Person: YILMAZ, EMEL
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YILMAZ
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EMEL
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Publication Cutaneous anthrax: Evaluation of 14 cases(Aves, 2011-12-01) Güler, Hicran; Alyanak, Alper; Yılmaz, Emel; YILMAZ, EMEL; Uludağ Üniversitesi/Tıp Fakültesi/İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı; 0000-0002-3894-1231; HJZ-6992-2023Anthrax is an endemic disease in Turkey. Cutaneous form accounts for 95% of cases. We have examined the clinical features, therapy and outcome of 14 cases with cutaneous anthrax diagnosed in Mus, Eastern Anatolia, Turkey, between July 2006 and November 2007. All but one patient had a history of exposure to infected animals or contaminated animal products. The patients were 15-65 years of age, 6 males and 8 females. Distrubutions of lesions were one on the face, one on the neck, three on the forearms and eight on the hands. The clinical presentation was malignant edema in one patient and malignant pustule in 13 patients. The agent was seen on Gram-stained smears in four patients. Other patients were diagnosed by clinical findings. While 13 patients were cured, one patient had to be referred to an advanced center because of impending asphyxia.Publication The distribution of mature and/or immature myeloid cells and their role in effective anti-viral immune responses in COVID-19 positive patients(Wiley, 2021-08-01) Ermiş, Diğdem Yöyen; Dömbaz, Fatma; Karaçay, Mehmet; Etgü, Onur; Kızmaz, Muhammed Ali; Şimşek, Abdurrahman; Çağan, Eren; Aşan, Ali; Yılmaz, Emel; Kazak, Esra; Pınar, İbrahim Ethem; Bal, Salih Haldun; Arslan, Gözde; Karaca, Mert; Özkocaman, Vildan; Özkalemtaş, Fahir; Akalın, Emin Halis; Budak, Ferah; Oral, Haluk Barbaros; YÖYEN ERMİŞ, DİĞDEM; Dombaz, Fatma; Karaçay, Mehmet; Etgü, Onur; Kızmaz, Muhammed Ali; ŞİMŞEK, ABDURRAHMAN; YILMAZ, EMEL; KAZAK, ESRA; PINAR, İBRAHİM ETHEM; BAL, SALİH HALDUN; Arslan, Gözde; KARACA, MERT; ÖZKOCAMAN, VİLDAN; Özkalemtaş, Fahir; AKALIN, EMİN HALİS; BUDAK, FERAH; ORAL, HALUK BARBAROS; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İmmünoloji Ana Bilim Dalı.; Bursa Uludağ Üniversitesi/Sağlık Bilimleri Enstitüsü.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Rasit Durusoy Kan Bankası.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Hemotoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; 0000-0001-7288-3250; 0000-0001-5334-7911; 0000-0001-8850-0269; 0000-0002-8856-7356; 0000-0003-1785-3539; 0000-0001-7530-1279; 0000-0001-7625-9148; 0000-0003-0463-6818; KHE-5423-2024; AAU-8952-2020; HKN-2347-2023; JGM-6601-2023; JFS-2013-2023; AAG-7381-2021; K-7285-2012; IZP-9398-2023; F-4657-2014; JWP-2738-2024; GYL-2038-2022; DWR-5356-2022; CXY-4200-2022; CPT-2053-2022; GDP-0005-2022; AAG-8459-2021; FQJ-3657-2022; FQG-8981-2022Publication Insight into pain syndromes in acute phase of mild-to-moderate covid-19: Frequency, clinical characteristics, and associated factors(Wiley, 2021-10-26) Karli, Necdet; KARLI, HAMDİ NECDET; Gullu, Gizem; GÜLLÜ, GİZEM; Kilic, Erhan; KILIÇ, ERHAN; Dinc, Yasemin; DİNÇ, YASEMİN; Ursavas, Ahmet; URSAVAŞ, AHMET; Yilmaz, Emel; YILMAZ, EMEL; Zarifoglu, Mehmet; ZARİFOĞLU, MEHMET; Bursa Uludağ Üniversitesi/Tıp Fakültesi.; 0000-0002-3894-1231; IUQ-6999-2023; AAI-3169-2021; IZQ-0662-2023; AAD-1271-2019Background Pain has been frequently described