Study presence of COVID-19 (SARS-CoV-2) in the sweat of patients infected with Covid-19

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease, which started in Wuhan, Chin, has now become a public health challenge in most countries around the world. Proper preventive measures are necessary to prevent the spread of the virus to help control the pandemic. Because, SARS-CoV-2 is new, its transmission route has not been fully understood. In this study, we aimed to investigate the presence of SARS-CoV-2 in the sweat secretion of COVID-19 patients. Sweat specimens of 25 COVID- 19 patients were collected and tested for SARS-CoV-2 RNA by Real-time Polymerase Chain Reaction (RT-PCR) method. After RNA extraction and cDNA amplification, all samples were examined for the presence of ORF-1ab and N genes related to COVID-19. Results annotated by Realtime PCR machines software based on Dynamic algorithm. The results of this study showed the absence of SARS-CoV-2 in the sweat samples taken from the foreheads of infected people. Therefore, it can be concluded that the sweat of patients with COVID- 19 cannot transmit SARS-CoV-2. However they can be easily contaminated with other body liquids.

Evaluation of the diagnostic validity of noninvasive tests for predicting liver fibrosis stage in chronic hepatitis B patients

BACKGROUND AND STUDY AIM

The aim of this study was to evaluate the effectiveness of noninvasive tests in predicting liver fibrosis levels in chronic hepatitis B (CHB) patients.

PATIENTS AND METHODS

A total of 539 treatment naive patients aged 18 years and older with CHB who underwent liver biopsy were included. Patients with coinfections and comorbidities were excluded. Data were obtained retrospectively from patient' follow- up files. Liver biopsy was evaluated according to the Ishak scoring system. SPSS 22.0 program was used for statistical analysis. Diagnostic sensitivity of APRI, FIB-4, NLR, GPR, AAR, RPR, API, King's score, Fibro Q and MPV was determined for predicting ≥F2, ≥F3, ≥F4, ≥F5 groups.

RESULTS

The median age of the CHB patients was 41 ±11.57 / year and 49.2% of the patients were female. The distribution of fibrosis stages was : F0, 16.5% ; F1, 26.4% ; F2, 39.7% ; F3, 10.4% ; F4, 4.1% ; F5, 2.4% ; F6 0.4%. Age, AST, ALT, GGT, ALP, RDW, HBV DNA levels were significantly higher, platelet and albumin levels were significantly lower in the ≥F3 group. All noninvasive tests except NLR and AAR predicted ≥F3 adequately (AUROC >0.5). King's score for predicting ≥F2, ≥F5, and GPR for predicting ≥F3 had the highest diagnostic power. The tests predicted the fibrosis stage better, as the fibrosis stage progressed.

CONCLUSION

As a result, most of the noninvasive tests we evaluated could predict significant fibrosis and cirrhosis with significant accuracy. The rate of unnecessary biopsies can be reduced with the help of these noninvasive tests.

Treatment cost of HIV/AIDS in Turkey

Purpose

The purpose of this study is to estimate the average cost of treatment and investigate the related parameters of HIV/AIDS among patients based on their annual treatment regime during the 2017 in Izmir.

Design/methodology/approach

The average annual direct cost of an HIV patient's treatment was estimated for 2017 at four university hospitals in a retrospective study in Izmir, Turkey. Inclusion criteria included confirmed HIV infection, age = 18 years, visited one of the hospitals at least three times a year and with at least one CD4+ T cell count. The average annual treatment cost per patient was calculated using accounting data for 527 patients from the hospitals' electronic databases.

