Effectiveness of Booster Measles-Mumps-Rubella Vaccination in Lower COVID-19 Infection Rates: A Retrospective Cohort Study in Turkish Adults

Objective

The aim of this study was to investigate the effectiveness of booster vaccination of adults with measles-mumps-rubella in the COVID-19 infection rates.

Methods

In order to investigate this hypothesis, we tested COVID-19 positivity rate through PCR assay on the participants (n=245; male), who had to share the same student accommodation together with the same dining hall to provide governmental service. Participants were divided into two groups based on their booster vaccination status with measles-mumps-rubella: the non-vaccinated group (n=207) and the vaccinated group (n=38). The rate of COVID-19 seropositivity, age, body mass index (BMI), active smoking and presence of comorbidity were also measured and recorded.

Results

All of the participants were healthy, and age distribution, comorbidity rates, active smoking status and BMI did not vary significantly among the two groups (p=0.305, p=0.594, p=0.280, and p=0.922, respectively). About 36.7% (n=90) of the participants were found to be COVID-19 positive by PCR among which the non-vaccinated cases had higher rates of COVID-19 seropositivity than the vaccinated cases (40.6% vs 15.8%) (OR=3.6, 95%CI: 1.5–9.0, p=0.004).

Conclusion

Based on these results, we cautiously predict that immunity produced by MMR vaccination boosters may provide some degree of protection against COVID-19 in the adult population.

Response to direct-acting antiviral agents in chronic hepatitis C patients with end-stage renal disease: a clinical experience

OBJECTIVE

The recent development of direct-acting antiviral agents (DAAs) has dramatically changed the treatment of chronic hepatitis C, and interferon-based regimes have become a poor treatment choice in clinical practice. Today DAAs offer shorter, well-tolerated, highly effective curative therapies. This study aimed to evaluate the effectiveness and safety of DAAs in patients with end-stage renal disease and HCV genotype 1 infection in real clinical practice.

METHODS

Thirty-six patients who attended our clinic, were diagnosed with chronic hepatitis C (CHC), undergoing hemodialysis, and fulfilled the criteria of age >18 years, genotype 1 infection, with a detectable HCV RNA level were considered for the study. Patients with GT1a infection received OBV/PTV/r plus DSV plus RBV for 12 weeks; GT1b infected patients received this regimen without RBV for 12 weeks.

RESULTS

The study was conducted on 33 patients. The mean age was 52.30 ±13.77 years, and 70 % of them were male. By the fourth week of treatment, HCV RNA levels decreased below 15 IU/ml in all patients. Sustained virologic response (SVR) 12 rate was 100%. Nine patients had side effects during treatment. Of the patients with side effects, 89.9% were in group 1a and 11.1% in group 1b.

CONCLUSION

In this study, treatment with OBV/PTV/r and DSV with or without RBV resulted in high rates of sustained virologic response in HCV GT1-infected patients with end-stage renal disease (ESRD). SVR was achieved in all patients with few side effects.

Incidence and predictors of direct-acting antiviral treatment failure in Turkish patients with chronic hepatitis C genotype 1b infection

Evaluation of the incidence and predictors of failure of direct-acting antiviral treatment for hepatitis C virus genotype 1b patients is important. Our retrospective cohort study assessed 172 Turkish patients who had received a full course of such treatment and could be checked for sustained virologic response. The overall treatment failure rate was 2.9% (5/172), all of whom relapsed. In three of these cases with sequencing data available, all had NS5A resistance-associated substitution. Multivariate analysis revealed that a 1 mg/dL increase in pre-treatment total bilirubin level was associated with a sevenfold increased likelihood of treatment failure. The baseline level of total bilirubin was the only significant independent predictor of direct-acting antiviral treatment failure.

The impact of hepatitis C viremia status on lung functions in chronic hepatitis c patients

Background

Previous trials have investigated the effect of hepatitis C on lung functions; however, the role of viral load levels is unclear. The aim of this study was to investigate the effect of HCV viremia status on lung functions.

Methods

This study was in 60 patients with chronic hepatitis C (CHC). Patients were classified into three groups (non-viremic, low-viremic and high-viremic) based on serum HCV RNA levels. Spirometric parameters (FEV1, FVC, FEV1/FVC) and the proportion of patients with spirometric abnormalities were compared between three groups.

