Publications by authors named "Ahmet ÇaĞkan İnkaya"

48 Publications

An Unusual Case of Early Dental Implant Failure in an Otherwise-Healthy Patient due to Actinomycosis.

J Oral Implantol 2021 Jun 5. Epub 2021 Jun 5.

Associate Professor, Hacettepe University Faculty of Dentistry, Periodontology Department, Ankara, Turkey.

Actinomyces spp. are members of normal oral flora that may give rise to a rare disease- oral actinomycosis . Here we present a case of early implant failure associated with actinomycosis in an otherwise -healthy 43-year-old female and the treatment adopted following explantation. Clinically, one month after the implant placement, the peri-implant soft tissues were hyperplastic and associated with an excessive tissue reaction, bleeding, suppuration, deep probing depth , and implant mobility at #19 and #20 implants. Both implants were removed and all granulomatous tissues were thoroughly debrided. Histopathological examination revealed signs of acute ulcerative inflammatory reaction and Actinomyces colonies. The patient was prescribed short-term oral penicillins. After six months following explantation, the deficient bone was augmented with using a combination of absorbable collagen membrane, autogenous block and xenograft. The patient was followed up for one year ; and subsequently, two implants were reinserted at the same positions. The patient was followed up and no recurrences were observed. Implant failure due to actinomycosis is an extremely rare condition , and a definitive diagnosis is therefore essential for successful treatment.
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http://dx.doi.org/10.1563/aaid-joi-D-20-00301DOI Listing
June 2021

Cystoisospora belli infection in a renal transplant recipient: a case report and review of literature.

J Infect Dev Ctries 2021 Apr 30;15(4):599-602. Epub 2021 Apr 30.

Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Cystoisospora belli is a coccidian parasite that causes prolonged watery diarrhea especially among immunocompromised patients. Herein, we report a renal transplant patient who complaints of alternating diarrhea and review of literature related to cystoisosporiasis amongst the transplant recipients.
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http://dx.doi.org/10.3855/jidc.12407DOI Listing
April 2021

COVID-19 Vaccination Scenarios: A Cost-Effectiveness Analysis for Turkey.

Vaccines (Basel) 2021 Apr 18;9(4). Epub 2021 Apr 18.

Department of Pharmacy Management, Faculty of Pharmacy, Hacettepe University, Ankara 06230, Turkey.

As of March 2021, COVID-19 has claimed the lives of more than 2.7 million people worldwide. Vaccination has started in most countries around the world. In this study, we estimated the cost-effectiveness of strategies for COVID-19 vaccination for Turkey compared to a baseline in the absence of vaccination and imposed measures by using an enhanced SIRD (Susceptible, Infectious, Recovered, Death) model and various scenarios for the first year after vaccination. The results showed that vaccination is cost-effective from a health care perspective, with an incremental cost-effectiveness ratio (ICER) of 511 USD/QALY and 1045 USD/QALY if vaccine effectiveness on transmission is equal or reduced to only 50% of effectiveness on disease, respectively, at the 90% baseline effectiveness of the vaccine. From a societal perspective, cost savings were estimated for both scenarios. Other results further showed that the minimum required vaccine uptake to be cost-effective would be at least 30%. Sensitivity and scenario analyses, as well as the iso-ICER curves, showed that the results were quite robust and that major changes in cost-effectiveness outcomes cannot be expected. We can conclude that COVID-19 vaccination in Turkey is highly cost-effective or even cost-saving.
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http://dx.doi.org/10.3390/vaccines9040399DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8073609PMC
April 2021

Functional responsiveness of memory T cells from COVID-19 patients.

Cell Immunol 2021 07 17;365:104363. Epub 2021 Apr 17.

Department of Basic Oncology, Hacettepe University Cancer Institute, Ankara, Turkey. Electronic address:

The presence of memory T cells in COVID-19 patients has been acknowledged, however the functional potency of memory responses is critical for protection. In this study, naïve, effector, effector memory, and central memory CD4 and CD8 T cells obtained from the COVID-19 survivors were re-exposed to autologous monocyte-derived DCs that were loaded with SARS-CoV-2 spike glycoprotein S1. Proliferation capacity, CD25, 4-1BB, and PD-1 expression, and IFN-γ, IL-6, granzyme, granulysin, and FasL secretion were enhanced in CD4 and CD8 effector memory and central memory T cells. Albeit being at heterogeneous levels, the memory T cells from the individuals with COVID-19 history possess functional capacities to reinvigorate anti-viral immunity against SARS-CoV-2.
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http://dx.doi.org/10.1016/j.cellimm.2021.104363DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8052500PMC
July 2021

The clinical course of COVID-19 in hematopoietic stem cell transplantation (HSCT) recipients.

Turk J Med Sci 2021 Apr 21. Epub 2021 Apr 21.

Background/aim: The disease caused by SARS-CoV-2 was named as COVID-19. There is as yet insufficient information about the effects of HSCT on the clinical course of COVID-19. In the present study, we aimed to investigate the clinical course of COVID-19 in patients who had undergone HSCT.

Materials And Methods: We analyzed baseline characteristics, clinical course and findings of COVID-19, hospitalization and death rates, overall survival and case fatality rates of HSCT recipients diagnosed with COVID-19 retrospectively.

