Publications by authors named "Ali Mert"

140 Publications

Clinical and microbiological characteristics of Aeromonas bacteremia in Turkey.

Acta Microbiol Immunol Hung 2021 Jun 16. Epub 2021 Jun 16.

5Department of Infectious Disease, Medical School of Cerrahpasa, Istanbul University, İstanbul, Turkey.

We investigated the cases with Aeromonas bacteremia in terms of clinical and microbiological characteristics, underlying disease and mortality rates. Patients with positive blood cultures were included in this research. Aeromonas bacteremia was diagnosed as at least one positive blood culture for Aeromonas species. The bacteremia was defined as community origin if the onset was in the community or within 72 hours of hospital admission. The others were considered as nosocomial. All bacteria were defined as Aeromonas with conventional method. Species identification was verified by VITEK system. Antibiotic susceptibility tests were analyzed with the disc diffusion, E-test method or VITEK system. Thirty-three patients were diagnosed with bacteremia due to Aeromonas spp. Hematologic and solid tumors were the leading underlying conditions, followed by cirrhosis. Two patients (6%) had community-acquired infections. Aeromonas hydrophila was the most common isolated bacterium. The crude mortality rate was 36%. 12 patients died and 6 deaths and 4 deaths were detected in patients with bacteremia caused by A. hydrophila and Aeromonas sobria respectively. All strains were resistant to ampicillin and more than 90% of the strains were susceptible to trimethoprim-sulfamethoxazole, fluoroquinolone, third generation cephalosporins, and carbapenems. Aeromonas sp. is not a frequent cause of bacteremia however, it may lead to high mortality rates, especially in the immunocompromised hosts and patients with liver cirrhosis. Nosocomial Aeromonas bacteremia is not uncommon in these populations. Broad-spectrum cephalosporins, piperacillin-tazobactam, fluoroquinolones, and carbapenems remain as effective antimicrobial agents for therapy of Aeromonas bacteremia.
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http://dx.doi.org/10.1556/030.2021.01449DOI Listing
June 2021

Real-world efficacy and safety of Ledipasvir + Sofosbuvir and Ombitasvir/Paritaprevir/Ritonavir ± Dasabuvir combination therapies for chronic hepatitis C: A Turkish experience.

Turk J Gastroenterol 2020 12;31(12):883-893

Division of Gastroenterology, Kanuni Sultan Suleyman Training and Research Hospital, İstanbul, Turkey.

Background/aims: This study aimed to evaluate the real-life efficacy and tolerability of direct-acting antiviral treatments for patients with chronic hepatitis C (CHC) with/without cirrhosis in the Turkish population.

Material And Methods: A total of 4,352 patients with CHC from 36 different institutions in Turkey were enrolled. They received ledipasvir (LDV) and sofosbuvir (SOF)±ribavirin (RBV) orombitasvir/paritaprevir/ritonavir±dasabuvir (PrOD)±RBV for 12 or 24 weeks. Sustained virologic response (SVR) rates, factors affecting SVR, safety profile, and hepatocellular cancer (HCC) occurrence were analyzed.

Results: SVR12 was achieved in 92.8% of the patients (4,040/4,352) according to intention-to-treat and in 98.3% of the patients (4,040/4,108) according to per-protocol analysis. The SVR12 rates were similar between the treatment regimens (97.2%-100%) and genotypes (95.6%-100%). Patients achieving SVR showed a significant decrease in the mean serum alanine transaminase (ALT) levels (50.90±54.60 U/L to 17.00±14.50 U/L) and model for end-stage liver disease (MELD) scores (7.51±4.54 to 7.32±3.40) (p<0.05). Of the patients, 2 were diagnosed with HCC during the treatment and 14 were diagnosed with HCC 37.0±16.0 weeks post-treatment. Higher initial MELD score (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.22-2.38; p=0.023]), higher hepatitis C virus (HCV) RNA levels (OR: 1.44, 95% CI: 1.31-2.28; p=0.038), and higher serum ALT levels (OR: 1.38, 95% CI: 1.21-1.83; p=0.042) were associated with poor SVR12. The most common adverse events were fatigue (12.6%), pruritis (7.3%), increased serum ALT (4.7%) and bilirubin (3.8%) levels, and anemia (3.1%).

Conclusion: LDV/SOF or PrOD±RBV were effective and tolerable treatments for patients with CHC and with or without advanced liver disease before and after liver transplantation. Although HCV eradication improves the liver function, there is a risk of developing HCC.
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http://dx.doi.org/10.5152/tjg.2020.20696DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7928249PMC
December 2020

Olfactory and Gustatory Dysfunctions in COVID-19 Patients: From a Different Perspective.

J Craniofac Surg 2021 Jan 7;Publish Ahead of Print. Epub 2021 Jan 7.

Department of Neurology Department of ENT Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey.

Purpose: The prevalence of sensory disorders (smell and/or taste) in affected patients has shown a high variability of 5% to 98% during the COVID-19 outbreak, depending on the methodology, country, and study. Loss of smell and taste occurring in COVID-19 cases are now recognized by the international scientific community as being among the main symptoms of the disease. This study investigates loss of smell and taste in outpatients and hospitalized patients with laboratory-confirmed COVID-19 infection.

Methods: Enrolled in the study were patients with a positive PCR test for COVID-19. Excluded were patients with chronic rhinosinusitis, nasal polyposis, common cold, influenza, and olfactory/gustatory dysfunction predating the pandemic. Patients were asked about changes in their sense of smell and taste by structured questionnaire. Their status was classified according to severity of the symptoms.

