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In this multicenter, retrospective study involving 62 patients, we investigated whether switching from entecavir (ETV) or tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) represents a superior treatment strategy for patients with chronic hepatitis B (CHB) experiencing low-level viremia (LLV). The study determined that TAF significantly improved both virological and biochemical outcomes. At 48 weeks, the complete virological response (CVR) rate was 77.8% for those who switched from ETV and 81.8% for those who switched from TDF, with Hepatitis B virus deoxyribonucleic acid (HBV DNA) negativity reaching 81% by month 12. Additionally, significant normalization of liver enzymes, albumin, and platelet counts was observed across the cohort. While the switch from TDF was associated with a significant increase in triglycerides and high-density lipoprotein (HDL) and a decrease in estimated glomerular filtration rate (eGFR), no such changes were detected in the ETV group. This evidence suggests that TAF provides robust virological control in LLV patients and is associated with favorable biochemical improvements. However, due to the study’s limitations, the strong assertion that TAF promotes the regression of liver fibrosis and reduces the risk of hepatocellular carcinoma (HCC) must be interpreted with caution.

We aimed to examine the D-dimer/platelet ratio (DPR), which includes the combination of D-dimer and platelet measurements, which are two important markers in predicting prognosis, considering that it will show clinical progression. After ranking the patients from high to low according to DPR level, they were divided into three equal groups. Demographic, clinical, and laboratory parameters between groups were compared according to DPR level. The consistency of DPR with other coronavirus disease 2019 (COVID-19) biomarkers in the literature in terms of hospitalization and mortality in the intensive care unit was examined. Complications such as renal failure, pulmonary thromboembolism (PTE), and stroke of the patients increased as the DPR increased. Patients in the third group with high DPR had higher oxygen demands from symptom onset, such as reservoir masks, high-flow oxygen, and mechanical ventilation. The first hospitalization location in the third group was determined as the intensive care unit. Mortality increased as the DPR value increased, and the time to death in patients in the third group was significantly shorter than the patients in the other two groups. While most of the patients in the first two groups recovered, 42% of the patients in the third group died. While the area under the curve was 80.6% in predicting DPR admission to the intensive care unit, the cut-off value was determined as 1.606. When the effect of DPR on predicting mortality was examined, the area under the curve for DPR was 82.6% and the cut-off value was determined as 2.284. DPR is successful in predicting the severity, ICU admission, and mortality of COVID-19 patients.

SummaryIntroduction: In the recent years, presepsin has been defined as a biomarker useful in the early diagnosis of sepsis. We aimed to evaluate the diagnostic and prognostic value of presepsin in patients with a Systemic inflammatory response syndrome (SIRS) and sepsis.Materials and Methods: Totally 65 patients (42 patients diagnosed with the SIRS, sepsis, or septic shock, and 23 healthy controls) were included in this prospective case-control study.Results: On the first day of hospitalization, the median value of presepsin [687.5 pg/ml (115-10049 pg/ml)] in the patient group was significantly higher than the control group [71.5 pg/ml (44.1-170 pg/ml)] (p<0.001). In the sepsis and septic shock groups, presepsin levels were higher than the SIRS group (p1=0.002, p2=0.001). There was a positive correlation between the disease severity and presepsin on the first day of hospitalization and second day of the treatment (r=0.448, 0.423; p<0.001, p<0.001, respectively). When the cut-off value of presepsin was taken as 124 pg/ml for SIRS, sepsis, and septic shock for the first day of hospitalization, the sensitivity was 97.6% and the specificity was 95.7% [area under the curve (AUC): 0.996 (p<0.001)]. When the cut-off value of the presepsin on admission was 439 pg/ml, the sensitivity of the presepsin was 100% and the specificity was 57.1% in separating a sepsis from the SIRS cases [AUC: 0.772 (p<0.001)]. When the threshold level of presepsin was taken as 864 pg/ml on the first day of hospitalization, septic shock was distinguished from the sepsis and SIRS cases with 100% sensitivity and 69.4% specificity [AUC: 0.856 (p<0.001)].Conclusion: Presepsin appears to be a useful biomarker in early diagnosis of the SIRS, sepsis, and septic shock patients in where a rapid diagnosis and treatment are known to be lifesaving.