Results: 57.6% of the patients underwent AHSCT, and 42.4% underwent allo-HSCT. 60.6%, 27.3%, and 12.1% of the patients had mild, moderate and severe COVID-19 or critical illness, respectively. 45.5% were hospitalized, and 12.1% required intensive care. 9.1% necessitated invasive mechanical ventilation. The total CFR was 9.1% in HSCT recipients, 22.2% in patients with active hematologic malignancy and 4.2% in patients without active hematologic malignancy.

Conclusion: It can be concluded that mortality of HSCT recipients is lower in patients whose primary disease is in remission compared to ones that are not in remission. Further studies with larger group patients are needed in order to delineate the effects of COVID-19 on HSCT patients.
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http://dx.doi.org/10.3906/sag-2103-72DOI Listing
April 2021

Carbapenem-resistant Klebsiella pneumoniae meningitis and abscess treated with ceftazidime-avibactam.

Enferm Infecc Microbiol Clin (Engl Ed) 2021 Apr 12. Epub 2021 Apr 12.

Hacettepe University Medical Faculty Department of Infectious Diseases and Clinical Microbiology, Turkey.

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http://dx.doi.org/10.1016/j.eimc.2021.03.014DOI Listing
April 2021

Investigation of Intestinal Protozoon Prevalence in Immunocompromised Patients at a University Hospital

Turkiye Parazitol Derg 2021 03;45(1):39-44

Hacettepe University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkey

Objective: Immunocompromised patients are at a greater risk of developing intestinal parasite infections. In this study, we examined the presence of and other intestinal protozoa in stool samples of immunosuppressed patients.

Methods: A total of 100 stool samples were obtained from patients receiving chemotherapy because of solid organ tumour with haematological malignancies and those receiving immunosuppressive treatment because of rheumatic diseases, organ transplant patients and patients receiving treatment for HIV-related infections. Stool samples were examined by using the native-lugol method in which the stool concentration, modified Kinyoun acid-fast and trichrome staining methods and parasite presence were analysed. The stool samples were also examined for the presence of and using an indirect fluorescent antibody method.

Results: Intestinal parasites were detected in 12% of all patients. The distribution of intestinal parasites in patients were 7% spp., 2% spp. + , 1% spp. + , 1% spp. + and 1% spp. were detected in 4% of all patients by the IFAT method and in 8% of all patients by calcoflour staining method.

Conclusion: In our study, the most prevalent parasite detected in the immunosuppressed patients was spp. The pathogenesis of spp. remains to be controversial, and their role in immunocompromised patients continues to remain unknown. Although these rates detected in our study are similar to the prevalence in the normal population, it is important to study these microorganisms in immunocompromised patients in terms of the associated decreasing morbidity and mortality rates.
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http://dx.doi.org/10.4274/tpd.galenos.2020.6819DOI Listing
March 2021

A case report of tigecycline induced acute pancreatitis in a renal transplant patient and review of the literature: Should we avoid tigecycline in patients on calcineurin inhibitors?

Transpl Infect Dis 2021 Mar 2:e13593. Epub 2021 Mar 2.

Division of Nephrology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Tigecycline has been approved by the US (United States) Food and Drug Administration in a variety of complicated infections due to its broad-spectrum antibiotic activity. Following phase III trials, the product label was revised and acute pancreatitis was listed as an adverse effect. Its safety profile in special groups such as renal transplant patients is not exactly known. We report the first case of unintentional rechallenge of tigecycline induced pancreatitis in a renal transplant patient. Ten days following the renal transplantation, a 35-year-old patient presented to the clinic with acute rejection. He received anti-thymocyte globulin (ATG) and pulse steroid treatments for rejection. Following the treatment, he developed perianal cellulitis and tigecycline was started. Nine days following initiation of tigecycline he received thrombectomy for his incidental cardiac thrombus. One day after thrombectomy, he developed acute pancreatitis (AP). Thrombectomy was suspected to be the cause of AP. During hospitalization for transplant rejection, tigecycline was re-started for a newly developed complicated abdominal infection. On the third day of the tigecycline re-treatment, he developed a second episode of AP. Following tigecycline withdrawal, his symptoms resolved and serum pancreatic enzymes returned to normal, thus AP was ultimately attributed to tigecycline. This lethal side effect should be kept in mind while treating severe infections in renal transplant recipients.
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http://dx.doi.org/10.1111/tid.13593DOI Listing
March 2021

Clinical implications of fungal isolation from sputum in adult patients with cystic fibrosis.

Turk J Med Sci 2021 Jan 12. Epub 2021 Jan 12.

Background/aim: Cystic fibrosis is an autosomal recessive disease with a defect in mucociliary activity that is characterized by recurrent pulmonary infections. Bacterial agents most frequently implicated in airway colonization and infection are Haemophilus influenzae, Staphylococcus spp. and Pseudomonas spp. Fungal isolation from sputum species is more common in adults. However, growth of fungal agent only in sputum culture in patients with cystic fibrosis is insufficient for the diagnosis of fungal diseases. There is limited and contraversial data about the clinical significance of fungal isolation in sputum cultures. The aim of the present study was to investigate the clinical outcomes including characteristics, lung function, therapy modalities and frequency of exacerbations and clinical significance of fungal isolation from sputum samples in adult patients with CF.

Materials And Methods: This retrospective cohort study included patients who have been admitted between October 2017 and January 2019 in an Adult Cystic Fibrosis Unit. Patients were grouped according to fungal pathogenicity as; fungal disease group, colonization group, and non-isolated group. The data of the last one year, including patients demographics, clinical data, laboratory results, treatment modalities, results of cultured bacteria and fungus from sputum samples, respiratory function parameters, frequency of exacerbation and hospitalization were compared between groups.