Results

High-viremic and low-viremic patients showed a significantly higher prevalance of spirometric abnormality than observed in non-viremic patients (p=0.02). Moreover, there was a significant moderate correlation between viremia level and the percentage of spirometric abnormalities (Cramer's U value=0.452, p=0.002). High-viremic patients were 14.2 times more likely to exhibiting pulmonary dysfunction than non-viremic patients. Additionally, spirometric parameters FEV1 and FVC were significantly reduced in high-viremic and low-viremic patients compared to those in non-viremic patients (p=0.013 and p<0.001 respectively).

Conclusion

These results indicate that persistent HCV infection may be associated with reduced pulmonary functions, especially in patients with high viremia levels. Therefore, these patients should be carefully monitored for lung function.

An evaluation of knowledge, attitudes, and behaviors of employees of a university hospital in an H1N1 influenza pandemic

INTRODUCTION

In this study, we aimed to evaluate the knowledge, attitudes, and behaviors concerning the transmission routes of an H1N1 pandemic and the protective measures of health professionals at a university hospital in Turkey.

METHODOLOGY

A stratified systematic sampling method was used to select the sample size of the study group. A total of 22 professors, 29 researchers, and 26 nurses were included in the study.

RESULTS

The mean scores of the individuals were 8.4±2.5 (over 20) for knowledge about H1N1 transmission, 27.6±4.0 (over 60) for knowledge about protection against H1N1, 25.8±4.2 (over 45) for correct or appropriate attitudes, and 33.6±8.9 (over 60) for correct behaviors. A negative correlation between total knowledge and behavior was found (p < 0.001, r = -0.543).

CONCLUSIONS

In epidemics, standard protection measures should be known and applied. Regarding this topic, the web page of the Ministry of Health comes to the forefront as a reliable source of information in addition to scientific explanations.

The characteristics of patients with chronic hepatitis B in Turkey

AIM

To evaluate the characteristics of patients with hepatitis B virus (HBV) infection and summarize the treatment modalities.

METHODS

By September 30, 2011 the data of 7871 HBsAg (+) patients were complied and analysed according to demographic and medical records (age, sex, laboratory tests, treatment with antiviral agents) in thirty centres of Turkey.

RESULTS

Of the 7871 patients 3078 (39.1%) were females; mean (standard deviation) age was 35 (14) years, 3180 (40.4%) were HBsAg positive (+) after admission to a hospital, 1488 (18.9%) after blood donation and 967 (11.9%) were found during routine screening. The HBV prevalence among relatives of HBsAg (+) patients was 1764 (22.4%), and most frequently infected family members were siblings and mothers, 4961 (63.0%) and 2149 (27.3%), respectively). Anti-HDV was negative in 7407 94.1% of patients. Three-fourths of the patients 6383 (81.1%) were HBeAg negative (-). Mean (SD) ALT was 85.8 (266.4) U/L. Majority of patients, 5588 (71.0%) were chronic hepatitis-B patients under treatment, while 2283 (29.0%) were asymptomatic carriers without treatment and only 165 (2.1%) of patients were cirrhotic and 6612 (84.0%) of those were compensated. One-third of the patients 2983 (37.9%) were under a combined treatment, while others were under monotherapy. Lamivudine, entecavir and adefovir were the most frequently used oral therapies, used for 2583 (32.8%), 11.6% and 787 (10.0%) of patients, respectively), while 2975 (37.8%) of patients were under interferon treatment.

CONCLUSION

Hepatitis B is still a problem in our country. First task of the physicians and our state should be to prevent the development and spread of the disease with education and vaccination programs, safe blood transfusions, and control of barbers.

Antibiotic resistance genes & susceptibility patterns in staphylococci

BACKGROUND & OBJECTIVES

This study was carried out to evaluate the association between the antibiotic susceptibility patterns and the antibiotic resistance genes in staphylococcal isolates obtained from various clinical samples of patients attending a teaching hospital in Hatay, Turkey.

