Hepatitis B Vaccination Results Which dose is Sufficient for Immunosuppressive Patients? Single or Double?

Aim: Despite effective HBV vaccine and vaccination programs, Hepatitis B still causes nearly one million deaths annually, according to the World Health Organization. The immunization rates are high by hepatitis B vaccination especially in young healthy population. However, advanced age, comorbidities and immune deficiency affect the rates of vaccine response negatively. We aimed to evaluate the factors affecting the vaccine response in the patients who received hepatitis B vaccine in our hospital retrospectively.Materials and Methods: Patients who received hepatitis B vaccine and followed-up for immunization status were evaluated retrospectively in our vaccination unit. The patients were examined in terms of age, comorbidities, vaccine scheme, vaccine dose, utilization of immunosuppressive-biological agents, immunization success, and common characteristics of patients who did not develop immunity.Results: Anti-HBs titers were significantly lower in patients over 50 years old. In addition, lower Anti-Hbs titers were detected in patients with comorbidity and who received immunosuppressive therapy. Statistically higher Anti-HBs titers were obtained with double dose vaccination than single dose vaccination in patients receiving immunosuppressive treatment. Moreover, it was documented that a single dose vaccination protocol was applied to all seven patients who failed vaccination. Six of these patients were over 50 years old, two were diabetic, five were diagnosed with rheumatic disease and all of them were using biological agents.Conclusion: Vaccination before treatment in patients who will receive immunosuppressive therapy, administration of high dose vaccines in patients under immunosuppressive therapy or delaying immunosuppressive therapy during vaccination may be considered as appropriate alternatives. Considering the safety and cost-effectiveness of high-dose hepatitis B vaccine, it should be preferred in the immunosuppressive patient group

The epidemiology, Clinical Manifestations, radiology, microbiology, treatment, and prognosis of echinococcosis: Results of NENEHATUN study

Aim: Echinococcosis, caused by Echinococcus species, is an important zoonotic disease causing major health problems in humans and animals. Herein, we aimed to evaluate the epidemiology, clinical and laboratory parameters, radiological, serological, pathological, and treatment protocols of followed-up cases of hydatidosis. Methods: A total of 550 patients diagnosed with hydatid cyst disease were included in this study. Patients who were positive for one or more of the enzyme-linked immunosorbent assay or indirect hemagglutination test, pathological results, or radiological findings were examined. The data analyzed were collected from nine centers between 2008 and 2020. Records were examined retrospectively. Results: Among the patients, 292 (53.1%) were women and 258 (46.9%) were men. The patients' mean age was 44.4 +/- 17.4 years. A history of living in rural areas was recorded in 57.4% of the patients. A total of 435 (79.1%) patients were symptomatic. The most common symptoms were abdominal pain in 277 (50.4%), listlessness in 244 (44.4%), and cough in 140 (25.5%) patients. Hepatomegaly was found in 147 (26.7%), and decreased breath sounds were observed in 124 (22.5%) patients. Radiological examination was performed in all cases and serological methods were also applied to 428 (77.8%) patients. The most frequently applied serological test was IHA (37.8%). A single cyst has been found in 66% patients. Hepatic involvement occurred in 327 (59.4%), pulmonary involvement was found in 128 (23.3%), whereas both of them were recorded in 43 (7.8%) patients. Splenic involvement was only detected in nine (1.6%) patients. Echinococcus granulosus (72.5%) was most frequently detected. Cyst diameters of 56.9% of the patients were in the range of 5-10 cm. A total of 414 (75.2%) patients received albendazole as an antiparasitic. Mortality was noted in nine (1.6%) patients. Conclusion: Echinococcosis is an important public health problem in Turkey. It can affect the social, economic, and political structures of the community. Public education and awareness are extremely important

The frequency of Duchenne muscular dystrophy/Becker muscular dystrophy and Pompe disease in children with isolated transaminase elevation: results from the observational VICTORIA study

