Treatment initiation rates of patients with positive anti-hepatitis C virus results in tertiary hospitals in Turkey

INTRODUCTION

The aim of this national, multicenter, cross-sectional, retrospective chart review study was to determine the proportion of patients in Turkey who received hepatitis C virus (HCV) treatment after receiving positive anti-HCV results during HCV screening.

METHODOLOGY

Data related to patients' demographics, laboratory results, time interval from obtaining a positive anti-HCV result to treatment initiation, specialty of the physician requesting anti-HCV screening, and type of hospital were analyzed.

RESULTS

Among 1,000 patients who received a positive anti-HCV result, 50.3% were male and 78.5% were screened for HCV-RNA. Among HCV-RNA screened patients, 54.8% (n = 430) had a positive result. Among patients who tested positive for HCV-RNA, 72.8% received HCV treatment in line with their positive anti-HCV results. The median time from obtaining a positive anti-HCV result to initiation of HCV treatment was 91.0 days (interquartile range 42.0 to 178.5). Non-surgical branches requested HCV-RNA testing more frequently than surgical branches (p < 0.001). The rate of access to HCV treatment was higher among patients screened in university hospitals than among patients screened in training and research hospitals (p < 0.001).

CONCLUSIONS

Our results indicate a higher rate of treatment initiation among patients with HCV infection than is described in the published literature. Furthermore, the time from screening to treatment initiation was considerably shorter compared with other international studies. However, since HCV-RNA testing was not requested in a significant portion of patients with a positive anti-HCV test result, there might be a large patient population with HCV who do not receive treatment.

New Treatment Options in Chronic Hepatitis B: How Close Are We to Cure?

Hepatitis B virus (HBV) infection is the leading cause of chronic liver disease worldwide. HBV-infected patients are at a lifetime risk of developing liver cirrhosis and hepatocellular carcinoma (HCC). Today, pegylated interferon (Peg-IFN) and nucleos(t)ide analogs (NAs) are used in the treatment of patients with chronic hepatitis B (CHB). Both treatment options have limitations. Despite effective viral suppression, NAs have little effect on covalently closed circular DNA (cccDNA), the stable episomal form of the HBV genome in hepatocytes. Therefore, the cure rate with NAs is low, and long-term treatment is required. Although the cure rate is better with Peg-IFN, it is difficult to tolerate due to drug side effects. Therefore, new treatment options are needed in the treatment of HBV infection. We can group new treatments under two headings: those that interfere with the viral life cycle and spread and those that modulate the immune response. Clinical studies show that combinations of treatments that directly target the viral life cycle and treatments that regulate the host immune system will be among the important treatment strategies in the future. As new direct-acting antiviral (DAA) and immunomodulatory therapies continue to emerge and evolve, functional cures in HBV treatment may be an achievable goal.

Evaluation and follow-up of pain, fatigue, and quality of life in COVID-19 patients

OBJECTIVES

We evaluated pain, fatigue, anxiety, depression, and quality of life in patients hospitalized for coronavirus disease 2019 (COVID-19) and observed them over a period of 3 months. We also investigated the relationship of these symptoms to age, sex, disease severity, and levels of anxiety and depression.

METHODS

The study included 100 confirmed COVID-19 patients (i.e., positive on a polymerase chain reaction test) between the ages of 18 and 75 years. Pain (visual analog scale [VAS]), fatigue (fatigue severity scale), anxiety, and depression (hospital anxiety and depression scales) were evaluated on the first day of hospitalization and at 1-month and 3-month follow-ups. The short form-12 questionnaire was used to measure quality of life at the 1-month and 3-month followups.

RESULTS

No differences were found in pain, fatigue, anxiety levels, depression levels, and quality of life according to disease severity. High VAS scores at hospital admission were related to continued pain at the 3-month follow-up (odds ratio [OR], 1.067; p<0.001). High VAS (OR, 1.072; p=0.003) and anxiety levels (OR, 1.360; p=0.007) were related to severe fatigue at the 3-month evaluation.

CONCLUSIONS

Pain, fatigue, anxiety, and depression appear to be long-term sequelae of COVID-19 and can affect quality of life. High VAS and anxiety levels were found to be associated with long-term fatigue.

Evaluation of clinical and laboratory characteristics and factors affecting mortality in 500 hospitalized COVID-19 patients: A retrospective study

OBJECTIVES

To evaluate the clinical and laboratory characteristics of COVID-19 patients admitted to Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey, and to determine the factors affecting mortality.