METHODS

A total of 298 staphylococci clinical isolates were subjected to antimicrobial susceptibility testing. The genes implicated in resistance to oxacillin (mecA), gentamicin (aac(6')/aph(2''), aph(3')-IIIa, ant(4')-Ia), erythromycin (ermA, ermB, ermC, and msrA), tetracyclin (tetK, tetM), and penicillin (blaZ) were amplified using multiplex PCR method.

RESULTS

Methicillin resistance rate among 139 Staphlococcus aureus isolates was 16.5 and 25.9 per cent of S. aureus carried mecA gene. Of the 159 CoNS isolates, methicillin resistance rate was 18.9 and 29.6 per cent carried mecA gene. Ninety four isolates identified as gentamicin resistant phenotypically, contained at least one of the gentamicin resistance genes [aac(6')/aph(2''), aph(3')-IIIa, ant(4')-Ia], 17 gentamicin-susceptible isolates were found as positive in terms of one or more resistance genes [aac(6')/aph(2''), aph(3')-IIIa, ant(4')-Ia] by multiplex PCR. A total of 165 isolates were resistant to erythromycin, and contained at least one of the erythromycin resistance genes (ermA, ermB, ermC and msrA). Phenotypically, 106 staphylococcal isolates were resistant to tetracycline, 121 isolates carried either tetK or tetM or both resistance genes. The majority of staphylococci tested possessed the blaZ gene (89.9%).

INTERPRETATION & CONCLUSIONS

The present results showed that the phenotypic antibiotic susceptibility patterns were not similar to those obtained by genotyping done by multiplex PCR. Rapid and reliable methods for antibiotic susceptibility are important to determine the appropriate therapy decisions. Multiplex PCR can be used for confirmation of the results obtained by conventional phenotypic methods, when needed.

Evaluation of nosocomial infections and risk factors in critically ill patients

Background

Nosocomial infections are one of the most serious complications in intensive care unit patients because they lead to high morbidity, mortality, length of stay and cost. The aim of this study was to determine the nosocomial infections, risk factors, pathogens and the antimicrobial susceptibilities of them in intensive care unit of a university hospital.

Material/Methods

The patients were observed prospectively by the unit-directed active surveillance method based on patient and the laboratory.

Results

20.1% of the patients developed a total of 40 intensive care unit-acquired infections for a total of 988 patient-days. The infection sites were the lower respiratory tract, urinary tract, bloodstream, wound, and the central nervous system. The respiratory deficiency, diabetes mellitus, usage of steroid and antibiotics were found as the risk factors. The most common pathogens were Enterobacteriaceae, Staphylococcus aureus, Candida species. No vancomycin resistance was determined in Gram positive bacteria. Imipenem and meropenem were found to be the most effective antibiotics to Enterobacteriaceae.

Conclusions

Hospital infection rate in intensive care unit is not very high. The diabetes mellitus, length of stay, usage of steroids, urinary catheter and central venous catheter were determined as the risk factors by the final logistic regression analysis. These data, which were collected from a newly established intensive care unit of a university hospital, are important in order to predict the infections and the antimicrobial resistance profile that will develop in the future.

The intensity of antibiotic usage in the university hospital and the investigation of an inappropriate use of antibiotics

AIMS

In the present study, we intended to investigate the intensity of antibiotic administration in our hospital and the ratio of an inappropriate antibiotic usage.

MATERIAL AND METHOD

Related data was collected during 3 consecutive days between 1-3 July 2009 at the Mustafa Kemal University, Faculty of Medicine Hospital. The antimicrobial usage was calculated as defined daily doses (DDDs) per 100 bed-days (BD) according to 2009 ATC-DDD index.

RESULTS

Antibiotics were administered to 74 patients (61.5%) out of 121 who were hospitalized in our hospital. Antibiotic usage in the internal clinics was intended for therapeutical reasons in 18 patients (94.7%) and for prophylactic reasons in 35 patients (77.8%) in the surgical clinics. The use of antibiotics in 44 patients (59.7%) out of 74 was appropriate. However, an inappropriate antibiotic use was detected in 30 patients (40.5%). The inappropriate antibiotics were administered to 21 patients (70%) who were hospitalized in the surgical clinics. A three days total antimicrobial consumption index value in the hospital was 81,19 DDD/100 BD, while this value was found 25,45 DDD/100 BD for the internal clinics and 38,39 DDD/100 BD for the surgical clinics. A positive correlation was observed among the inappropriate antibiotic usage and the antibiotic consumption (p<0.001).