Findings

The mean treatment cost per patient was US$4,381.93. Costs for treatment and care were statistically significantly higher (US$5,970.55) for patients with CD4+ T cell counts of fewer than 200 cells/mm3 than for other patients with CD4+ T cell counts above 200 cells/mm3. The mean treatment cost for patients who were 50 years old or older (US$4,904.24) was statistically significantly higher than for those younger than 50 years (US$4,216.10). The mean treatment cost for female patients (US$4,624.92) was higher than that of male patients ($US4,339.72), although the difference was not statistically significant. The main cost driver was antiretroviral treatment (US$3,852.38 per patient), accounting for almost 88% of all costs. However, the high burden of antiretroviral treatment cost is counterbalanced by relatively low care and hospitalization costs in Turkey.

Originality/value

The paper contributes to the literature by providing average annual treatment cost of an HIV-infected patient in Turkey by using a comprehensive bottom up approach. Moreover, cost drivers of HIV treatment are investigated.

How CRISPR-Cas System Could Be Used to Combat Antimicrobial Resistance

Rapid emergence of antibiotic-resistant bacteria has made it harder for us to combat infectious diseases and to develop new antibiotics. The clustered regularly interspaced short palindromic repeats - CRISPR-associated (CRISPR-Cas) system, as a bacterial adaptive immune system, is recognized as one of the new strategies for controlling antibiotic-resistant strains. The programmable Cas nuclease of this system used against bacterial genomic sequences could be lethal or could help reduce resistance of bacteria to antibiotics. Therefore, this study aims to review using the CRISPR-Cas system to promote sensitizing bacteria to antibiotics. We envision that CRISPR-Cas approaches may open novel ways for the development of smart antibiotics, which could eliminate multidrug-resistant (MDR) pathogens and differentiate between beneficial and pathogenic microorganisms. These systems can be exploited to quantitatively and selectively eliminate individual bacterial strains based on a sequence-specific manner, creating opportunities in the treatment of MDR infections, the study of microbial consortia, and the control of industrial fermentation.

Protection and disinfection policies against SARS-CoV-2 (COVID-19)

In late December 2019, reports from China of the incidence of pneumonia with unknown etiology were sent to the World Health Organization (WHO). Shortly afterwards, the cause of this disease was identified as the novel beta-coronavirus, SARS-CoV-2, and its genetic sequence was published on January 12, 2020. Human-to-human transmission via respiratory droplets and contact with aerosol infected surfaces are the major ways of transmitting this virus. Here we attempted to collect information on virus stability in the air and on surfaces and ways of preventing of SARS-CoV-2 spreading.

Clinical manifestation, diagnosis, prevention and control of SARS-CoV-2 (COVID-19) during the outbreak period

The novel coronavirus SARS-CoV-2 (Covid-19), spreading from Wuhan, China, is one of the causes of respiratory infections that can spread to other people through respiratory particles, and can cause symptoms such as fever, dry cough, shortness of breath, anorexia, fatigue and sore throat in infected patients. This review summarizes current strategies on the diagnosis. Additionally, treatments, infection prevention and control of the SARS-CoV-2 are addressed. In addition to the respiratory system, this virus can infect the digestive system, the urinary system and the haematological system, which causes to observe the virus in the stool, urine and blood samples in addition to throat sample. The SARS-CoV-2 causes changes in blood cells and factors and makes lung abnormalities in patients, which can be detected by serological, molecular, and radiological techniques by detecting these changes and injuries. Radiological and serological methods are the most preferred among the other methods and the radiological method is the most preferred one which can diagnose the infection quickly and accurately with fewer false-negatives, that can be effective in protecting the patient's life by initiating treatment and preventing the transmission of infection to other people.

Response to direct-acting antiviral agents in chronic hepatitis C patients with end-stage renal disease: a clinical experience

OBJECTIVE

The recent development of direct-acting antiviral agents (DAAs) has dramatically changed the treatment of chronic hepatitis C, and interferon-based regimes have become a poor treatment choice in clinical practice. Today DAAs offer shorter, well-tolerated, highly effective curative therapies. This study aimed to evaluate the effectiveness and safety of DAAs in patients with end-stage renal disease and HCV genotype 1 infection in real clinical practice.