METHODS

A total of 500 patients who were diagnosed with COVID-19 between 19th of March and 30th of September 2020 in Afyonkarahisar Health Sciences University, Faculty of Medicine, Pandemic Service, Afyonkarahisar, Turkey, were retrospectively investigated for this study. These individuals' prognoses, demographic, clinical, laboratory, and radiological information were examined and recorded retrospectively. Comparisons were carried out between the characteristics of patients with a prognosis of death and those who recovered.

RESULTS

Of the 500 definite COVID-19 cases included in the study, 53.8% were male and the mean age was 57.6±15.1 (18-88 years). The most common comorbidities were hypertension and diabetes mellitus. A total of 45 (9%) patients developed mortality. Factors such as advanced age, male gender, shortness of breath, fever at admission, comorbid conditions such as hypertension, diabetes mellitus, cardiovascular diseases, lymphopenia, high C-reactive protein, high D-dimer, and high ferritin in the laboratory were found to be important risk factors for mortality. Treatments such as hydroxychloroquine, favipiravir, and lopinavir/ritonavir were not found to have lower mortality rates than one another.

CONCLUSION

Considering these elements when assessing patients and adjusting the course of treatment according to the recommendations of the most recent guidelines may lower mortality.

Investigation of the Characteristics of Crimean Congo Hemorrhagic Fever Cases Reported in Afyonkarahisar Province

OBJECTIVE

Crimean Congo Hemorrhagic Fever (CCHF); fever, widespread pain in the body, deterioration in liver function tests; it is a tick-borne viral infectious disease that can cause bleeding and death in the skin, mucous membranes, and sometimes internal organs. In this study, we retrospectively evaluated the clinical, laboratory, and epidemiological characteristics of CCHF cases diagnosed in Afyonkarahisar.

METHODS

Demographic and clinical characteristics, laboratory findings, treatments, and prognoses of patients diagnosed with CCHF in Afyonkarahisar were retrospectively analyzed.

RESULTS

In Afyonkarahisar, it was determined that 35 case reports were made between 2002 and November 2019, the date when the CCHF was first seen in Turkey. A history of tick attachment was detected in 31 subjects. Tick arrest cases were most common in June (12 cases; 34.3%) and July (9 cases; 2.9%). There was a history of living in rural areas in twenty-seven (77.1%) patients, close contact with animals in 12 patients, and a history of contact with animal blood in 4 patients. All the 35 cases that followed resulted in healing and no mortality was observed.

CONCLUSION

CCHF is an endemic disease that still maintains its importance in our country. The most important factor in the control with the disease is to prevent virus contact to prevent transmission. People living in endemic areas should be informed about the precautions to be taken against tick bites, and awareness should be raised by providing education about the disease.

Evaluation of Tenofovir Disoproxil Fumarate Treatment in Patients with Chronic Hepatitis B

Objective

The main purpose of chronic hepatitis B (CHB) treatment is to improve the patients' life quality and prevent the disease from progressing to cirrhosis or hepatocellular carcinoma. Continuous suppression of hepatitis B virus (HBV) DNA with nucleoside or nucleotide analogues is the most critical way to achieve this goal. This study aimed to evaluate the CHB patients retrospectively followed up with tenofovir disoproxil fumarate (TDF) treatment.

Materials and Methods

The study was planned as retrospective research by Afyonkarahisar Health Sciences University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology between January 2001 and December 2020. We evaluated all treatment-naive and treatment-experienced patients who received TDF (245 mg/day) treatment with the diagnosis of CHB. The data were obtained by reviewing the file information registered in the hospital automation system. HBsAg, Anti-HBs, HBeAg, Anti-HBe, HBV DNA, aspartate aminotransferase (AST), alanine aminotransferase (ALT) values of the patients were evaluated at 1st, 3rd, 6th, 12th months, and 6-month follow-ups throughout the treatment. Virological (HBV-DNA of < 50 IU/ml), biochemical (decrease below 40 IU/Ml in patients with pre-treatment value of ALT >40 IU/ml) and serological (Anti-HBe seroconversion in HBeAg positives and HBsAg negative and anti-HBs seroconversion in all patients) responses were examined. Adverse effects were also assessed during the treatment.

