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

Detection of Echinococcusgranulosus and Echinococcusmultilocularis in Cyst Samples Using a Novel Single Tube Multiplex Real-Time Polymerase Chain Reaction

Dünyada ve ülkemizde Echinococcus granulosus ve Echinococcus multilocularis'in neden olduğu sırasıyla kistik ekinokokkoz (KE) ve alveolar ekinokokkoz (AE) önemli helmint hastalıkları arasındadır. Türkiye'de yapılan epidemiyolojik çalışmalar KE prevalansının 291-585/100.000 arasında olduğunu göstermiştir. AE seroprevalansının da %3.5 oranında olduğu bildirilmiştir. KE ve AE tanısında klinik bulgular yanında genelde radyoloji (ultrason, bilgisayarlı tomografi , manyetik rezonans) ve serolojik yöntemler kullanılmaktadır. Kesin tanı patolojik incelemeye dayalıdır. Hidatik kistlerin steril olması ya da protoskoleks içermemesi durumunda ise, patolojik tekniklerle E.granulosus ve E.multilocularis tür ayrımında zorluklar yaşanmaktadır. Bu çalışmada, aynı test içerisinde AE ve KE tanısının yapılmasına imkan verebilecek Echi S (5'-TTTATGAATATTGTGACCCTGAGAT-3') ve Echi A (5'-GGTCTTAACTCAACTCATGGAG-3') primerleri ve üç farklı prob; Anchor Ech (5'-GTTTGCCACCTCGATGTTGACTTAG-fl oresan-3'), Granulosus (5'-LC640-CTAAGGTTTTGGTGTAGTAATTGATATTTT-fosfat-3') ve Multilocularis (5'-LC705CTGTGATCTTGGTGTAGTAGTTGAGATT-fosfat-3') kullanılarak, E.granulosus ve E.multilocularis mitokondriyal 12S rRNA genini hedefl eyen yeni bir multipleks gerçek zamanlı polimeraz zincir reaksiyonu (M-RTPCR) yönteminin geliştirilmesi amaçlanmıştır. M-RT-PCR sırasında, E.granulosus (GenBank: AF297617.1) ve E.multilocularis (GenBank: NC_000928.2) mitokondriyal 12S rRNA gen bölgelerini içeren plazmidler pozitif kontrol olarak kullanılmıştır. M-RT-PCR yönteminin geliştirilmesinde ayrıca, patolojik olarak KE (n: 10) ve AE (n: 15) olduğu doğrulanmış hastalara ait kist örneklerinin yanı sıra, negatif kontrol olarak sağlıklı insan DNA örnekleri (n: 25) ve 12 farklı parazite (Taenia saginata, Hymenolepis nana, Trichuris trichiura, Fasciola hepatica, Enterobius vermicularis, Toxoplasma gondii, Pneumocystis jirovecii, Trichomonas vaginalis, Cryptosporidium hominis, Strongyloides stercoralis, Plasmodium falciparum, Plasmodium vivax) ait DNA örnekleri de çalışılmıştır. Testin analitik duyarlılığının saptanması için TOPO klonlama ile E.granulosus ve E.multilocularis pozitif kontrol plazmidleri oluşturulmuştur. Pozitif kontrol plazmidi, analitik duyarlılık ve özgüllüğün belirlenmesi amacıyla her reaksiyonda 106-105-104-103-102-101-1 plazmid kopya olacak şekilde distile su ile sulandırılmıştır. Çalışmamızın sonuçları, testin pozitif kontrol plazmidi kullanılarak elde edilen analitik duyarlılığının, E.granulosus ve E.multilocularis için 1 plazmid kopya/?l örnek olduğunu göstermiştir. Testin 12 farklı parazite ait DNA örneği ile çapraz reaksiyon vermemesi, analitik özgüllüğünü ortaya koymuştur. Yirmibeş hastaya ait kist örneğinde Echinococcus DNA varlığının gösterilmesi ve tür ayrımının yapılabilmesinin yanında, sağlıklı (negatif kontrol) insan DNA örnekleri ile çapraz reaksiyon vermemesi, testin klinik duyarlılık ve özgüllüğünün %100 olduğunu göstermiştir. Sonuç olarak, bu çalışmada geliştirilen M-RT-PCR yönteminin, kist