A Case of Septic Pulmonary Embolism with an Initial Diagnosis of Tuberculosis

Septic pulmonary embolism (SPE) is a rare lung disease that typically occurs when a thrombus containing microorganisms from a nonpulmonary infection focus settles in the pulmonary arteries via the hematogenous route and causes infarction and infection. Nonspecific symptoms such as fever, cough, and chest pain are manifested. SPE is associated with predisposing conditions such as infective endocarditis, intravenous drug addiction, venous catheter, tonsillitis, and tooth and pelvis infections. It has high morbidity and mortality, and the most important point that determines the prognosis is early diagnosis and broad-spectrum antibiotic therapy in the early phase. SPE should be considered when the primary focus of infection is accompanied by high fever and multiple nodules and/or cavitary lesions, which are signs of feeding vessels in the lungs. Here, we present a case of SPE with a hemodialysis catheter and clinical findings of sepsis, which was referred to our center with a preliminary diagnosis of tuberculosis

Disseminated tuberculosis infection and paradoxical reaction during antimycobacterial treatment related to TNF-alpha blocker agent Infliximab

Tumor necrosis factor (TNF)-alpha inhibitors play an important role in the treatment of immun-mediated diseases such as Crohn's disease. But they also have been related to increased risk for disseminated Mycobacterium tuberculosis infections and paradoxical response to antimycobacterial treatment. Here we report a disseminated tuberculosis case and a paradoxical response to treatment after receiving TNF-inhibitor agent Infliximab for Crohn's disease. The patient had a severe clinical condition before the antimycobacterial treatment and although proper treatment was initiated his radiological findings were worsened one month after initiation of the treatment. All control microbologic tests for secondary infections were negative and this situation was accepted as a paradoxical response to antimycobacterial treatment and treatment was continued with the same regimen. At the end of the second month of the treatment, most of the symptoms disappeared and chest radiograph findings were better than the previous one. In conclusion, TNF-alpha inhibitor therapy increases risk of mycobacterial infections and patients should be examined carefully about tuberculosis before starting this therapy. Also, it is important for physicians to recognize and know how to manage paradoxical response related to TNF-alpha inhibitors during anti-tuberculosis treatment

Protective Effects of Resveratrol in a Rat Model of Ischemia-Reperfusion Injury of Sciatic Nerve

Objective: The aim of this study was to determine the effects of resveratrol on ischemia-reperfusion (I/R) injury in the rats sciatic nerve

Effectiveness and safety of entecavir and tenofovir in chronic hepatitis b patients: A multicenter Turkish study in clinical practice

64th Annual Meeting and Postgraduate Course of the American-Association-for-the-Study-of-Liver-Diseases -- NOV 01-05, 2013 -- Washington, DCWOS: 000330252203197Amer Assoc Study Liver Di

Peginterferon alfa-2a plus tenofovir disoproxil fumarate for hepatitis D (HIDIT-II): A randomised, placebo controlled, phase 2 trial

Abstract Background Hepatitis D is the most severe form of chronic viral hepatitis. Treatment guidelines recommend 1 year of peginterferon alfa, which is effective in 25-30% of patients only. Whether prolonged therapy with peginterferon alfa-2a for 96 weeks and combination therapy with tenofovir disoproxil fumarate (TDF) would increase hepatitis D virus (HDV) RNA suppression is unknown. We aimed to explore whether prolonged treatment of HDV with 96 weeks of peginterferon would increase HDV RNA response rates and reduces post-treatment relapses. Methods We did two parallel, investigator-initiated, multicentre, double-blind randomised, controlled trials at 14 study sites in Germany, Greece, Romania, and Turkey. Patients with chronic HDV infection and compensated liver disease who were aged 18 years or older were eligible for inclusion. All patients were HBsAg positive for at least 7 months, anti-HDV positive for at least 3 months, and HDV-RNA positive at the local laboratory at the screening visit. Patients were ineligible if alanine aminotransferase levels were higher than ten times above the upper limit of normal and if platelet counts were lower than 90 000 per mu L, or if they had received interferon therapy or treatment with a nucleoside and nucleotide analogue within the preceding 6 months. Patients were randomly assigned by blinded stratified block randomisation (1:1) to receive 180 mu g of peginterferon alfa-2a weekly plus either TDF (300 mg once daily) or placebo for 96 weeks. The primary endpoint was the percentage of patients with undetectable HDV RNA at the end of treatment assessed by intention to treat. The trials are registered as NCT00932971 and NCT01088659. Findings Between June 24, 2009, and Feb 28, 2011, we randomly assigned 59 HDV RNA-positive patients to receive peginterferon alfa-2a plus TDF and 61 to receive peginterferon alfa-2a plus placebo, including 48 (40%) patients with cirrhosis to the two treatment groups (23 in the peginterferon alfa-2a plus TDF group and 25 in the peginterferon alfa-2a plus placebo group). The primary endpoint was achieved in 28 (48%) of 59 patients in the peginterferon alfa-2a plus TDF group and in 20 (33%) of 61 patients in the peginterferon alfa-2a plus placebo group (odds ratio 1.84, 95% CI 0.86-3.91, p=0.12). We recorded 944 adverse events (459 in the peginterferon alfa-2a plus TDF group and 485 in the peginterferon alfa-2a plus placebo group). The most common adverse events were haematological, behavioural (eg, fatigue), musculoskeletal, influenza-like syndromes, and psychiatric complaints. Interpretation Addition of TDF resulted in no significant improvement in HDV RNA response rates at the end of treatment. These findings highlight that alternative treatment options are needed for hepatitis D.HepNet Study-HouseHoffmann-La RocheGilead Science

Pegylated-Interferon-a-2a plus Tenofovir or Placebo for the treatment of hepatitis delta: First results of the HIDIT-2 study

63rd Annual Meeting of the American-Association-for-the-Study-of-Liver-Diseases (AASLD) -- NOV 09-13, 2012 -- Boston, MAWOS: 000310955601024Amer Assoc Study Liver Di