Results: A total of 217 patients were included in the study, of whom 129 received outpatient treatment, whereas 88 were hospitalized; mean age was 41.74 years (range18-76), 59.4% were male. At evaluation for olfactory dysfunction, 53.9% of the patients were found to be normal, whereas 33.2% were anosmic. No gustatory dysfunction was found in 49.8% of patients, whereas in those with loss of taste, the most commonly recorded symptom was ageusia. Anosmia was significantly more common in outpatients (P = 0.038). Presentation of chemosensorial symptoms in women was higher than in men (P = 0.009). No correlation was found between olfactory and gustatory dysfunction and age (P = 0.178).

Conclusions: About one-half of our patients presented olfactory and/or gustatory deficits, and loss of smell was more common in mild cases. It should be considered; a sudden, severe, and isolated loss of smell and/or taste may also be present in COVID-19 patients who are otherwise asymptomatic. We suggest that identification of persons with these signs and early isolation could prevent spread of the disease in the community.
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http://dx.doi.org/10.1097/SCS.0000000000007412DOI Listing
January 2021

A single center cohort of 40 severe COVID-19 patients who were treated with convalescent plasma

Turk J Med Sci 2020 12 17;50(8):1781-1785. Epub 2020 Dec 17.

Department of Hematology, School of Medicine, İstanbul Medipol University, İstanbul, Turkey

Background/aim: A SARS-Cov2 infection which was first arised from Wuhan in December 2019 and named as COVID-19. Still there lacks either a specific treatment or a vaccine to treat COVID-19. Convalescent plasma (CP) was previously used successfully to treat SARS-CoV-1 and MERS infections. Health authority in Turkey has published a guideline to integrate this promising option in the treatment process of patients who are prone to high risk of developing severe COVID 19.

Materials And Methods: Forty consecutive patients who had received CP at our center were included in the study. Demographics, COVID-19 specific parameters, biomarkers to detect the severity of COVID-19 infection and outcome variables were collected retrospectively. The correlation between outcome variables and the independent predictors of the outcome were reported.

Results: Median age of the patients was 57.5 and 72.5% were male. At least one COVID-19 PCR test was confirmed to be positive in 75% of patients. Remaining 25% had a Chest-CT which was reported to be compatible with an ongoing COVID-19. All patients (100%) were classified as having severe COVID-19 infection. Over a half of the patients harbored an oxygen saturation of less than 90 despite of a continuous 5 L/min support of O2. 82.5% of the patients had a need for mechanical ventilation and 45.5% had a need for invasive mechanical ventilation. Nine out of 10 patients who have received CP outside ICU have totally recovered from COVID-19 at a median of 9 days, and a half of the patients who needed invasive mechanical ventilation were successfully free of mechanical ventilation support and managed to recover from COVID-19.

Conclusion: According to the results of this study, CP is an efficient conjunct to conventional therapy against COVID-19 with a favorable safety profile.
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http://dx.doi.org/10.3906/sag-2009-77DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7775681PMC
December 2020

Infections in urology: slow progress reflected in clinical practice.

World J Urol 2020 Nov;38(11):2667-2668

Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, Istanbul, Turkey.

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http://dx.doi.org/10.1007/s00345-020-03473-9DOI Listing
November 2020

Turkish inappropriate medication use in the elderly (TIME) criteria to improve prescribing in older adults: TIME-to-STOP/TIME-to-START.

Eur Geriatr Med 2020 06 5;11(3):491-498. Epub 2020 Mar 5.

Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey.

Purpose: To improve prescribing in older adults, criterion sets have been introduced from different countries. While current criterion sets are useful to some extent, they do not meet the need in some European countries. Turkish inappropriate medication use in the elderly (TIME) criteria was planned to meet this need.

Methods: In phase 1, the user friendly sets: STOPP/START version2 and CRIME criteria were combined. National experts composed of geriatricians and non-geriatricians were invited to review and comment. In phase 2, thorough literature review was performed and reference-based revisions, omissions, and additions were made. Explanatory additions were added to some criteria to improve application in practice. In phase 3, all working group members reviewed the criteria/explanations and agreed on the final content.

Results: Phase 1 was performed by 49 expert academicians between May and October 2016. Phase 2 was performed by 23 working group academicians between October 2016 and November 2018 and included face-to-face interviews between at least two geriatrician members and one criterion-related specialist. Phase 3 was completed between November 2018-March 2019 with review and approval of all criteria by working group academicians. As a result, 55 criteria were added, 17 criteria were removed, and 60 criteria were modified from the first draft. A total of 153 TIME criteria composed of 112 TIME-to-STOP and 41 TIME-to-START criteria were introduced.

Conclusion: TIME criteria is an update screening tool that differs from the current useful tools by the interactive study of experts from geriatrics and non-geriatrics, inclusion of practical explanations for some criteria and by its eastern European origin. TIME study respectfully acknowledges its roots from STOPP/START and CRIME criteria. Studies are needed whether it would lead improvements in older adults' health.
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http://dx.doi.org/10.1007/s41999-020-00297-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280176PMC
June 2020

Urinary tuberculosis: still a challenge.

World J Urol 2020 Nov 21;38(11):2693-2698. Epub 2020 Mar 21.

Department of Urology, Istanbul Medipol University, Istanbul, Turkey.

Background: Urinary tuberculosis (TB) is a challenging disease to cope with, as there has been no noticeable difference in basic diagnostic and therapeutic options in clinical practice over time.

Purpose: The aim of the current review was the critical assessment and evaluation of TB, which remains a major global health problem.

