In a Real-Life Setting, Direct-Acting Antivirals to People Who Inject Drugs with Chronic Hepatitis C in Turkey

Background: People who inject drugs (PWID) should be treated in order to eliminate hepatitis C virus in the world. The aim of this study was to compare direct-acting antivirals treatment of hepatitis C virus for PWID and non-PWID in a real-life setting. Methods: We performed a prospective, non-randomized, observational multicenter cohort study in 37 centers. All patients treated with direct-acting antivirals between April 1, 2017, and February 28, 2019, were included. In total, 2713 patients were included in the study among which 250 were PWID and 2463 were non-PWID. Besides patient characteristics, treatment response, follow-up, and side effects of treatment were also analyzed. Results: Genotype 1a and 3 were more prevalent in PWID-infected patients (20.4% vs 9.9% and 46.8% vs 5.3%). The number of naive patients was higher in PWID (90.7% vs 60.0%), while the number of patients with cirrhosis was higher in non-PWID (14.1% vs 3.7%). The loss of follow-up was higher in PWID (29.6% vs 13.6%). There was no difference in the sustained virologic response at 12 weeks after treatment (98.3% vs 98.4%), but the end of treatment response was lower in PWID (96.2% vs 99.0%). In addition, the rate of treatment completion was lower in PWID (74% vs 94.4%). Conclusion: Direct-acting antivirals were safe and effective in PWID. Primary measures should be taken to prevent the loss of follow-up and poor adherence in PWID patients in order to achieve World Health Organization's objective of eliminating viral hepatitis

In a real-life setting, direct-acting antivirals to people who inject drugs with chronic hepatitis c in Turkey

Background: People who inject drugs (PWID) should be treated in order to eliminate hepatitis C virus in the world. The aim of this study was to compare direct-acting antivirals treatment of hepatitis C virus for PWID and non-PWID in a real-life setting. Methods: We performed a prospective, non-randomized, observational multicenter cohort study in 37 centers. All patients treated with direct-acting antivirals between April 1, 2017, and February 28, 2019, were included. In total, 2713 patients were included in the study among which 250 were PWID and 2463 were non-PWID. Besides patient characteristics, treatment response, follow-up, and side effects of treatment were also analyzed. Results: Genotype 1a and 3 were more prevalent in PWID-infected patients (20.4% vs 9.9% and 46.8% vs 5.3%). The number of naïve patients was higher in PWID (90.7% vs 60.0%), while the number of patients with cirrhosis was higher in non-PWID (14.1% vs 3.7%). The loss of follow-up was higher in PWID (29.6% vs 13.6%). There was no difference in the sustained virologic response at 12 weeks after treatment (98.3% vs 98.4%), but the end of treatment response was lower in PWID (96.2% vs 99.0%). In addition, the rate of treatment completion was lower in PWID (74% vs 94.4%). Conclusion: Direct-acting antivirals were safe and effective in PWID. Primary measures should be taken to prevent the loss of follow-up and poor adherence in PWID patients in order to achieve World Health Organization’s objective of eliminating viral hepatitis

Entekavire bağlı nadir bir yan etki : hepatomegali ve steatoz

Hepatomegali ve steatoz nükleozid analoglarının nadir görülen ancak fatal seyredebilen bir yan etkisidir. Bu olgu sunumunda 5 yıl süre ile entekavir tedavisi almakta olan 53 yaşında erkek hastada hepatomegali ve steatoz gelişimi sunulmuştur. Hastada entekavir tedavisi sırasında laktik asidoz bulgusu olmaksızın progresif hepatomegali ve steatoz gelişmiştir. Entekavir tedavisi tenofovir ile değiştirildikten 3 ay sonra karaciğer boyutu normalleşmiş ve tenofovir tedavisinin ilk 3 yılında normal aralıkta seyretmiştir. Bu nedenle, hepatomegali ve steatozun entekavir tedavisine bağlı gelişmiş olması muhtemeldir. Nükleozid analoglarının neden olduğu hepatomegali ve steatoz nadirdir ve bildirilen olguların çoğunda laktik asidoz ile ilişkilidir. Bildiğimiz kadarıyla daha önce entekavir tedavisine sekonder, laktik asidoz bulgusu olmaksızın gelişen hepatomegali ve steatoz olgusu bildirilmemiştir. Bu olgu sunumunun amacı entekavirin nadir görülen bir yan etkisini ortaya koymak ve uygulanan tedavi yaklaşımını paylaşmaktırHepatomegaly and steatosis are rare but potentially fatal side-effects of nucleoside analogues. Here, we present the case of development of hepatomegaly and steatosis in a 53-year-old male who had been treated with entecavir for five years. There were no symptoms of lactic acidosis. At three months after changing entecavir to tenofovir, the liver size returned to normal and maintained within the normal range during the 3-year follow-up. Therefore, it can be presumed that the hepatomegaly and steatosis were due to entecavir therapy. There are very few reports of hepatomegaly and steatosis caused by nucleoside analogues and the majority of the reported cases were associated with lactic acidosis. To the best of our knowledge, there are no previously reported cases of hepatomegaly and steatosis due to entecavir therapy without evidence of lactic acidosis. The aim of this clinical report was to point out a rare side-effect of entecavir and to share our treatment approac