Results

Data from 131 patients who received TDF treatment were evaluated. Virological responses were determined as 78.6%, 81.3%, 94.2%, and 100% in the patients at 24th week, 48th week, 4th year, and 8th year, respectively. While there was no Anti-HBs seroconversion in any patients in four years of the treatment, it was observed at a rate of 10.5% in the eighth year. We did not determine any significant adverse effects requiring discontinuation of the treatment in the long-term follow-up of 131 patients under TDF treatment.

Conclusion

As a result of our study, TDF was an effective and well-tolerated choice for CHB treatment.

Neurological symptoms and findings in COVID-19: a prospective clinical study

OBJECTIVE

We sought to evaluate neurologic symptoms and findings in patients with COVID-19 infection hospitalized in a ward and intensive care unit (ICU).

METHODS

This study was designed as a prospective study. Hospitalized COVID-19 rRt-PCR positive patients in the ward and ICU were included in the study. A 54-item questionnaire was used to evaluate the patients. Patients were examined within 3 hours of hospitalization.

RESULTS

A total of 379 patients were included in the study. The mean age of the patients was 56.1 ± 17.8. 89 of the patients were in intensive care. At least one general symptom was recorded in 95.5% of patients. The most common neurologic symptoms were myalgia (48.5%), headache (39.6%), anosmia (34.8%), and dysgeusia (34%). Neurological symptoms in ICU patients were higher than in the ward. 53.6% of patients had comorbidities.

DISCUSSION

This study indicated that the prevalence of neurological symptoms was very high in patients with COVID-19. The percentage of neurological symptoms and findings was higher in patients hospitalized in ICU.

Real-World Data from Turkey: Is Sofosbuvir/Ledipasvir With or Without Ribavirin Treatment for Chronic Hepatitis C Really Effective?

BACKGROUND

In this study, we aimed to investigate the efficacy and safety of sofosbuvir-based therapies in the treatment of chronic hepatitis C in real-world clinical practice.

METHODS

Data from patients with chronic hepatitis C treated with SOF/LDV ± RBV or SOF/RBV in 31 centers across Turkey between April 1, 2017, and August 31, 2018, were recorded in a nationwide database among infectious disease specialists. Demographics, clinical, and virological outcomes were analyzed.

RESULTS

A total of 552 patients were included in the study. The mean age of the patients was 51.28 ± 14.2, and 293 (55.8%) were female. The majority had HCV genotype 1b infection (65%), 75.04% of the patients underwent treatment, and non-cirrhosis was present at baseline in 381 patients (72.6%). SOF/LDV ± RBV treatment was given to 477 patients and 48 patients received SOF/RBV according to HCV genotype. The total SVR12 rate was 99% in all patients. Five patients experienced disease relapse during the study and all of them were genotype 2. In patients infected with HCV GT2, SVR12 was 77.3%. SVR was 100% in all patients infected with other HCV genotypes. All treatments were well tolerated by patients without causing severe adverse events. Side effects and side effects-associated treatment discontinuation rates were 28.2% and 0.4%, respectively. Weakness (13.7%) was the common side effect.

CONCLUSION

The present real-world data of 525 patients with HCV genotypes 1, 1a, 1b, 3, 4, and 5 who underwent SOF/LDV ± RBV treatment in Turkey demonstrated a high efficacy and safety profile. HCV GT2 patients should be treated with more efficacious treatment.

Evaluation of the effectiveness and safety of adding ivermectin to treatment in severe COVID-19 patients

BACKGROUND AND OBJECTIVES

An effective treatment option is not yet available for SARS-CoV2, which causes the COVID-19 pandemic and whose effects are felt more and more every day. Ivermectin is among the drugs whose effectiveness in treatment has been investigated. In this study; it was aimed to investigate the presence of gene mutations that alter ivermectin metabolism and cause toxic effects in patients with severe COVID-19 pneumonia, and to evaluate the effectiveness and safety of ivermectin use in the treatment of patients without mutation.

MATERIALS AND METHODS

Patients with severe COVID19 pneumonia were included in the study, which was planned as a prospective, randomized, controlled, single-blind phase 3 study. Two groups, the study group and the control group, took part in the study. Ivermectin 200 mcg/kg/day for 5 days in the form of a solution prepared for enteral use added to the reference treatment protocol -hydroxychloroquine + favipiravir + azithromycin- of patients included in the study group. Patients in the control group were given only reference treatment with 3 other drugs without ivermectin. The presence of mutations was investigated by performing sequence analysis in the mdr1/abcab1 gene with the Sanger method in patients included in the study group according to randomization. Patients with mutations were excluded from the study and ivermectin treatment was not continued. Patients were followed for 5 days after treatment. At the end of the treatment and follow-up period, clinical response and changes in laboratory parameters were evaluated.

