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[LANGUAGE= \"English\"] BACKGROUND: Firearm injuries (FI) remain a significant cause of morbidity and mortality globally. Antibiotic use, supported by guideline recommendations for preventing post-injury infections in FI cases, encounters uncertainties regarding the selection of anti-microbial agents and associated outcomes. This study aimed to investigate the relationship between Injury Severity Scores (ISS) for FI cases presented to the emergency department.METHODS: We empirically revised antimicrobial treatment protocols based on culture results and mortality rates. In the study, 164 firearm injury cases, admitted to the emergency department in 2022 and subsequently hospitalized in clinics and intensive care units (ICU), were evaluated. Cases included in the study were categorized into four groups based on ISS: mild, moderate, severe, and profound injury severity. The study compared the timing of hospital presentation following the injury, hospital length of stay, tissue or blood culture positivity, empirical treatment administered, antimicrobial revision based on culture results, need for ICU admission, mortality status, and ISS among the cases. Data were analyzed using IBM SPSS Statistics 22.0 (SPSS Inc., Chicago, IL). Variables in trauma patients were compared among various groups using Pearson Chi-Square tests. Binary logistic regression tests were performed to identify independent risk factors. A significance level of p<0.05 was considered statistically significant.RESULTS: The study included 164 patients, all of whom were male. The mean age was calculated as 28.9±4.51 years. The average hospital length of stay was 25.54±21.81 days. Eighty-three patients (50.6%) required intensive care. Tissue cultures were obtained from 79 patients (48%). Bacterial growth was observed in 45 of these 79 patients (57%). The appropriate empirical antibiotic treatment rate, assessed among patients who received empirical treatment followed by culture-based antibiotic sensitivity testing, was 48.9%. It was observed that empirical antibiotic regimens were appropriate in 80% of cases in the mild group and 16.7% in the profound severe group (p=0.005). Our study compared the relationship between hospitalization duration and ISS groups. It was observed that hospitalization duration was significantly shorter in the mild group compared to the other groups (p=0.003, p=0.000, p=0.000). It was also observed that the need for ICU admission was higher in groups with higher ISS, indicating a correlation between higher ISS and increased ICU requirements (p=0.000).CONCLUSION: In conclusion, for cases of firearm injuries, we believe empirical antimicrobial therapy should be initiated with narrow-spectrum agents such as beta-lactam + beta-lactamase inhibitor or third-generation cephalosporin + nitroimidazole in the mild group, considering the lack of Pseudomonal activity.