as a clinical feature of COVID-19, and the main pain syndromes that have been associated with the acute phase of this disease so far are headache, myalgia, arthralgia, and neuropathic pain. Understanding the characteristics of pain symptoms is crucial for a better clinical approach. Methods Patients who were diagnosed as having COVID-19 using reverse transcription-polymerase chain reaction were included in the study. Patients were asked to complete a 51-item questionnaire via a phone interview, which included questions on demographics, acute COVID-19 symptoms, the presence of pain symptoms, and their characteristics in the acute phase of COVID-19. Results A total of 222 out of 266 patients with COVID-19 participated in the study, yielding a response rate of 83.5%. A total of 159 patients reported at least one kind of pain syndrome with a prevalence of 71.6%. Myalgia was reported in 110 (49.6%) patients, headache in 109 (49.1%), neuropathic pain symptoms in 55 (24.8%), and polyarthralgia in 30 (13.5%) patients. A total of 66 patients reported only one type of pain, 46 reported two types, 42 reported three types, and five patients reported all four types of pain. Logistic regression analysis showed that there were significant associations between these pain syndromes and a strong association was found between neuropathic pain and headache. Conclusion Pain is a frequently observed symptom of mild-to-moderate COVID-19. There are significant relationships between pain syndromes in COVID-19, which may be due to a sequence of common etiologic factors. Significance This study described the main pain syndromes associated acute phase of mild-to-moderate COVID-19 and its associated features. Headaches and pain of neuropathic characteristics were prevalent in this sample.Publication Conventional culture and molecular screening methods for detection of vancomycin-resistant enterococci activity(Carbone Editore, 2016-01-01) Karakecili, Faruk; Cilo, Burcu Dalyan; Akın, Hicran; Ağca, Harun; Sınırtaş, Melda; Özakın, Cüneyt; Yılmaz, Emel; Akalın, Halis; Cilo, Burcu Dalyan; Akın, Hicran; AĞCA, HARUN; Sınırtaş, Melda; ÖZAKIN, CÜNEYT; YILMAZ, EMEL; AKALIN, EMİN HALİS; Uludağ Üniversitesi/Tıp Fakültesi/Microbiooji Bölümü; 0000-0002-7368-7187; 0000-0002-2651-2034; 0000-0002-3894-1231; 0000-0001-7530-1279; IVV-5845-2023; AAH-4027-2021; AAU-8952-2020; AAG-8392-2021; ISU-9626-2023Introduction: Early identification of vancomycin-resistant enterococci (VRE) colonization by screening patients is necessary in tends of preventing spread and development of infection. The purpose of this study was to investigate the presence of VRE using and real time polymerase chain reaction (RT-PCR) and to compare the results and costs.Materials and methods: Patients in the risk group attending our hospital and planned for treatment with hospitalization were included. Two rectal swab specimens were taken. One swab specimen was inoculated into enterococci broth for CCSM. Resistant gene investigation was performed with the other specimen by using RT-PCR. The costs of the two methods were then compared.Results: VRE were detected in 75 (6.63%) of the 1130 patients screened using the two methods. Resistance gene was determined in 69 (6.1%) patients using RT-PCR and 32 (2.8%) with CCSM. RT-PCR results were negative in 6 patients with VRE growth determined using CCSM. VRE was detected with CCSM in