METHODS

Thirty-six patients who attended our clinic, were diagnosed with chronic hepatitis C (CHC), undergoing hemodialysis, and fulfilled the criteria of age >18 years, genotype 1 infection, with a detectable HCV RNA level were considered for the study. Patients with GT1a infection received OBV/PTV/r plus DSV plus RBV for 12 weeks; GT1b infected patients received this regimen without RBV for 12 weeks.

RESULTS

The study was conducted on 33 patients. The mean age was 52.30 ±13.77 years, and 70 % of them were male. By the fourth week of treatment, HCV RNA levels decreased below 15 IU/ml in all patients. Sustained virologic response (SVR) 12 rate was 100%. Nine patients had side effects during treatment. Of the patients with side effects, 89.9% were in group 1a and 11.1% in group 1b.

CONCLUSION

In this study, treatment with OBV/PTV/r and DSV with or without RBV resulted in high rates of sustained virologic response in HCV GT1-infected patients with end-stage renal disease (ESRD). SVR was achieved in all patients with few side effects.

Long-Term Effects of Tenofovir on Liver Histopathology in Patients with Chronic Viral Hepatitis B Infection

OBJECTIVE

The aim of this study to evaluate histopathological improvement and virological, serological and biochemical response rates in patients with chronic hepatitis B (CHB) who were treated with tenofovir disoproxil fumarate (TDF).

MATERIAL AND METHOD

A total of 91 nucleosid(t)e-naive CHB patients who received TDF were evaluated. Virological, serological and biochemical test results were assessed at baseline and every 12 weeks. Liver biopsy specimens were assessed according to the modified Ishak scoring.

RESULTS

The study was conducted on 52 patients. The mean age was 40±10 years and 40.4% were female. The mean follow-up period was 33±11 months. HBsAg seroclearance occurred in none of the patients. The serum level of HBV-DNA became undetectable in 94.2% of the patients. Mean histological activity index at baseline and on-treatment were 8.2±2.3 and 6.2±2.0 and the mean fibrosis scores were 2.65±1.3 and 2.33±1.1, respectively.

CONCLUSION

We determined that TDF therapy provided remarkably good HBV DNA suppression and biochemical response rates, but low seroconversion. Improvement of liver necroinflammation was detected, but no significant change observed in fibrosis.

Efficacy of tenofovir and entecavir in patients who relapsed after pegylated interferon therapy

Hepatitis B virus (HBV) infections and sequelae present significant health problems worldwide. Two groups of medications are available for chronic HBV infection treatment: (1) interferons (IFNs) and (2) nucleos(t)ide analogues. This study aimed to evaluate entecavir (ETV) and tenofovir disoproxil fumarate (TDF) efficacies in chronic HBV patients, who achieved virological response during Peg-IFN treatment but did not sustain this response and relapsed a year after treatment end. In this study, 74 patients with chronic HBV infection who had virological responses to 180 μg/week Peg-IFNα-2a treatment were included; 38 (20 and 18 HBeAg positive and negative, respectively) of these patients were treated with 245 mg/day TDF, and 36 (20 and 16 HBeAg positive and negative, respectively) were treated with 0.5 mg/day ETV upon relapse after initial treatment discontinuation. In HBeAg-positive patients biochemical response rates were higher for TDF at weeks 96 and 144 (p = 0.044 and 0.019, respectively). However, biochemical response rates were similar for TDF and ETV in HBeAg-positive and HBeAg-negative groups at other weeks (p > 0.05). Virological and serological response rates were similar in patients treated with TDF and ETV in HBeAg-positive and HBeAg-negative groups (p > 0.05).

Seroprevalence of measles, mumps, rubella, and varicella zoster virus antibodies among healthcare students: analysis of vaccine efficacy and cost-effectiveness

OBJECTIVE

The aims of this study are to determine the seroprevalence for measles, mumps, rubella, and varicella zoster virus (VZV) in a cohort of nursing students, to evaluate vaccination response rates of nonimmune students, and to calculate the cost of vaccinating students based on seroprevalence screening.