[LANGUAGE= \"Turkish\"] AMAÇ: Ateşli silah yaralanmaları (ASY) küresel olarak halen önemli bir morbidite ve mortalite nedenidir. Antibiyotik kullanımı, ASY olgularında yaralanma sonrası enfeksiyonların önlenmesi için kılavuz önerileri ile desteklenmektedir, ancak antimikrobiyal ajan seçimi ve bunlarla ilişkili sonuçlar belirsizliğini korumaktadır. Bu çalışmada acil servise başvuran ASY olgularının yaralanma şiddet skorları (ISS) ile ampirik ve kültür sonucuna göre revize edilen antimikrobiyal tedavi protokolleri ve mortalite arasındaki ilişkiyi araştırmayı amaçladık.GEREÇ VE YÖNTEM: Araştırmada 2022 yılında acil servise başvurusu olan ve sonrasında klinik ve yoğun bakım ünitelerinde (YBÜ) yatarak tedavi gören 164 ASY olgusu değerlendirildi. Bu vakalar ISS’a göre 9'dan küçük olanlar hafif, 9-15 arası olanlar orta, 16-24 arası olanlar şiddetli, 25 ve üzeri olanlar derin şiddetli olmak üzere dört gruba ayrıldı. Olgularda hastane yatış süresi, hastaneye yaralanma sonrası kaçıncı günde başvurduğu, doku veya kan kültür üremesi, verilen ampirik tedavi seçeneği, kültür sonucuna göre yapılan antimikrobiyal revizyon durumu, hastanın YBÜ ihtiyacı olup olmaması ve mortalite durumu, ISS ile karşılaştırıldı. Araştırmanın verileri SPSS IBM 22,0 (SPSS Inc, Chicago, IL) istatistik programına aktarılarak veri kontrolü ve analizler bu programda yapıldı. Travma hastalarında değişkenler çeşitli gruplar arasında Pearson Chi-Square ile karşılaştırılmıştır. Binary logistic regression testleri ile analiz edilerek bağımsız risk faktörleri belirlenmiştir. İstatistiksel açıdan p<0,05 düzeyi anlamlı kabul edildi. BULGULAR: Çalışmaya alınan 164 hastanın tamamı erkekti. Ortalama yaş 28.9±4.51 yıl olarak hesaplandı. Ortalama hastane yatış süresi 25.54±21.81 gün olarak bulundu. Hastaların %96’sı (158/164) akut enfeksiyon ile hastaneye başvurmuştur. Hastaların 83’ünde (%50.6) yoğun bakım ihtiyacı gelişmiştir. Hastaların 79’undan (%48) doku kültürü alındı. Doku kültürü alınan 79 hastanın 45’inde (%57) bakteri üremesi olmuştur. Kültür üremelerinde en sık Acinetobacter baumannii ve Klebsiella pneumoniae görülmüştür. Ampirik tedavi verilen ve sonrasında kültür sonucuna göre antibiyotik duyarlılıklarına bakılan hastalar incelendiğinde uygun ampirik antibiyotik tedavi oranı %48,9 hesaplanmıştır. Ampirik antibiyotik rejimlerinin hafif grupta %80 olguda, derin şiddetli grupta ise %16.7 olguda uygun verildiği ve bu sonucun anlamlı olduğu görülmektedir (p=0.005). Hafif grupta hastanede kalış süresinin istatistiksel anlamlı şekilde daha kısa olduğu görülmüştür (p=0.003, p=0.000, p=0.000). ISS dört grupta sınıflandırılan hastalar YBU ihtiyacına göre değerlendirildiğinde anlamlı bir fark saptanmış olup (p=0.000) ISS skorunun yüksek olduğu gruplarda yoğun bakım ihtiyacı daha yüksek hesaplanmıştır.SONUÇ: Sonuçta ASY olgularında ampirik antimikrobiyal tedavinin hafif grupta psödomonal etkinliği olmayan beta laktam+beta laktamaz inhibitörü veya üçüncü kuşak sefalosporin+nitroimidazol gibi dar spektrumlu olacak şekilde, şiddetli grupta ise gram negatif bakterileri de kapsayacak şekilde daha geniş spektrumlu olarak başlanması gerektiğini düşünmekteyiz. Özellikle üçüncü basamak travma merkezlerinin bu hasta gruplarına yönelik sistematik tedavi protokolleri oluşturması gerekmektedir.