Metoklopramide bağlı akut distonik reaksiyon : İki olgu sunumu

Metoclopramide is a widely used antiemetic agent in paediatric population with the primary side-effect of extrapyramidal reactions. Incidence is 0.5-1% in children while incidence in young adults and elders is 25%. Patients can be misdiagnosed as meningitis, encephalitis, hypocalcemia, seizure and tetanus. We report two cases, 8-month-and 10-year-old boys referred to our hospital with a presumptive diagnosis of encephalitis and diagnosed as metoclopramide induced acute dystonic reaction, to stress this side-effect of metoclopramide.Metoklopramid, çocukluk çağında yaygın olarak kullanılan antiemetik bir ajan olup, en sık görülen yan etkisi ekstrapiramidal reaksiyonlardır. Çocuklarda insidansı % 0.5-1 iken, adölesan ve yaşlılarda % 25 civarındadır. Hastalar, meninjit, ensefalit, hipokalsemi, nöbet ve tetanoz şeklinde yanlış tanı alabilmektedir. Biz de ensefalit ön tanısı ile hastanemize sevk edilen 8 aylık ve 10 yaşında iki erkek hastada, metoklopramide bağlı akut distonik reaksiyon gelişen iki vaka saptadık

Hepatit C enfeksiyonunun ve klirensinin diyabetik hastalarda koroner arter hastalığı sıklığına etkisi