The intersection of human immunodeficiency virus (HIV) and tuberculosis (TB) presents a significant public health challenge, particularly in regions with high prevalence of both diseases. This multicenter, retrospective study aimed to evaluate the clinical characteristics, treatment outcomes, and factors influencing the development of TB in individuals infected with HIV. This multicenter, retrospective study included individuals infected with HIV from 15 centers, assessing demographic and disease-related data. Inclusion criteria encompassed HIV patients over 18 years of age with TB treatment histories. Data analysis utilized SPSS Statistics version 25.0, adhering to the ethical principles of the Declaration of Helsinki. The study included 9,720 HIV-infected patients from 15 centers, with TB detected in 124 (1.28%) of these individuals. The majority were male, and the median age at TB diagnosis was 43 years. Clinical findings revealed that pulmonary TB was the most common form (69.4%), with weight loss, cough, and fever as prevalent symptoms. The study also noted a significant delay in TB diagnosis, with a median symptom duration of 60 days. Only six patients exhibited resistance to TB medications. The most commonly used antiretroviral treatment regimen was tenofovir disoproxil fumarate/emtricitabine/dolutegravir (TDF/FTC/DTG). Immune reconstitution inflammatory syndrome (IRIS) developed in 12.1% of patients. Despite these challenges, 79.8% of patients successfully completed TB treatment. However, mortality was observed in 11.3% of cases. The study highlighted the need for improved screening and prophylaxis for latent TB in individuals infected with HIV, especially those with low CD4+ T lymphocyte counts. The results underscore the importance of timely diagnosis and careful management of HIV-TB co-infection to reduce morbidity and mortality.

The aim of this study was to search for any relations between the neutrophil-tolymphocyte ratio (NLR) and the development of osteomyelitis and the need for amputation in patients with diabetic foot infection (DFI). All data included DFI patients who were hospitalized in our Infectious Diseases Clinic between 2012 and 2015 and who were classified according to International Classification Disease Code System. 75 patients were analyzed in the study. The DFI patients were stratified into 3 groups of whom had amputation procedure, whom had only debridement/drainage procedure and whom had any surgery procedure. Sidac post hoc analysis was used to perform the effects of NLR, C-reactive protein, erythrocyte sedimentation rate and glycosylated hemoglobin on the surgery procedure status. The DFI patients were also stratified into two another separate group for another analysis to search for the effect of NLR values on the development of osteomyelitis. The mean value of NLR in the amputated patients’ group (15.7 ± 10.3 was significantly higher than those with debridement procedure (9.9 ± 5.6) and those without any surgery (6.0 ± 2.8) (p = 0.001). NLR values were also found significantly higher in patients with osteomyelitis in the second analysis (p = 0.004). In this study, the NLR was found to have a predictive value on the development of osteomyelitis and on the progression to amputation in patients with DFI.

Fever of unknown origin (FUO) is a serious challenge for physicians. The aim of the present study was to consider epidemiology and dynamics of FUO in countries with different economic development. The data of FUO patients hospitalized/followed between 1st July 2016 and 1st July 2021 were collected retrospectively and submitted from referral centers in 21 countries through ID-IRI clinical research platform. The countries were categorized into developing (low-income (LI) and lower middle-income (LMI) economies) and developed countries (upper middle-income (UMI) and high-income (HI) economies). This research included 788 patients. FUO diagnoses were as follows: infections (51.6%; n  = 407), neoplasms (11.4%, n  = 90), collagen vascular disorders (9.3%, n  = 73), undiagnosed (20.1%, n  = 158), miscellaneous diseases (7.7%, n  = 60). The most common infections were tuberculosis ( n  = 45, 5.7%), brucellosis ( n  = 39, 4.9%), rickettsiosis ( n  = 23, 2.9%), HIV infection ( n  = 20, 2.5%), and typhoid fever ( n  = 13, 1.6%). Cardiovascular infections ( n  = 56, 7.1%) were the most common infectious syndromes. Only collagen vascular disorders were reported significantly more from developed countries ( RR  = 2.00, 95% CI: 1.19–3.38). FUO had similar characteristics in LI/LMI and UMI/HI countries including the portion of undiagnosed cases ( OR , 95% CI; 0.87 (0.65–1.15)), death attributed to FUO ( RR  = 0.87, 95% CI: 0.65–1.15, p -value = 0.3355), and the mean duration until diagnosis ( p  = 0.9663). Various aspects of FUO cannot be determined by the economic development solely. Other development indices can be considered in future analyses. Physicians in different countries should be equally prepared for FUO patients.

