No abstract

Highlights Earlier use of tocilizumab in COVID-19 infection is beneficial for survival, length of hospitalization and duration of oxygen support Administration of tocilizumab is based on an increase in requirements of oxygen support, progression of thoracic CT, elevation of inflammation IL-6, CRP, ferritin, d -dimer, and decrease in % lymphocytes Among the inflammation parameters, the earliest changes were detected at the levels of CRP, IL-6 and % lymphocytes

We aimed to describe the potential benefit of new rapid molecular respiratory tests (MRT) in decreasing inappropriate antibiotic use among the inpatients presenting with influenza-like illness (ILI). We included patients from inpatient and outpatient departments who had ILI and performed MRT between 1 January 2015 and 31 December 2016 in a 265-bed private hospital in Istanbul. At the end of 2015, we implemented antimicrobial stewardship including systematic use of MRT. Then, we compared our observations between the year 2015 and the year 2016. We designed the study according to the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) tool. A U.S. Food and Drug Administration (FDA)-cleared multiplexed polymerase chain reaction (PCR) system (BioFire FilmArray, Idaho Technology, Salt Lake City, UT) which detects 17 viruses and three bacteria was used for diagnosis. In total, 1317 patients were included; 630 (48%) were inpatients and 569 (43%) were older than 16 years of age. At least one virus was detected in 747 (57%) patients. Rhinovirus/enterovirus, influenza virus, and adenovirus were the most commonly detected. Among hospitalized patients, in children, a significant decrease in antibiotic use (44.5% in 2015 and 28.8% in 2016, p = 0.009) was observed, but in adults, the decrease was not statistically significant (72% in 2015 and 63% in 2016, p = 0.36). The duration of antibiotic use after the detection of virus was significantly decreased in both children and adults (p < 0.001 and p = 0.007, respectively). By using MRT, inappropriate antibiotic use and, also, duration of inappropriate antibiotic use after the detection of virus was significantly decreased. It is time to increase the awareness about the viral etiology in respiratory tract infections (RTIs) and implement MRT in clinical practice.

Triglyceride synthesis is catalyzed by acyl CoA:diacylglycerol acyltransferases (DGAT), microsomal enzymes that use diacylglycerol and fatty acyl CoAs as substrates. Because DGAT1 expression is up-regulated during adipocyte differentiation and DGAT1 deficiency is associated with leanness in mice, we hypothesized that alterations in DGAT1 expression may affect human body weight. We identified five polymorphisms in the human DGAT1 promoter and 5' non-coding sequence in a random Turkish population. Functional analysis of one common variant, C79T, revealed reduced promoter activity for the 79T allele in cultured cell lines. In 476 Turkish women, the 79T allele was associated with lower body mass index (BMI) (p = 0.004), conferring an odds ratio of 2.0 (95% CI = 1.30-3.07, p = 0.0001) for BMI

Introduction Maternal anti-SARS-CoV-2 Spike antibodies can cross the placenta during pregnancy, and neonates born to infected mothers have acquired antibodies at birth. Few studies reported data on the histopathological changes of the placenta during infection and placental infection. SARS-CoV-2 infection may cause impaired development of the placenta, thus predisposing maternal and fetal unfavorable outcomes. The prospective study aims to evaluate the risk of vertical transmission of SARS-CoV-2 and placental passage of anti-Spike antibodies as well as the impact of clinical severity on placental structures. Methods This is a prospective cohort study on 30 pregnant women infected by SARS-CoV-2 with their neonates. The demographic features and pregnancy outcomes were collected. Gross and microscopic examinations of the placentas were done. Maternal and umbilical cord sera were obtained at the time of delivery. Nasopharyngeal swabs were collected from neonates immediately after birth. Results The concentrations of total anti-SARS-CoV-2 Spike antibodies were higher in pregnant women with moderate to severe/critical disease. The maternal total anti-SARS-CoV-2 Spike levels were correlated with those of neonatal levels. The rate of placental abnormalities is high in the mothers with severe disease, and those with positive anti-SARS-CoV-2 IgM. All neonates had negative nasopharyngeal swabs for SARS- CoV-2 infections and all placentas were negative in immunohistochemical staining for Spike protein. Discussion The maternally derived anti-SARS-CoV-2 Spike antibody can transmit to neonates born to infected mothers regardless of gestational age. Our results indicated that the disease severity is associated with ischemic placental pathology which may result in adverse pregnancy outcomes.

We aimed to detect the etiological agents of acute diarrhea by a molecular gastrointestinal pathogen test (MGPT) and to assess the impact of MGPT on antimicrobial stewardship programs (ASP). This is a prospective observational study and was conducted between 1 January 2015 and 30 June 2017. We included consequent patients who had acute diarrhea. At the end of 2015, we implemented ASP in acute diarrhea cases and compared the outcomes in the pre-ASP and post-ASP periods. An FDA-cleared multiplexed gastrointestinal PCR panel system, the BioFire FilmArray (Idaho Technology, Salt Lake City, UT), which detects 20 pathogens in stool, was used. In 499 out of 699 patients (71%), at least one pathogen was detected. Among 314 adults with positive MGPT, 101 (32%) enteropathogenic (EPEC), 71 (23%) enteroaggregative (EAEC), 68 (22%) enterotoxigenic (ETEC), 55 (18%) Shiga toxin-producing (STEC) (17%) , 48 (15%), 21 (7%) , and 20 (6%) strains were detected. Among 185 children, 55 (30%) EPEC, 37 (20%) , 32 (17%), 29 (16%) EAEC, 22 (12%) STEC, 21 (11%) ETEC, 21 (11%) , 20 (11%), and 16 (5%) strains were detected. Inappropriate antibiotic use decreased in the post-ASP period compared with the pre-ASP period among inpatients (42.9% and 25.8%, respectively; = 0.023). Using MGPT in clinical practice significantly decreased the unnecessary use of antibiotics. Detection of high rates of in children and spp., as well as relatively high rates of spp., which were hard to isolate by routine stool culture, were remarkable.

Hepatitis C virus (HCV) and hepatitis E virus (HEV) are the principal causes of non-A, non-B hepatitis worldwide, and in Turkey one-third of the cases of acute hepatitis are non-A, non-B. To explore the epidemiology of HCV in Turkey (including the association of HCV with HEV), a seroprevalence study of HCV was conducted. Sera from residents from five distinct regions of the country were tested for antibodies to HCV (anti-HCV) and HEV (anti-HEV). Anti-HCV was detected in 21 (1.5%) of 1,374 persons and was more common in residents over 54 years of age (p = 0.02), with less than primary education (p = 0.013), more than two children (p = 0.003), and who lived in the regions of Ayvalik (p = 0.046) or Trabzon (p = 0.038) compared to Istanbul. Anti-HCV was marginally associated with anti-HEV, which was found in 5.9% of residents. However, this association was lost after controlling for age and education (p = 0.225). HCV infection occurs in all regions of Turkey and is more common in persons who are older and of low socioeconomic status. As resources permit, efforts to reduce the transmission of HCV in Turkey (such as screening blood donations for anti-HCV) are indicated.

No abstract