Objectives: Chronic hepatitis C (CHC) infection considered to be associated with an increased risk of coronary artery disease (CAD). However, there is not enough data concerning this association in diabetics. Thus, this study investigated the effect of chronic HCV infection and its clearance on the CAD risk in diabetics. Materials and Methods: This was a retrospective case-control study conducted at the Mustafa Kemal University, Department of Infectious Diseases and Clinical Microbiology, Hatay, between January 2010 and January 2015. The presence of CAD and its main risk factors such as age, sex, hypertension (HT), hyperlipidaemia (HL), chronic obstructive pulmonary disease and chronic renal failure were compared between 100 HCV infected diabetic patients and 100 uninfected diabetic controls. The HCV-infected patients were further divided into a viral clearance group and a persistence group, and the CAD prevalence was also compared between these two groups. Results: Patients with CHC were predominantly male (55% vs 39%) and predominantly older than 60 years of age (68% vs 51%) in comparison with controls. The HCV-infected group had a significantly lower prevalence of CAD, HT and HL compared with controls (p<0.001). Furthermore, no significant differences were found between groups with viral clearance and persistent viremia for the prevalence of CAD (p=0.80). Conclusion: Our data suggested that chronic HCV infection might be a protective factor against CAD and successful HCV eradication may not increase the risk of CAD in diabetics. These findings indicate a need for additional studies to clarify the effects of HCV infection and its clearance on the risk of CAD in diabeticsAmaç: Kronik hepatit C (KHC) enfeksiyonunun artmış koroner arter hastalığı (KAH) riski ile ilişkili olduğu kabul edilmektedir. Bununla birlikte diyabetik hastalarda bu ilişki ile ilgili yeterli veri bulunmamaktadır. Bu nedenle bu çalışma ile kronik HCV enfeksiyonunun ve klirensinin, diyabetik hastalardaki KAH riski üzerine etkisi araştırılmıştır. Gereç ve Yöntemler: Bu çalışma; Mustafa Kemal Üniversitesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilimdalı, Hatay’da, Ocak 2010-2015 tarihleri arasında yapılan retrospektif bir olgu kontrol çalışmasıdır. HCV ile enfekte diyabetik olgular (n=100) ile HCV ile enfekte olmamış diyabetik kontrol grubu (n=100) arasında KAH varlığı ve yaş, cinsiyet, hipertansiyon (HT), hiperlipidemi (HL), kronik obstrüktif akciğer hastalığı ve kronik böbrek yetmezliği gibi KAH için risk faktörleri açısından karşılaştırıldı. Buna ek olarak, HCV ile enfekte diyabetik olgular viral klirens gelişen ve persistan viremisi olan olgular olarak iki alt gruba ayrıldı ve bu iki grup arasında da KAH prevalansı karşılaştırıldı. Bulgular: CHC olguları kontrol grubuna göre çoğunluğu erkekti (%55’e karşı %39) ve ağırlıklı olarak 60 yaşından büyüktü (%68’e karşı %51). HCV ile enfekte olan grupta, kontrol grubuna kıyasla KAH, HT, HL prevalansı anlamlı olarak daha düşüktü (p<0.001). Ayrıca, viral klirens gelişen ve persistan viremisi olan olgular arasında KAH prevalansı açısından anlamlı fark bulunmadı (p=0.80). Sonuç: Verilerimiz kronik HCV enfeksiyonunun KAH’a karşı koruyucu bir faktör olabileceğini ve başarılı HCV eradikasyonunun diyabetik hastalarda KAH riskini arttırabileceğini düşündürmektedir. Bu bulgular HCV enfeksiyonunun ve klirensinin diyabetik hastalarda KAH riski üzerindeki etkilerini açıklığa kavuşturmak için ek çalışmalara ihtiyaç olduğunu göstermektedi

Strongyloides stercoralis in a patient complaining of chronic diarrhea

Kronik diyare ve karın ağrısı yakınmaları 5-6 yıldır devam eden 38 yaşındaki erkek hastada Strongyloides stercoralis saptanması üzerine konunun önemini vurgulamak amacıyla olgunun sunulmasına karar verilmiştir. 25 yıldır oto tamirciliği yapan hastanın aynı zamanda çiftçilikle de uğraştığı öğrenilmiştir. Parazitolojik incelemede hastadan üç kez alınan dışkı örneklerinde S.stercoralis larvaları saptanmıştır. Hastaya 15 gün süre ile 400mg/gün dozunda Albendazol verilmiş, 5 gün sonra yapılan dışkı incelemesinde parazit yoğunluğunun azaldığı görülmüştür. Tedavinin onuncu, onbeşinci günü ve tedavi sonrası yapılan dışkı incelemelerinde de parazite rastlanmamıştır. Tedavi bitiminde hastanın tüm şikayetlerinin kaybolduğu saptanmıştır. Değişik tedaviler alan hastanın şimdiye kadar hiçbir parazitolojik tetkik yaptırmadığı saptanmıştır. Kronik diyare yakınması olan hastalarda parazitolojik inceleme yapılmasının oldukça önemli olduğu vurgulanmıştır.In this study, a case of Strongyloides stercoralis infection in a 38-year-old patient with complaints of chronic diarrhea and stomach ache is presented. His history showed that the patient who has been a mechanic for 25 years is a farmer as well. S. stercoralis larvae were found during the parasitological examination of the patient's stool samples taken 3 times. The patient was given Albendazol (400 mg a day) for fifteen days. After the patient started to take Albendazol, there was a reduction in the number of parasites in the stool examined on the fifth day. In the stool examinations made on the tenth day, fifteenth day and after the treatment ended, no parasites were seen. When the treatment was completed, all the complaints of the patient disappeared. It was found that no investigation of parasitic infection had been made previously and he had been given different treatments. For this reason, it is important to investigate the possibility of parasitic infection in patients with chronic diarrhe