Methods: The available literature regarding TB in the PubMed database was extensively searched.

Results: New interdisciplinary team approaches such as next-generation sequencing are promising for the diagnosis and treatment of the disease. The epidemiology of the disease is changing with globalization and increasing migration events; however, the knowledge here is limited. Despite ongoing destruction, kidney functions need to be preserved as much as possible, and relatively rapid development of minimally invasive techniques relieved the surgeons in this regard. Experience is increasing in minimally invasive techniques that provide better comfort for patients compared to extensive radical surgeries.

Conclusions: Knowing the pathogenesis of urinary TB is essential for understanding the range of clinical manifestations. The onset of the disease is usually insidious. Despite modern TB drugs, reconstructive surgery, and minimally invasive procedures, progression cannot be prevented in some patients, and patient selection is essential, but we still do not have sufficient information and objective parameters to predict progression.
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http://dx.doi.org/10.1007/s00345-020-03146-7DOI Listing
November 2020

Urological infections in the developing world: an increasing problem in developed countries.

World J Urol 2020 Nov 27;38(11):2681-2691. Epub 2020 Feb 27.

Department of Urology, All India Institute of Medical Sciences, New Delhi, India.

Purpose: Infectious diseases that often follow geographical distribution patterns are increasingly crossing such boundaries, aided by human travel and commerce. These pose a new challenge to physicians who are required to diagnose previously unseen conditions and address drug-resistant organisms. We review some such common infections.

Methods: A literature review was performed for six common urological infections and a narrative review based on recent publications on these infections was compiled.

Results: In Urology, some infections that are now crossing geographical boundaries include Brucellosis, Schistosomiasis, Tuberculosis, Filariasis, Hydatidosis and emphysematous pyelonephritis. Brucellosis, a zoonotic infection, is common in the Mediterranean areas, Asia, South America and Africa. Infection can involve all parts of the genitourinary tract. Schistosomiasis, a parasitic disease, is particularly common in Sub-Saharan Africa and may have bacterial superinfection. Voiding symptoms are common and bladder carcinoma may develop. Tuberculosis affects almost every organ in the body and in the male genital system, often presents with abscesses, nodules, ulcers and infertility that is difficult to manage. Filariasis is caused by two species of worms and is transmitted through a bite from a mosquito carrying larvae of the worm. It causes lymphatic obstruction leading to scrotal edema, hydrocoele to elephantiasis of scrotum. Emphysematous pyelonephritis is a life-threatening suppurative necrotizing infection of the renal parenchyma. While not being geographically limited, it is more common in developing areas with poor health care access. Genitourinary hydatidosis is a rare disease that is associated mainly with renal involvement in the genitourinary tract. Large cysts with destruction of renal parenchyma may be found.

Conclusions: Although uncommon, these urological infections are associated with significant morbidity and mortality and awareness in all healthcare settings is now an essential requirement.
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http://dx.doi.org/10.1007/s00345-020-03120-3DOI Listing
November 2020

Candida urinary tract infections in adults.

World J Urol 2020 Nov 25;38(11):2699-2707. Epub 2019 Oct 25.

Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, Istanbul, Turkey.

Candiduria is commonly seen in hospitalized patients and most of the patients are asymptomatic, but it may be due to cystitis, pyelonephritis, prostatitis, epididymo-orchitis or disseminated candidiasis. Major risk factors are diabetes mellitus, indwelling urinary catheters, use of broad-spectrum antibiotics, urinary obstruction, and admission to intensive care units. Candida urinary tract infections can be caused by hematogenous spread following candidemia, or retrograde route via the urethra. The presence of Candida species in urine in asymptomatic patients does not warrant antifungal therapy except neutropenic patients, very low-birth-weight infants and patients undergoing urologic procedures. Fluconazole is the treatment of choice for symptomatic infections, it achieves high urinary levels. The other azole antifungals and echinocandins do not reach sufficient urine levels. Amphotericin B deoxycholate is the alternative antifungal agent if fluconazole can not be used because of resistance, allergy or failure.
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http://dx.doi.org/10.1007/s00345-019-02991-5DOI Listing
November 2020

Primary gastrointestinal aspergillosis: a case report and literature review.

Infez Med 2019 Mar;27(1):85-92

Medipol University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.

Invasive aspergillosis is a severe infection that generally involves the lungs. Primary gastrointestinal aspergillosis is the least common form of invasive aspergillosis. A patient aged 65 years developed a febrile neutropenic episode following an autologous stem cell transplant for plasmacytoid variant diffuse large B-cell gastric non-Hodgkin's lymphoma. He had abdominal pain on the second day of the febrile neutropenic episode and ileus occurred on the sixth day. His general condition deteriorated despite broad spectrum antibiotics and caspofungin treatment, and intestinal perforation occurred on the nineteenth day of the febrile neutropenic episode. Pathological examination of the resected jejunum and ileum revealed mould hyphae compatible with aspergillus. The patient died due to massive gastrointestinal bleeding on the fifth post-operative day. Although a rare condition, primary gastrointestinal aspergillosis should be kept in mind while treating neutropenic patients with gastrointestinal symptoms.
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March 2019

Clinical Presentation and Cranial MRI Findings of Listeria monocytogenes Encephalitis: A Literature Review of Case Series.

Neurologist 2018 Nov;23(6):198-203

Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Kadikoy.

Background: Listeria monocytogenes-associated encephalitis is a severe clinical condition that can also be seen in immunocompetent patients. Clinical manifestation and radiologic features of this entity need to be elaborated.