Results: A total of 330 sputum samples from 88 adult patients with CF were collected during the preceeding one year. Patients were divided into three groups, fungal disease group (n = 10, 11.4%), colonization group (n = 49, 55.7%), and non-isolated group (n = 29, 32.9%). Presence of pulmonary exacerbation and number of admission to emergency department and the number of positive cultures for bacteria from sputum were significantly higher in the fungal disease group (p = 0.03, p = 0.01 and p ?0.001). Patients in the fungal disease group had higher rate of administered antibiotics by parenteral route than other groups (p = 0.001) whereas lung function parameters were similar. Use of nutritional supplementation and parenteral antibiotherapy in the preceeding one year were the factors associated with elevated risk of fungal isolation.

Conclusion: Frequent use of parenteral antibiotics and use of nutritional supplementation were found to be independent risk factors for fungal isolation from sputum in adult CF patients.
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http://dx.doi.org/10.3906/sag-2006-94DOI Listing
January 2021

Tsukamurella paurometabola peritonitis in a patient on automated peritoneal dialysis.

Enferm Infecc Microbiol Clin (Engl Ed) 2020 Dec 23. Epub 2020 Dec 23.

Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.

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http://dx.doi.org/10.1016/j.eimc.2020.10.010DOI Listing
December 2020

Pharmacist intervention to improve patients' knowledge and attitude towards hepatitis B infection.

Int J Clin Pract 2021 Apr 12;75(4):e13952. Epub 2021 Jan 12.

Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey.

Objective: Lack of knowledge/awareness of people living with hepatitis B (PLH) often leads to misinformation and stigmatisation. This study aimed to assess the contribution of the clinical pharmacist (CP)-led education on knowledge of PLH about their disease.

Methods: This prospective, cross-sectional study was carried out between 1 October 2017 and 1 April 2018, at infectious disease and gastroenterology outpatient clinics in a university hospital. All PLH were interviewed face-to-face by a CP and a questionnaire about hepatitis B virus (HBV) knowledge was applied both at the beginning of the study (first interview) and 3 months later (second interview). Correct information was provided verbally to the patients by the CP concerning their incorrect answers during the first interview. A 10% increase in the number of correct answers was targeted for the second interview.

Results: A total of 147 PLH with a mean age of 43.05 ± 13.25 years were included in the study (55.8% female). In the first interview, the mean (±standard deviation) number of correct answers was 35.53 ± 9.15 out of 51 questions. In the second interview, correct answers were 48.67 ± 2.74 with an increase of 25.8% (P < .001). In the first interview, the number of correct answers was higher for the following groups: 20-39 age group, people with monthly income of >1081 $ and university graduates. The number of correct answers to all questions but one was elevated (P < .001) in the second interview. Answers to the question "there is a carrier state in chronic hepatitis B (CHB)" did not change (P = .125).

Conclusion: Significant improvement was observed in the correct answer rate after CP's contribution, therefore as a team member, CP has an important role in improving patients' knowledge and attitude towards HBV infection.
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http://dx.doi.org/10.1111/ijcp.13952DOI Listing
April 2021

Thirty-day readmission rate of COVID-19 patients discharged from a tertiary care university hospital in Turkey: an observational, single-center study.

Int J Qual Health Care 2021 Feb;33(1)

Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey.

Background: The 30-day readmission rate is an important indicator of patient safety and hospital's quality performance. In this study, we aimed to find out the 30-day readmission rate of mild and moderate severity coronavirus disease of 2019 (COVID-19) patients discharged from a tertiary care university hospital and to demonstrate the possible factors associated with readmission.

Methods: This is an observational, single-center study. Epidemiological and clinical data of patients who were hospitalized with a diagnosis of COVID-19 were retrieved from a research database where patient information was recorded prospectively. Readmission data were sought from the hospital information management system and the National Health Information System to detect if the patients were readmitted to any hospital within 30 days of discharge. Adult patients (≥18 years old) hospitalized in COVID-19 wards with a diagnosis of mild or moderate COVID-19 between 20 March 2020 (when the first case was admitted to our hospital) and 26 April 2020 were included.

Results: From 26 March to 1 May, there were 154 mild or moderate severity (non-critical) COVID-19 patients discharged from COVID-19 wards, of which 11 (7.1%) were readmitted. The median time of readmission was 8.1 days (interquartile range [IQR] = 5.2). Two patients (18.1%) were categorized to have mild disease and the remaining 9 (81.9%) as moderate disease. Two patients who were over 65 years of age and had metastatic cancers and hypertension developed sepsis and died in the hospital during the readmission episode. Malignancy (18.7% vs. 2.1%, P = 0.04) and hypertension (45.5% vs. 14%, P = 0.02) were more common in those who were readmitted.

Conclusions: This is one of the first studies to report on 30-day readmission rate of COVID-19 in the literature. More comprehensive studies are needed to reveal the causes and predictors of COVID-19 readmissions.
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http://dx.doi.org/10.1093/intqhc/mzaa144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7665548PMC
February 2021

Should prolonged ceftriaxone infusions be preferred in septic patients?

Am J Emerg Med 2021 06 3;44:474-475. Epub 2020 Jul 3.

Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.

