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

Katmanlanmış malzemelerin çarpma yükü altında ayrılması

In this study, a cold worked tool steel and a low carbon steel ( St 37 ), which were joined by brazing, were subjected to impact and shear loading. The end product is used as paper cutting blades in the industry. Effects of different brazing filler metals on the delamination of the blades under impact loading and on the impact toughness of the blades were studied. The target is to achieve higher impact toughness values without delamination. Impact toughness of the steels, joined by Cu, CuNi and BNi brazing filler metals and separation of brazed surfaces under shear loading were studied. The microstructures that were formed as a result of each application were studied by scanning electron microscopy and x-ray diffraction. The results indicate that brittle intermetallic compounds are formed in BNi brazing filler metal application. It is observed that CuNi alloy with 24% wt Ni form stronger bonds with the base metals than pure Cu and 10% wt Ni CuNi alloy.M.S. - Master of Scienc

Investigation of the Antibiotic Residue Levels in Honey produced in Ardahan Province

Bal sahip olduğu özellikleri ve sağlıklı bir gıda maddesi olması nedeniyle tüketiciler tarafından tercih edilen hayvansal orjinli bir üründür. Bal arılarında görülen American foulbrood (AFB) ve European foulbrood (EFB) gibi hastalıklar ciddi kayıplara yol açmaktadır. Bu hastalıklar ile mücadelede antibakteriyel ajanların kullanımı ise bal ve bal ürünlerinde kalıntı sorununa neden olmaktadırlar. Olası antibiyotik kalıntıları nihai tüketici olan insanlarda antibiyotik direnci ve allerjik reaksiyonlar gibi ciddi sorunlar oluşturmaktadır. Bu nedenle, gerek Avrupa Birliği gerekse ülkemizde arı yetiştiriciliğinde antibiyotik kullanımı yasaklanmıştır. Bu çalışmada, Ardahan ve ilçelerinden toplanan 180 adet bal numunesi antibiyotik (sulfonamid ve streptomisin) kalıntısı yönünden analiz edildi. Direk üreticilerden sağlanan numunelerin kalıntı analizi ticari kit (Ridascreen) kullanılarak ELISA yöntemiyle gerçekleştirildi. Bulguların istatistiki karşılaştırmaları için variyans analizi metodu uygulanmış, gruplar arası önem kontrolleri Duncan-testi ile tespit edilmiştir. Analiz sonuçlarına göre, streptomisin için numunelerin %37sinde, sulfonamid için ise numunelerin %52sinde kalıntı tespit edilmiştir. Streptomisin için en yüksek kalıntı düzeyi (ortalama 5.57 ppm) Posof ilçesinde, sulfonamid içinse ortalama 2.79 ppm ile Çıldır ilçesinden alınan örneklerde ölçülmüştür. Sonuç olarak, üreticilerin antibiyotik kullanımı hakkında bilgilendirilmeleri ve antibiyotik kalıntısı bakımından kontrollerin daha sık yapılması gerektiği düşünülmektedir.Owing to special properties and being a healthy food, honey is an animal originated product, preferred by consumers. Diseases such as American foulbrood (AFB) and European foulbrood (EFB) seen in honeybees lead to serious economical losses. The use of antibacterial agents against these diseases results in residual problems in honey and honey products. Possible antibiotic residues cause serious problems, such as antibiotic resistance and allergic reactions in people who are the ultimate consumers. Therefore, the use of antibiotics in honeybee keeping has been forbidden in the EU countries and in our country. In this study, 180 honey samples obtained from Ardahan and its towns were analysed for the antibiotic residues (sulphonamides and streptomycin). Residual analyses of samples obtained directly from the procuders were carried out by using ELISA commercial test kits (Ridascreen). Variance analysis method was applied for statistical comparisons and the differences between groups were determined by Duncan test. According to the results, 37 and 52% of the samples contained residues for streptomycin and sulfonamides, respectively. Maximum residue levels for streptomycin (mean 5.57 ppm) were measured in samples taken from Posof and for sulfonamide (mean 2.79 ppm) in samples taken from çıldır. As a result, beekeepers should be educated about the use of antibiotics and the inspections determining the antibiotic residue should be made more often

Psoas Abscess Due to Aeromonas hydrophila: Case Report

Forty-one years old male patient who was operated on with the diagnosis of acute necrotizing pancreatitis admitted with probable intraabdominal infection. We determined psoas abscess which fistulized to the skin of abdominal wall by radiological examinations. As Aeromonas hydrophila was isolated from the pus, the patient was evaluated for the risk factors. Intraabdominal infection was treated by imipenem during three weeks without any surgical intervention. The patient remained symptomless during three months follow up. The case was presented because of the unusual psoas abscess which was caused by A. hydrophila

Effects of ozone and photo-activated disinfection against Enterococcus faecalis biofilms in vitro