Review Summary: We searched the medical literature during the period spanning from 1991 to 2017 using the keyword "listeria AND [abscess odds ratio (OR) brainstem OR encephalit* OR magnetic* OR imaging*]." We included in the review well-documented adult cases with a definitive diagnosis and having magnetic resonance imaging data. Confusion, hemiparesis, cerebellar ataxia, facial paralysis, and gait disturbance were the most frequent findings, detected in >30% of patients during admission. The high rate of facial paralysis was of particular interest. T2 hyperintensity (80/82), contrast enhancement (60/82), and ring-enhancing lesions, which are considered as brain abscess, were found in 46/82 patients. The mortality and neurological sequel rates were 20% and 68%, respectively.

Conclusions: Listeria encephalitis is a severe disease and should be remembered in cases admitted with symptoms related to the brainstem and cranial nerve dysfunction. Cranial magnetic resonance imaging with brainstem and cerebellum involvements and contrast enhancement with or without abscess are particularly suggestive of the listeria-related infection.
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http://dx.doi.org/10.1097/NRL.0000000000000212DOI Listing
November 2018

Hemophagocytic Lymphohistiocytosis in Adults: Low Incidence of Primary Neoplasm as a Trigger in a Case Series from Turkey.

Mediterr J Hematol Infect Dis 2018 1;10(1):e2018047. Epub 2018 Sep 1.

Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey.

Hemophagocytic Lymphohistiocytosis (HLH) is an indicator of an exaggerated immune response and eventually adverse outcomes. This study aimed to investigate the clinical and laboratory features and outcomes of patients with HLH. The medical records of 26 HLH adult patients (≥ 16 years of age) were retrospectively analyzed. Gender, age, the duration of fever, time to diagnosis, etiology and laboratory data were extracted from the records. The mean age was 38 ± 18 years, and 15 (58%) patients were female. A total of nine cases had infectious diseases; four cases had rheumatologic diseases, three cases had hematological malignancies while nine cases could not have a definitive diagnosis. The median time to detection of HLH was 20 days (IQR: 8-30 d). Of the 25 patients, 11 (44%) died. The erythrocyte sedimentation rates of the surviving and non-surviving patients were 39 ± 22 mm/h and 15 ± 13 mm/h, respectively. When a long-lasting fever is complicated by bicytopenia or pancytopenia (especially), clinicians should promptly consider the possibility of HLH syndrome to improve patients' prognosis.
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http://dx.doi.org/10.4084/MJHID.2018.047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6131110PMC
September 2018

Risk factors for recurrences in patients with hepatitis C virus after achieving a sustained virological response: a multicentre study from Turkey.

Infez Med 2018 Jun;26(2):133-138

Department of Internal Medicine, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey.

In this study, we aimed to determine the late relapse rate in hepatitis C patients with sustained virological response after interferon-based regimens, and evaluated the predictors of late relapse while comparing the real-life data of our country with that of others. A multicenter retrospective study was performed to investigate the data of patients infected with HCV who obtained sustained virological response after classical or pegylated interferon alpha (PegIFNα) and ribavirin (RBV) for 48 weeks. Sustained virological response was based on negative HCV RNA level by PCR at the end of six months after the therapy. The information of patients enrolled in the study was retrieved from the hospital computer operating system and outpatient follow-up archives. We evaluated the age, gender, HCV RNA levels, HCV genotype, six-month and further follow-up of patients with sustained virologic response, presence of cirrhosis, steatosis and relapse. In all, 606 out of 629 chronic hepatitis C patients (mean age was 53±12 years; 57.6% of them were female) with sustained virological response were evaluated. We excluded 23 patients who relapsed within six months after the end of treatment (EOT). The mean follow-up period of the patients was 71 months (range: 6-136) after therapy. Late relapse rate was 1.8% (n=11) in all patients. Univariate Cox proportional hazard regression models identified that cirrhosis and steatosis were associated with the late relapse [(p = 0.027; Hazard Ratio (HR) 2.328; 95% confidence interval (CI): 1.309-80.418), (p = 0.021; HR 1.446; 95% CI: 1.243-14.510, respectively]. In multivariable Cox regression analysis, steatosis was the only independent risk factor for late relapse (p = 0.03; HR 3.953; 95% CI: 1.146-13.635). Although the late relapse rate was approximately 2% in our study, clinicians should consider that pretreatment steatosis may be an important risk factor for late relapse.
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June 2018

Human Herpesvirus 6 encephalitis in an immunocompetent pregnant patient and review of the literature.

Clin Neurol Neurosurg 2018 08 5;171:106-108. Epub 2018 Jun 5.

Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, Istanbul, Turkey.

Central nervous system infection caused by Human Herpesvirus 6 (HHV-6) is well known in immunocompromised; however, data regarding immunocompetent patients is limited to case series. We describe a 29-year-old immunocompetent pregnant woman with meningoencephalitis due to HHV-6 and review current literature. HHV-6 should be kept in mind in patients with meningoencephalitis of unknown etiology.
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http://dx.doi.org/10.1016/j.clineuro.2018.05.026DOI Listing
August 2018

Rifampicin-Induced Fever in a Patient with Brucellosis: A Case Report.

Drug Saf Case Rep 2018 Feb 9;5(1). Epub 2018 Feb 9.

Department of Infectious Diseases and Clinical Microbiology, Medipol Mega Hospital Complex, Istanbul Medipol University, TEM Avrupa Otoyolu Goztepe Cikisi No: 1, Bagcilar, 34214, Istanbul, Turkey.