RESULTS

A total of 66 patients, 36 in the study group and 30 in the control group were included in the study. Mutations affecting ivermectin metabolism was detected in genetic tests of six (16.7%) patients in the study group and they were excluded from the study. At the end of the 5-day follow-up period, the rate of clinical improvement was 73.3% (22/30) in the study group and was 53.3% (16/30) in the control group (p = 0.10). At the end of the study, mortality developed in 6 patients (20%) in the study group and in 9 (30%) patients in the control group (p = 0.37). At the end of the follow-up period, the average peripheral capillary oxygen saturation (SpO2) values of the study and control groups were found to be 93.5 and 93.0%, respectively. Partial pressure of oxygen (PaO2)/FiO2 ratios were determined as 236.3 ± 85.7 and 220.8 ± 127.3 in the study and control groups, respectively. While the blood lymphocyte count was higher in the study group compared to the control group (1698 ± 1438 and 1256 ± 710, respectively) at the end of the follow-up period (p = 0.24); reduction in serum C-reactive protein (CRP), ferritin and D-dimer levels was more pronounced in the study group (p = 0.02, p = 0.005 and p = 0.03, respectively).

CONCLUSIONS

According to the findings obtained, ivermectin can provide an increase in clinical recovery, improvement in prognostic laboratory parameters and a decrease in mortality rates even when used in patients with severe COVID-19. Consequently, ivermectin should be considered as an alternative drug that can be used in the treatment of COVID-19 disease or as an additional option to existing protocols.

[Evaluation of Healthcare Professionals in Contact with Patients Diagnosed with COVID-19 Detected Outside of the Pandemic Service in our Hospital]

The "Coronavirus Disease 19 (COVID-19)" caused by "Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)" is still active all over the world as a pandemia. It is reported that at least 7000 health care workers (HCW) had lost their lives due to COVID-19 from the beginning of the pandemia till September 2020 in the world. In our country between the dates, March 11, 2020 which the first case was reported, and September 1, 2020, the date which our study has been finalized, 7428 HCW were infected by SARS-CoV-2, and 52 of them were deceased. In this study, it was aimed to evaluate the contact and illness of healthcare workers working outside of the pandemic clinics in our hospital and to examine the possible transmission routes and disease prognoses. Healthcare workers who were working outside the pandemic service between March 11, 2020 and September 1, 2020 and who had a definite diagnosis of COVID-19 and all hospital staff who had contacted with these people, and HCW who had contact with patients diagnosed with COVID-19 while receiving inpatient treatment in services other than the pandemic service was evaluated and classified as low, medium and high risk according to the risk scoring defined in the published "Ministry of Health COVID-19 Guidelines". Healthcare workers who were evaluated as contacted were questioned in detail regarding the use of personal protective equipment (PPE) at the time of contact, especially suitability of the masks, contact time and shape and all the data were recorded. A total of 53 index cases (40 HCW and 13 inpatients diagnosed as COVID-19) were detected during the study period. The number of HCW contacted with these index cases was 672. In our study, we examined the data of 40 index cases and 672 contacted HCW (total of 712 HCW). Only 3 of 40 index cases (7.5%) had hospital-acquired COVID-19 infection, the other 37 cases were infected by community sources. COVID-19 was not detected in 94.2% of the contacted HCW during the follow-up while 5.8% of them had positive PCR test results. Considering the possible way of contamination among the contacted HCW who developed COVID-19 during the follow-up period, it was determined that 13.1% of the cases were a result of taken care of patients, 86.9% of the cases were a result of being in hospital social environments (drinking tea, smoking, eating, chatting in the same room without personal precautions) and in the days after the contact, it was in the form of contact with healthcare personnel diagnosed with COVID-19. When the contacted HCW were questioned about using proper masks at the time of contact, we determined that 93.3% of them used masks during patient caring procedures, however, only 48.9% used masks when they were in social areas (p<0.001). Healthcare workers face an unprecedented risk of occupational disease and death due to the COVID-19 pandemic. However, it is also observed that prolonged pandemia period caused health workers to disregard rigorous infection control precautions in social areas of hospitals which they follow inpatient care although this has shown to be the most common way of contamination. Commonly performed in-service training and causing awareness in all areas of the hospital about following infection control precautions and PPE usage and checking the process regularly are the most important ways to prevent HCW from being affected by COVID-19.

