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

The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study

Objective To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. Patients and Methods This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. Results Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3–34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1–30.2), UTUC (n = 128) 1.14% (95% CI 0.77–1.52), renal cancer (n = 107) 1.05% (95% CI 0.80–1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32–2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03–1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90–4.15; P < 0.001), male sex 1.30 (95% CI 1.14–1.50; P < 0.001), and smoking 2.70 (95% CI 2.30–3.18; P < 0.001). Conclusions A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer

A Case of Aids Diagnosed Incidentally in the Presence of Bilateral Pneumonia

Pneumocystis pneumonia (PCP) is a serious opportunistic infection caused by a fungus named Pneumocystis jirovecii. A 20-year-old male patient came to the Emergency Department complaining about weakness, fatigue, achy muscles, joint pain, cold chills, fever, coughing, mucus production for about 2 weeks. Levofloxacin therapy was started with the diagnosis of community-acquired pneumonia to the patient who had no medical history of chronic disease or hospitalization.The patient was consulted as there was no clinical response. Physical examination revealed tachypnea, and ralles in both hemithorax were detected. No other abnormalities were identified on multi-systemic exam. Laboratory work-up showed leukocytes of 2800/cm (45% neutrophil), hemoglobin: 10.1 g/dL (htc: 33.5%), urea: 50 mg/dL, creatinine: 1.2 mg/dL, serum albumin level: 2.4 g/dL, LDH: 798 IU/L, elevated levels of C-reactive protein: 97 mg/L, procalcitonin: 7 ng/mL, sedimentation rate of 83 mm/hour and rapid HIV test was positive. HIV load observed was 125.000 copies/mL, CD4 + cell counts were 125/mm3. A CT scan revealed the presence of diffuse ground glass opacity. Lopinavir + ritonavir 2 x 2 tb + tenofovir disoproxil + emtricitabine treatment with 1 x 1 tb treatment was started. In addition, treatment with trimethoprim-sulfamethoxazole (TMP-SMX) 3 x 160 mg/kg IV and corticosteroids was initiated with the possible diagnosis of PCP pneumonia. Clinical and radiological findings improved and the patient’s treatment was completed in 21 days. PCP pneumonia is an important cause of pneumonia in people who have immunosuppressive diseases such as HIV/AIDS, or in people who are treated with immunosuppressive medications. Therefore, it is important to remember that HIV tests are also required in patients with risk factors or in the presence of clinical, radiological and laboratory findings consistent with opportunistic pneumonia

Varicella Pneumonia in a Healthy Adult: Case Report

Varicella virus infection is a highly contagious, mild, rash viral disease often seen in childhood. In adult age, it is more severe and complicated. In adults, the most common life-threatening complication is varicella pneumonia. A 31-year-old male patient was admitted to the emergency department on the 5th day of onset of rash on hisback and all-body rash and on the development of complaints of high fever, chills, widespread chest pain, drowsiness and coughing during the last 2 days. Physical examination revealed tachypnea and there were maculopapular and vesicular lesions on his whole body. He was a smoker and his child had suffered from chickenpox, two weeks earlier. The eyelids were edematous, the conjunctive were hyperemic and the oropharynx and tonsils were normal. Pulmonary auscultation revealed bilateral crackles. On examination, he was febrile (38.5ºC), heart rate was 120 beats/min, arterial blood pressure was 100/60 mmHg and oxygen saturation was 88%. In laboratory examinations; leukocyte count: 7300/μL (49% PNL, 37% lymphocytes, 13% monocytes), platelet count: 83.000/mm3, C-reactive protein: 15.7 mg/L, erythrocyte sedimentation rate: 13 mm/hour, blood sugar: 91 mg/dL, urea: 26 mg/dL, creatinine: 0.6 mg/dL, ALT: 112 U/L, AST: 151 U/L, ALP: 244 U/L, GGT: 414 U/L, LDH: 4400 U/L, and HBsAg, anti-HBs, anti-HCV and anti-HIV were negative. A diffuse, poorly defined, bilateral alveolar-interstitial opacities were detected on her chest X-ray. Treatment with ampicillin-sulbactam (1 g IV 4 times a day) + acyclovir (3 x 10 mg/kg/day IV) was initiated empirically with varicella pneumonia plus seconder bacterial pneumonia. Varicella IgM was positive and Varicella IgG were negative in the patient’s tests. On the 10th day of the patients treatment, he was discharged by cure after he recovery his laboratory and clinical findings. As a result; it is once again understood how important vaccination for vaccine-preventable infections is, and care should be taken in terms of viral infections with rash and the complications that may arise therefrom