We present a 35-year-old female patient who was started on rifampicin (900 mg orally once daily) and trimethoprim/sulfamethoxazole (TMP/SMX) (160/800 mg orally twice daily) after being diagnosed with brucellosis. Following defervescence and improvement in her general condition, fever recurred on the 12th day of treatment. A re-challenge drug test lead to causality assessment and treatment was switched to a combination of streptomycin (1 g intramuscularly) for 10 days and TMP/SMX (160/800 mg orally twice daily) for 4 weeks. Our patient is doing well after 12 months of follow-up.
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http://dx.doi.org/10.1007/s40800-018-0074-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5807255PMC
February 2018

Anatomical landmarks of mandibular interforaminal region related to dental implant placement with 3D CBCT: comparison between edentulous and dental mandibles.

Surg Radiol Anat 2018 Jun 9;40(6):615-623. Epub 2017 Nov 9.

Department of Oral and Maxillofacial Radiology, School of Dentistry, Ege University, Izmir, Turkey.

Background: Anterior mandibular (interforaminal) region is important in implant applications as it serves a basis for neurovascular bedding and holds the prosthesis for patients. Treatment planning for dental implant patients is often complicated by the unknown extent of the anterior loop of the neurovascular bundle. Anatomical structures including mandibular incisive canal (MIC) and lingual foramen (LF) should also be examined as part of the detailed analysis for their neurovascular structures. This study aimed to detect the positions of LF and MIC as well as the prolongation of interforaminal region in Anatolian population to supply the reference data of the surgical safe zone in chin for the clinicians.

Materials And Methods: Mandibles of 70 adult specimens (35 edentulous + 35 dentate) were retrieved from the Department of Anatomy, Ege University. Images of the dry mandibles were obtained using a cone beam computed tomography unit applying a standardized exposure protocol. Afterwards, mandibles were sawn into vertical sections according to the respective tomographic cross-sections. Images were evaluated for the absence/presence of the MIC, its dimensions and antero-posterior length for both edentulous and dentate groups. In addition; the presence, number, location, labial canal and LF diameter and height of the LF were determined for both groups.

Results: The MIC was observed in 80 and 68.6% of the dentate and edentulous groups, consecutively (p > 0.05). The MIC continued towards the incisor region in a slightly downward direction. The LF was observed in all dentate mandibles (100%), while it was present in 94.3% of the edentulous mandibles (p > 0.05). For the dentate group, 62.9% of the specimens had two foramens and 20% had three foramens in the mandibular midline. Mean length of the MIC in dentate groups and edentulous groups was measured as 2.55 ± 0.809 and 3.08 ± 1.745 mm, respectively. Well-defined MIC mean diameter in dentate groups and edentulous groups were measured as 2.44 ± 0.702 and 2.35 ± 0.652 mm, respectively. Significant difference was found between dentate and edentulous group in most of the parameters except for the LF and the diameter of the MIC (p > 0.05). The correlation between observers' measurements ranged between 0.742 and 0.993 for all anatomical landmarks and mandible groups.

Conclusion: The MIC and LF are associated with neurovascular bundle variations in number, location and size. Therefore, clinicians should determine each of these anatomical structures on a case-by-case basis to recognize their presence and to take measures for the possible implications of various treatment options. These guidelines included leaving a 2 mm safety zone between an implant and the coronal aspect of the neurovascular bundle. To avoid neurovascular injury during surgery in the interforaminal area, guidelines were developed with respect to validating the presence of an anterior loop of the neurovascular bundle.
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http://dx.doi.org/10.1007/s00276-017-1934-8DOI Listing
June 2018

Epstein-Barr virus-associated haemophagocytic lymphohistiocytosis presenting with acute sensorineural hearing loss: a case report and review of the literature.

Infez Med 2017 Sep;25(3):277-280

Department of Internal Medicine, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey.

Epstein-Barr virus-associated haemophagocytic lymphohistiocytosis (EBV-HLH) is a life-threatening catastrophic and rarely seen complication of EBV infection especially in adults. While typical presentation of EBV infection is easily diagnosed as mononucleosis syndrome in teenagers and adults, some atypical clinical presentations may be challenged. We did not encounter any patient presenting with sudden sensorineural hearing loss associated with EBV infection in our English medical literature research (1966-2016). In this study, we report an adult patient who was complicated with EBV-HLH under high dose steroid therapy after diagnosis as sensorineural hearing loss. Our aim is to emphasise the atypical presentation of EBV infection and to discuss steroid therapy complication in sensorineural hearing loss that had been simply defined as idiopathic.
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September 2017

[Erratum: An unnoticed origin of fever: Periapical tooth abscess - Three case reports and literature review].

Infez Med 2017 06;25(2):195

Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University Hospital, Istanbul, Turkey.

Erratum Following publication of the Original article An unnoticed origin of fever: Periapical tooth abscess - Three case reports and literature review (Infez. Med., volume 24, issue 1, pages 67-70, year 2016) We became aware that some authors were missing from the title page The correct list of the authors and affiliations is the following An unnoticed origin of fever: Periapical tooth abscess - Three case reports and literature review Ferhat Arslan1, Ergenekon Karagöz2, Mesut Yilmaz1, Ayse Batirel3, Birsen Yigit Arslan4, Nedim Ozer5, Nadir Alpay6, Ali Mert1 1Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University Hospital, Istanbul, Turkey 2Department of Infectious Diseases and Clinical Microbiology, Van Military Hospital, Van, Turkey 3Department of Infectious Diseases and Clinical Microbiology, Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey 4Department of Anesthesiology and Reanimation, Esenyurt State Hospital, Istanbul, Turkey 5Department of Dentistry, Istanbul Medipol University Hospital, Istanbul, Turkey 6Department of Internal Medicine, Istanbul Medipol University Hospital, Istanbul, Turkey.
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June 2017

Miliary tuberculosis: Epidemiologicaland clinical analysis of large-case series from moderate to low tuberculosis endemic Country.

