Real-world efficacy and safety of Ledipasvir plus Sofosbuvir and Ombitasvir/Paritaprevir/Ritonavir +/- Dasabuvir combination therapies for chronic hepatitis C: A Turkish experience

Background/Aims: This study aimed to evaluate the real-life efficacy and tolerability of direct-acting antiviral treatments for patients with chronic hepatitis C (CHC) with/without cirrhosis in the Turkish population.Material and Methods: A total of 4,352 patients with CHC from 36 different institutions in Turkey were enrolled. They received ledipasvir (LDV) and sofosbuvir (SOF)+/- ribavirin (RBV) ombitasvir/paritaprevir/ritonavir +/- dasabuvir (PrOD)+/- RBV for 12 or 24 weeks. Sustained virologic response (SVR) rates, factors affecting SVR, safety profile, and hepatocellular cancer (HCC) occurrence were analyzed.Results: SVR12 was achieved in 92.8% of the patients (4,040/4,352) according to intention-to-treat and in 98.3% of the patients (4,040/4,108) according to per-protocol analysis. The SVR12 rates were similar between the treatment regimens (97.2%-100%) and genotypes (95.6%-100%). Patients achieving SVR showed a significant decrease in the mean serum alanine transaminase (ALT) levels (50.90 +/- 54.60 U/L to 17.00 +/- 14.50 U/L) and model for end-stage liver disease (MELD) scores (7.51 +/- 4.54 to 7.32 +/- 3.40) (p<0.05). Of the patients, 2 were diagnosed with HCC during the treatment and 14 were diagnosed with HCC 37.0 +/- 16.0 weeks post-treatment. Higher initial MELD score (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.22-2.38; p=0.023]), higher hepatitis C virus (HCV) RNA levels (OR: 1.44, 95% CI: 1.31-2.28; p=0.038), and higher serum ALT levels (OR: 1.38, 95% CI: 1.21-1.83; p=0.042) were associated with poor SVR12. The most common adverse events were fatigue (12.6%), pruritis (7.3%), increased serum ALT (4.7%) and bilirubin (3.8%) levels, and anemia (3.1%).Conclusion: LDV/SOF or PrOD +/- RBV were effective and tolerable treatments for patients with CHC and with or without advanced liver disease before and after liver transplantation. Although HCV eradication improves the liver function, there is a risk of developing HCC.Turkish Association for the Study of The Liver (TASL

Evaluation of trunk asymmetry in school children and adolescent

BACKGROUND: We aim to determine the frequency of structural and nonstructural scoliosis in children and evaluate the relationship between sportive activity and nonstructural scoliosis.METHODS: Three hundred and fourteen (314) children and adolescents (149 boys and 165 girls) between the ages of 8-16 were evaluated with forward bending test and the angle of trunk rotation (ATR) was measured with scoliometer. Children were grouped by their participation or nonparticipation in sports. Those with ATR≥7 were referred to our clinic. The bending test was performed in both standing and sitting forward bending position. Radiographic and leg length inequality were also evaluated.RESULTS: Girls were significantly asymmetrical compared to boys (X2 =7.685; P=0.021). In 10 children, with the scoliometer readings were 7° or more. 8 screened-positive children participated in the hospital-based diagnostic stage. Structural scoliosis was found in 4 subjects. Nonstructural scoliosis was found to in other 4 subjects. Out of 4 subjects with nonstructural scoliosis 3 subjects were found to participate in high-intensity sports for more than 5 years.CONCLUSIONS: Trunk asymmetry can be a sign of structural scoliosis or it can be detected in cases related to functional disorders. Especially in athletic population, repetitive asymmetric motion patterns can cause an increase in the frequency of this nonstructural scoliosis. It may be important for physicians – especially sports physicians – to evaluate adolescent athletes with trunk asymmetries in terms of functional disorder

Emiralem Deresi'nin (İzmir-Menemen) Bazı Fiziko-Kimyasal ve Biyolojik (Bentik Makroomurgasızlar) Özelliklerinin İncelenmesi

Bu çalısma Mart 2004 ve Haziran 2004 tarihleri arasında, İzmir ili Menemen ilçesi sınırları içinde yer alan Emiralem deresinin bazı biyolojik ve fiziko-kimyasal özelliklerini incelemek ve bu özelliklere dayanarak su kalitesini belirlemek amacı ile yapılmıstır. Çözünmüs oksijen miktarı, elektriksel iletkenlik, pH ve su sıcaklıgı degerleri arazide tasınabilir ölçüm aletleri kullanılarak, asit baglama yetenegi, toplam sertlik; kalsiyum iyonu, magnezyum iyonu, amonyum azotu, nitrat azotu, nitrit azotu ve fosfat fosforu miktarları ise laboratuar ortamında analiz edilmistir. Çalısma sonucunda, sekiz takıma ait 24 cins saptanmıstır. Tayin edilen taksonlardan indikatör özellikte olanlar kullanılarak Emiralem deresinin su kalitesi biyolojik olarak tanımlanmıstır. Ayrıca fiziko-kimyasal veriler de kullanılarak su kalitesi tayini yapılmıs ve elde edilen sonuçlar karsılastırılmıstır