Hatay ilinde Hepatit C Virüs genotip dağılımı, Türkiye

Objectives: The treatment duration and response of chronic hepatitis C (CHC) are closely related to the genotypes of hepatitis C virus (HCV). This study aimed to determine the genotype distributions among CHC patients in the Hatay province of Turkey. Materials and Methods: In this study, demographic data of 589 patients who received a therapy for CHC at the infectious diseases and gastroenterology clinics between June 2016 and May 2019 were retrieved from the hospital information system and medical charts of the patients and were retrospectively reviewed. Results: The most common HCV genotype in our study was genotype 1b (66.9%), followed by genotype 2 (10.5%), genotype 1a (7.3%), genotype 4 (7.1%), genotype 3 (7%), and mixed genotype (1.2%). Six of the mixed genotypes were identified as 1b+4, while one was 1a+3. There was a statistically significant difference between females and males with regards to the HCV genotypes (p<0.001). Patients with genotype 1b tended to be older, while patients with genotypes 3 and 4 tended to be younger. Conclusion: Genotype 1b is the most common HCV genotype in Hatay province, and it is followed by genotypes 2, 1a, 4 and 3. Compared to the studies conducted in previous years in Turkey, our study identified a lower rate for genotype 1b, along with an increase in the distribution rates of the other genotypes. Monitoring the changes in HCV genotype distribution is of vital importance to develop effective strategies in the treatment of HCVAmaç: Kronik Hepatit C (KHC) enfeksiyonunun tedavi süresi ve tedaviye verilen yanıt hepatit C virüs (HCV) genotipleri ile yakından ilişkilidir. Coğrafi bölgelere göre HCV genotiplerinin dağılımında farklılıklar vardır. Bu çalışmada Hatay ilindeki KHC hastalarında genotip dağılımlarının belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmada KHC nedeni ile Haziran 2016-Mayıs 2019 tarihleri arasında enfeksiyon hastalıkları ve gastroenteroloji klinikleri tarafından tedavi başlanan 589 hastanın demografik verileri, hastane elektronik bilgi sistemi ve hasta dosyalarından retrospektif olarak incelendi. Bulgular: HCV-RNA pozitif 589 hastada HCV genotiplerinin yüzdesi genotip 1b: %66,9, genotip 1a: %7,3, genotip 2: %10,5, genotip 3: 41 %7, genotip 4: %7,1 ve mix genotip: %1,2 olarak tespit edildi. Mix genotiplerin 6 tanesi 1b+4, bir tanesi 1a+3 olarak belirlenmiştir. Kadın ve erkek cinsleri arasında HCV genotipleri arasında istatistiksel olarak anlamlı farklılık görüldü (p<0,001). Genotip 1b hastaları daha ileri yaşlarda, genotip 3 ve genotip 4 hastalarının daha genç yaşlarda olduğu tespit edildi. Sonuç: Hatay’da HCV genotip 1b en yaygın genotiptir ve bunu genotip 2, 1a, 4 ve 3 izlemektedir. Bizim çalışmamızda ülkemizdeki önceki yıllarda yapılan çalışmalara göre genotip 1b daha düşük tespit edilmiştir ve diğer genotiplerin dağılımında artış olduğu saptanmıştır. HCV genotip dağılımındaki değişikliklerin izlenmesi HCV’nin tedavisinde etkili stratejilerin geliştirilmesinde hayati öneme sahipti

Immune thrombocytopenic purpura after varicella infection: Case report

İmmün trombositopenik purpura çocukluk çağında en sık görülen kanama bozukluklarından birisi olup, patogenezinde trombositlere karşı antikorların gelişmesi rol oynamaktadır. İmmün trombositopenik purpura, idiopatik olabildiği gibi, enfeksiyon gibi altta yatan patolojiye bağlı olarak da meydana gelebilmektedir. Biz de varisella enfeksiyonu sonrasında gelişen bir immün trombositopenik purpura olgusunu bildirdik.Immun trombocytopenic purpura is the most common hemorrhagic disorder of the childhood and produced antibodies against platelets have major role in pathogenesis. Immun trombocytopenic purpura may be seen without any reason or secondary to underlying pathologies as infections. Here we present a case of immun thrombocytopenic purpura secondary to varicella infection