IntroductionElevated transaminases and/or creatine phosphokinase can indicate underlying muscle disease. Therefore, this study aims to determine the frequency of Duchenne muscular dystrophy/Becker muscular dystrophy (DMD/BMD) in male children and Pompe disease (PD) in male and female children with isolated hypertransaminasemia.MethodsThis multi-center, prospective study enrolled patients aged 3–216 months with serum alanine transaminase (ALT) and/or aspartate transaminase (AST) levels >2× the upper limit of normal (ULN) for ≥3 months. Patients with a known history of liver or muscle disease or physical examination findings suggestive of liver disease were excluded. Patients were screened for creatinine phosphokinase (CPK) levels, and molecular genetic tests for DMD/BMD in male patients and enzyme analysis for PD in male and female patients with elevated CPK levels were performed. Genetic analyses confirmed PD. Demographic, clinical, and laboratory characteristics of the patients were analyzed.ResultsOverall, 589 patients [66.8% male, mean age of 63.4 months (standard deviation: 60.5)] were included. In total, 251 patients (188 male and 63 female) had CPK levels above the ULN. Of the patients assessed, 47% (85/182) of male patients were diagnosed with DMD/BMD and 1% (3/228) of male and female patients were diagnosed with PD. The median ALT, AST, and CPK levels were statistically significantly higher, and the questioned neurological symptoms and previously unnoticed examination findings were more common in DMD/BMD patients than those without DMD/BMD or PD (p < 0.001).DiscussionQuestioning neurological symptoms, conducting a complete physical examination, and testing for CPK levels in patients with isolated hypertransaminasemia will prevent costly and time-consuming investigations for liver diseases and will lead to the diagnosis of occult neuromuscular diseases. Trial RegistrationClinicaltrials.gov NCT04120168

Unusual central nervous system involvement of rheumatoid arthritis: successful treatment with steroid and azathioprine

Central nervous system involvement of rheumatoid arthritis (RA) frequently develops in patients who had a long-term history of RA, irrespective of the disease activity of systemic arthritis, and it has a high mortality rate despite treatment. Since clinical symptoms and radiologic signs are rather nonspecific, in short of doing biopsy, the diagnosis of rheumatoid meningitis is one of exclusion. However, the strongly positive rheumatoid factor in the cerebrospinal fluid is quite specific. We here report a 70-year-old man who had not been diagnosed as RA before he was admitted with neurological findings, who was diagnosed as RA later and successfully treated with prednisolone and azathioprine

Results of a Multinational Study Suggest the Need for Rapid Diagnosis and Early Antiviral Treatment at the Onset of Herpetic Meningoencephalitis

Beraud, Guillaume/0000-0002-4705-0916; Ghaydaa, Shehata/0000-0002-3631-893X; Senbayrak, Seniha/0000-0002-4983-6613; Gunst, Jesper/0000-0002-3787-0259; Kanj, Souha/0000-0001-6413-3396; Karabay, Oguz/0000-0003-0502-432X; Larsen, Lykke/0000-0002-4113-4182; Stahl, Jean Paul/0000-0002-0086-3557; johansen, isik somuncu/0000-0002-2189-9823; VAHABOGLU, Haluk/0000-0001-8217-1767WOS: 000358623200015PubMed: 25779579Data in the literature regarding the factors that predict unfavorable outcomes in adult herpetic meningoencephalitis (HME) cases are scarce. We conducted a multicenter study in order to provide insights into the predictors of HME outcomes, with special emphasis on the use and timing of antiviral treatment. Samples from 501 patients with molecular confirmation from cerebrospinal fluid were included from 35 referral centers in 10 countries. Four hundred thirty-eight patients were found to be eligible for the analysis. Overall, 232 (52.9%) patients experienced unfavorable outcomes, 44 died, and 188 survived, with sequelae. Age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02 to 1.05), Glasgow Coma Scale score (OR, 0.84; 95% CI, 0.77 to 0.93), and symptomatic periods of 2 to 7 days (OR, 1.80; 95% CI, 1.16 to 2.79) and >7 days (OR, 3.75; 95% CI, 1.72 to 8.15) until the commencement of treatment predicted unfavorable outcomes. The outcome in HME patients is related to a combination of therapeutic and host factors. This study suggests that rapid diagnosis and early administration of antiviral treatment in HME patients are keys to a favorable outcome

Risk Factors and Seroprevalence of Hepatitis B, C, and D Virus in Hemodialysis Patients in Istanbul

Introduction: Hemodialysis units pose a risk for transmission of hepatitis viruses. In this study, we aimed to detect the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis D virus (HDV) in our hospital’s hemodialysis unit and to determine the risk factors for transmission of hepatitis viruses. Materials and Methods: In Haydarpasa Numune Training and Research Hospital Hemodialysis Unit, hepatitis B surface antigen (HBsAg), hepatitis B core IgG antibody (anti-HBcIgG), hepatitis B surface antibody (anti-HBs), antibody to hepatitis C virus (anti- HCV), and anti-delta total were studied by enzyme-linked immunosorbent assay (ELISA) method in the serum samples of 50 hemodialysis patients. Risk factors for transmission of hepatitis virus were identified in hemodialysis patients. As a control group, 50 healthy individuals were included. Result: In hemodialysis patients, HBsAg was determined as 6% and anti-HCV as 28%, whereas anti-HDV positivity was not detected. HBsAg, anti-HBcIgG, and anti-HBs frequencies did not show statistically significant differences between the two groups, while anti-HCV frequency was found to be significantly higher in hemodialysis patients (p= 0.001). The mean age of HBsAg-positive hemodialysis patients was found significantly lower than that of HBsAg-negative hemodialysis patients (p= 0.045). Similarly, anti-HCV-positive hemodialysis patients had a statistically lower mean age compared to anti-HCV-negative hemodialysis patients (p< 0.004). Increase in hemodialysis duration and amount of blood transfusion were shown statistically to not affect anti-HBcIgG positivity. Anti-HCV positivity was found statistically significantly higher in patients undergoing hemodialysis for more than 10 years (p= 0.003). Conclusion: In hemodialysis patients, transmission of hepatitis viruses will decrease with promotion of the use of erythropoietin instead of blood transfusion and implementation of alternative methods of dialysis