örneklerinde ekinokokkoz tanısının konulmasına ek olarak, E.granulosus ve E.multilocularis'in ayırt edilmesinde duyarlı, özgül, hızlı ve güvenilir bir yöntem olduğu tespit edilmiştirCystic echinococcosis (CE) and alveolar echinococcosis (AE) caused by Echinococcus granulosus and Echinococcus multilocularis, respectively, are important helminthic diseases worldwide as well as in our country. Epidemiological studies conducted in Turkey showed that the prevalence of CE is 291-585/100.000. It has also been showed that the seroprevalence of AE is 3.5%. For the diagnosis of CE and AE, radiological (ultrasonography, computed tomography, magnetic resonance) and serological methods, in addition to clinical fi ndings, are being used. The defi nitive diagnosis relies on pathological examination When the hydatid cysts are sterile or does not contain protoscolex, problems may occur during pathological discrimination of E.granulosus and E.multilocularis species. In this study, we aimed to develop a novel multiplex real-time polymerase chain reaction (M-RTPCR) targeting mitochondrial 12S rRNA gene of E.granulosus and E.multilocularis using Echi S (5'-TTTATGAATATTGTGACCCTGAGAT-3') and Echi A (5'-GGTCTTAACTCAACTCATGGAG-3') primers and three different probes; Anchor Ech (5'-GTTTGCCACCTCGATGTTGACTTAG-fl uoroscein-3'), Granulosus (5'-LC640-CTAAGGTTTTGGTGTAGTAATTGATATTTT-phosphate-3') and Multilocularis (5'-LC705-CTGTGATCTTGGTGTAGTAGTTGAGATT-phosphate-3') that will enable the diagnosis of CE and AE in same assay. During M-RTR-PCR, plasmids containing E.granulosus (GenBank: AF297617.1) and E.multilocularis (GenBank: NC_000928.2) mitochondrial 12S rRNA regions were used as positive controls. Cysts samples of patients which were pathologically confi rmed to be CE (n: 10) and AE (n: 15) and healthy human DNA samples (n: 25) as negative control as well as DNA samples of 12 different parasites (Taenia saginata, Hymenolepis nana, Trichuris trichiura, Fasciola hepatica, Enterobius vermicularis, Toxoplasma gondii, Pneumocystis jirovecii, Trichomonas vaginalis, Cryptosporidium hominis, Strongyloides stercoralis, Plasmodium falciparum, Plasmodium vivax) were used to develop M-RT-PCR. E.granulosus and E.multilocularis control plasmids were constructed to detect analytic sensitivity of the test using TOPO cloning. Positive control plasmids were diluted to determine analytical sensitivity and specifi city by distilled water at 106-105-104-103-102-101-1 plasmid copy of dilution in each reaction. According to the results, analytical sensitivity of the assay for E.granulosus and E.multilocularis was 1 copy plasmid/?l reaction. The non-existence of cross reactivity with 12 different parasites' DNA samples showed the analytical specifi city of the assay. Displaying Echinococcus DNA in cyst samples among 25 patients and species discrimination as well as non-existence of cross reactivity with human DNA samples showed that the clinical sensitivity and specifi city of the assay were 100%. As a result, the M-RT-PCR developed in the present study provided a sensitive, specifi c, rapid, and reliable method in the diagnosis of echinococcosis and the discrimination of E.granulosus and E.multilocularis from cyst sample