Visual and quantitative assessment of COVID-19 pneumonia on chest CT: The relationship with disease severity and clinical findings

BACKGROUND

Lungs are the primary organ of involvement of COVID-19, and the severity of pneumonia in COVID-19 patients is an important cause of morbidity and mortality.

AIM

We aimed to evaluate the visual and quantitative pneumonia severity on chest computed tomography (CT) in patients with coronavirus disease 2019 (COVID-19) and compare the CT findings with clinical and laboratory findings.

METHODS

We retrospectively evaluated adult COVID-19 patients who underwent chest CT, clinical scores, laboratory findings, and length of hospital stay. Two independent radiologists visually evaluated the pneumonia severity on chest CT (VSQS). Quantitative CT (QCT) assessment was performed using a free DICOM viewer, and the percentage of the well-aerated lung (%WAL), high-attenuation areas (%HAA) at different threshold values, and mean lung attenuation (MLA) values were calculated. The relationship between CT scores and the clinical, laboratory data, and length of hospital stay were evaluated in this cross-sectional study. The student's t-test and chi-square test were used to analyze the differences between variables. The Pearson correlation test analyzed the correlation between variables. The diagnostic performance of the variables was assessed using receiver operating characteristic (ROC) analysis was used.

RESULTS

The VSQS and QCT scores were significantly correlated with procalcitonin, d-dimer, ferritin, and C-reactive protein levels. Both VSQ and QCT scores were significantly correlated with disease severity (p<0.001). Among the QCT parameters, the %HAA-600 value showed the best correlation with the VSQS (r=730,p<0.001). VSQS and QCT scores had high sensitivity and specificity in distinguishing disease severity and predicting prolonged hospitalization.

CONCLUSION

The VSQS and QCT scores can help manage the COVID-19 and predict the duration of hospitalization.

Real-world efficacy, safety, and clinical outcomes of ombitasvir/paritaprevir/ritonavir ± dasabuvir ± ribavirin combination therapy in patients with hepatitis C virus genotype 1 or 4 infection: The Turkey experience experience

BACKGROUND/AIMS

mbitasvir/paritaprevir/ritonavir (OMV/PTV/r) ± dasabuvir (DSV) ± ribavirin (RBV) combination has demonstrated excellent rates of sustained virologic response (SVR) and a very good safety profile in patients with the chronic hepatitis C virus (HCV) genotype 1 or 4 infections. We aimed to investigate the effectiveness and safety of OMV/PTV/r ± DSV ± RBV combination regimen in a real-world clinical practice.

MATERIALS AND METHODS

Data from HCV genotype 1 and 4 patients treated with OMV/PTV/r ± DSV ± RBV (n=862) in 34 centers across Turkey between April 1, 2017 and August 31, 2018 were recorded in a large national database. Demographic, clinical, and virologic data were analyzed.

RESULTS

The mean age of the patients was 55.63, and 430 patients (49.9%) were male. The majority had HCV genotype 1b infection (77.3%), and 66.2% were treatment-naïve. Non-cirrhosis was present at baseline in 789 patients (91.5%). SVR12 rate was 99.1% in all patients. Seven patients had virologic failure. No significant differences were observed in SVR12 according to HCV genotypes. HCV RNA was undetectable at treatment week 4 in 90.9%, at treatment week 8 in 98.5%, and at the end of treatment (EOT) in 98.9%. SVR12 ratio was significantly higher in the non-cirrhotic patients compared to that in the compensated cirrhotic patients. Rates of adverse events (AEs) in the patients was 59.7%.

CONCLUSION

The present real-life data of Turkey for the OBV/PTV/r ± DSV ± RBV treatment of patients with HCV genotype 1b, 1a, or 4 infection from 862 patients demonstrated high efficacy and a safety profile.

Evaluation of Patients with Cystic Echinococcosis

OBJECTIVE

Cystic echinococcosis (CE) is a globally prevalent zoonotic disease.

METHODS

Demographic, clinical, laboratory, and follow-up data of patients between May 2009 and 2015 were retrospectively analyzed by screening data from a hospital automation system.