BACKGROUND: Firearm injuries (FI) remain a significant cause of morbidity and mortality globally. Antibiotic use, supported by guideline recommendations for preventing post-injury infections in FI cases, encounters uncertainties regarding the selection of antimicrobial agents and associated outcomes. This study aimed to investigate the relationship between Injury Severity Scores (ISS) for FI cases presented to the emergency department. METHODS: We empirically revised antimicrobial treatment protocols based on culture results and mortality rates. In the study, 164 firearm injury cases, admitted to the emergency department in 2022 and subsequently hospitalized in clinics and intensive care units (ICU), were evaluated. Cases included in the study were categorized into four groups based on ISS: mild, moderate, severe, and profound injury severity. The study compared the timing of hospital presentation following the injury, hospital length of stay, tissue or blood culture positivity, empirical treatment administered, antimicrobial revision based on culture results, need for ICU admission, mortality status, and ISS among the cases. Data were analyzed using IBM SPSS Statistics 22.0 (SPSS Inc., Chicago, IL). Variables in trauma patients were compared among various groups using Pearson Chi-Square tests. Binary logistic regression tests were performed to identify independent risk factors. A significance level of p<0.05 was considered statistically significant. RESULTS: The study included 164 patients, all of whom were male. The mean age was calculated as 28.9 [+ or -] 4.51 years. The average hospital length of stay was 25.54 [+ or -] 21.81 days. Eighty-three patients (50.6%) required intensive care. Tissue cultures were obtained from 79 patients (48%). Bacterial growth was observed in 45 of these 79 patients (57%). The appropriate empirical antibiotic treatment rate, assessed among patients who received empirical treatment followed by culture- based antibiotic sensitivity testing, was 48.9%. It was observed that empirical antibiotic regimens were appropriate in 80% of cases in the mild group and 16.7% in the profound severe group (p=0.005). Our study compared the relationship between hospitalization duration and ISS groups. It was observed that hospitalization duration was significantly shorter in the mild group compared to the other groups (p=0.003, p=0.000, p=0.000). It was also observed that the need for ICU admission was higher in groups with higher ISS, indicating a correlation between higher ISS and increased ICU requirements (p=0.000). CONCLUSION: In conclusion, for cases of firearm injuries, we believe empirical antimicrobial therapy should be initiated with narrow-spectrum agents such as beta-lactam + beta-lactamase inhibitor or third- generation cephalosporin + nitroimidazole in the mild group, considering the lack of Pseudomonal activity. Keywords: Firearm injuries; Injury Severity Score (ISS); mortality. AMAC: Atesli silah yaralanmalari (ASY) kuresel olarak halen onemli bir morbidite ve mortalite nedenidir. Antibiyotik kullanimi, ASY olgularinda yaralanma sonrasi enfeksiyonlarin onlenmesi icin kilavuz onerileri ile desteklenmektedir, ancak antimikrobiyal ajan secimi ve bunlarla iliskili sonuclar belirsizligini korumaktadir. Bu calismada acil servise basvuran ASY olgularinin yaralanma siddet skorlari (ISS) ile ampirik ve kultur sonucuna gore revize edilen antimikrobiyal tedavi protokolleri ve mortalite arasindaki iliskiyi arastirmayi amacladik. GEREC VE YONTEM: Arastirmada 2022 yilinda acil servise basvurusu olan ve sonrasinda klinik ve yogun bakim unitelerinde (YBU) yatarak tedavi goren 164 ASY olgusu degerlendirildi. Bu vakalar ISS'a gore 9'dan kucuk olanlar hafif, 9-15 arasi olanlar orta, 16-24 arasi olanlar siddetli, 25 ve uzeri olanlar derin siddetli olmak uzere dort gruba ayrildi. Olgularda hastane yatis suresi, hastaneye yaralanma sonrasi kacinci gunde basvurdugu, doku veya kan kultur uremesi, verilen ampirik tedavi secenegi, kultur sonucuna gore yapilan antimikrobiyal revizyon durumu, hastanin YBU ihtiyaci olup olmamasi ve mortalite durumu, ISS ile karsilastirildi. Arastirmanin verileri SPSS IBM 22,0 (SPSS Inc, Chicago, IL) istatistik programina aktarilarak veri kontrolu ve analizler bu programda yapildi. Travma hastalarinda degiskenler cesitli gruplar arasinda Pearson Chi-Square ile karsilastirilmistir. Binary