Genel cerrahi uzmanlık eğitimine farklı bir bakış

Aim: We planned a trial to establish the realities on the suggestion which included the idea that there is loss of interest to General Surgery residency or it is not among the top choices. Material and Method: We performed a questionairre on 202 residents who studied general surgery residency in 9 state universities in Ankara, Istanbul, Izmir and Bursa. The residents were asked about which medical school they have graduated from, how many times they joined residency examination, in which examination they succeede to start residency and the order of their choice of general surgery residency was in their list. Results: Among those 202 residents, only 40 of them preferred general surgery residency as the first choice in their list (19.8 %). Most of residents who were successful in the first examination period preferred Ankara University General Surgery Department (44.4%). The residents who preferred general surgery residency as the first choice were found mostly in Hacettepe University General Surgery Department (37.5 %). Most residents who preferred general surgery residency in their first 3 choice in their list were found in Uludag University General Surgery Department (64.3 %). Examination for medical doctor residency April 2009 results have shown that general surgery residency was chosen in the 24th level among 25 branches. Conclusion: As a result general surgery residency was found to be placed at the end of the choices in residency examination among other branches in our trial.Amaç: Son yıllarda Genel Cerrahi Uzmanlık Eğitimi'ne ilginin azaldığı veya ilk sıralarda tercih edilmediği şeklinde ortaya çıkan bir görüşün gerçek boyutunu saptamak amacıyla bir çalışma planladık. Yöntem: Ankara, İstanbul, İzmir ve Bursa'daki 9 Devlet Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalları'nda uzmanlık eğitimi yapan 202 asistana bir anket uyguladık. Bu anketimizde halen eğitim gören asistanların hangi Tıp Fakültesi'nden mezun oldukları, Tıpta Uzmanlık Sınavına kaç kez girdikleri, hangi sınavda başarılı oldukları, Genel Cerrahi uzmanlık alanını hangi sırada tercih ettikleri ve kazandıkları soruldu. Bulgular: Genel Cerrahi uzmanlık alanını 1. sırada, 202 asistanın ancak 40'ı (%19,8) tercih etmiştir. İlk girdikleri Tıpta Uzmanlık Sınavı'nda başarılı olanlar arasında Ankara Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı'nı tercih edenlerin %44,4 ile 1. sırada yer aldığı izlenmiştir. Genel cerrahiyi ilk sırada tercih edenlerin analizi yapıldığında %37,5 ile Hacettepe Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı ilk sırada yer almaktadır. Genel cerrahiyi ilk 3 sırada tercih edenlerin sonuçları incelendiğinde Uludağ Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı %64,3 ile 1. sırada yer almaktadır. ÖSYM-Tıpta Uzmanlık Sınavı 2009 Nisan Dönemi tüm uzmanlık alanlarının tavan puan sıralamasında 25 uzmanlık alanı içerisinde Genel Cerrahi 24. sırada yer almaktadır. Sonuç: Sonuç olarak uzmanlığa giriş sınavında tercih sırasında Genel Cerrahi'nin son sıralarda yer aldığı bu sonuçlarda da çarpıcı bir şekilde ortaya koyulmaktadı

Pediatric-Onset Chronic Inflammatory Demyelinating Polyneuropathy: A Multicenter Study

Background: To evaluate the clinical features, demographic features, and treatment modalities of pediatric-onset chronic inflammatory demyelinating polyneuropathy (CIDP) in Turkey. Methods: The clinical data of patients between January 2010 and December 2021 were reviewed retrospectively. The patients were evaluated according to the Joint Task Force of the European Federation of Neurological Societies and the Peripheral Nerve Society Guideline on the management of CIDP (2021). In addition, patients with typical CIDP were divided into two groups according to the first-line treatment modalities (group 1: IVIg only, group 2: IVIg + steroid). The patients were further divided into two separate groups based on their magnetic resonance imaging (MRI) characteristics. Results: A total of 43 patients, 22 (51.2%) males and 21 (48.8%) females, were included in the study. There was a significant difference between pretreatment and post-treatment modified Rankin scale (mRS) scores (P 0.05); however, a significant decrease was found in the mRS scores of both groups with treatment (P < 0.05). The patients with abnormal MRI had significantly higher pretreatment mRS scores compared with the group with normal MRI (P < 0.05). Conclusions: This multicenter study demonstrated that first-line immunotherapy modalities (IVIg vs IVIg + steroids) had equal efficacy for the treatment of patients with CIDP. We also determined that MRI features might be associated with profound clinical features, but did not affect treatment response