Medicine (Baltimore) 2017 Feb;96(5):e5875

Department of Internal Medicine, Istanbul Medipol University Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Sureyyapasa Chest Disease and Thoracic Surgery Training and Research Hospital Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Department of Chest Disease Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul Department of Infectious Diseases and Clinical Microbiology, Cukurova University Medical Faculty, Adana Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University Department of Infectious Diseases and Clinical Microbiology, Ege University, Izmir, Turkey Department of Infectious Diseases and Clinical Microbiology, LutfiKirdar Training and Research Hospital, Istanbul, Turkey Department of Infectious Diseases and Clinical Microbiology, Atatürk University Faculty of Medicine, Erzurum, Turkey Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey Department of Clinical Microbiology and Infectious Diseases, Gazi University Hospital, Ankara, Turkey Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey Faculty of Medicine, Department of Public Health, Medipol University, Istanbul, Turkey Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, Istanbul, Turkey.

The aim of this study was to determine the clinical features, and outcome of the patients with miliary tuberculosis (TB).We retrospectively evaluated 263 patients (142 male, 121 female, mean age: 44 years, range: 16-89 years) with miliary TB. Criteria for the diagnosis of miliary TB were at least one of the followings in the presence of clinical presentation suggestive of miliary TB such as prolonged fever, night sweats, anorexia, weight loss: radiologic criterion and pathological criterion and/or microbiological criterion; pathological criterion and/or microbiological criterion.The miliary pattern was seen in 88% of the patients. Predisposing factors were found in 41% of the patients. Most frequent clinical features and laboratory findings were fever (100%), fatigue (91%), anorexia (85%), weight loss (66%), hepatomegaly (20%), splenomegaly (19%), choroid tubercules (8%), anemia (86%), pancytopenia (12%), and accelerated erythrocyte sedimentation rate (89%). Tuberculin skin test was positive in 29% of cases. Fifty percent of the patients met the criteria for fever of unknown origin. Acid-fast bacilli were demonstrated in 41% of patients (81/195), and cultures for Mycobacterium tuberculosis were positive in 51% (148/292) of tested specimens (predominantly sputum, CSF, and bronchial lavage). Blood cultures were positive in 20% (19/97). Granulomas in tissue samples of liver, lung, and bone marrow were present in 100% (21/21), 95% (18/19), and 82% (23/28), respectively. A total of 223 patients (85%) were given a quadruple anti-TB treatment. Forty-four (17%) patients died within 1 year after diagnosis established. Age, serum albumin, presence of military pattern, presence of mental changes, and hemoglobin concentration were found as independent predictors of mortality. Fever resolved within first 21 days in the majority (90%) of the cases.Miliary infiltrates on chest X-ray should raise the possibility of miliary TB especially in countries where TB is endemic. Although biopsy of the lungs and liver may have higher yield rate of organ involvement histopathologicaly, less invasive procedures including a bone marrow biopsy and blood cultures should be preferred owing to low complication rates.
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http://dx.doi.org/10.1097/MD.0000000000005875DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293426PMC
February 2017

Variables determining mortality in patients with Acinetobacter baumannii meningitis/ventriculitis treated with intrathecal colistin.

Clin Neurol Neurosurg 2017 Feb 14;153:43-49. Epub 2016 Dec 14.

Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medipol University, Turkey.

Aim: To examine the variables associated with mortality in patients with Acinetobacter baumannii-related central nervous system infections treated with intrathecal colistin.

Materials And Methods: This multi-centre retrospective case control study included patients from 11 centres in Turkey, as well as cases found during a literature review. Only patients with CNS infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii treated with intrathecal colistin were included in this study. The variables associated with mortality were determined by dividing the patients into groups who died or survived during hospitalisation, and who died or survived from Acinetobacter meningitis.

Results: Among the 77 cases enrolled in the study, 35 were found through a literature review and 42 were cases from our centres. Forty-four cases (57.1%) were male and the median age was 48 years (range: 20-78 years). Thirty-seven patients (48%) died during hospitalisation. The variables associated with increased all-cause mortality during hospitalisation included old age (odds ratio, 1.035; 95% confidence interval (CI), 1.004-1.067; p=0.026) and failure to provide cerebrospinal fluid sterilisation (odds ratio, 0.264; 95% confidence interval, 0.097-0.724; p=0.01). There is a trend (P=0.062) towards higher mortality with using of meropenem during meningitis treatment. Fifteen cases (19%) died from meningitis. There were no significant predictors of meningitis-related mortality.

Conclusions: The mortality rate for central nervous system infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii is high. Old age and failure to provide CSF sterilisation are associated with increased mortality during hospitalisation.
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http://dx.doi.org/10.1016/j.clineuro.2016.12.006DOI Listing
February 2017

Pneumonia in a Patient with Chronic Obstructive Pulmonary Disease.

Case Rep Infect Dis 2016 2;2016:4737321. Epub 2016 Nov 2.

Department of Family Medicine, Karabuk University, Karabuk, Turkey.