Prostat kanseri̇nde kli̇ni̇k lokali̇ze hastalik evresi̇nde preoperati̇f ga-68 psma pet/bt gerekli̇ mi̇di̇r?

PROSTAT KANSERİNDE KLİNİK LOKALİZE HASTALIK EVRESİNDE PREOPERATİF GA-68 PSMA PET/BT GEREKLİ MİDİR?Günal Özgür, Bahadır Şahin, Fevzi Batuhan Topbaş, Mehmet Çetin, Tunç Öneş, İlker TinayAMAÇ:Günümüzde prostat kanseri hastalarında evreleme amaçlı yapılan görüntülemelerde Ga-68 PSMA pozitron emisyon tomografisi / bilgisayarlı tomografi (Ga-68 PSMA PET/BT) giderek artan oranda tercih edilmektedir ancak bu görüntüleme yöntemi yüksek maliyete sahiptir. Bu çalışmada, klinik lokalize hastalık evresindeki prostat kanseri hastalarında radikal prostatektomi (RP) öncesi evreleme amacıyla çekilen Ga-68 PSMA PET/BT görüntülemesinin hasta grubumuzdaki sonuçlarını paylaşmayı amaçladık. MATERYAL METOT: Mart 2016 – Ağustos 2020 tarihleri arasında prostat kanseri nedeniyle RP yapılan ve ameliyat öncesi Ga-68 PSMA PET/BT görüntülemesi yapılan 39 hasta retrospektif olarak incelendi. Hastalardaki Ga-68 PSMA PET/BT görüntüleme endikasyonları; yüksek veya çok yüksek riskli hastalık varlığı, evreleme amaçlı çekilen Tüm Vücut Kemik Sintigrafisi veya Manyetik Rezonans Görüntüleme/Bilgisayarlı Tomografi görüntülerinde kemik ya da lenf nodu metastazı açısından şüpheli lezyon saptanması olarak belirlendi. Ameliyat öncesi Briganti nomogramında skoru %5’in altında olan hastalara lenfadenektomi işlemi uygulanmadı. Hastalarda yaş, preoperatif PSA değeri, biyopsi ve patolojik Gleason derece grupları (GDG), Ga-68 PSMA PET/BT’de lenf nodu tutulumu/seminal vezikül tutulumu ve patoloji örneklerindeki lenf nodu/seminal vezikül tutulumu bulguları incelendi. BULGULAR:Çalışmaya dahil edilen 39 hastanın yaş ortalaması 65,92 (+/- 4,6) idi. Hastaların operasyon öncesi PSA değerleri ortanca değeri 14,6 (2,5-83) ng/dl idi. Hastaların prostat biyopsi ve RP patolojilerine göre GDG kategorileri tablo 1’de verilmiştir. Preoperatif yapılan Ga-68 PSMA PET/BT görüntülemesinde 39 hastanın 5’inde (%12,8) patolojik lenf nodu tutulumu saptanırken, 1 (%2,5) hastada da seminal vezikül tutulumu rapor edildi.Ga-68 PSMA PET/BT görüntülemesinde lenf nodu tutulumu saptanmayan ve GDG 1 ve 2 olan 11 hastada Briganti nomogramına göre lenf nodu tutulumu riski %5 ‘ten az olması nedeniyle lenf nodu diseksiyonu (LND) yapılmadı. Genişletilmiş LND yapılan 28 hastada patoloji örneklerinde ortanca 14 (8-31) adet lenf nodu saptandı. Genişletilmiş LND yapılan 28 hastanın 7’sinde (%25) metastatik lenf nodu tespit edildi. Preoperatif çekilen Ga-68 PSMA PET/BT’de lenf nodu tutulumu tespit edilen 5 hastanın 2’sinde metastatik lenf nodu tespit edilirken 3 hastada ise patolojik örneklerde metastatik lenf nodu saptanmadı. Ga-68 PSMA PET/BT’de preoperatif lenf nodu tutulumu saptanmayan ancak Briganti nomogramına göre lenf nodu tutulumu riski %5 ‘ten yüksek saptanan ve genişletilmiş LND yapılan 23 hastanın ise 5’inde (%21,7) metastatik lenf nodu tespit edildi. PSMA’da tutulum izlenmeyip patolojik lenf nodu metastazı saptanan 5 hastadan 4’ü yüksek risk grubundaki hastalardı. Preoperatif yapılan Ga-68 PSMA PET/BT görüntülemesinde 39 hastanın 1’inde (%2,5) seminal vezikül tutulumu izlendi. RP patolojilerinde bu hasta dahil olmak üzere toplamda 10 hastada (%25,6) seminal vezikül invazyonu saptandı. SONUÇ :Klinik lokalize hastalık evresindeki prostat kanseri hastalarında radikal prostatektomi (RP) öncesi evreleme amacıyla çekilen Ga-68 PSMA PET/BT görüntülemesi evreleme açısından sınırlı bilgi vermektedir. Ga-68 PSMA PET/BT’de lenf nodu tutulumu saptanmamış olsa da patolojik tümör pozitif lenf nodlarının olabileceği göz önünde bulundurularak, yüksek risk grubundaki hastalara ve Briganti nomogramında yüksek tutulum riski olan hastalara genişletilmiş lenf nodu diseksiyonu yapılması onkolojik açıdan uygulanması gerekli yaklaşımdır. Anahtar Kelimeler : prostat kanseri; lenf nodu; prostat spesifik membran antijen; radikal prostatektomi Tablo 1. Prostat biyopsisi ve Radikal Prostatektomi Patolojilerine göre Gleason Grade Grup bilgileri Grade Grup Prostat Biyopsi % Radikal Prostatektomi % 1 10(4*) 25,6 8 20,5 2 6(1*) 15,4 10 25,6 3 4(1*) 10,3 6 15,4 4 13(3*) 33,3 5 12,8 5 6 15,4 10 25,6 * RP patolojisinde gleason grade grup yükselmesi saptanan hasta sayıs