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http://dx.doi.org/10.1016/j.ajem.2020.06.077DOI Listing
June 2021

Persistent dermal lesions in a patient with previous history of visceral leishmaniasis.

Parasitol Int 2021 Feb 11;80:102197. Epub 2020 Sep 11.

Department of Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey.

Post-kala-azar dermal leishmaniasis (PKDL) is a complication of visceral leishmaniasis (VL) that most frequently occurs after an episode of VL caused by Leishmania donovani. In this case report, we present a 21-year-old male patient with persistent skin lesions and recurrent visceral leishmaniasis (VL) due to Leishmania infantum. The patient did not respond to multiple lines of anti-leishmanial treatment (including Liposomal amphotericin B and miltefosine) and later died from cerebral lesions presumed to be secondary to persistent VL.
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http://dx.doi.org/10.1016/j.parint.2020.102197DOI Listing
February 2021

Lung and kidney perfusion deficits diagnosed by dual-energy computed tomography in patients with COVID-19-related systemic microangiopathy.

Eur Radiol 2021 Feb 29;31(2):1090-1099. Epub 2020 Aug 29.

Faculty of Medicine, Department of Radiology, Hacettepe University, Sihhiye, Ankara, Turkey.

Objectives: There is increasing evidence that thrombotic events occur in patients with coronavirus disease (COVID-19). We evaluated lung and kidney perfusion abnormalities in patients with COVID-19 by dual-energy computed tomography (DECT) and investigated the role of perfusion abnormalities on disease severity as a sign of microvascular obstruction.

Methods: Thirty-one patients with COVID-19 who underwent pulmonary DECT angiography and were suspected of having pulmonary thromboembolism were included. Pulmonary and kidney images were reviewed. Patient characteristics and laboratory findings were compared between those with and without lung perfusion deficits (PDs).

Results: DECT images showed PDs in eight patients (25.8%), which were not overlapping with areas of ground-glass opacity or consolidation. Among these patients, two had pulmonary thromboembolism confirmed by CT angiography. Patients with PDs had a longer hospital stay (p = 0.14), higher intensive care unit admission rates (p = 0.02), and more severe disease (p = 0.01). In the PD group, serum ferritin, aspartate aminotransferase, fibrinogen, D-dimer, C-reactive protein, and troponin levels were significantly higher, whereas albumin level was lower (p < 0.05). D-dimer levels ≥ 0.485 μg/L predicted PD with 100% specificity and 87% sensitivity. Renal iodine maps showed heterogeneous enhancement consistent with perfusion abnormalities in 13 patients (50%) with lower sodium levels (p = 0.03).

Conclusions: We found that a large proportion of patients with mild-to-moderate COVID-19 had PDs in their lungs and kidneys, which may be suggestive of the presence of systemic microangiopathy with micro-thrombosis. These findings help in understanding the physiology of hypoxemia and may have implications in the management of patients with COVID-19, such as early indications of thromboprophylaxis or anticoagulants and optimizing oxygenation strategies.

Key Points: • Pulmonary perfusion abnormalities in COVID-19 patients, associated with disease severity, can be detected by pulmonary DECT. • A cutoff value of 0.485 μg/L for D-dimer plasma levels predicted lung perfusion deficits with 100% specificity and 87% sensitivity (AUROC, 0.957). • Perfusion abnormalities in the kidney are suggestive of a subclinical systemic microvascular obstruction in these patients.
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http://dx.doi.org/10.1007/s00330-020-07155-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455509PMC
February 2021

Outcome of noncritical COVID-19 patients with early hospitalization and early antiviral treatment outside the ICU

Turk J Med Sci 2021 04 30;51(2):411-420. Epub 2021 Apr 30.

Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey

Background/aim: Despite the fact that the COVID-19 pandemic has been going on for over 5 months, there is yet to be a standard management policy for all patients including those with mild-to-moderate cases. We evaluated the role of early hospitalization in combination with early antiviral therapy with COVID-19 patients in a tertiary care university hospital.

Materials And Methods: This was a prospective, observational, single-center study on probable/confirmed COVID-19 patients hospitalized in a tertiary care hospital on COVID-19 wards between March 20 and April 30, 2020. The demographic, laboratory, and clinical data were collected.

Results: We included 174 consecutive probable/confirmed COVID-19 adult patients hospitalized in the Internal Medicine wards of the University Adult Hospital between March 20 and April 30, 2020. The median age was 45.5 (19–92) years and 91 patients (52.3%) were male. One hundred and twenty (69%) were confirmed microbiologically, 41 (23.5%) were radiologically diagnosed, and 13 (7.5%) were clinically suspected (negative microbiological and radiological findings compatible with COVID-19); 35 (20.1%) had mild, 107 (61.5%) moderate disease, and 32 (18.4%) had severe pneumonia. Out of 171 cases, 130 (74.3%) showed pneumonia; 80 were typical, and 50 showed indeterminate infiltration for COVID-19. Patients were admitted within a median of 3 days (0-14 days) after symptoms appear. The median duration of hospitalization was 4 days (0-28 days). In this case series, 13.2% patients were treated with hydroxychloroquine alone, 64.9% with hydroxychloroquine plus azithromycin, and 18.4% with regimens including favipiravir. A total of 15 patients (8.5%) were transferred to the ICU. Four patients died (2.2%).