logistic regression testleri ile analiz edilerek bagimsiz risk faktorleri belirlenmistir. Istatistiksel acidan p<0,05 duzeyi anlamli kabul edildi. BULGULAR: Calismaya alinan 164 hastanin tamami erkekti. Ortalama yas 28.9 [+ or -] 4.51 yil olarak hesaplandi. Ortalama hastane yatis suresi 25.54 [+ or -] 21.81 gun olarak bulundu. Hastalarin %96'si (158/164) akut enfeksiyon ile hastaneye basvurmustur. Hastalarin 83'unde (%50.6) yogun bakim ihtiyaci gelismistir. Hastalarin 79'undan (%48) doku kulturu alindi. Doku kulturu alinan 79 hastanin 45'inde (%57) bakteri uremesi olmustur. Kultur uremelerinde en sik Acinetobacter baumannii ve Klebsiella pneumoniae gorulmustur. Ampirik tedavi verilen ve sonrasinda kultur sonucuna gore antibiyotik duyarliliklarina bakilan hastalar incelendiginde uygun ampirik antibiyotik tedavi orani %48,9 hesaplanmistir. Ampirik antibiyotik rejimlerinin hafif grupta %80 olguda, derin siddetli grupta ise %16.7 olguda uygun verildigi ve bu sonucun anlamli oldugu gorulmektedir (p=0.005). Hafif grupta hastanede kalis suresinin istatistiksel anlamli sekilde daha kisa oldugu gorulmustur (p=0.003, p=0.000, p=0.000). ISS dort grupta siniflandirilan hastalar YBU ihtiyacina gore degerlendirildiginde anlamli bir fark saptanmis olup (p=0.000) ISS skorunun yuksek oldugu gruplarda yogun bakim ihtiyaci daha yuksek hesaplanmistir. SONUC: Sonucta ASY olgularinda ampirik antimikrobiyal tedavinin hafif grupta psodomonal etkinligi olmayan beta laktam+beta laktamaz inhibitoru veya ucuncu kusak sefalosporin+nitroimidazol gibi dar spektrumlu olacak sekilde, siddetli grupta ise gram negatif bakterileri de kapsayacak sekilde daha genis spektrumlu olarak baslanmasi gerektigini dusunmekteyiz. Ozellikle ucuncu basamak travma merkezlerinin bu hasta gruplarina yonelik sistematik tedavi protokolleri olusturmasi gerekmektedir. Anahtar sozcukler: Atesli silah yaralanmalari; ISS; mortalite.

Objectives:Serological tests and elastography have recently been used more commonly for the detection of liver fibrosis. The aim of this study was to compare the histopathologically confirmed liver fibrosis stage with serological tests and point shear wave elastography (pSWE) in chronic hepatitis B (CHB) patients.Materials and Methods:Patients who underwent liver biopsy for CHB in the infectious diseases clinic were included. Demographic characteristics, laboratory results, and pSWE measurements were recorded retrospectively. pSWE measurements were evaluated according to the guidelines of the European Federation of Ultrasound Societies in Medicine and Biology.Results:Thirty-five patients were included in the study, 23 (65.7%) of whom were male. The mean age was 47.2±12.6. Significant fibrosis was found in 15 patients (42.9%) on histopathological evaluation. The mean pSWE value of patients with mild fibrosis was 1.6±0.5 m/sec and with significant fibrosis was 2.2±0.5 m/sec. Significant fibrosis risk was shown to be associated with mean pSWE values (p=0.002) and the accuracy rate was calculated 62.8% (the area under the curve: 0.807). When the cut-off value of pSWE was taken as 1.77 m/sec to determine significant fibrosis (likelihood ratio: 2.67), the sensitivity was 80% and the specificity was 70% (p=0.002). The correlation between pSWE median values with age (r=0.452, p<0.01), body mass index (r=0.673, p<0.01), grade of steatosis (r=0.534, p<0.01), and stage of fibrosis (r=0.633, p<0.01) was calculated.Conclusion:pSWE is promising; however, it is thought that the method will develop further if pSWE is used more frequently in clinical practice.

A 20-year-old male was admitted to our department with the complaint of pustular psoriasis. Initial conventional therapies including cyclosporin and methotrexate were discontinued due to the onset of hypertension and elevated liver enzymes. Consequently, infliximab therapy was started after one month of prophylaxis for latent tuberculosis infection. Here, we report a case of disseminated tuberculosis and heart failure associated with infliximab therapy. After the cessation of infliximab and starting therapy for both heart failure and tuberculosis, the patient improved significantly. Tuberculosis reactivation and heart failure are known side effects associated with biologic agents, but, as far as we know, there are no published reports of both condition in the same patient in the literature.