Short-Term or Long-Term Treatment in Osteomyelitis?

No abstrac

Side Effects of Therapy for Chronic Hepatitis C: High Incidence of Dermal and Mucosal Adverse Events

Introduction: During chronic hepatitis C therapy, both pegylated interferon and ribavirin cause numerous side-effects. In this study, we ascertained the side-effects other than flu-like symptoms and hematologic abnormalities, including neuropsychiatric and dermatologic toxicities, development of autoimmune disorders, and focused on frequencies and management of mucosal-dermal side-effects. Patients and Methods: Out of 76 patients who had received peginterferon (peginterferon alpha-2a or alpha-2b) combined with ribavirin treatment for chronic hepatitis C in the period of 2008 January-2009 July, 71 were included in the study. Patients were questioned about side-effects in each follow-up visit during treatment. Side effects seen in patients receiving peginterferon alpha-2a (28, 39.4%) were also compared to those of patients receiving peginterferon alpha-2b (43, 60.6%). Results: Adverse effects of two different types of peginterferon were found to be similar. When we took all patients into consideration, psychiatric disorders were seen in 42.9% of patients, thyroid disorder in 11.4%, weight loss over 10% in 54%, nausea-vomiting in 47.9%, diarrhea in 31.4%, alopecia in 79.1%, dry mouth in 80%, oral lesion/burning feeling in mouth in 57.4%, pruritus in 74.3%, rash in 26.9%. Topical steroid treatment was given to 17 of 70 patients (24.3%) because of dermatitis. Conclusion: In conclusion, most of the patients receiving treatment for chronic hepatitis C showed dryness of skin and mucous membranes in various levels, and one fourth of the patients developed dermatitis. Importantly, these dermatologic lesions can be controlled with emollients and topical steroids