METHODS

A cross-sectional study was conducted August 2015-November 2016 among 326 healthy nursing students aged 14.1-18.1 years. Serum IgG antibodies were measured by ELISA. Results were analyzed by the Chi-square test; a p-value of < 0.05 was considered statistically significant.

RESULTS

The number of seropositive participants (%) was 308 (94.5%) for rubella, 295 (90.5%) for VZV, 244 (74.9%) for measles, and 219 (67.2%) for mumps. A significant correlation was found between measles IgG and age. A relationship was also observed between VZV IgG and kindergarten attendance. Response rates to measles, rubella, VZV, and mumps vaccination were 96%, 92.3%, 87.5%, 78.8%, respectively. The total cost of vaccination after IgG screening was less than vaccination without screening.

CONCLUSIONS

In this study, participants' immunity to measles and VZV was low. Prevaccination serological screening was cost-effectiveness method for preventing measles, mumps, rubella, and varicella infections. We believe that administering booster measles, mumps, and rubella (MMR) vaccine doses or developing a special MMR vaccination strategy for at-risk groups may prevent MMR outbreaks.

[Investigation of bacterial and viral etiology in community acquired central nervous system infections with molecular methods]

In this multicenter prospective cohort study, it was aimed to evaluate the bacterial and viral etiology in community-acquired central nervous system infections by standart bacteriological culture and multiplex polymerase chain reaction (PCR) methods. Patients hospitalized with central nervous system infections between April 2012 and February 2014 were enrolled in the study. Demographic and clinical information of the patients were collected prospectively. Cerebrospinal fluid (CSF) samples of the patients were examined by standart bacteriological culture methods, bacterial multiplex PCR (Seeplex meningitis-B ACE Detection (Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Listeria monocytogenes, Group B streptococci) and viral multiplex PCR (Seeplex meningitis-V1 ACE Detection kits herpes simplex virus-1 (HSV1), herpes simplex virus-2 (HSV2), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein Barr virus (EBV) and human herpes virus 6 (HHV6)) (Seeplex meningitis-V2 ACE Detection kit (enteroviruses)). Patients were classified as purulent meningitis, aseptic meningitis and encephalitis according to their clinical, CSF (leukocyte level, predominant cell type, protein and glucose (blood/CSF) levels) and cranial imaging results. Patients who were infected with a pathogen other than the detection of the kit or diagnosed as chronic meningitis and other diseases during the follow up, were excluded from the study. A total of 79 patients (28 female, 51 male, aged 42.1 ± 18.5) fulfilled the study inclusion criteria. A total of 46 patients were classified in purulent meningitis group whereas 33 were in aseptic meningitis/encephalitis group. Pathogens were detected by multiplex PCR in 41 patients. CSF cultures were positive in 10 (21.7%) patients (nine S.pneumoniae, one H.influenzae) and PCR were positive for 27 (58.6%) patients in purulent meningitis group. In this group one type of bacteria were detected in 18 patients (14 S.pneumoniae, two N.meningitidis, one H.influenzae, one L.monocytogenes). Besides, it is noteworthy that multiple pathogens were detected such as bacteria-virus combination in eight patients and two different bacteria in one patient. In the aseptic meningitis/encephalitis group, pathogens were detected in 14 out of 33 patients; single type of viruses in 11 patients (seven enterovirus, two HSV1, one HSV2, one VZV) and two different viruses were determined in three patients. These data suggest that multiplex PCR methods may increase the isolation rate of pathogens in central nervous system infections. Existence of mixed pathogen growth is remarkable in our study. Further studies are needed for the clinical relevance of this result.