all 26 patients in whom vanA genotype VRE were determined using RT-PCR, but no growth was determined with CCSM in any of the 43 patients in whom vanB genotype VRE were detected. Results obtained in 3 days using CCSM and within 4 hours using RT-PCR. Costs were 58 $ with CCSM and 46 $ with RT-PCR.Conclusion: VRE colonization being detected faster with RT-PCR than CCSM. When the costs in isolation of patients until VRE screening test results emerged were compared, VRE screening with RT-PCR was cost-effective. RT-PCR was markedly superior to CCSM in determining VanB type resistance. Due to the late results from CCSM and its failure to detect VanB type resistance, we think that RT-PCR can be an alternative to CCSM or that the two techniques can usefully be combined depending on the hospital conditions.Publication Orbital tuberculosis: Two patients(Türk Oftalmoloji Derneği, 2005-11-01) Yazıcı, Bülent; Aygül, Feray; Yılmaz, Emel; Yazıcı, Bülent; Aygül, Feray; YILMAZ, EMEL; Uludağ Üniversitesi/Tıp Fakültesi/Göz Hastalıkları Anabilim Dalı; Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları Anabilim Dalı; 0000-0001-8889-1933; AAA-5384-2020; HTL-9425-2023; JPZ-0738-2023Purpose: To report two patients with orbital tuberculosis.Methods: The records of two patients treated at our institution were reviewed.Results: Both patients were male; their ages were 18 and 29 years. The presenting symptoms were proptosis in one patient and swelling in the eyelid and brow regions in the other. The radiological investigation showed a mass lesion, located in the intraconal region in the first patient and located in the orbita-frontal region in the other. We performed surgical excision and biopsy in both patients. The diagnosis was made through the histopathological examination, demonstrating granulomatosis inflammation associated with caseificatin necrosis; the results of the bacteriological examination was negative. No other focus of tuberculosis was determined. The patients received a multi-drug anti-tuberculosis treatment for 11 and 8 months. No recurrence or systemic involvement developed in the patients who were followed-up 39 and 22 months after treatment.Discussion: Tuberculosis should be considered in the differential diagnosis of the space occupying lesions of the orbit.Publication The diagnostic utility of the "Thwaites' system" and "lancet consensus scoring system" in tuberculous vs. non-tuberculous subacute and chronic meningitis: multicenter analysis of 395 adult patients(Bmc, 2020-10-23) Sulaiman, Tarek; Medi, Sai; Erdem, Hakan; Şenbayrak, Seniha; Öztürk-Engin, Derya; İnan, Asuman; Civljak, Rok; Nechifor, Mihai; Akbulut, Ayhan; Crisan, Alexandru; Özgüler, Müge; Namiduru, Mustafa; Savic, Branislava; Dulovic, Olga; Pehlivanoğlu, Filiz; Şengöz, Gönül; Yaşar, Kadriye; İnal, Ayşe Seza; Parlak, Emine; Johansen, Işık Somuncu; Kurşun, Ebru; Parlak, Mehmet; Yılmaz, Emel; Yılmaz, Gülden; Gül, Hanefi Cem; Öncül, Oral; Simeon, Soline; Tattevin, Pierre; Ulu-Kılıç, Ayşegül; Alabay, Selma; Beovic, Bojana; Catroux, Melanie; Hansmann, Yves; Harxhi, Arjan; Şener, Alper; Özkaya, Hacer Deniz; Cağ, Yasemin; Agalar, Canan; Vahaboğlu, Haluk; Uğur, Berna Kaya; Hasbun, Rodrigo; YILMAZ, EMEL; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; HJZ-6992-2023Background Tuberculous meningitis (TBM) represents a diagnostic and management challenge to clinicians. The "Thwaites' system" and "Lancet consensus scoring system" are utilized to differentiate TBM from bacterial meningitis but their utility in subacute and chronic meningitis where TBM is an important consideration is unknown. Methods A multicenter retrospective study of adults with subacute and chronic meningitis, defined by symptoms greater than 5 days and less than 30 days for subacute meningitis (SAM) and greater than 30 days for chronic meningitis (CM). The "Thwaites' system" and "Lancet consensus scoring system" scores and the diagnostic accuracy by sensitivity, specificity, and area under the curve of receiver operating curve (AUC-ROC) were calculated. The "Thwaites' system" and "Lancet consensus scoring system" suggest a high probability of TBM with scores <= 4, and with scores of >= 12, respectively. Results A total of 395 patients were identified; 313 (79.2%) had subacute and 82 (20.8%) with chronic meningitis. Patients with chronic meningitis were more likely caused by tuberculosis and had higher rates of HIV infection (P < 0.001). A total of 162 patients with TBM and 233 patients with non-TBM had unknown (140, 60.1%), fungal (41, 17.6%), viral (29, 12.4%), miscellaneous (16, 6.7%), and bacterial (7, 3.0%) etiologies. TMB patients were older and presented with lower Glasgow coma scores, lower CSF glucose and higher CSF protein (P < 0.001). Both criteria were able to distinguish TBM from bacterial meningitis; only the Lancet score was able to differentiate TBM from fungal, viral, and unknown etiologies even though significant overlap occurred between the etiologies (P < .001). Both criteria showed poor diagnostic accuracy to distinguish TBM from non-TBM etiologies (AUC-ROC was <. 5), but Lancet consensus scoring system was fair in diagnosing TBM (AUC-ROC was .738), sensitivity of 50%, and specificity of 89.3%. Conclusion Both criteria can be helpful in distinguishing TBM from bacterial meningitis, but only the Lancet consensus scoring system can help differentiate TBM from meningitis caused by fungal, viral and unknown etiologies even though significant overlap occurs and the overall diagnostic accuracy of both criteria were either poor or fair.Publication Fatal pneumococcal purpura fulminans in an asplenic patient(Doc Design Informatics Co Ltd, 2008-08-01) Kahveci, Ferda; Kuruefe, Necmi Riza; KELEBEK GİRGİN, NERMİN; Kelebek-Girgin, Nermin; Akalin, Halis; Yılmaz, Emel; YILMAZ, EMEL; AKALIN, EMİN HALİS; Özcan, Berin; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Klinik Mikrobiyoloji Anabilim; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anestezi ve Reanimasyon Anabilim; 0000-0001-7530-1279; AAU-8952-2020Splenectomized patients are at an increased risk of serious infection with encapsulated bacteria such as Streptococcus pneumoniae. Purpura fulminans is a rare complication of Streptococcus pneumoniae infections, and occurs with acute onset characterized by cutaneous ecchymoses, symmetrical gangrene of the extremities, renal failure and disseminated intravascular coagulation. A 41-year-old woman admitted to the emergency department with shivering, high fever and sore throat persisting for 2 days. It was learned that she had had a splenectomy 30 years ago and she was not regularly vaccinated with pneumococcal vaccine. After taking blood cultures, treatment with intravenous antibiotic was started. Within a short time, haemorrhagic and ecchimotic