Introduction: Intravenous colistin is increasingly used to treat multidrug-resistant Gram-negative infections. Highly variable nephrotoxicity rates have been reported. Recent PK/PD studies propose a loading dose and a maintenance dose for better efficacy, but data on the renal toxicity of such regimens are rare. This study aimed to evaluate the incidence and risk factors for nephrotoxicity related to colistin after implementation of a new dosing regimen including a loading dose. Methodology: This was a prospective observational study that was made between adult patients who received a minimum of 48 hours of intravenous colistin from December 2012 to January 2014 at the medical and surgical intensive care units (ICU) of a university hospital. The severity of acute kidney injury (AKI) was defined by the RIFLE criteria. Results: Fifty-nine patients met the inclusion criteria, and 31 (52.5%) developed nephrotoxicity. The APACHE-II score was > 15 in 81% of patients. The median time to nephrotoxicity was 7 days. Patients with AKI were in risk (10.2%), injury (16.9%), failure (25.4%), and none of the patients developed permanent renal insufficiency. A logistic regression model identified three predictors of colistin-associated nephrotoxicity: age; the number of days that estimated target plasma concentrations of colistin were ≥ 3.5 mg/L in the first week of therapy; and baseline creatinine level. Conclusion: In this cohort of severely ill ICU patients, colistin led to a relatively high rate of nephrotoxicity. Further studies are needed to identify the optimal dose for both efficacy and safety.

Objective: Human herpesvirus-8 (HHV-8) infection—also known as Kaposi sarcoma-associated herpesvirus (KSHV)—is the causative agent of Kaposi’s sarcoma, especially in human immunodeficiency virus (HIV) / acquired immune deficiency syndrome (AIDS) patients. The prevalence of HHV-8/KSHV varies according to country and geographical region. However, despite the increasing amount of research on HHV-8/KSHV after identifying the virus, few studies have systematically collected data on the scientific production process. Therefore, this study aimed to make a bibliometric evaluation of the literature on HIV/AIDS-associated HHV-8/KSHV. Methods: Scientific publications produced in Turkey were analyzed using specific keywords of AIDS-related HHV-8/KSHV in the Scopus database between 2001 and 2020. Quantitative and qualitative analysis of the collected data was reviewed using appropriate bibliometric indicators regarding the number of publications, publication language, most influential institutions, most cited publications, active authors, and active journals. In addition, the VOSviewer v.1.6.16 program (Leiden University’s Centre for Science and Technology Studies, Leiden, Holland) was used to create a keyword network map and determine research interest areas and relationships. Results: There were 40 scientific publications produced in Turkey. The first publication of AIDS-related HHV-8/KSHV in Turkey was in 2001 (n=5, 5%). Most studies were conducted in 2013 and 2020 (n=5, 12.5%). The highest number of publications were in English (82.5%), and 7.5% were published in the Journal of Microbiology Bulletin. Generally, the publications were in article form (82.5%) and in the area of medical sciences (95%). Kaposi’s sarcoma was the most frequently used word in the map created with the network analysis of the keywords.

Introduction: Since the beginning of the pandemic, factors associated with mortality in patients with corona virus infection disease 2019 (COVID-19) have been investigated. Comorbidities and increased age have been frequently reported to be associated with mortality. We aimed to evaluate the factors associated with unfavorable outcome of patients with COVID-19 at an early period of the pandemic. Methodology: This single center, retrospective, observational study was conducted among laboratory confirmed COVID-19 patients hospitalized between March 11 and May 5, 2020, at Umraniye Training and Research Hospital, Istanbul, Turkey. The effects of the severity of illness, comorbidities, symptoms, and laboratory findings on the clinical outcome were evaluated. Factors associated with unfavorable outcome (necessity of mechanical ventilation or death) were examined using Cox proportional hazards models. Results: Out of a total of 728 patients, 53.8% were men and median age 54 years. The 30-day mortality rate was 4.9% among all hospitalized patients. A logistic regression model identified six predictors of unfavorable clinical outcome: age, severity of illness, the numbers of comorbidities, lymphopenia, high levels of C-reactive protein, and procalcitonin. Conclusions: The mortality rate was lower among the patients with COVID-19, hospitalized during the early period of the pandemic. Older age, higher severity score on admission, the numbers of comorbidities, higher levels of C-reactive protein, procalcitonin, and lymphopenia were identified to be associated with unfavorable outcome of the hospitalized patients with COVID-19.

Objective: Interleukin-6 inhibitor Tocilizumab (TCZ) is effective to prevent the mortality of severe COVID-19 by suppressing the cytokine storm, however, its appropriate use needs to be detailed. We aimed to describe the appropriate use of TCZ in severe to critical cases with COVID-19 pneumonia in the early phase of the pandemic. Materials and Methods: This single-center, retrospective, observational study was conducted in a polymerase chain reaction (PCR) positive COVID-19 patients who received TCZ between April 01, 2020 and June 30, 2020, in Ümraniye Research and Training Hospital İstanbul, Turkey. The factors affecting mortality were compared. Results: A total of 67 patients met the inclusion criteria during the study period. Overall, 76% of those patients were male, with a median age of 61 years. The 28-day mortality rate was 51% among all patients who were hospitalised for COVID-19 pneumonia. A logistic regression model identified the predictors of 28-day fatality; the number of comorbidities, high levels of C-reactive protein (CRP) before initiation of TCZ, initiation of TCZ in the intensive care unit (ICU) and not receiving an additional dose of TCZ. Conclusion: The number of comorbidities, high levels of CRP, initiation of TCZ in the ICU and not receiving the additional dose of TCZ were significant risk factors for fatality among patients with COVID-19 who received TCZ. Early initiation of TCZ when cytokine storm is suspected is appropriate for the prevention of fatality. Keywords: COVID-19, tocilizumab, cytokine storm, treatment, mortality

Objective: Our country has limited data on protective antibody levels following primary tetanus immunization. In this study, we planned to evaluate the tetanus antibody seroprevalence of healthcare workers in our hospital according to age and occupational groups. Methods: Tetanus antibody levels were determined by the enzyme-linked immunosorbent assay (ELISA) method. Antibody results were obtained through the hospital operating system, and the tetanus antibody level ≥0.5 IU/mL was considered seropositive. Results: 77.5% of 2082 healthcare workers were seropositive. According to age groups, the highest seropositivity was between 20-29; the lowest seropositivity was found in individuals over 50 years of age and over (66.3%). We determined that tetanus antibody protection decreased with age (p=0.03). There was no difference between tetanus seropositivity according to occupational groups. Conclusion: Antibody levels of tetanus decrease with age, and protection decreases significantly, especially over 50 years of age. It is important to apply a booster dose every ten years following the primary vaccine schedule in tetanus immunization.