Seroprevalence of Tick-Borne Lyme Borreliosis in Hatay

Amaç: Kene tutunması vakalarına son yıllarda artan sıklıkla rastlanan Hatay yöresinde kene kaynaklı Lyme borelyozu varlığının saptanması amaçlanmıştır.Yöntemler: Kenelerin aktif olduğu Nisan-Ekim ayları arasında Hatay il merkezinde ve ilçelerinde yaşayan ve kene tutunması öyküsü olan 65 bireyden, kene temasının üzerinden en az 6 hafta geçmiş olması göz önünde bulundurularak alınan kan örneklerinde ELISA yöntemiyle Borrelia burgdorferi IgG ve IgM antikorları araştırılmıştır. Daha önce keneyle hiç karşılaşmamış olduğunu belirten 105 birey, kontrol grubunu oluşturmuştur. Bulgular: IgM antikorları, kene tutunması öyküsü olan 65 bireyin 45 (%69.2)'inde pozitif ve 5 (%7.7)'inde negatifken, kene tutunması öyküsü olmayan 105 bireyin 1 (%0.95)'inde pozitif bulunmuştur. Ayrıca, kene tutunması olanlardan 15 (%23.1)'inin, olmayanlarınsa 70 (%66.7)'inin gri zonda oldukları saptanmıştır. Sonuçlar: Hatay yöresinde farklı sağlık birimlerine başvuran risk altındaki her birey için yapılacak tanısal testler aşamasında, Lyme hastalığının da düşünülmesi gerekmektedir. Kene tutunması öyküsü olan kişilerin akut/kronik Lyme hastalığı olgularına dönüşüp dönüşmedikleri izlenmeli ve Lyme hastalığının prevalans ve insidansının gerek ülkemizde gerekse bölgemizde kesin olarak belirlenmesini sağlayacak çalışmalar yapılmalıdır. Klimik Dergisi 2012; 25(2): 58-62.Objective: The objective of this study is to determine the presence of Lyme borreliosis transmitted by ticks in Hatay, where cases of tick bites recently increased.Methods: Blood samples collected from 65 persons at least 6 weeks after their tick bite incident who were living in Hatay (Antakya) city and surrounding districts were tested to determine the presence of Borrelia burgdorferi IgG and IgM antibodies by ELISA between April and October, the active tick period. As a control group, 105 persons without a tick bite history were tested as well. Results: Of 65 persons with a history of tick bite, 45 (69.2%) were IgM-positive and 5 (7.7%) were IgM-negative, while only 1 (0.95%) individual was IgM-positive among people without a tick bite history. In addition, 15 (23.1%) people with a history of tick bite, and 70 (66.7%) control individuals were identified in the grey zone. Conclusions: Lyme disease should be taken into consideration for patients who are at risk in Hatay and its surroundings when they apply to health facilities. Each tick bite case should be followed up in order to determine if they develop acute or chronic Lyme disease. Detailed investigations should be performed to determine the prevalence and incidence of Lyme disease in the whole country, including our region. Klimik Dergisi 2012; 25(2): 58-62

The high rate of Candida parapsilosis candidemia among non-burn patients with polytrauma in the surgical intensive care units of a university hospital

Aim: Candidemia is a life-threatening infection that has been reported to be associated with poorer outcomes in trauma patients. The present study aimed to investigate the epidemiology of candidemia in non-burn patients with polytrauma. Material and Methods: We conducted a retrospective, single-center, observational study of polytrauma patients with candidemia admitted to the surgical intensive care units of a university hospital in Turkey between 2013 and 2017 on. Results: The incidence of candidemia was 127 episodes per 1000 intensive care unit admissions in polytrauma patients. Nonalbicans Candida species accounted for 75.5% of all candidemia episodes. C. parapsilosis (51.05%) was the predominant species, followed by C. albicans (24.52%) and C. tropicalis (12.21%). The highest crude mortality rate (72%) was observed in patients with C. parapsilosis candidemia. In multivariate analyses, who had undergone prior gastrointestinal surgery were 7.1 times more likely to have C. parapsilosis candidemia than those with other strains. Conclusion: Our study, remarkable, demonstrated a high incidence of Candidemia had in polytrauma patients, and non-albicans Candida species were the most frequently isolated candida species. According to our study findings, a prior history of gastrointestinal surgery may help predict C. parapsilosis, as the causative agent of candidemia in polytrauma patients. However, since our study was observational and limited to such a small number of patients, the results obtained should be applied with caution