rashes occurred on her face and were spread throughout the body. Her condition rapidly deteriorated and she died within 36 hours. Streptococcus pneumoniae was identified in her blood culture.Publication Macrophage polarization capacity of peripheral blood monocytes and monocytic cell line THP-1 in response to secreted factors from COVID-19 patients(Wiley, 2021-08-01) Etgü, Onur; Karaçay, Mehmet; Dombaz, Fatma; Kızmaz, Muhammed Ali; Şimsek, Abdurrahman; Asan, Ali; Yılmaz, Emel; Kazak, Esra; Pınar, İbrahim Ethem; Bal, Salih Haldün; Özkocaman, Vildan; Özkalemkaş, Fahir; Akalın, Emin Halis; Budak, Ferah; Oral, Haluk Barbaros; Ermiş, Diğdem Yöyen; Etgü, Onur; Karaçay, Mehmet; Dombaz, Fatma; Kızmaz, Muhammed Ali; ŞİMŞEK, ABDURRAHMAN; YILMAZ, EMEL; KAZAK, ESRA; PINAR, İBRAHİM ETHEM; BAL, SALİH HALDUN; ÖZKOCAMAN, VİLDAN; ÖZKALEMKAŞ, FAHİR; AKALIN, EMİN HALİS; BUDAK, FERAH; ORAL, HALUK BARBAROS; YÖYEN ERMİŞ, DİĞDEM; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İmmünoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Temel Tıp Bilimleri Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Dr Raşit Durusoy Kan Bankası.; 0000-0001-7288-3250; 0000-0001-5334-7911; 0000-0001-8850-0269; 0000-0002-8856-7356; 0000-0003-1785-3539; 0000-0001-9907-1498; 0000-0001-7530-1279; 0000-0001-7625-9148; 0000-0003-0463-6818; JIJ-1849-2023; JHB-7829-2023; DWR-5356-2022; HKN-2347-2023; AAG-7381-2021; GDP-0005-2022; AAG-8459-2021; JGM-6601-2023; KBR-5535-2024; FQG-8981-2022; JIW-1248-2023; AAU-8952-2020; IZP-9398-2023; K-7285-2012; GYL-2038-2022Publication Prognostic factors for COVID-19 patients(J Infection Developing Countries, 2022-03-01) Önal, Uğur; Güçlü, Özge Aydın; Akalın, Halis; Öztürk, Nilüfer Aylin Acet; Semet, Cihan; Demirdoğen, Ezgi; Dilektaşlı, Aslı Görek; Sağlık, İmran; Kazak, Esra; Özkaya, Güven; Coşkun, Funda; Ediger, Dane; Heper, Yasemin; Ursavaş, Ahmet; Yılmaz, Emel; Uzaslan, Esra; Karadağ, Mehmet; ÖNAL, UĞUR; AYDIN GÜÇLÜ, ÖZGE; AKALIN, EMİN HALİS; ACET ÖZTÜRK, NİLÜFER AYLİN; SEMET, CİHAN; DEMİRDÖĞEN, EZGİ; GÖREK DİLEKTAŞLI, ASLI; SAĞLIK, İMRAN; KAZAK, ESRA; ÖZKAYA, GÜVEN; COŞKUN, NECMİYE FUNDA; EDİGER, DANE; HEPER, YASEMİN; URSAVAŞ, AHMET; YILMAZ, EMEL; UZASLAN, AYŞE ESRA; KARADAĞ, MEHMET; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Göğüs Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; 0000-0001-6194-3254; 0000-0003-1005-3205; 0000-0001-7530-1279; 0000-0002-6375-1472; 0000-0002-7400-9089; 0000-0001-7099-9647; 0000-0003-0864-4989; 0000-0003-0297-846X; 0000-0003-3604-8826; 0000-0002-2954-4293; 0000-0002-3894-1231; 0000-0002-9027-1132; A-4421-2016; AAG-8459-2021; GCM-3391-2022; DTT-7416-2022; AAH-9812-2021; AEA-4817-2022; Z-1424-2019; AAU-8952-2020; AAG-9930-2019; ACQ-7832-2022; AAD-1271-2019; AAE-9142-2019; CTY-9474-2022; AAI-3169-2021; HJZ-6992-2023; CDI-1977-2022; AAG-8744-2021Introduction: Determining prognostic factors in patients with coronavirus disease (COVID-19) can have great impact on treatment planning and follow-up strategies. Herein, we aimed to evaluate prognostic factors and clinical scores for confirmed COVID-19 patients in a tertiary care hospital in the Bursa region of Turkey. Methodology: Patients who had been diagnosed with COVID-19 microbiologically and/or radiologically between March and October 2020 in a tertiary-care university hospital were enrolled retrospectively. Adult patients (>= 18 years) with a clinical