Pneumonia remains an important cause of morbidity and mortality among infectious diseases. and viruses are the most common cause of pneumonia. Candidiasis in such patients has been associated with haemodialysis, fungal colonization, exposure to broad-spectrum antibiotics, intensive care unit (ICU) hospitalization, and immunocompromised patients. The most common cause of infection is . The case presented here is of a 66-year-old male patient diagnosed with . The patient suffered from chronic obstructive pulmonary disease.
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http://dx.doi.org/10.1155/2016/4737321DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5110868PMC
November 2016

Digital ischemic necrosis with cryoglobulinemia associated with hepatitis B infection.

J Orthop 2016 Dec 20;13(4):448-449. Epub 2015 Oct 20.

Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University Hospital, Istanbul, Turkey.

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http://dx.doi.org/10.1016/j.jor.2015.09.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5103040PMC
December 2016

Allogeneic stem cell transplantation in a blast-phase chronic myeloid leukemia patient with carbapenem-resistant tricuspid valve endocarditis: A case report.

Mol Clin Oncol 2016 Oct 17;5(4):347-350. Epub 2016 Aug 17.

Division of Hematology, Department of Internal Medicine, Istanbul Medipol University, 34214 Istanbul, Turkey.

In chronic myeloid leukemia (CML), the occurrence of blastic transformation is rare. Treatment outcome is generally poor. Allogeneic stem cell transplantation (allo-SCT) is the only potentially curative treatment option for advanced-phase CML. Infections caused by carbapenem-resistant (CRKP) isolates are associated with high morbidity and mortality rates, particularly in patients with haematological malignancies. Infection and colonization by these multiresistant bacteria may represent a challenge in SCT recipients for the management of post-transplantation complications, as well as for the eligibility to receive a transplant in patients who acquire the pathogen prior to the procedure. We herein report the case of a blast-phase CML patient with a highly resistant, CRKP-associated tricuspid valve endocarditis, who was treated with a combination of systemic antimicrobial therapy and surgical valve repair, and subsequently underwent a successful allo-SCT.
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http://dx.doi.org/10.3892/mco.2016.995DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5038443PMC
October 2016

Survey on Retention Protocols Among Turkish Orthodontists.

Turk J Orthod 2016 Sep 1;29(3):51-58. Epub 2016 Sep 1.

Department of Orthodontics, Ege University School of Dentistry, İzmir, Turkey.

Objective: The purpose of this study was to identify general retention protocols practiced by Turkish orthodontist and to compare the results obtained with those of similar studies in Western countries.

Methods: The Web-based survey consisted of 29 questions: 3 to identify the demographic characteristics of the participants and 26 to examine how orthodontists manage the retention phase. Data was interpreted by descriptive statistical methods such as the median test, the Mann-Whitney U-test and logistic regression analysis.

Results: The survey return rate was 73.8%. Pretreatment malocclusion status (87%), oral hygiene status (78%), and presence of third molars (63%) were reported to be the most important factors in determining the type of retainer. Bonded retainers, either alone (29% in maxilla and 34% in mandible) or supplemented with vacuum-formed retainers (27% in maxilla and 32% in mandible) were the most commonly used type of retainer. The preference for lifelong retention varied from 7% to 19%. Female orthodontists scheduled the first appointment after debonding sooner than male orthodontists (p<0.05). Orthodontists working in universities scheduled first appointments later than orthodontists working in private practices (p<0.05).

Conclusion: Turkish orthodontists still give importance to the third molars in their retention protocols, contrary to what is suggested in the current literature, and lifetime retention is rarely preferred as compared to other countries.
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http://dx.doi.org/10.5152/TurkJOrthod.2016.06DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007623PMC
September 2016

Simultaneous Chronic Invasive Fungal Infection and Tracheal Fungus Ball Mimicking Cancer in an Immunocompetent Patient.

Case Rep Med 2016 23;2016:2416452. Epub 2016 Jun 23.

Pulmonary and Critical Care, University of Minnesota, Minneapolis, MN 55455, USA.

Fungal infections of the lung are uncommon and mainly affect people with immune deficiency. There are crucial problems in the diagnosis and treatment of this condition. Invasive pulmonary aspergillosis and candidiasis are the most common opportunistic fungal infections. Aspergillus species (spp.) are saprophytes molds that exist in nature as spores and rarely cause disease in immunocompetent individuals. In patients with immune deficiency or chronic lung disease, such as cavitary lung disease or bronchiectasis, Aspergillus may cause a variety of aspergillosis infections. Here we present a case of a 57-year-old patient without immunodeficiency or chronic lung disease who was diagnosed with endotracheal fungus ball and chronic fungal infection, possibly due to Aspergillus. Bronchoscopic examination showed a paralyzed right vocal cord and vegetating mass that was yellow in color, at the posterior wall of tracheal lumen. After 3 months, both the parenchymal and tracheal lesions were completely resolved.
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http://dx.doi.org/10.1155/2016/2416452DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4935908PMC
July 2016

Tick-related facial cellulitis caused by Francisella tularensis.

Infez Med 2016 Jun;24(2):140-3

Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University Hospital, Istanbul, Turkey.

Tick-borne illnesses have diverse biological and clinical features that make recognition and appropriate treatment challenging. Arthropod-transmitted (ticks, fleas and deer flies) tularaemia remains a concern worldwide. Generally, two kinds of tularaemia manifestations, namely ulceroglandular and glandular infections, can arise from the bite of an infected arthropod vector. If the ulceroglandular or glandular form is not treated, suppuration can arise from the gland. In addition, cellulitis is rarely observed around the ulcers. In our case, with the knowledge of tick exposure to the scalp, tularaemia was not initially considered for facial cellulitis without regional lymphadenopathy and also due to apparent failure to respond to doxycycline and gentamicin therapy. Serological confirmation in the late stages of the disease suggests the importance of clinical suspicion in such rare conditions.
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June 2016

An unnoticed origin of fever: periapical tooth abscess. Three case reports and literature review.