RESULTS

A total of 238 (females, n=139 and males, n=99) patients with a mean age of 40.6±20.58 years were included. Less than half (40.8%) of the patients were living in the countryside. Hepatic involvement of CE was most frequently (72.2%) seen. A majority (75.6%) of the patients were symptomatic, but abdominal pain was the most frequently seen symptom. For diagnosis, in all patients, imaging modalities were used, while in 66% of the patients, serological methods were also employed. The patients received both medical and surgical treatments (78.5%, n=187), only surgical treatment (10.5%, n=25), or only medical treatment (8.8%, n=21). Surgical treatment was performed for patients with hepatic (n=139/176, 80.6%), pulmonary (n=78/94, 82.9%), splenic (n=7/9; 77.7%), and mesenteric (n=6/7, 85.1%) cysts, and patients cases with brain, bone, muscle, omentum, bladder, and adrenal cysts had undergone surgical intervention.

CONCLUSION

Publication of regional data is important in terms of epidemiological considerations and may aid in the formulation of standard treatment approaches.

[Effect of IL-28B polymorphisms on the natural course of HBV infection]

The prediction of the consequences of disease is important to determine the therapy approaches and prevention of the chronical state in patients infected with hepatitis B virus (HBV). In recent years various studies are carried on to investigate the effect of IL-28B gene polymorphisms on the clinical course or therapy response in patients with chronic hepatitis B infection. The aim of the study was to evaluate the influence of IL-28B rs12979860 polymorphisms on the natural course of HBV infection. The study was designed prospectively, and the subjects were randomly selected among patients admitted to infectious disease outpatient clinics of Kocatepe University Medical School Hospital and Yunus Emre State Hospital located at provinces in Central Anatolia, Turkey. A total of 99 cases were included in the study and evaluated into three groups, namely, chronic hepatitis B patients (group 1, n= 43); inactive HBV carriers (group 2, n= 34) and subjects with acquired immunity after native infection (group 3, n= 22). There were no significant differences regarding the age and gender distribution between the groups (p> 0.05). All subjects were investigated for the IL-28B promoter single nucleotide polymorphism rs12979860 at position 3176 C/T, by real-time polymerase chain reaction (RT-PCR). Evaluation of the range of IL-28B rs12979860 C/T polymorphisms observed in the study groups showed that, the frequency of CC, CT and TT allels were as follows; 34.9%, 48.8% and 16.3 % in group 1; 47.1%, 35.3% and 17.6% in group 2; 63.6%, 27.7% and 13.6% in group 3, respectively. No significant differences were observed between the groups in terms of C/T allel distriubution (p> 0.05). However, in spite of statistical insignificance, the rate of CC allel in IL-28B rs12979860 gene was the highest in immune subjects (63.6%), while it was the lowest in chronic hepatitis B patients (34.9%). According to our data, IL-28B rs12979860 gene polymorphisms were not effective on the clinical course of HBV infection. In conclusion, further studies with large numbers of patients are needed to support these data.

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.

[Genotype distribution of chronic hepatitis B and hepatitis C patients and investigation of the resistance patterns in hepatitis B cases]

The high genetic diversity in hepatitis B and C viruses (HBV and HCV, respectively), and the presence of differences in pathogenicity and response to therapy, necessitates continous monitorization of the genotypes and antiviral resistance patterns. The aims of this study were to investigate the genotype distribution of HBV and HCV in chronically infected patients and to detect the resistance patterns of HBV strains in treatment-naive patients and those under lamivudine (LAM) treatment. A total of 44 chronic hepatitis B (CHB) patients (mean age: 42 +/- 13.6 years; 31 were male) and 30 chronic hepatitis C (CHC) patients (mean age: 47 +/- 12.4 years; 8 were male) were included to this study which was carried on between September 2007-March 2008. Mutational analysis and antiviral drug resistance studies were performed by sequence analysis (ABI PRISM 310 Genetic Analyzer; Applied Biosystems, USA), with the use of the region between 80-260 codons in HBV DNA polymerase gene, and the genotype determining sequences in 5' non-coding region in HCV genome. As a result, all of the 44 CHB patients (100%) were found to be infected with HBV genotype D, while genotype 1 (26/30; 86.6%) was found to be the predominant HCV genotype in CHC patients. The frequency of HCV genotypes were as follows; 63.3% (n = 19) genotype 1b, 20% (n = 6) 1a, 13.3% (n = 4) 4a and 3.3% (n = 1) 1c. Various mutations were detected in 34.1% (15/44) of CHB patients and these were identified as M2041 (n = 6), Q215S (n = 2), L801 + M2041 (n = 1), L80V + M2041 (n = 1), Q215S + M2041 (n = 1) and M2041 + L180M (n = 1) mutations responsible for LAM resistance; V214A (n = 1) and A181T + N236T (n = 1) mutations responsible for adefovir (ADV) resistance, and V84M + V173L (n = 1) mutation responsible for ADV + LAM resistance. In 12% (3/25) of the treatment-naive CHB patients LAM resistance was detected. However, total antiviral resistance rate was found 63.2% (12/19) for CHB patients (LAM resistance in 9, ADV resistance in 2, and LAM + ADV resistance in 1 patient) who were currently under LAM treatment. Accordingly, total LAM resistance in our CHB cases was 27.3% (6.8% primary and 20.5% secondary resistance), ADV resistance was 4.5% and multidrug (LAM + ADV) resistance was 2.3%. It was concluded that, our data would be helpful in the diagnosis and management of patients with chronic liver diseases due to viral hepatitis in our region.