Conclusion: In our series, 174 patients were admitted to the hospital wards for COVID-19, 69% were confirmed with PCR and/or antibody test. At the time of admission, nearly one fifth of the patients had severe diseases. Of the patients, 95.4% received hydroxychloroquine alone or in combination. The overall case fatality rate was 2.2%.
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http://dx.doi.org/10.3906/sag-2006-173DOI Listing
April 2021

Prolonged viral shedding in a lymphoma patient with COVID-19 infection receiving convalescent plasma.

Transfus Apher Sci 2020 Oct 3;59(5):102871. Epub 2020 Jul 3.

Hacettepe University Faculty of Medicine, Department of Internal Medicine, Hematology Unit, Ankara, Turkey. Electronic address:

Acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first identified in Wuhan, China; and spread all over the world. Reverse-transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2 usually returns to negative in 20 days post-infection, but prolonged positivity has been reported up to 63 days. A case whose viral shedding lasted 60 days is reported from China. Herein we report a patient with a history of autologous stem cell transplantation (ASCT) for lymphoma whose RT-PCR test remained positive for SARS-CoV-2 for 74 days. The prolonged RT-PCR positivity, despite convalescent plasma infusion, may suggest that the given antibodies may be ineffective in terms of viral clearance. In patients with hematological malignancies or immunosuppression, such as ASCT, may lead to prolonged viral shedding, and strict isolation is warranted for long-term SARS-CoV-2 infection control.
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http://dx.doi.org/10.1016/j.transci.2020.102871DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333597PMC
October 2020

The effects of blood group types on the risk of COVID-19 infection and its clinical outcome

Turk J Med Sci 2020 06 23;50(4):679-683. Epub 2020 Jun 23.

Department of Internal Medicine, Section of Hematology,Faculty of Medicine, Hacettepe University, Ankara, Turkey

Background/aim: COVID-19 (Coronavirus disease of 2019) is an infectious disease outbreak later on declared as a pandemic, caused by the SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2). It spreads very rapidly and can result in severe acute respiratory failure. The clinical studies have shown that advanced age and chronic diseases increase the risk of infection. However, influence of the blood groups on COVID-19 infection and its outcome remains to be confirmed. The aim of this study is to investigate whether there exists a relationship between the blood groups of the patients and risk of SARS-CoV-2 infection and the clinical outcomes in COVID-19 patients

Material And Method: 186 patients with PCR confirmed diagnosis of COVID-19 were included in this study. Age, sex, blood groups, comorbidities, need for intubation and intensive care unit follow up and mortalities of the patients were analyzed retrospectively. 1881 healthy individuals, who presented to the Hacettepe University Blood Bank served as the controls.

Results: The most frequently detected blood group was blood group A (57%) amongst the COVID-19 patients. This was followed by blood group O (24.8%). The blood group types did not affect the clinical outcomes. The blood group A was statistically significantly more frequent among those infected with COVID-19 compared to controls (57% vs. 38%, P < 0.001; OR: 2.1). On the other hand, the frequency of blood group O was significantly lower in the COVID-19 patients, compared to the control group (24.8% vs. 37.2%, P: 0.001; OR: 1.8).

Conclusions: The results of the present study suggest that while the blood group A might have a role in increased susceptibility to the COVID-19 infection, the blood group O might be somewhat protective. However, once infected, blood group type does not seem to influence clinical outcome.
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http://dx.doi.org/10.3906/sag-2005-395DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7379446PMC
June 2020

Convalescent (immune) plasma treatment in a myelodysplastic COVID-19 patient with disseminated tuberculosis.

Transfus Apher Sci 2020 Oct 29;59(5):102821. Epub 2020 May 29.

Hacettepe University Faculty of Medicine, Department of Internal Medicine, Hematology Unit, Turkey.

During the ongoing COVID-19 pandemic due to the SARS-CoV-2 virus of which evidence-based medical paradigms cannot be easily applied; difficult clinical decisions shall be required particularly in the 'difficult-to-treat' cases of high risk group with associated comorbidities. Convalescent immune plasma therapy is a promising option as a sort of 'rescue' treatment in COVID-19 immune syndrome, where miraculous antiviral drugs are not available yet. In this report, we aim to convey our experience of multi-task treatment approach with convalescent immune plasma and anti-cytokine drug combination in a COVID-19 patient with extremely challenging comorbidities including active myeloid malignancy, disseminated tuberculosis and kidney failure.
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http://dx.doi.org/10.1016/j.transci.2020.102821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7258803PMC
October 2020

May drug-related cardiovascular toxicities persist after hospital discharge in COVID-19 patients?

Int J Antimicrob Agents 2020 Jun 30;55(6):106003. Epub 2020 Apr 30.

Hacettepe University Faculty of Pharmacy, Department of Clinical Pharmacy, Ankara, Turkey.

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http://dx.doi.org/10.1016/j.ijantimicag.2020.106003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191282PMC
June 2020

Invasive Aspergillosis Due to Aspergillus Section Usti: A Multicenter Retrospective Study.

Clin Infect Dis 2021 04;72(8):1379-1385

Department of Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Background: Aspergillus spp. of section Usti (A. ustus) represent a rare cause of invasive aspergillosis (IA). This multicenter study describes the epidemiology and outcome of A. ustus infections.

Methods: Patients with A. ustus isolated from any clinical specimen were retrospectively identified in 22 hospitals from 8 countries. When available, isolates were sent for species identification (BenA/CaM sequencing) and antifungal susceptibility testing. Additional cases were identified by review of the literature. Cases were classified as proven/probable IA or no infection, according to standard international criteria.