Objectives: The purpose of this study was to compare the antibacterial effects of gaseous ozone (O3) and photo‑activated disinfection (PAD) methods against Enterococcus faecalis (E. faecalis) biofilms.Materials and Methods: Sixty‑five human mandibular premolars with straight root canals were selected. After root canal preparation, the samples were sterilized and placed into eppendorf tubes with 1 mL brain heart infusion broth containing 1.5 × 108 colony‑forming units (CFUs)/mL of E. faecalis. The contaminated samples were then divided into four groups (n = 15) according to the disinfection method used: Group 1, Saline (positive control); Group 2, NaOCl (negative control); Group 3, Gaseous O3; and Group 4, PAD. Three non‑contaminated teeth were used to control the infection and sterilization process. The CFUs were counted and the data were analyzed statistically.Results: There was a statistically significant difference between the experimental and control groups (P &lt; 0.05). The saline group had the highest number of remaining microorganisms. Complete sterilization was achieved in the 2.5% NaOCl group. There were no statistically differences between PAD and gaseous O3 (P &gt; 0.05).Conclusion: Both PAD and gaseous O3 have a significant antibacterial effect on infected root canals. However, 2.5% NaOCl was superior in terms of its antimicrobial abilities compared with the other disinfection procedures.Keywords: Biofilm, Ozone, Photo‑activated Disinfection, Root Canal Disinfectio

A multicenter, randomized, prospective study of 14-day ranitidine bismuth citrate- vs. lansoprazole- based triple therapy for the eradication of Helicobacter pylori in dyspeptic patients

Giriş ve Amaç: Proton pompa inhibitörü ve ranitidin bizmut sitrat bazlı üçlü tedavi rejimleri Helikobakter pilori eradikasyonun- da ilk basamak tedavi olarak önerilir. Çok merkezli prospektif, randomize bir çalışma ile bu iki tedavi rejiminin etkinlik ve tolere edilebilirliğini araştırmayı amaçladık. Gereç ve Yöntem: On beş çalışma merkezinden dispeptik yakınmaları olan hastalar seçil- di. Hem histolojik hem de hızlı üreaz testi ile Helikobakter pilori pozitifliği tanımlanan hastalar belirlendi. Hastalar 14 gün bo- yunca günde ikişer defa olmak üzere ya ranitidin bizmut sitrat 400 mg + amoksisilin 1 g + klaritromisin 500 mg ya da lansopra- zol 30 mg + amoksisilin 1 g + klaritromisin 500 mg kullanacak şekilde randomize edildi. Tedavi süresince yan etkiler kaydedildi. Tedavi bitiminden 6 hafta sonra 13C üre nefes testi ile Helikobakterin eradike olup olmadığına bakıldı. Etkinlik intension to treat ve per protocol analizleri ile değerlendirildi. Bulgular: 279 hasta randomizasyona uygundu (123 erkek, 156 kadın). Per protocol analizinde (247 hasta) ranitidin bizmut sitrat bazlı tedavinin ve lansoprazol bazlı tedavinin eradikasyon oranları sırasıyla %74,6 ve %69,2 idi (p>0,05). Intension to treat analizinde ise (279 hasta) ranitidin bizmut sitrat bazlı tedavinin ve lansoprazol bazlı te- davinin eradikasyon oranları sırasıyla %65,1 ve %63,6 idi (p>0.05). Her iki tedavide iyi tolere edildi ve anlamlı bir yan etki gözlen- medi. Sonuç: Ranitidin bizmut sitrat bazlı tedavi klasik proton pompa inhibitörlü tedavi kadar etkin ve tolere edilebilirdir. Ama her iki tedavi de önerilebilir eradikasyon oranlarına ulaşamamıştır.Background/aims: Proton-pump inhibitor- and ranitidine bismuth citrate-based triple regimens are the two recommended first- line treatments for the eradication of Helicobacter pylori. We aimed to compare the effectiveness and tolerability of these two treat- ments in a prospective, multi-centric, randomized study. Materials and Methods: Patients with dyspeptic complaints were recrui- ted from 15 study centers. Presence of Helicobacter pylori was investigated by both histology and rapid urease test. The patients we- re randomized to either ranitidine bismuth citrate 400 mg bid plus amoxicillin 1 g bid plus clarithromycin 500 mg bid (n=149) or lansoprazole 30 mg bid plus amoxicillin 1 g bid plus clarithromycin 500 mg bid (n=130) treatment arm for 14 days. Adverse events have been recorded during the treatment phase. A 13C urea breath test was performed 6 weeks after termination of treatment to as- sess the efficacy of the therapy. Eradication rate was calculated by intention-to-treat and per-protocol analysis. Results: Two hun- dred seventy-nine patients (123 male, 156 female) were eligible for randomization. In per-protocol analysis (n=247), Helicobacter pylori was eradicated with ranitidine bismuth citrate- and lansoprazole-based regimens in 74,6% and 69,2% of cases, respectively (p&gt;0,05). Intention-to-treat analysis (n=279) revealed that eradication rates were 65,1% and 63,6% in ranitidine bismuth citrate- and in lansoprazole-based regimens, respectively (p&gt;0,05). Both regimes were well-tolerated, and no serious adverse event was ob- served during the study. Conclusion: Ranitidine bismuth citrate-based regimen is at least as effective and tolerable as the classi- cal proton-pump inhibitor-based regimen, but none of the therapies could achieve the recommendable eradication rate