Seroprevalence of rubella among Turkish women and children in Afyonkarahisar, Turkey

The objective of this study was to determine the seroprevalence of rubella virus infection among women and female children/youth (0- 17-years-old) in Afyonkarahisar, Turkey. This study was conducted between November 2005 and February 2006. One thousand four hundred nine serum specimens were studied by the enzyme-linked immunosorbent assay (ELISA) method. Age, educational level, economic and marital status, smoking habit, application or not of measles-mumps-rubella (MMR) vaccination, and previous skin rash of the patients included in the study were questioned and noted. Positive rubella-specific IgG antibodies prevalence was found as 18.5% in girls between 0-1 years of age, 28.6% in girls between 2-6 years of age, 36.8% in girls between 7-17 years of age, and 80.0%, 80.9%, 78.5%, 73.7% and 78.1% in women between 18-20, 21-30, 31-40, 41-50, and 50+ years of age, respectively. There were no statistically significant correlations between immunity to rubella and other sociodemographic characteristics. In conclusion, nearly 20% of women of reproductive age are sensitive to rubella and should be vaccinated. The clear effects of adding MMR to the routine vaccination schedule will be observed in the following years in Turkey.

Brucellosis: a retrospective evaluation of 99 cases and review of brucellosis treatment

This retrospective study was performed in two university hospitals between January 2002 and 2006. Ninety-nine brucellosis patients were included in the study. These patients were classified as acute (91), chronic (4) and relapse (4) according to their clinical presentations and serological tests. Brucella bacteria were isolated in the blood of 17 (17.2%) cases. The most frequent symptom and clinical sign was fever. The osteoarticular complications were found in 17 patients (17.2%). Four of them were complicated with epidural abscess the same time. Two (2.2%) had meningitis, two (2.2%) had epididymoorchitis, three (3.3%) had skin rashes and one (1.1%) had hepatitis. Three of the acute brucellosis patients were pregnant. Rifampin and doxycycline combination therapy had been administered to most of the patients with acute and relapse brucellosis. However, complicated and chronic brucellosis cases were given different treatment combinations. This study reviews brucellosis therapy choices.

[Investigation of hemodialysis patients in terms of the presence of occult hepatitis B]