An evaluation of the effect of ertapenem in rats with sepsis created by cecal ligation and puncture

BACKGROUND

Intra-abdominal adhesions are still a major problem which is expected to be reduced by the provision of bacterial decontamination. Various antibiotics have been used to prevent the formation of adhesion in the septic abdomen. This study aims to investigate the efficacy of ertapenem in sepsis of rats induced by cecal ligation and puncture.

METHODS

Twenty-eight Wistar rats were divided into four groups randomly. In all groups, bacterial peritonitis was created by cecal ligation and puncture method. Group 1 was considered as sham group. Groups 2, 3 and 4 were given, respectively, saline, a single dose of ertapenem and a dose of ertapenem intraperitoneally every day. Intra-abdominal adhesions were assessed seven days after surgery by histopathological examination. Microbiological examination was performed through the ascites obtained. TNF-α was measured from blood taken from rats.

RESULTS

Adhesion score decreased significantly by the application of ertapenem (p<0.001) and fibrosis scores were found to be significantly lower (p=0.005). Among all groups, the relationship between the decrease in the number of colonies and antibiotics application was not statistically significant (p=0.109). No statistically significant difference was found between the group given a single dose of ertapenem and the group given multiple ertapenem (p=1).

CONCLUSION

Peritoneal lavage with ertapenem appears to be effective in preventing the adhesion in the septic abdomen. As no difference was detected at the end of a single dose and multiple-dose administration of antibiotics in the adhesion scores, a single dose after surgery seems to be enough. The findings suggest that the results should be evaluated in a clinical trial.

Hepatitis A, B, C and HIV seroprevalence among Syrian refugee children admitted to outpatient clinics

Viral hepatitis is the most common cause of serious health problems such as liver cirrhosis and hepatocellular carcinoma (HCC). Leading to immunodeficiency disorders through different mechanisms, Human Immunodeficiency Virus (HIV) causes the development of severe secondary infections. Hepatitis A (HAV) is thought to spread by the faecal-oral route, while Hepatitis B (HBV), Hepatitis C (HCV) and HIV are mostly transmitted vertically during childhood. In our study, we aimed to determine the seroprevalence of HAV, HBV, HCV and HIV among Syrian refugee children who were admitted to outpatient clinics. We conducted a retrospective review of data concerning 171 Syrian children aged between 0-18 years admitted between April 2014 and December 2015 to the outpatient infectious disease clinic of ?zmir Tepecik Training and Research Hospital and the social welfare outpatient clinic for Syrian refugees for reasons other than jaundice. Serum samples from patients were studied for HAV antibody IgG (anti-HAV IgG), HBV surface antigen (HBsAg), antibodies against HBV surface antigen (anti-HBs), antibodies against HBV core antigen (anti-HBc total), HCV antibody (anti-HCV) (anti-HIV) with the ELISA (Enzyme-Linked Immunosorbent Assay) method. In this study 51% of patients were female, with a mean age of 6.52 years among all patients. Six of the 140 patients (4.2%) scanned for HBV among the patients enrolled in the study were HBsAg and anti-HBc total positive and anti-HBs negative. Three patients (2.1%) were HBsAg negative, and anti-HBc total and anti-HBs positive, which indicated they had previously recovered from an HBV infection. HBsAg, anti-HBs, anti-HBc total data for 140 patients (81.9%), anti-HCV data for 109 patients (63.8%), anti-HIV data for 88 patients (51.5%) and HAV IgG data for 86 patients (50.3%) were obtained. Due to migration from regions in Syria where there is no regular follow-up of HBV vaccination in children, HBsAg seroprevalence of refugee children is thought to be higher than in other children in Turkey and anti-HBs positivity is thought to be lower. We expected to see a higher seroprevalence of anti-HCV and anti-HIV in Syria due to the lack of health facilities such as non-regular anti-HCV and anti-HIV screening before blood transfusions and during pregnancy in all regions of Syria. Yet in this study, the anti-HCV, anti-HIV seroprevalence of Syrian refugee children was similar to that in Turkey. According to the results, if the children of asylum seekers are admitted to the national HAV and HBV vaccination schedule, hepatitis infections and their complications may be prevented.