DISCUSSION

Consequently, the ratio of an inappropriate antibiotic usage in our hospital is high and parallel to this, the antibiotic consumption ratio is excessive. It is necessary to share microbiological data and provide an adequate education to reduce the antibiotic consumption and enable a better and rational antibiotic consumption (Tab. 2, Fig. 2, Ref. 22).

Antibacterial activity of propolis against MRSA and synergism with topical mupirocin

OBJECTIVES

The aim of the present study was to investigate the activity of the propolis and its combinations with mupirocin against methicillin-resistant Staphylococcus aureus (MRSA) in nasal carriage.

METHODS

This study was carried out between June and August 2005. To infect nares of the rabbits, MRSA (ATCC 33591) strain was used. Minimum inhibitory concentration was determined according to National Committee for Clinical Laboratory Standards. Each inoculum was prepared in the same medium at a density adjusted to a 0.5 McFarland turbidity standard (10(5) colony-forming units [cfu]/mL) and diluted 1:100 for the broth microdilution procedure. Ten microliters (10 microL) (10(5) cfu/mL) of the bacterial suspension containing approximately 1000 cfu of MRSA was administered with sterile microsyringe through both nostrils of each rabbit. Ninety-six (96) hours after inoculation, the presence of infection was confirmed by using bacterial cultures. Twenty-six young New Zealand rabbits were randomly divided into 4 groups. Each treatment group (1, 2, and 3) included 7 rabbits and control group (group 4) included 5 rabbits. Group 1 was treated with topical mupirocin + ethanolic extract of propolis drops, group 2 received topical mupirocin, group 3 was administered ethanolic extract of propolis drops, and the control group (group 4) was only treated with phosphate-buffered solution drops for 7 days. At the end of study, nasal cultures and smears were obtained for bacterial count and cytologic examination.

RESULTS

The colony numbers of bacteria in group 1 were determined to be significantly lower than in group 2 (p = 0.0001), group 3 (p = 0.0001), and group 4 (p = 0.0001). The mean bacterial cell counts of groups 1-4 were 360.2 +/- 52.4 cfu/mL, 4120.6 +/- 860.4 cfu/mL, 5980.8 +/- 1240.6 cfu/mL, and 11500.0 +/- 2568.4 cfu/mL, respectively. Mupirocin + propolis administration (group 1) resulted in a significant reduction in the polymorphonuclear leukocyte (PMNL) count in the mucous membranes of rabbits compared with the other treatment groups (p < 0.05).

CONCLUSIONS

Propolis addition to mupirocin regimen was found to result in more profound reduction in bacterial cell count and inflammatory response compared with the rest of the treatment modalities.

Inducible nitric oxide synthase and histopathological correlation in chronic viral hepatitis

BACKGROUND

Chronic liver disorders represent a serious health problem. Nitric oxide (NO) synthesized by inducible nitric oxide synthase (iNOS) can function as an antimicrobial agent able to kill or reduce replication of microorganisms, and plays an important role in immune regulation. This study was undertaken to evaluate the expression of iNOS in chronic viral hepatitis and its relation to histopathology.

METHODS

This study included 56 patients with chronic viral hepatitis (38 hepatitis B, 18 hepatitis C). There were 35 men and 21 women with a mean age of 38.6+/-21.731 years. A modified form of the histology activity index (HAI) designed by Ishak and colleagues was used to assess grading and staging of chronic viral hepatitis. The needle biopsy specimens were fixed in 10% formalin and routinely processed. Routine hematoxylin-eosin, periodic acid-Schiff, and reticulin staining, and iNOS immunoperoxidase technique were performed on paraffin-embedded tissues.

RESULTS

We demonstrated that all liver samples had a marked iNOS expression, with a diffuse distribution pattern. iNOS consistently labeled mononuclear cells infiltrating portal tracts in all samples. Statistical evaluation of data showed that the iNOS expression correlated with the HAI and fibrosis. Furthermore a correlation between iNOS and severity of disease was detected (r=0.772, p=0.000).

