasında kan kültürlerinde Candida türü izole edilen 98 kandidemi olgusu retrospektif olarak incelendi. Tür tanımlaması ve antifungal duyarlılık testleri Vitek 2 Compact otomatize sistemi ile gerçekleştirildi. Hastaların demografik verileri, Candida tür dağılımı, antifungal direnç oranları ve 30 günlük mortalite değerlendirildi. Bulgular:Toplam 98 kandidemi olgusunun %59,1’i erkek, %40,9’u kadın olup hastaların yaş ortalaması 73,95±11,40 yıl idi. Olguların büyük çoğunluğu (%87,8) yoğun bakım ünitelerinde takip edilen hastalardan oluşmaktaydı. Candida türlerinin dağılımında C. albicans %54,1 ile en sık izole edilen etkendi.Non-albicans türler arasında en sık C. tropicalis (%18,4), ardından C. parapsilosis (%13,3), C. glabrata (%9,2), C. auris (%2,0), C. guilliermondii (%2,0) ve C. dubliniensis (%1,0) saptandı. Antifungal duyarlılık sonuçlarında Amfoterisin B direnci %1, flukonazol direnci %4,7 ve vorikonazol direnci %3,5 olarak belirlendi. Ekinokandin grubu ajanlara direnç oranı %4,2 olarak bulundu. Olguların 30 günlük mortalite oranı %63,3 (62/98) idi. Türlere göre mortalite incelendiğinde, türler arasında istatistiksel olarak anlamlı bir fark saptanmadı (p=0,25). Mortalite gelişen hastaların yaş ortalaması (76,4±10,46), sağ kalanlara (69,66±11,81) göre anlamlı derecede yüksekti (p=0,006). Erkeklerde mortalite kadınlara göre daha yüksek bulunmakla birlikte fark istatistiksel olarak anlamlı değildi ( p=0,23). Sonuç: Tür dağılımı, antifungal direnç ve mortalite verilerinin kapsamlı değerlendirilmesi, kandidemi yönetiminde hasta sonuçlarını iyileştirmek ve tedavi stratejilerini geliştirmek için önemlidir.

Objective: The reverse transcription–polymerase chain reaction test (RT-PCR) is the gold standard for the diagnosis of coronavirus disease 2019 (COVID-19), and antibody tests are useful as supplemental tools for diagnosis, for measuring the population’s immunity levels, and for checking infection in asymptomatic contacts. This study aimed to evaluate the reliability of five commercial antibody detection test kits. Materials and Methods: The reliability of the Colloidal Gold COVID-19 IgG/IgM Rapid Test Kit, Antibody Rapid Test Hotgen, Beijing Hotgen Biotech Co., Ltd., China), Abbott Chemiluminescent Microparticle Immunoassay (Illinois, USA), Roche Electrochemiluminescence Immunoassay (Roche Diagnostics, Switzerland), Siemens Chemiluminescence (Munich, Germany), and Euroimmun ELISA (Lübeck, Germany) for COVID-19 diagnosis was studied. The antibody-negative group included 50 sera from 2018, and the antibody-positive group included 98 patients with positive RT-PCR results from whom blood samples had been collected 3–9 weeks after hospital discharge. Statistical analysis was performed using SPSS version 23.0 (IBM Corporation, Armonk, NY, USA). The antibody tests’ validity and intra-assay reproducibility were examined, and the Cohen’s kappa coefficients were obtained. The disease prevalence was pegged at 10%. Results: The antibody tests’ sensitivity (69.12–72.46%) and positive predictive values (42.44–100.0%) were low, and their specificity (89.58–100%) and negative predictive values (96.31–97.03%) were high. Their accuracy rates varied from 87.54% to 97.25%, and their intra-assay coefficients of variation varied from 1% to 10%. Conclusion: The agreement between the results of the antibody detection test kits was higher when the kits were classified according to the targeted antigens. The time of blood sample collection, targeted antigens, and antibody types affected the results. Serological tests were found to be useful, and the commercial kits were found to be largely reliable, although, some parameters need to be improved.

Aim: This study purposed to determine anti-spike IgG levels at the fourth week after the second dose in healthcare workers (HCWs) who had two doses of the CoronaVac vaccine (Sinovac Life Sciences, Beijing, China). The second purpose of the study was to evaluate several factors that may affect antibody levels. Material and Method: The study was performed at Kastamonu Training and Research Hospital. A total of 197 HCWs of both genders aged 20-63 were included in this study. Antibody levels that neutralize the SARS-CoV-2 spike protein S1 subunit were determined using the SARS-CoV-2 IgG II Quant kit from serum samples collected from the subjects between 10-16 March 2021. Also, a questionnaire containing information about demographic and clinical data was administered to all subjects. It was statistically investigated whether these data affected the anti-spike IgG levels. Results: All subjects had anti-spike IgG levels positive. The median value of the subjects' anti-spike IgG levels was calculated as 860.2 AU/mL (519.1-1674.1 AU/mL). Anti-spike IgG levels were statistically higher in non-smokers and Rh-positive subjects versus the smokers and Rh-negative subjects (p=0.001 and p=0.046, respectively). However, age groups, gender, COVID-19 history, blood type, and seasonal influenza vaccine did not significantly affect anti-spike IgG levels in the subjects (p>0.05). Conclusion: Anti-spike IgG responses were positive in all HCWs who received the CoronaVac vaccine. Besides, the results showed that smoking and Rh-factor affect the anti-spike IgG response. On the other hand, further studies need to examine more parameters with a larger number of subjects.