A Case of Cerebral Malaria Managed by Erythrocyte Exchange

Plasmodium falciparum may cause serious and sometimes even fatal cerebral malaria. Cerebral malaria is a disease characterized by alterations in consciousness and epileptic attacks; therefore, it requires a rapid evaluation and quick intervention. It may progress to a fatal outcome despite administering targeted therapeutic interventions. There are studies indicating that erythrocyte exchange (erythrocytapheresis) can be a treatment modality for managing severe malaria patients. In this case report, the successful management of a cerebral malaria patient by the combination of antimalarial drug therapy and erythrocyte exchange is presented.

Knowledge and practice of intensive care nurses for endotracheal suctioning in a teaching hospital in western Turkey

OBJECTIVES

This study was conducted to determine intensive care nurses' knowledge and practice levels regarding open system endotracheal suctioning and to investigate if there is a relationship between nurses' demographic characteristics and their knowledge and practice.

RESEARCH METHODOLOGY/DESIGN

The study was conducted as a cross-sectional and non-participant structured observational design. Data were collected using a 45-item structured and self-administered questionnaire and a 31-item observational checklist. The study sample included 72 nurses.

SETTING

Three adult intensive care units in a teaching hospital.

RESULTS

The nurses' mean scores of knowledge and practice were 23.79±3.83 and 12.88±2.53. Their level of knowledge was very good in 59.7%, good in 34.7%, and the level of practice was fair in 79.2% and good in 18.1%. The relationship between the type of unit and the nurses' knowledge scores was statistically significant (p=0.013). The correlation between the nurses' scores of knowledge and practice was not statistically significant (r=0.220; p=0.063).

CONCLUSION

This study suggests that the knowledge level of most of the nurses was good and their practice level was fair. Intensive care nurses must perform suctioning procedures safely and effectively to ensure delivery of quality of care and eliminate complications.

Prevalence of hepatitis B and C viruses among asylum seekers in Izmir

Hepatitis B and C virus infections are known to be an important health problem all over the World. According to the data from World Health Organization, 350 million people are estimated to have been chronically infected by hepatitis B virus and 180 million people have been infected by hepatitis C virus. Most of the patients are not aware of their illnesses. Hepatitis B and C virus infections are the most common cause of sequel liver disease related to decompensate liver cirrhosis and hepatocellular carcinoma. Many people are obliged to leave their country due to political, economic and social reasons. In Turkey, where there is refugee and asylum seeker problem because of geographical location, we aimed to specify the demographic characteristics of asylum seekers in Izmir and to evaluate the asylum seekers in terms of blood-borne and sexually transmitted diseases such as hepatitis B and C.

Evaluation of Dual Therapy in Real Life Setting in Treatment-Naïve Turkish Patients with HCV Infection: A Multicenter, Retrospective Study

BACKGROUND

Before the introduction of direct-acting antivirals in the treatment of chronic hepatitis C patients, the combination of peginterferon alpha and ribavirin was the standard therapy. Observational studies that investigated sustained virological response (SVR) rates by these drugs yielded different outcomes.

AIMS

The goal of the study was to demonstrate real life data concerning SVR rate achieved by peginterferon alpha plus ribavirin in patients who were treatment-naïve.

STUDY DESIGN

A multicenter, retrospective observational study.

METHODS

The study was conducted retrospectively on 1214 treatment naïve-patients, being treated with peginterferon alpha-2a or 2b plus ribavirin in respect of the current guidelines between 2005 and 2013. The patients' data were collected from 22 centers via a standard form, which has been prepared for this study. The data included demographic and clinical characteristics (gender, age, body weight, initial Hepatitis C virus RNA (HCV RNA) level, disease staging) as well as course of treatment (duration of treatment, outcomes, discontinuations and adverse events). Renal insufficiency, decompensated liver disease, history of transplantation, immunosuppressive therapy or autoimmune liver disease were exclusion criteria for the study. Treatment efficacy was assessed according to the patient's demographic characteristics, baseline viral load, genotype, and fibrosis scores.

