Objective: Helicobacter pylori (Hp) eradication therapy is crucial for preventing the development of gastritis, peptic ulcers, and gastric cancer. An increase in resistance against antibiotics used in the eradication of Hp is remarkable. This meta-analysis aims to examine the resistance rates of Hp strains isolated in Turkey over the last 20 years against clarithromycin (CLR), metronidazole (MTZ), levofloxacin (LVX), tetracycline (TET), and amoxicillin (AMX) antibiotics. Basic methods: Literature search was carried out in electronic databases, by searching articles published in Turkish and English with the keywords ‘helicobacter pylori’ or ‘Hp’ and ‘antibiotic resistance’ and ‘Turkey’. That meta-analysis was carried out using random-effect model. First, the 20-year period data between 2002 and 2021 in Turkey were planned to be analyzed. As a second stage, the period between 2002 and 2011 was classified as Group 1, and the period between 2012 and 2021 as Group 2 for analysis, with the objective of revealing the 10-year temporal variation in antibiotic resistance rates. Main results: In gastric biopsy specimens, 34 data from 29 studies were included in the analysis. Between 2002–2021, CLR resistance rate was 30.9% (95% CI: 25.9–36.2) in 2615 Hp strains. Specifically, in Group 1, the CLR resistance rate was 31% in 1912 strains, and in Group 2, it was 30.7% in 703 strains. The MTZ resistance rate was found to be 31.9% (95% CI: 19.8–45.4) in 789 strains, with rates of 21.5% in Group 1 and 46.6% in Group 2. The overall LVX resistance rate was 25.6%, with rates of 26.9% in Group 1 and 24.8% in Group 2. The 20-year TET resistance rate was 0.8%, with 1.50% in Group 1 and 0.2% in Group 2. The overall AMX resistance rate was 2.9%, 3.8% between 2002–2011, and 1.4% between 2012–2021. Principal conclusion: Hp strains in Turkey exhibit high resistance rates due to frequent use of CLR, MTZ, and LVX antibiotics. However, a significant decrease has been observed in TET and AMX resistance to Hp in the last 10 years. Considering the CLR resistance rate surpasses 20%, we suggest reconsidering the use of conventional triple drug therapy as a first-line treatment. Instead, we recommend bismuth-containing quadruple therapy or sequential therapies (without bismuth) for first-line treatment, given the lower rates of TET and AMX resistance. Regimens containing a combination of AMX, CLR, and MTZ should be given priority in second-line therapy. Finally, in centers offering culture and antibiogram opportunities, regulating the Hp eradication treatment based on the antibiogram results is obviously more appropriate.

Amaç: Sağlık hizmet sunumunda önemli bir yere sahip eczane çalışanlarının COVID-19 salgınında kaygı, uykusuzluk ve depresyon durumlarını tespit etmek amacıyla çalışma planlanmıştır. Yöntem: Bu çalışma COVID-19 salgını sırasında il merkezinde bulunan tüm eczane çalışanlarına uygulanan kesitsel nitelikli anket çalışmasıdır. Bu çalışmada tüm katılımcılara demografik bilgiler içeren anket formu Yaygın Anksiyete Bozukluğu-7 (YAB-7) Testi, uykusuzluk şiddet indeksi ve Hasta Sağlık Anketi – 9 (PHQ - 9) uygulandı. Bulgular: Çalışmada 126 eczane çalışanı katılmış olup bunların %45.2’si eczacılardan, %54.8’i diğer çalışanlardan oluşmuştur. Çalışma grubunun önemli bir kısmında anksiyete (%49.1), depresyon (%45.2) ve uykusuzluk (%52.4) problemleri vardı. Daha önce ruhsal hastalık geçirme öyküsü, enfekte olma korkusu, iş yükü artışı olanlarda ve hastayla karşılaşma ihtimalini yüksek görenlerde anksiyete, depresyon ve uykusuzluk puanları anlamlı olarak daha yüksek bulunmuştur. Araştırma grubumuzda eczacı olanlarda olmayanlara göre anksiyete, depresyon ve uykusuzluk durumları açısından istatistiksel olarak anlamlı fark bulunmamıştır. Sonuç: Çalışmada COVID-19 pandemi sırasında eczane çalışanlarında orta düzeyde anksiyete, depresyon ve uykusuzluk durumu geliştiği görülmüştür. Eczane çalışanlarının literatürde bildirilen sağlık çalışanlarına yakın düzeyde ölçek puanlarına sahip olması, hastanede çalışmasa da bu grupta da risk artışı olduğunu göstermektedir. Planlanan tüm psikososyal girişimlerde hastane dışında çalışan ve sağlık hizmeti veren eczane personelide göz önüne alınmalıdır.