OBJECTIVE: The aim of this study was to monitor the time-dependent change by evaluating the antibody levels at the 4th, 7th, 10th, 13th, and 16th weeks after the second dose of the CoronaVac vaccine.METHODS: The study group (n=65) were between 21 and 60 years old and received two doses of the CoronaVac vaccine. Blood samples were collected after 4th, 7th, 10th, 13th, and 16th weeks of the second dose of the vaccine administration. There was a coronavirus disease 2019 recovered group (n=29) who were SARS-CoV-2 real-time PCR test result positive before the vaccination period, and no coronavirus disease 2019 history group (n=36). Age, BMI, gender, smoking, comorbidity, coronavirus disease 2019 contact history, and working in the coronavirus disease 2019 service history of the individuals were recorded.RESULTS: No statistically significant difference was found in the descriptive findings of the individuals according to coronavirus disease 2019 recovered group and no coronavirus disease 2019 history group. It was observed that antibody levels in the coronavirus disease 2019 recovered group were found to be higher for each period of serum collection compared to the no coronavirus disease 2019 history group, which were statistically significant. The distribution curves of the antibody levels according to the timing of blood collection in coronavirus disease 2019 recovered group, no coronavirus disease 2019 history group, and total subjects were extrapolated, and it was observed that the estimated time for the antibodies to reach the threshold value of the test was 214, 145, and 166 days after vaccination.CONCLUSION: It is important to make booster doses, as the CoronaVac vaccine will lose its effect after the fifth month due to the decrease in Ab levels. In addition, since the antibody levels decrease later in those who have a history of coronavirus disease 2019 infection and are vaccinated, individuals who have no previous history of coronavirus disease 2019 should be given priority for vaccination.

Toxoplasma gondii (T. gondii) is a protozoan parasite that infects most warm-blooded animal species and causes toxoplasmosis. Especially infections that occur during pregnancy can lead to serious clinical symptoms. This study retrospectively revealed the T. gondii seroprevalence of pregnant women in Kastamonu province, Turkey. Anti-T. gondii IgM and IgG positivity of 1.294 pregnant women between the ages of 15-44 years who applied to the Obstetrics and Gynecology Outpatients of Kastamonu Training and Research Hospital from January 2018 to January 2022 were investigated retrospectively. The IgG avidity test was performed for both anti-T. gondii IgM and IgG positivity. Anti-T. gondii IgM and IgG seropositivity were determined as 1.1% (n=14) and 20.3% (n=263), respectively. Anti-T. gondii IgM and IgG positivity were detected together in 11 pregnant women. IgG avidity test results of only six pregnant women could be reached, two pregnant had high IgG avidity, and four pregnant had low IgG avidity. Anti-T. gondii IgG positivity rate increased with increasing age (p=0.039). The number of seronegative pregnant women was considered high in Kastamonu. It is significant for expectant mothers to know about prevention methods in order not to acquire toxoplasmosis.

Introduction COVID-19 infection develops neurologic symptoms such as smell and taste loss. We aimed to determine the volumetric changes in the brain and correlation of possible related biochemical parameters and endocannabinoid levels after COVID-19 recovery. Methods Brain magnetic resonance images of recovered COVID-19 patients and healthy volunteers, whose olfactory and gustatory scores were obtained through a questionnaire, were taken, and the volumes of the brain regions associated with taste and smell were measured by automatic and semiautomatic methods. Endocannabinoids (EC), which are critical in the olfactory system, and vitamin B12, zinc, iron, ferritin, thyroid-stimulating hormone (TSH), and thyroxine (T4) levels, which are reported to have possible roles in olfactory disorders, were measured in peripheral blood. Results Taste and smell disorder scores and EC levels were found to be higher in recovered COVID-19 patients compared to controls. EC levels were negatively correlated with bilateral entorhinal cortex (ENT) volumes in the COVID-19 group. Subgenual anterior cingulate cortex volumes showed correlations with gustatory complaints and ferritin in recovered COVID-19 patients. Conclusions The critical finding of our study is the high EC levels and negative correlation between EC levels and left ENT volumes in recovered COVID-19 patients. Implications It is possible that ECs are potential neuromodulators in many conditions leading to olfactory disorders, including COVID-19.

Aim: Hepatitis A disease is a contagious liver infection caused by the hepatitis A virus (HAV). This study aimed to decide the hepatitis A seroprevalence in all age groups in Kastamonu province, Turkey. Material and Method: The current study analyzed the anti-HAV antibodies test results of the patients who applied to Kastamonu Training and Research Hospital for various reasons between 2018-2022. The most up-to-date test results of patients sent more than one serum sample were evaluated. The patients were separated into eight age groups: 0-10,11-20, 21-30, 31-40, 41-50, 51-60, 61-70, and ≥71. The anti-HAV IgM and anti-HAV IgG values were determined using the chemiluminescence microparticle immunoassay method in the Abbott Architect i2000SR. The results were evaluated based on the manufacturer’s instructions. Results: There was positivity in 27 (1.3%) of 2083 patients in whom anti-HAV IgM was studied and in 837 (58.2%) of 1439 patients in whom anti-HAV IgG was studied. The anti-HAV IgG positivity in females and males was 55.9% and 61.0%, respectively; anti-HAV IgM positivity was 1.7% and 0.8%. The anti-HAV IgG positivity rate increased with increasing age (p