Results: Clinical report forms were obtained for 90 patients, of whom 27 had proven/probable IA. An additional 45 cases were identified from literature review for a total of 72 cases of proven/probable IA. Hematopoietic cell and solid-organ transplant recipients accounted for 47% and 33% cases, respectively. Only 8% patients were neutropenic at time of diagnosis. Ongoing antimold prophylaxis was present in 47% of cases. Pulmonary IA represented 67% of cases. Primary or secondary extrapulmonary sites of infection were observed in 46% of cases, with skin being affected in 28% of cases. Multiple antifungal drugs were used (consecutively or in combination) in 67% of cases. The 24-week mortality rate was 58%. A. calidoustus was the most frequent causal agent. Minimal inhibitory concentrations encompassing 90% isolates (MIC90) were 1, 8, >16, and 4 µg/mL for amphotericin B, voriconazole, posaconazole, and isavuconazole, respectively.

Conclusions: Aspergillus ustus IA mainly occurred in nonneutropenic transplant patients and was frequently associated with extrapulmonary sites of infection. Mortality rate was high and optimal antifungal therapy remains to be defined.
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http://dx.doi.org/10.1093/cid/ciaa230DOI Listing
April 2021

Visceral Leishmaniasis in A Patient Presenting with Fever of Unknown Origin: A Case Report From a Low-endemic Region of Turkey

Turkiye Parazitol Derg 2019 Dec;43(4):210-212

Hacettepe Univesity Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey

Leishmaniasis is a neglected disease that is prevalent in tropical and subtropical regions of the world. Even though cutaneous leishmaniasis is the most common form, visceral leishmaniasis is associated with high mortality. The case presented herein is a 39 year-old bed-ridden female who presented with fever of unknown origin, tachypnea and pancytopenia. She was initially misdiagnosed as having autoimmune pancytopenia elsewhere and treated with corticosteroids and intravenous immunoglobulin. She had also received wide-spectrum antibiotics for febrile neutropenia. We performed a leishmania rK39 dipstick test which turned out to be positive along with visualisation of amastigote forms of leishmania on bone marrow biopsy. Thus, we made a diagnosis of visceral leishmaniasis and treated her with liposomal amphotericin B. Her clinical course was complicated by respiratory failure necessitating invasive mechanical ventilation. She responded well to treatment and was later extubated, shortly before being discharged. At 6 months of follow-up, no sign of recurrence was observed.
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http://dx.doi.org/10.4274/tpd.galenos.2019.6362DOI Listing
December 2019

[The Importance of Awareness for Malaria Regarding Prophylaxis and Early Diagnosis: Two Imported Malaria Cases in Turkey].

Mikrobiyol Bul 2019 Oct;53(4):472-479

Hacettepe University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkey.

In spite of the fact that Plasmodium vivax is the leading causative agent of malaria in our country, imported malaria cases have been reported, recently. In this report, two malaria cases originated from sub-Saharan Africa, and their diagnostic and therapeutic approaches were aimed to be presented. First case, 45-year-old male, who has been working in Republic of Ghana, was admitted to Hacettepe University Hospitals Emergency Service with complaints of fever, sweating and shivering, after returning to Turkey. On admission, his general condition was fine and his physical examination revealed no pathological finding. After his admission, a fever episode occured and his blood tests revealed anemia, trombocytopenia and increased alkaline phosphatase level. Second case, 39-year-old-male admitted to the emergency service with the complaints of fever, shivering and myalgia. His physical examination revealed decreased breath sounds and splenomegaly, his laboratory tests resulted in pansitopenia and elevated liver enzymes. In the thick blood smears of the patients ring formed young trophozoites are detected and in the thin films multiple ring forms demonstrated in one erythrocyte with the absence of mature trophozoites and schizont forms, which were compatible with falciparum malaria. The rapid antigen test (Digamed, Belgium) of the second case found to be positive for both Plasmodium falciparum and P.vivax and this patient followed-up in intensive care unit due to his deterioration of general condition, respiratory distress, hematuria and change of consciousness. Neither cases were commenced on malaria prophylaxis. Both patients have been in countries which chloroquine resistance is commonly seen, they were treated with artemether/lumefantrine as current World Health Organization recommended. Targeting hypnozoites of P.vivax, primaquine was added to the therapy of the second patient. Both patients resulted in cure. In conclusion, while travelling to endemic countries, people should be informed about the importance of malaria prophylaxis and prophylaxis should be commenced immediately and continued appropriately. Additionally, malaria should always be considered in the differential diagnosis of high fever for the patients who admitted to the hospital with a travelling history to these countries.
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http://dx.doi.org/10.5578/mb.68419DOI Listing
October 2019

Perinatal outcomes of twenty-five human immunodeficiency virus-infected pregnant women: Hacettepe University experience

J Turk Ger Gynecol Assoc 2020 09 30;21(3):180-186. Epub 2019 Sep 30.

Department of Obstetrics and Gynecology, Division of Perinatology, Hacettepe University Faculty of Medicine, Ankara, Turkey

Objective: To evaluate perinatal outcomes in human immunodeficiency virus (HIV) infected pregnant women in Turkey.

Material And Methods: Maternal characteristics, pregnancy complications, laboratory findings including HIV load, CD4 cell count, CD4/CD8 ratio, neonatal features and final HIV status of the baby were retrospectively analyzed.