Infez Med 2016 ;24(1):67-70

Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University Hospital, Istanbul, Turkey.

Dental infections may lead to severe local or systemic infections such as endocarditis, brain abscesses and mediastinitis. Fever may be the only symptom. We aim to highlight dental/odontogenic abscesses as the occult source of unexplained fever by reporting on three cases and reviewing the relevant literature. Early dental evaluation and referral of patients with persistent fever (even without any oral symptoms) to a dentist plays a critical role in preventing unnecessary, time-consuming and high-cost further diagnostic tests and invasive procedures. A simple panoramic dental radiography may suffice to establish the diagnosis.
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July 2017

Mortality predictors of Staphylococcus aureus bacteremia: a prospective multicenter study.

Ann Clin Microbiol Antimicrob 2016 Feb 9;15. Epub 2016 Feb 9.

Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1, Bağcılar, 34214, İstanbul, Turkey.

Background: Staphylococcus aureus is one of the causes of both community and healthcare-associated bacteremia. The attributable mortality of S. aureus bacteremia (SAB) is still higher and predictors for mortality and clinical outcomes of this condition are need to be clarified. In this prospective observational study, we aimed to examine the predictive factors for mortality in patients with SAB in eight Turkish tertiary care hospitals.

Methods: Adult patients with signs and symptoms of bacteremia with positive blood cultures for S. aureus were included. All data for episodes of SAB including demographics, clinical and laboratory findings, antibiotics, and outcome were recorded for a 3-year (2010-2012) period. Cox proportional hazard model with forward selection was used to assess the independent effect of risk factors on mortality. A 28-day mortality was the dependent variable in the Cox regression analysis.

Results: A total of 255 episodes of SAB were enrolled. The median age of the patients was 59 years. Fifty-five percent of the episodes were considered as primary SAB and vascular catheter was the source of 42.1 %. Healthcare associated SAB was defined in 55.7 %. Blood cultures yielded methicillin-resistant S. aureus (MRSA) as a cause of SAB in 39.2 %. Initial empirical therapy was inappropriate in 28.2 %. Although overall mortality was observed in 52 (20.4 %), 28-day mortality rate was 15.3 %. Both the numbers of initial inappropriate empirical antibiotic treatment and the median hours to start an appropriate antibiotic between the cases of fatal outcome and survivors after fever onset were found to be similar (12/39 vs 60/216 and 6 vs 12 h, respectively; p > 0.05). High Charlson comorbidity index (CCI) score (p = 0.002), MRSA (p = 0.017), intensive care unit (ICU) admission (p < 0.001) and prior exposure to antibiotics (p = 0.002) all were significantly associated with mortality. The Cox analysis defined age [Hazard Ratio (HR) 1.03; p = 0.023], ICU admission (HR 6.9; p = 0.002), and high CCI score (HR 1.32; p = 0.002) as the independent predictive factors mortality.

Conclusions: The results of this prospective study showed that age, ICU stay and high CCI score of a patient were the independent predictors of mortality and MRSA was also significantly associated with mortality in SAB.
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http://dx.doi.org/10.1186/s12941-016-0122-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748515PMC
February 2016

Spinal brucellosis diagnosed with positron emission tomography combined with computed tomography (PET/CT).

Spine J 2016 06 27;16(6):e381-2. Epub 2016 Jan 27.

Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University Hospital,Ataturk Street, 34083, Fatih, Istanbul, Turkey.

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http://dx.doi.org/10.1016/j.spinee.2015.12.016DOI Listing
June 2016

Impact of fatty liver on hepatitis B virus replication and virologic response to tenofovir and entecavir.

Turk J Gastroenterol 2016 Jan 17;27(1):42-6. Epub 2015 Dec 17.

Department of Infectious Diseases and Clinical Microbiology, İstanbul Medipol University, İstanbul, Turkey.

Background/aims: We aimed to evaluate the impact of non-alcoholic fatty liver disease (NAFLD) on viral kinetics and virologic response to tenofovir and entecavir treatment in patients with chronic hepatitis B virus (HBV) infection.

Materials And Methods: This study was designed as a retrospective multicenter cohort study. The impact of hepatosteatosis on pre-treatment serum HBV DNA levels and also on the virologic response to either tenofovir or entecavir at 6 and 12 months of therapy was investigated.

Results: A total of 145 cases were involved in the study [median age 40 (18-73) years, 90 (62%) males]. In multivariate analysis, it was detected that patients with NAFLD were older and had a higher body mass index (BMI) [Odds ratio (95% confidence interval) and p-value for age were 1.040 (1.003-1.079) and 0.033 and for BMI were 1.348 (1.190-1.528) and 0.0001, respectively]. When only the 43 patients who were younger than 35.5 years old and who had a BMI less than 27.59 were investigated, serum high-density lipoprotein (HDL) levels and serum HBV DNA levels were lower in patients with NAFLD in multivariate analysis [Odds ratio (95% confidence interval) and p-values for serum HDL level and HBV DNA level were 0.864 (0.061-0.980) and 0.023 and 0.995 (0.990-0.999) and 0.025, respectively]. Totally, 57 and 75 of the patients had received entecavir and tenofovir, respectively.

Conclusion: Viral replication decreases in patients with chronic HBV infection in the presence of NAFLD, and NAFLD had no impact on the virologic response to entecavir and tenofovir treatment.
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http://dx.doi.org/10.5152/tjg.2015.150348DOI Listing
January 2016
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