RESULTS

The mean age of the patients was 50.74 (±0.64) years. Most of them were infected with genotype 1 (91.8%). SVR was achieved in 761 (62.7%) patients. SVR rate was 59.1% in genotype 1, 89.4% in genotype 2, 93.8% in genotype 3, and 33.3% in genotype 4 patients. Patients with lower viral load yielded higher SVR (65.8% vs. 58.4%, p=0.09). SVR rates according to histologic severity were found to be 69.3%, 66.3%, 59.9%, 47.3%, and 45.5% in patients with fibrosis stage 0, 1, 2, 3 and 4, respectively. The predictors of SVR were male gender, genotype 2/3, age less than 45 years, low fibrosis stage, low baseline viral load and presence of early virological response. SVR rates to each peginterferon were found to be similar in genotype 1/4 although SVR rates were found to be higher for peginterferon alpha-2b in patients with genotype 2/3. The number of patients who failed to complete treatment due to adverse effects was 33 (2.7%). The number of patients failed to complete treatment due to adverse effects was 33 (2.7%).

CONCLUSION

Our findings showed that the rate of SVR to dual therapy was higher in treatment-naïve Turkish patients than that reported in randomized controlled trials. Also peginterferon alpha-2a and alpha-2b were found to be similar in terms of SVR in genotype 1 patients.

Retreatment of Chronic Hepatitis C Infection with Telaprevir: Preliminary Results in Turkey

BACKGROUND

The use of pegylated interferon alpha and ribavirin (PegIFN/RBV) for the retreatment of chronic hepatitis C virus (HCV) infection without a sustained virological response (SVR) prior to PegIFN/RBV treatment has resulted in low success rates.

AIMS

To investigate the efficacy and safety of telaprevir (TVR) in combination with PegIFN/RBV in patients infected with HCV genotypes 1 and 4 who were previously treated with PegIFN/RBV and failed to achieve SVR.

STUDY DESIGN

Multi-center, retrospective, cross-sectional study.

METHODS

The study included 111 patients: 80 prior relapsers, 25 prior null responders, and six prior partial responders to PegIFN/RBV treatment. The patients were given TVR/PegIFN/RBV for 12 weeks, followed by a 12-week PegIFN/RBV treatment; virological response results were assessed at weeks 4, 12, and 24. Treatment was discontinued in patients with HCV RNA >1000 IU/mL at week 4 or with negative RNA results at week 4 but >1000 IU/mL at week 12. Rapid virological response (RVR), early virological response (EVR), extended rapid virological response (eRVR), and virological response at 24th week of treatment were evaluated. The side effects of combination therapy and the rates of treatment discontinuation were investigated.

RESULTS

The mean age of the patients was 56.02±9.96 years and 45.9% were male. Ninety-one percent of the patients were infected with viral genotype 1, 69.6% with the interleukin (IL) 28B genotype CT and 20.2% were cirrhotic. The RVR rate was 86.3% in prior relapsers, 56% in prior null responders, and 50% in prior partial responders (p=0.002). EVR rates in those groups were 91.3%, 56%, and 83.3%, respectively (p<0.001). eRVR rates were 83.8% in prior relapsers, 48% in prior null responders, and 50% in prior partial responders (<0.001). The virological response at the 24th week of treatment was found to be the highest in prior relapsers (88.8%); it was 56% in prior null responders and 66.7% in prior partial responders (p<0.001). Common side effects were fatigue, headache, anorexia, malaise, anemia, pruritus, dry skin, rash, dyspepsia, nausea, pyrexia, stomachache, and anorectal discomfort. All treatments were discontinued due to side effects in 9.9% of patients.