spectrum of moderate, severe, or critical illness were included. The dependent variable was 30-day mortality and logistic regression analysis was used to evaluate any variables with a significant p value (< 0.05) in univariate analysis. Results: A total of 257 patients were included in the study. The mortality rate (30-day) was 14.4%. In logistic regression analysis, higher scores on sequential organ failure assessment (SOFA) (p < 0.001, odds ratio (OR) = 1.86, 95% CI = 1.42-2.45) and CURB-65 pneumonia severity criteria (p = 0.001, OR = 2.60, 95% CI = 1.47-4.57) were found to be significant in predicting mortality at admission. In deceased patients, there were also significant differences between the baseline, day-3, day-7, and day-14 results of D-dimer (p = 0.01), ferritin (p = 0.042), leukocyte (p = 0.019), and neutrophil (p = 0.007) counts. Conclusions: In our study of COVID-19 patients, we found that high SOFA and CURB-65 scores on admission were associated with increased mortality. In addition, D-dimer, ferritin, leukocyte and neutrophil counts significantly increased after admission in patients who died.Publication Experience of pandemic influenza A (H1N1) 2009(Aves, 2012-12-01) Kebabçı, Nesrin; Akalın, Halis; Bölük, Gülçin; Oğuz-Ayarcı, Ayşe; Kazak, Esra; Topal, Uğur; Yorulmaz, Hakan; Akköse, Şule; Özvatan-Şener, Tülay; Aslan, Emel; Köprücüoğlu, Duygu; Heper, Yasemin; Yılmaz, Emel; Kahveci, Ferda; Mıstık, Reşit; Helvacı, Safiye; Kebabçı, Nesrin; AKALIN, EMİN HALİS; Bölük, Gülçin; Oğuz-Ayarcı, Ayşe; KAZAK, ESRA; Topal, Uğur; Yorulmaz, Hakan; Akköse, Şule; Özvatan-Şener, Tülay; Aslan, Emel; Köprücüoğlu, Duygu; HEPER, YASEMİN; YILMAZ, EMEL; KAHVECİ, FERDA ŞÖHRET; Mıstık, Reşit; Helvacı, Safiye; Uludağ Üniversitesi/Tıp Fakültesi/İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Göğüs Hastalıkları Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; 0000-0001-7530-1279; 0000-0002-3894-1231; 0000-0003-4820-2288; FCW-3335-2022; AAU-8952-2020; KFT-0453-2024; FOZ-1105-2022; AAG-8459-2021; JLP-0593-2023; EIO-1059-2022; EJV-1316-2022; FQE-4671-2022; EJJ-4181-2022; FGO-0266-2022; AAH-6506-2021; HJZ-6992-2023; AAG-9356-2021; DFY-3761-2022; EXQ-2687-2022Objective: Pandemic influenza A (H1N1) 2009 first appeared in April, 2009 in Mexico and affected the entire world. The objective of this study is to analyze epidemiological, clinical and laboratory findings of probable or confirmed pandemic inluenza A (H1N1) 2009 adult cases who were admitted to our clinic.Methods: Eighty-five patients with pandemic influenza A (H1N1) 2009 admitted to Uludag University Hospital between November 3, 2009 and January 22, 2010 were retrospectively evaluated.Results: Of the 85 cases, 44 (51.8%) were females and 41 (48.2%) were males. The median age was 33 (17-82). 16 of cases (18.8%) were assessed as accurate, and 69 (81.2%) as probable cases of influenza. Pneumonia was diagnosed in 17 (20%) patients by evaluating clinical findings and chest X-ray. Eleven of the cases were treated in the Intensive Care Unit. Seventy-one (83.5%) of the cases were treated by oseltamivir. Mean duration of treatment was 10 days. The mortality rate of the cases was 4.7%.Conclusions: Pandemic influenza A (H1N1) 2009 perpetuates its epidemic potential as in the past years. The disease is frequently accompanied by pneumonia during its course.
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