Single-tablet regimens (STRs) can increase treatment success and even improve the quality of life of human immunodeficiency virus (HIV) patients. In this study, we aim to analyze the real-life efficacy and tolerability data of people living with HIV (PLWH) initiated on or switched to bictegravir/emtricitabine/tenofovir alafenamide fumarate (BIC/FTC/TAF) as first-line treatment.INTRODUCTIONSingle-tablet regimens (STRs) can increase treatment success and even improve the quality of life of human immunodeficiency virus (HIV) patients. In this study, we aim to analyze the real-life efficacy and tolerability data of people living with HIV (PLWH) initiated on or switched to bictegravir/emtricitabine/tenofovir alafenamide fumarate (BIC/FTC/TAF) as first-line treatment.This retrospective analysis was performed in HIV-1-positive patients who were initiated BIC/FTC/TAF in the HIV clinic between June 2020 and June 2022. Patients who received BIC/FTC/TAF for at least 12 months were included in this study. Virological suppression, laboratory parameters, side effects, and immunological response were analyzed at one, three, six, nine, and 12 months.MATERIALS AND METHODSThis retrospective analysis was performed in HIV-1-positive patients who were initiated BIC/FTC/TAF in the HIV clinic between June 2020 and June 2022. Patients who received BIC/FTC/TAF for at least 12 months were included in this study. Virological suppression, laboratory parameters, side effects, and immunological response were analyzed at one, three, six, nine, and 12 months.A total of 116 patients, 66 (56.9%) treatment-experienced and 50 (43.1%) naive, were evaluated within the scope of the study. In the naive patient group, baseline HIV-RNA, CD4+ and CD8+ T cell counts, CD4/CD8 ratio, and estimated glomerular filtration rate (eGFR) values were significantly different in different follow-up months. The number of patients with HIV-1 RNA levels below 50 copies/mL was 55.9% in the first month, 73.7% in the third month, 90.2% in the sixth month, and 100% in the ninth and 12th months.RESULTSA total of 116 patients, 66 (56.9%) treatment-experienced and 50 (43.1%) naive, were evaluated within the scope of the study. In the naive patient group, baseline HIV-RNA, CD4+ and CD8+ T cell counts, CD4/CD8 ratio, and estimated glomerular filtration rate (eGFR) values were significantly different in different follow-up months. The number of patients with HIV-1 RNA levels below 50 copies/mL was 55.9% in the first month, 73.7% in the third month, 90.2% in the sixth month, and 100% in the ninth and 12th months.In our real-life observational study, BIC/FTC/TAF treatment achieved rapid viral suppression, maintained viral suppression in virally suppressed patients, and was effective for immunological recovery in both treatment-experienced and naive HIV patients. No serious side effects were observed. Our study has proved the potential of BIC/FTC/TAF as an important option in the treatment of HIV patients.CONCLUSIONIn our real-life observational study, BIC/FTC/TAF treatment achieved rapid viral suppression, maintained viral suppression in virally suppressed patients, and was effective for immunological recovery in both treatment-experienced and naive HIV patients. No serious side effects were observed. Our study has proved the potential of BIC/FTC/TAF as an important option in the treatment of HIV patients.

The aim of this study was to search for any relations between the neutrophil-to-lymphocyte ratio (NLR) and the development of osteomyelitis and the need for amputation in patients with diabetic foot infection (DFI). All data included DFI patients who were hospitalized in our Infectious Diseases Clinic between 2012 and 2015 and who were classified according to International Classification Disease Code System. 75 patients were analyzed in the study. The DFI patients were stratified into 3 groups of whom had amputation procedure, whom had only debridement/drainage procedure and whom had any surgery procedure. Sidac post hoc analysis was used to perform the effects of NLR, C-reactive protein, erythrocyte sedimentation rate and glycosylated hemoglobin on the surgery procedure status. The DFI patients were also stratified into two another separate group for another analysis to search for the effect of NLR values on the development of osteomyelitis. The mean value of NLR in the amputated patients' group (15.7±10.3 was significantly higher than those with debridement procedure (9.9±5.6) and those without any surgery (6.0±2.8) (P=0.001). NLR values were also found significantly higher in patients with osteomyelitis in the second analysis (P=0.004). In this study, the NLR was found to have a predictive value on the development of osteomyelitis and on the progression to amputation in patients with DFI.