In the hepatitis C virus (HCV) diagnostic algorithm, an anti-HCV screening test is recommended first. In countries with low HCV prevalence, anti-HCV testing can often give false-positive results. This may lead to unnecessary retesting, increased costs, and psychological stress for patients.

Human immunodeficiency virus (HIV)/acquired immundeficiency syndrome (AIDS) is a critical global public health problem that significantly affects both life expectancy and the overall quality of life of in dividuals in all age groups. The landscape of HIV infection has changed significantly in recent years due to the introduction of effective combination antiretroviral therapies (ART). A key component of first -line ART regimens for HIV treatment is abacavir, a nucleoside HIV reverse transcriptase inhibitor. Although ab acavir is effective in suppressing viral replication and managing disease, its clinical utility is overshadowed by the potential for life -threatening hypersensitivity reactions in HLA-B*57:01-positive patients. In our country, local data obtained from various centers regarding the prevalence of HLA-B*57:01 in HIV -1 -infected patients are available. In this study, it was aimed to determine the prevalence of the HLA-B*57:01 genotype in HIV -infected patients who were followed up and treated in many regions of our country. This retrospective study consists of the data of the patients aged 18 years and over diagnosed with HIV -1 infection between 01.01.2019 and 31.07.2022. Age, gender, place of birth, mode of transmission of the disease, death status, CD4+ T cell count and HIV RNA levels at the first clinical presentation, HLA-B*57:01 positivity, and the method used, clinical stage of the disease, virological response time with the treatment they received were recorded from the patient files. Data were collected from 16 centers and each center used different methods to detect HLA-B*57:01. These methods were sequence -specific oligonucleotide probe hybridization (SSOP), DNA sequence -based typing (SBT), single -specific primer-polymerase chain reaction (SSP-PCR), allele -specific PCR (AS-PCR) and quantitative PCR (Q-PCR). A total of 608 HIV -infected individuals, 523 males (86%) and 85 females (14%), were included in the study. The mean age of the patients was 36.9 +/- 11.9 (18-73) years. The prevalence of HLA-B*57:01 allele was found to be 3.6% (22 patients). The number of CD4+ T lymphocytes in HLA-B*57:01 allele -positive patients was > 500/ mm(3) in 10 patients (45.5%), while the number of CD4+ T lymphocytes in HLA-B*57:01 negative pa- tients was > 500/mm(3) in 216 patients (36.9%) (p> 0.05). Viral load at the time of diagnosis was found to be lower in patients with positive HLA-B*57:01 allele but it was not statistically significant (p> 0.05). Although different treatment algorithms were used in the centers following the patients, it was observed that the duration of virological response was shorter in HLA-B*57:01 positive patients (p= 0.006). Although the presence of the HLA-B*57:01 allele has a negative impact due to its association with hypersensitivity, it is likely to continue to attract interest due to its association with slower progression of HIV infection and reduced risk of developing AIDS. In addition, although the answer to the question of whether it is cost-effective to screen patients for HLA-B*57:01 before starting an abacavir-containing ART regimen for the treatment of HIV infection is being sought, it seems that HIV treatment guidelines will continue to recommend screening to identify patients at risk in this regard.

Comparison of COVID-19 RT-PCR-Positive Patients in Oro-Nasopharynx Samples with RT-PCR Results in Simultaneous Stool Samples, Prospective Study - Istanbul Medical Journal

Objective: Multidrug-resistant Gram-negative bacteria cause difficult-to-treat infections associated with high mortality. Carbapenems are widely used; however, their overuse has led to the emergence of carbapenem-resistant bacteria. This study aimed to evaluate the indications, clinical and microbiological efficacy, and side effects of ceftazidime-avibactam (CAZ-AVI) and to identify factors influencing mortality, based on data from a large multicenter patient cohort in Türkiye. Materials and Methods: Patients with carbapenem-resistant but CAZ-AVI-susceptible Gram-negative bacterial infections who received CAZ-AVI treatment were retrospectively reviewed. Results: A total of 1245 patients were included. The most common indication for CAZ-AVI use was hospital-acquired pneumonia (47.8%). Klebsiella pneumoniae was the predominant pathogen (81.3%). CAZ-AVI was used as a monotherapy in 80% of cases. Clinical side effects were observed in 8 (0.64%) patients, while laboratory abnormalities occurred in 73 (5.86%). The 7-day, 14-day, and 28-day all-cause mortality rates were 13.8%, 28.9%, and 45.2%, respectively. Microbiological eradication was achieved in 82.3% of patients. Higher Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores at admission, requirement for continuous renal replacement therapy, mechanical ventilation, and elevated C-reactive protein levels were identified as independent risk factors for mortality. Conclusion: This large multicenter real-world analysis demonstrates that CAZ-AVI is an effective treatment option for severe infections with high mortality, such as those caused by carbapenem-resistant Enterobacterales and Pseudomonas aeruginosa.