The presence of hepatitis B virus (HBV) DNA in case of negative HBV surface antigen (HBsAg) in serum is known as "occult hepatitis B". There are many reports indicating that occult HBV infections are more frequently encountered in case of hepatocellular carcinoma, hemodialysis practice and co-infections with hepatitis C virus (HCV). The aim of this study was to investigate the presence of HBV-DNA in HBsAg negative hemodialysis. patients and subjects who had never experienced hemodialysis. A total of 226 HBsAg negative sera were included to the study, of which 153 were from hemodialysis patients (97 male, 56 female; mean age: 41.3 +/- 5.8 years), and 73 were from non-hemodialyzed individuals (46 male, 27 female; mean age: 36.5 +/- 6.9 years) who had serological evidence of previous HBV and HCV infections. Of these 73 subjects, 41 were anti-HCV positive, 22 were "anti-HBc IgG positive alone", seven were anti-HBc IgG and anti-HBs positive, and three were anti-HBc IgG and anti-HBe positive, while 40 of 153 (26.1%) hemodialysis patients were anti-HCV positive. HBV and HCV markers were detected by commercial enzyme immunoassays (bioMerieux, France and Murex, UK, respectively), and HBV-DNA testing was performed by a commercial real-time polymerase chain reaction (PCR; 5700 and 7700 Sequence Detection System, Applied Biosystems, UK) assay. Nineteen (12.4%) of HBsAg-negative hemodialysis patients and five (6.8%) of the non-hemodialyzed subjects were found positive for HBV-DNA (viral loads were > or =10(4) copies/ml, and 10(3)-10(4) copies/ml, repectively). The rates of occult HBV infection in the anti-HCV positive hemodialysis patients and anti-HCV positive non-hemodialyzed subjects were detected as 27.5% (11/40) and 2.4% (1/41), respectively. These rates in the other groups were found as follows; 7.1% (8/113) in the anti-HCV negative hemodialysis patients, 9.1% (2/22) in the "anti-HBc positive alone" subjects, and 20% (2/10) in the subjects positive for anti-HBc+anti-HBs or anti-HBe. The results of this study indicated that the prevalence of HBV viremia (12.4%) in hemodialysis patients being more prominent in those of anti-HCV positive patients (27.5%) should not be overlooked. In conclusion, the hemodialysis patients should be screened by sensitive PCR-based methods for occult HBV infections, even if they were negative for HBsAg, in order to prevent or at least to decrease the transmission risk of HBV infection which is still an important health problem in dialysis units.

Hepatitis B and C virus in West-Central Turkey: seroprevalence in healthy individuals admitted to a university hospital for routine health checks

BACKGROUND/AIMS

The aim was to determine the seroprevalence rates for hepatitis B virus and hepatitis C virus and the frequency of hepatitis B core antibody seropositivity alone in residents of a city in Turkey. The subjects visited the Family Medicine Outpatient Clinics of a university hospital in Afyon for routine health checks between January 2002 and January 2004.

METHODS

A single serum sample was collected from subjects examined. The sera were analyzed by ELISA for hepatitis B surface antigen, hepatitis B surface antibody, anti-HBcIgG and anti-hepatitis C virus. Samples that were HBsAg-positive were also screened for hepatitis B early antigen and antibody. Subjects who were positive for anti-HBcIgG alone were considered to have "isolated anti-HBcIgG positivity".

RESULTS

1320 persons weere screened the rates of positivity for HBsAg, anti- HBs, isolated anti-HBcIgG, and anti-hepatitis C virus were 6.6%, 27.2%, 6.1% and 2.2%, respectively. Eight percent of the 87 HBsAg-positive individuals were HBeAg-positive. Comparison of marker detection rates according to sex and age (younger than 50 years vs 50 years or older) revealed a significantly higher prevalence of HBsAg positivity in males than in females (p=0.02), and a significantly higher prevalence of anti-hepatitis C virus and anti-HBcIgG positivity in the older than in the younger group (p=0.001 and p=0.001, respectively).

CONCLUSION

According to our results, the rates of hepatitis B virus and hepatitis C virus seropositivities in our region are similar to those reported in recent studies from other parts of Turkey. But these results cannot be extrapolated to all residents of the Afyon area because a random sampling method was not used for statistical analysis. However, they provide a good reference for future studies because of the large number of cases investigated.

Comparison of different treatment combinations for chronic hepatitis B infection

Chronic hepatitis B virus (HBV) infection is a leading cause of cirrhosis and hepatocellular carcinoma worldwide. Its prevalence approaches 10% in hyper endemic areas. The aim of treating chronic HBV infection is to halt progression of liver injury by suppressing viral replication or eliminating infection. This study was planned to evaluate the advantages of combination therapy with interferon-alpha plus second-generation nucleoside analogues (lamivudine or famciclovir), or vaccination with a pre-S2 and S proteins containing vaccine in chronic HBV infection. 29 patients were divided into three groups and were treated with the following combinations: (1) IFN-alpha2a 9 million units 3x week for 6 months with HBV vaccine 20 microg given on 0, 1 and 2 months; (2) IFN-alpha2a 6 million units 3x week plus famciclovir 250 mg 3x day for 6 months; (3) IFN-alpha2a 6 million units 3x week plus lamivudine 100 mg/day for 6 months. Complete response was suspected in 3 patients in group 1, in 4 patients in group 2, and in 7 patients in group 3. Partial response was suspected in 4, 1 and 2 patients in groups 1, 2 and 3, respectively. The results of the present study suggest that the combination of IFN-alpha with lamivudine is more effective than the combination of IFN-alpha with HBV vaccination or famciclovir.