Seroprevalence and Risk Factors for Epstein-Barr Virus Infection in Adults

Introduction: Epstein-Barr virus (EBV), also known as human herpesvirus 4, is the causative agent of infectious mononucleosis. Infection with EBV is associated with multiple malignancies. The aim of this study was to determine the seroprevalence and risk factors for seropositivity. Materials and Methods: This study was conducted in Haydarpaşa Numune Training and Research Hospital in İstanbul between August 2012 and October 2012. Epstein-Barr virus viral capsid antigen IgG antibody was measured using ELISA in 500 cases. Age, gender, occupation, education level, family income, the area and type of residence, and chronic illness of the participants were also evaluated. Differences between risk groups were statistically analyzed. Results: The mean age of the 500 study participants was 47.7±19.1 (15-87) years and 289 (57.8%) were male. Mean EBV seropositivity was 96.4%, and 91% of the cases became seropositive for EBV by 15 years of age. No significant associations with age, gender, occupation, education level, family income, area and type of residence, and chronic illness were detected. Conclusion: Epstein-Barr virus seropositivity rates were very high and about 91% of the cases become seropositive for EBV by 15 years of age. There was no significant relationship between risk factors and seroprevalence of EBV

Bloodstream infections in a medical-surgical intensive care unit: incidence, aetiology, antimicrobial resistance patterns of Gram-positive and Gram-negative bacteria

P>In the present study, the incidence and antimicrobial resistance patterns of the microorganisms that caused bloodstream infections (BSIs) in a medical-surgical intensive care unit during the years 2005-2007 were determined. The mean BSI incidence density was 6.56 per 1000 patient-days. The incidence density increased linearly during the study period (from 3.57 to 9.60 per 1000 patient-days). Staphylococcus aureus was most frequently isolated (47.3%), followed by Enterococcus spp. (10.8%) and Candida spp. (10.1%). There was a high rate of resistance to several of the prescribed antimicrobials among the bacteria isolated from patients with BSIs

Alterations in bacterial spectrum and increasing resistance rates in isolated microorganisms from device-associated infections in an intensive care unit of a teaching hospital in Istanbul (2004-2010)

The aim of the present study was to determine the rate of device-associated infection (DAI) and the change in profiles and antimicrobial resistance patterns of the causative microorganisms in a medical-surgical intensive care unit (ICU), as well as to evaluate the effect of a new nationwide hospital infection control program (NHICP), which has been implemented in Turkey. In this study, 5,772 patients that were hospitalized for a total of 43,658 days acquired 1,321 DAIs, with an overall rate of 30.2% per 1,000 ICU days. Between 2004 (before the NHICP) and 2010, the incidence densities of catheter-associated urinary tract infection (CAUTI) decreased from 10.2 to 5.7 per 1,000 device-days (P < 0.0001), and central venous catheter-associated bloodstream infection (CVC-BSI) decreased from 5.3 to 2.1 per 1,000 device-days (P < 0.0001). However, ventilator-associated pneumonia increased from 27.0 to 31.5 per 1,000 device-days. Multidrug-resistant species rates increased from 5.8% to 76.6% (P < 0.0001) for Acinetobacter spp. and from 6.8% to 53.1% (P < 0.0001) for Pseudomonas aeruginosa. The extended-spectrum beta-lactamase-producing Enterobacteriaceae rate increased from 23.1% to 54.2% (P = 0.01); the vancomycin-resistance rate among Enterococcus spp. increased from 0% in 2004 to 12.5% in 2010 (P = 0.0003). In conclusion, while a significant decrease was achieved in the incidences of CAUTI and CVC-BSI, the NHICP was not completely effective in our ICU. The high incidence of DAI and the increasing prevalence of multidrug-resistant microorganisms indicate that further interventions are urgently needed