Results: The sample included 26 singleton pregnancies, from 25 HIV-infected women. The ethnicities were Turkish (n=18), East European (n=4), Asian (n=2) and African (n=2). The majority (76.9%) was aware of their HIV status before becoming pregnant. Four cases (15.3%) were diagnosed during pregnancy and two (7.8%) at the onset of labor. The results for median HIV viral load, CD4 count, and CD4/CD8 ratio at birth were 20 copies/mL (0-34 587), 577/mm (115-977), and 0.7 (0.1-1.9), respectively. The HIV viral load rate was 5.5% in eighteen women taking anti-retroviral treatment. The rates of gestational diabetes mellitus, gestational hypertension, intrauterine growth restriction, and preterm delivery were 3.8%, 3.8%, 7.6%, and 8% (numbers are 1;1;2;2), respectively. The mean gestational week at birth was 38 weeks and mean birthweight is 2972±329 g. Two babies were congenitally infected with HIV (infection rate of 8.3%). There was one needle-related accident during surgery.

Conclusion: Timely diagnosis of HIV infection during pregnancy is important for preventing mother to child transmission. HIV infected women may give birth to HIV negative babies with the help of a multidisciplinary team, composed of perinatology, infectious diseases, and pediatrics specialists.
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http://dx.doi.org/10.4274/jtgga.galenos.2019.2019.0033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7495123PMC
September 2020

Determination of medication adherence and related factors among people living with HIV/AIDS in a Turkish university hospital

Turk J Med Sci 2019 Feb 11;49(1):198-205. Epub 2019 Feb 11.

Background/aim: Widespread use of antiretroviral treatment (ART) has led to decrease in the incidence of HIV/AIDS-related mortality. Besides the availability of ART, medication adherence is essential for treatment success. There is a scarcity of data reported from Turkey regarding ART adherence among people living with HIV/AIDS (PLWHA). Therefore, this study was undertaken to determine medication adherence and related factors among PLWHA in Turkey.

Materials And Methods: The sample consisted of 158 PLWHA, who were being followed up at Infectious Diseases Outpatient Clinic of Hacettepe University Hospital. Data were collected using an individual questionnaire and the Turkish version of the Morisky Medication Adherence Scale.

Results: The median patient age was 38 years, 80.4% were male, and 51.3% were married. The median duration of both HIV infection and ART was 3 years. Sixty-one percent used two drug regimens. Sixty-one percent were highly adherent to ART while 37.9% were moderately adherent. The absence/presence of social support resources, disease duration, ART duration, and being informed about the ART regimen were statistically associated with medication adherence.

Conclusion: Our results suggest that medication adherence is excellent among Turkish PLWHA. Interventions, including effective social support, and continuous counseling about ART, might further boost the adherence of PLWHA
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http://dx.doi.org/10.3906/sag-1802-137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350793PMC
February 2019

Polypharmacy and drug-related problems among people living with HIV/AIDS: a single-center experience

Turk J Med Sci 2019 Feb 11;49(1):222-229. Epub 2019 Feb 11.

Background/aim: The HIV-infected population is aging, and the concomitant comorbidities increase the likelihood of polypharmacy. There is a scarcity of data for determining drug-related problems in people living with HIV/AIDS (PLWHA).

Materials And Methods: This cross-sectional study was carried out between 1 September 2015 and 1 July 2016. All patients underwent a face-to-face interview with a clinical pharmacist. PCNE Classification V 7.0 was used classify incident drug-related problems (DRPs).

Results: The mean age of the patients was 40.4 ± 13.06 years. The rate of polypharmacy was 66.1% in patients with comorbidities and 12.3% in those without comorbidities (P < 0.001). DRPs were more prominent in older patients (46 vs. 37 years, P < 0.001), those with longer durations of antiretroviral therapy (ART) (45 vs. 27 months, P = 0.014), and those with lower education levels (P = 0.013). Receiving >3 ART drugs was associated with more DRPs in the logistic regression model (odds ratio: 8.299, 95% confidence interval: 1.924–35.803). Fifty-eight interventions were performed in 45 (24.9%) patients. Clinical pharmacist interventions were performed in 18.9% of patients without polypharmacy and in 38.9% of patients with polypharmacy (P < 0.001).

Conclusion: DRPs and polypharmacy are common among elderly PLWHA. More interventions are warranted to boost the quality of life in aging PLWHA.
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http://dx.doi.org/10.3906/sag-1807-295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350848PMC
February 2019

The investigation of Strongyloides stercoralis seroprevalence in immunosupressed patients in Turkey

Turk J Med Sci 2019 Feb 11;49(1):16-19. Epub 2019 Feb 11.

Background/aim: In immunosuppressed patients, strongyloidiasis can be lifethreatening because of hyperinfection or dissemination. Therefore, diagnosis of S. stercoralis is important in immunosuppressed patients with chronic strongyloidiasis. In this study, our objective was to investigate the presence of S. stercoralis antibodies by an ELISA method in immunosuppressed patients.

Materials And Methods: A total of 100 immunosuppressed patients’ sera were included in the study. Forty-two of the patients were receiving immunosuppressive therapies for cancer or being treated for hematopoietic malignancies, 38 of the patients were receiving immunosuppressive drugs for rheumatic diseases, 14 were receiving immunosuppressive therapies for liver transplantation. Two of the patients were being treated for HIV infection and 4 were being treated for hypogammaglobulinemia. As control group, 50 individuals without a known disease were included in the study. The presence of IgG antibodies against S. stercoralis was investigated with a commercial ELISA kit.