CONCLUSIONS

Further investigations are required to determine whether iNOS-related treatment protocols could be useful in reducing disease severity.

[Falciparum malaria originating in foreign country: four cases]

Malaria has been commonly determined in tropical and subtropical regions and the Plasmadium (P.) vivax generally occurs in our country, Turkey. However, in the people who have been travelling abroad from Turkey P. falciparum and P. malaria were also detected. The diagnosis was confirmed by microscopy of Giemsa stained thin and thick blood slides in four cases, at a magnification of 1000. The diagnosis of four cases was made by seeing the gametocytes of P.falciparum in thin blood films. The cases were found in Hatay region and the patients are those working abroad. The cases are presented in order to emphasize on the necessity of giving education on public health and taking the precautions for the prevention of the disease and in order to draw attention to malaria diseases caused by different species from abroad and to the fact that it can be seen in local cases as well.

Causes of nosocomial pneumonia and evaluation of risk factors in a university hospital in Turkey

OBJECTIVE

To determine the incidence, risk factors, mortality rate, and organisms causing nosocomial pneumonia (NP).

METHODS

We carried out this study in the Intensive Care Units (ICUs), General Medical and Surgical wards of Baskent University, Training and Research Hospital in Adana, Turkey, between November 2000 and August 2002. Patients were observed from the time of admission until 48 hours after discharge from the hospital.

RESULTS

In this study, 618 (2.1%) nosocomial infections (NIs) were detected in 29778 patients. One hundred and fifteen of these infections were NP and investigated with surveillance prospectively. The most frequently isolated microorganisms in NP were methicillin-resistant Staphylococcus aureus (MRSA) 32.8%, Pseudomonas species 21.5%, methicillin-sensitive Staphylococcus aureus (MSSA) 10.2%, Klebsiella species (9.1%) and Acinetobacter species 5.9%, E. coli; 5.4% (10/186), Streptococcus species; 4.8% (9/186), Candida species; 4.8% (9/186), Enterobacter species; 2.7% (5/186) and the other bacteria; 2.7%. The predominant pathogens isolated in this study were MRSA (33.8%), Pseudomonas species (16.9%) and MSSA (16.9%) in early-onset pneumonias and MRSA (32.2%), Pseudomonas species (24.0%), and Klebsiella species (10.7%) in late-onset pneumonias.

CONCLUSION

This study demonstrated that the possibility of developing NP, significantly increases with such risk factors as decreased level of consciousness, respiratory failure, mechanical ventilation and tracheostomy. Each center should know its patients' profile, the factors that increase the infection, the antibiotic resistance patterns of microorganisms, and the distribution of hospital infections in every department. Strategies to prevent both development of antibiotic resistance and spread of resistant organisms are necessary.

Nosocomial urinary tract infections: micro-organisms, antibiotic sensitivities and risk factors

OBJECTIVE

Although urinary tract infections (UTIs) are the most common hospital-acquired infections, the epidemiology of these UTIs is not well defined in Turkey. The aim of this surveillance study was to determine micro-organisms responsible for UTI, their antibiotic sensitivities and to describe the incidence and risk factors of nosocomial urinary tract infections (NUTI).

SUBJECTS AND METHODS

This was a prospective surveillance study including cases of NUTI in intensive care units and various inpatient clinics. This study was carried out between November 2000 and January 2002. The following information was recorded: patients' age, gender, type of infection (hospital-acquired), presence of urinary catheter, intensive care unit admission, duration of hospital stay, type of organisms isolated and their antimicrobial susceptibility. The diagnosis of NUTI was based on criteria established by the Centers for Disease Control, Atlanta. Mini Api and conventional culture methods were used to determine the causative agents. The agents were isolated on eosin methylene blue agar and 5% sheep blood agar Statistical analyses of data were by chi-square test and logistic regression.