CONCLUSION

High virological response rates were obtained with TVR/PegIFN/RBV treatment. Although side effects were frequently observed, the discontinuation rate of combination therapy was low.

Clinical manifestations, complications, and treatment of brucellosis: evaluation of 72 cases

AIM

Brucellosis is an important disease in developing countries. We aimed to determine the epidemiologic, clinical, and laboratory characteristics of brucellosis, which still has a high morbidity in Turkey.

MATERIALS AND METHODS

Seventy-two patients with brucellosis, monitored at our clinic from January 2004 to July 2010, were reviewed retrospectively.

RESULTS

The average age was determined to be 44.8 ± 18 years, and 40 of the patients were female (55.6%). The most frequent transmission route was the use of raw milk and dairy products, in 45 of the patients (62.5%). The most frequent complaints were joint pain, high fever, weakness, low back pain, and gastrointestinal symptoms, whereas the most frequent physical examination findings were fever, osteoarticular involvement, splenomegaly, hepatomegaly, and lymphadenopathy. All of the patients were positive for Rose Bengal testing. The standard tube agglutination titer was 1/160 or higher in 64 (88.9%) patients. Brucella melitensis was isolated from blood cultures of 13 (18.1%) patients and bone marrow cultures of 7 (9.7%) patients. Complications of sacroiliitis in 6 (8.3%), spondylodiscitis in 4 (5.6%), endocarditis in 2 (2.8%), neurobrucellosis in 1 (1.4%), and epididymo-orchitis in 1 (1.4%) of the patients were observed.

CONCLUSION

Brucellosis has various clinical presentations. It should be included in the differential diagnosis of high fever and joint pains in endemic countries.

Staphylococcal empyema secondary to IgA nephropathy

A 27-year-old male patient, applied to the emergency unit with complaints of high fever, nausea, vomiting, and hematuria. In his physical examination, fever was 38 °C with normal findings in all other systems. The laboratory values were as follows: urea 58 mg/dL, creatinine 2.4 mg/dL, white blood cell count 15.9K/μL (PNL: 79 %). In his urine analysis; +1 proteinuria and +3 hematuria were detected. Kidney biopsy was performed. Kidney biopsy interpreted in favor of IgA nephropathy. As the patient had tonic-clonic seizures, cranial CT examination was performed. In the cranial CT, there was a subdural effusion in the anterolateral area of the right cerebral hemisphere with the left shift in the midline secondary to the effusion. Empyema fluid, which was drained postoperatively, was cultured. In the direct examination of the empyema fluid, Gram positive cocci and abundant amount of PNLs were observed. There was no growth in the culture. Although the most commonly encountered agents for post-infectious glomerulonephritis are streptococcus infections, it has been reported that glomerulonephritis attacks may be rarely observed due to staphylococcus infections. Proliferative glomerulonephritis cases are rarely encountered conditions characterized by mesangial IgA accumulations secondary to staphylococcus infections.

Prevalence of allergic diseases in Izmir Province, Turkey

BACKGROUND

The aim of the present study is to determine the prevalence of allergic diseases and related risk factors in Izmir, Turkey, and to assess the positive immunoglobulin E (IgE) levels against common allergens.

METHODS

The questionnaires were completed via face-to-face interview with a total of 2937 individuals. Specific IgE was studied in the serum samples by enzyme-linked immunosorbent assay (ELISA). This cross-sectional population-based study comprised adolescents over the age of 15 years and adults of Izmir province.

RESULTS

In Izmir, the prevalence of self-reported allergy was 35.5%. Allergy was statistically significantly more common in females, university graduates, in those with high income, with family history for allergy, aged 40-49 years, those living in a flat, keeping pet(s), and in those using central heating. The prevalence of atopy according to the serum IgE levels (Class 3 with any of 3 IgEs) was found 1.6%.

CONCLUSION

In conclusion, the prevalence of atopy was found lower in Izmir as compared to the results of other studies.