Brucellosis case with thrombocytopenia

Brusellozisde hematolojk komplikasyonlar görülür ve bunlardan biri de trombositopenidir. Biz burada hepatomegali, splenomegali, lenfadenopati, periferik yaymada dev trombositler ve kemik iliği incelemesinde megakaryositer seride artış olan trombositopeni ile seyreden bir Brusella olgusu sunduk.Heametologic complications of brucellosis is seen and thromboyctopenia is the one. Here, we report a brucellosis one with trombocytopenia who had hepatosplenomegaly, lympadenopaty and peripheral blood smear contained giant platelets, examination of bone marrow showed elevating numbers of megakaryocytes

Kala-azar in childhood

Kala-azar (Visceral Leishmaniasis;, sıklıkta Leishmania (L) donovani, L. infantum ve L. chagasi tarafından oluşturulan, tedavi edilmediğinde ölümle sonuçlanan protozoal bîr hastalıktır. Bu yazıda, Çukurova Üniversitesi Tıp Fakültesi Balcalı Hastanesi Çocuk Enfeksiyon Hastalıktan Servisinde son 3 yılda izlenen 14 Kala-azar'lı olgu retrospektif olarak incelenerek, hastalığın klinik, laboratuvar ve tedavi özellikleri literatürün ışığında gözden geçirilmiştir. Olgularda en sık görülen başvuru yakınmalarının karın sisliği (%85.7), ateş (%78.6) ve iştahsızlık (%57.1) olduğu ve olguların tümünde anemi ve hepatosplenomegali bulunduğu saptanmıştır. 13 olguda (%92.8) kemik iliğinde, 1 olguda (%7.2) karaciğer biopsi örneğinde amastigotların saptanması ile tanı konulduğu, 10 olguda (%71.4) tek basına meglumin antimonate tedavisi ile şifa sağlandığı görülmüştür. Hastalığın bulasıcılığını kolaylaştıran koşulların yaygın olarak bulunduğu bölgemizde, ateş, karın şişliği, iştahsızlık gibi yakınmalar ile gelen olguların Kala-azar yönünüden değerlendirilmesi ve hastalığın yayılımının engellenmesi için bölgede etkin önlemlerin alınması gerektiği düşünülmüştür.Kala-azar (Visceral leishmaniasis) which is frequently caused by Leishmania (L) donovani, L.infantum and Lchagasi, is a protozoal disease. Visceral dissemination may result in fatal complications, if the disease is not treated. In this retrospective study, we evaluated the clinical and laboratory findings and the treatment modalities of 14 patients with Kala-azar who had been followed up in the Department of P&eacute;diatrie Infectious Disease during the last three years. At the beginning of the disease, the most frequent complaints were abdominal distention (85.7%), fever (78.6%) and anorexia (57.1%). The most prominent findings were marked anemia and hepato splenomegaly. The diagnosis had been confirmed by demonstrating the amastigotes in bone marrow aspiration in 13 patients (92.8%) and by liver biopsy in 1 patient (7.2%). Ten patients (71.4%) were treated with meglumin antimony successfully. We concluded that, since the Çukurova region is an endemic area for Kala-azar and factors leading to transmission are very common, children who present with fever, abdominal distention and anorexia should be evaluated for Kala-azar, and effective preventive measures need to be taken against this infection in this region

The Most Common Cause of Sudden Cardiac Death in Athletes: Hypertrophic Cardiomyopathy-Associated Genes and Mutations

The term of Sudden Cardiac Death (SCD) is a special situation occurred when a person dies suddenly and unexpectedly from cardiovascular diseases. Hypertrophic Cardiomyopathy (HCM), coronary artery abnormalities, myocarditis, arrhythmogenic right ventricular dysplasia, ion channel defects and aortic stenosis can all cause etiopathogenesis of SCD. The most common reason of sudden death in athletes is Hypertrophic Cardiomyopathy (HCM) which caused by mutations in genes encoding sarcomeric proteins. Here, we review the genetic basis of sudden cardiac death with a focus on the current knowledge on the genetics of the HCM by mutations in genes

Funerals and elections: the effects of terrorism on voting behavior in Turkey

This article empirically analyzes the effects of terrorism on the electoral choices of the Turkish voters in the 1991 and 1995 general elections. It relies on a unique data set that includes the date and the place of burial of Turkish soldiers and police officers who died in the fight against the terrorist organization PKK. These young men are very highly regarded in the Turkish culture, and are known as "terror martyrs". Moreover, for the most part of the Turkish people, they constitute the most tangible and important loss to terrorism. I employ the number of these security force terror casualties at the district level as a measure of the level of terrorism that the people of that district have been exposed to, and analyze whether and how exposure to terrorism affects people's electoral choices. The results indicate that Turkish voters are highly sensitive to terrorism, and that they blame the government for their losses. Moreover, exposure to terrorism leads to an increase in the vote share of the right-wing parties who are less concessionist towards the terrorist organizations cause compared to their left-wing counterpart

A multicentered study on efficiency of noninvasive ventilation procedures (SAFE-NIV)

Background/aim: To characterize the clinical course of noninvasive positive pressure ventilation (NIPPV) and high flow humidified nasal cannula ventilation (HFNC) procedures; perform risk analysis for ventilation failure