RESULTS

In this study, 618 (2.1%) nosocomial infections (NIs) were determined in 29,778 patients, and 178 of these infections were NUTI (28.8%, 178/618). The mean age of NUTI patients was 61.0 +/- 19.4 years (0-91 years) and 82 NUTI patients (46.1%) were male and 96 (53.9%) were female. The most frequently isolated micro-organism was Escherichia coli (31.4%) followed by Candida spp (21.3%), Klebsiella spp (10.6%) and Enterococcus spp (6.9%). Compared to the rate of other NIs, the rate of NUTI increased by 1.011 times per year of age, by 2.052 times in females and by 3.83 times in patients with urinary catheters (p < 0.05). The most effective antibiotics against Gram-negative bacteria were found to be imipenem and meropenem.

CONCLUSIONS

Important factors to prevent NUTI are to avoid unnecessary urethral catheterization, to choose narrow spectrum antibiotics according to antibiotic sensitivities, to investigate regularly the causative micro-organisms and their resistance patterns and to update the treatment protocols.

Comparative trial of different anti-bacterial combinations with propolis and ciprofloxacin on Pseudomonas keratitis in rabbits

The aim of the current study was to evaluate the effects of five different treatment combinations to find out whether propolis could be an alternative or an adjunctive treatment, in experimental Pseudomonas aeruginosa keratitis. Intrastromal P. aeruginosa strains were given to both eyes of 20 young New Zealand white rabbits. The rabbits were randomly divided equally into five treatment groups; ciprofloxacin and dexamethasone drops (C+D), ciprofloxacin drop (C), ciprofloxacin and propolis drops (C+P), propolis drop (P), 3% ethanol drop (control), respectively. Directly before the first treatment and 108 h after inoculation, the eyes were examined by slit lamp to assess the corneal opacity and rabbits were sacrificed for bacterial count. The mean corneal opacity scores and the mean bacterial counts log cfu/ml were significantly different in the treatment groups (P=0.001; ANOVA). According to post hoc tests for both the mean bacterial counts and corneal opacity scores, C+D, C, C+P groups were found to be statistically the same (P>0.05), and although the P group had significantly better scores than the control group it did not reach the scores of the rest of the treatment groups (P<0.01). We conclude that propolis may be a useful adjunctive agent but should not be regarded as a replacement for traditional antibiotic therapy for P. aeruginosa keratitis in rabbits.

[Strongyloides stercoralis in a patient complaining of chronic diarrhea]

In this study, a case of Strongyloides stercoralis infection in a 38-year-old patient with complaints of chronic diarrhea and stomach ache is presented. His history showed that the patient who has been a mechanic for 25 years is a farmer as well. S. stercoralis larvae were found during the parasitological examination of the patient's stool samples taken 3 times. The patient was given Albendazol (400 mg a day) for fifteen days. After the patient started to take Albendazol, there was a reduction in the number of parasites in the stool examined on the fifth day. In the stool examinations made on the tenth day, fifteenth day and after the treatment ended, no parasites were seen. When the treatment was completed, all the complaints of the patient disappeared. It was found that no investigation of parasitic infection had been made previously and he had been given different treatments. For this reason, it is important to investigate the possibility of parasitic infection in patients with chronic diarrhea.

Hydatid disease with atypical localization: 4 cases report

Hydatid disease caused by Echinococcus often manifests as slowly growing cystic mass and mainly affects the liver or lung and rarely other parts of the body such as brain, heart, bone and muscle. Cyst may be single or multiple, uni-or multiloculated. In this paper 4 hydatic cases, multiple and atypically localized are presented. Of the 4 cases, 2 were known to suffer from hydatid disease, having had a hepatic cyst removal previously. Thus, when faced with a hydatid cyst in any part of the body, it is preferable to examine other parts of the body by radiological imaging methods.

Full recovered meningoencephalomyelitis caused by mumps virus

Meningitis is the most common central nervous system complication of mumps virus, whereas encephalitis, cranial nerve palsies, poliradiculoneuritis are less common and myelitis caused by mumps virus is very rare [Nussinovitch et al., Acta Pediatrica (1992) 81, 183]. Lesions in young age as a result of severe acute transverse myelitis [shown on a magnetic resonance imaging (MRI) procedure] often has a viral cause. The case of a young male afflicted by meningoencephalomyelitis because of mumps virus is discussed.