Results: S. stercoralis antibody test was positive in 4 of 100 (4%) sera from immunosuppressed patients. All control patients were negative for S. stercoralis.

Conclusions: Strongyloidiasis can be a lifelong chronic infection if not treated. In patients who are going to receive immunosuppressive therapy, it should be tested before treatment, as it can become a disseminated and life-threatening infectious disease.
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http://dx.doi.org/10.3906/sag-1804-16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350872PMC
February 2019

[Comparison of immunochromatographic (IC) and real-time polymerase chain reaction (Rt-PCR) tests for screening Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma spp. and Mycoplasma spp. in HIV-infected men].

Mikrobiyol Bul 2019 Jan;53(1):37-42

Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.

Laboratory testing is critical for sexually transmitted infections (STIs) as most of the infected people usually have no symptoms. It is known that having HIV and STI coinfection increases the risk of HIV transmission. Sensitive tests are required for the infection control. The aim of this study was to compare the 2 different diagnostic tests-an immunochromatographic (IC) test and a real-time polymerase chain reaction (Rt-PCR) assay-for screening Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma spp. and Mycoplasma spp. in HIV-infected men. The tests were evaluated in terms of sensitivity, specificity, rapidity, sample types and cost per test. Eighty HIV-infected adult men who were admitted to Hacettepe University Faculty of Medicine Hospital STIs Outpatient Clinic between October 2017-April 2018 were included in the study. Urine and urethral swab samples were collected from each patient. Urine samples were tested by BDMAX (Becton-Dickinson, Canada) assay, Chlamydia antigen cassette test (Monlab, Spain) and Mycoview test (Zeakon, France). Urethral swabs were tested by Gonorrhoeae cassette test (Monlab, Spain). In 18 (22.5%) of the 80 HIV-infected individuals, the presence of at least one of the four agents was detected by Rt-PCR method. A total of 23 agents were reported as one N.gonorrhoeae (1/80), two C.trachomatis (2/80), seven Mycoplasma spp. (7/80), 13 Ureaplasma spp. (13/80). In five (27.7%) patients, Ureaplasma spp. and Mycoplasma spp. were detected simultaneously. Twelve of 23 bacteria detected by Rt-PCR were also detected by IC tests; however, the remaining 11 bacteria (one N.gonorrhoeae, two C.trachomatis, four Ureaplasma spp., four Mycoplasma spp.) were not detected. When IC tests were compared to the gold standard test Rt-PCR, the sensitivity was 47.8% (11/23) and the positive-predictive value was 100% (11/11). Sixteen patients had STI-related signs and symptoms whereas 64 were asymptomatic. Only two of the 18 men with positive-Rt-PCR test results had STI-related symptoms. It was concluded that all individuals with risky behaviours should undergo STIs screening regardless of their symptoms. As obtaining urethral samples could create difficulty for the patients as well as for the physicians, using urine samples determined to be more convenient. In our study the sensitivity of IC tests found to be insufficiently low. It was concluded that in STI screening the use of Rt-PCR method, which has high sensitivity, specificity and ability to give results on the same day although a high cost test could be preferred on high risk groups such as HIV-infected individuals with no signs of infection.
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http://dx.doi.org/10.5578/mb.67694DOI Listing
January 2019

Predictors of unfavorable outcome in neurosyphilis: Multicenter ID-IRI Study.

Eur J Clin Microbiol Infect Dis 2019 Jan 27;38(1):125-134. Epub 2018 Oct 27.

Department of Medicine, Infectious Diseases Division, King Saud University Hospital, Riyadh, Saudi Arabia.

Neurosyphilis (NS) has different clinical manifestations and can appear during any stage of syphilis. We aimed to identify the factors affecting poor outcome in NS patients. Patients with positive cerebrospinal fluid Venereal Disease Research Laboratory test, and positive serological serum treponemal or nontreponemal tests were classified as definite NS. The data of 141 patients with definite NS were submitted from 22 referral centers. Asymptomatic NS, syphilitic meningitis, meningovascular syphilis, tabes dorsalis, general paresis, and taboparesis were detected in 22 (15.6%), 67 (47.5%), 13 (9.2%), 10 (7%), 13 (9.2%), and 16 patients (11.3%), respectively. The number of HIV-positive patients was 43 (30.4%). The most common symptoms were headache (n = 55, 39%), fatigue (n = 52, 36.8%), and altered consciousness (50, 35.4%). Tabetic symptoms were detected in 28 (19.8%), paretic symptoms in 32 (22.6%), and vascular symptoms in 39 patients (27.6%). Eye involvement was detected in 19 of 80 patients (23.7%) who underwent eye examination and ear involvement was detected in eight of 25 patients (32%) who underwent ear examination. Crystallized penicillin was used in 109 (77.3%), procaine penicillin in seven (4.9%), ceftriaxone in 31 (21.9%), and doxycycline in five patients (3.5%). According to multivariate regression analysis, while headache was a protective factor in NS patients, double vision was significantly associated to poor outcome. We concluded that double vision indicated unfavorable outcome among NS patients. A high clinical suspicion is needed for the diagnosis NS. As determined in our study, the presence of headache in syphilitic patients can help in early diagnosis of central nervous system disease.
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http://dx.doi.org/10.1007/s10096-018-3403-7DOI Listing
January 2019