Četverogodišnja studija učinkovitosti i sigurnosti entekavira u bolesnika s kroničnim hepatitisom B pozitivnih na HBeAg bez prethodne nukleoz(t)idne terapije

Entecavir is a guanosine analogue with activity against hepatitis B virus. The aim of this 4-year trial was to evaluate entecavir treatment in nucleos(t)ide-naive HBeAg-positive chronic hepatitis B patients. Forty-nine patients received entecavir and nine of them withdrew from the trial at the end of week 96. The initial mean value of alanine aminotransferase was 79.4}41.5 IU /L, and at the end of the 4-year study period, 90% of patients had alanine aminotransferase values within the normal range. At week 96, 91.7% of patients had HBV DNA <300 copies; at month 48, 90% of patients had HBV DNA <50 IU /mL. HBeAg loss was recorded in 7.1% of patients at week 96 and in 12.5% at month 48. The rate of HBeAg seroconversion was 4.8% at week 96 and 7.5% at month 48. The rate of HBsAg seroconversion was 2.1% at week 96 and 2.5% at month 48. Entecavir as a potent and safe agent leading to continuous viral suppression proved to be safe and well tolerated therapy.Entekavir je analog gvanozina koji djeluje protiv virusa hepatitisa B. Cilj ove četverogodišnje studije bio je procijeniti liječenje entekavirom kod bolesnika s kroničnim hepatitisom B pozitivnih na HBeAg bez prethodne nukleoz(t)idne terapije. Ukupno je 49 bolesnika primalo entekavir, a devetoro ih se povuklo s terapije na kraju 96. tjedna. Početna srednja vrijednost alanin aminotransferaze bila 79,4}41,5 IU /L, dok je nakon 4 godine vrijednost alanin aminotransferaze bila u normalnim granicama kod 90% bolesnika. U 96. tjednu je <300 kopija HBV DNA zabilježeno u 91,7% bolesnika, a u 48. mjesecu je 48,90% bolesnika imalo <50 IJ/mL HBV DNA. Gubitak HBeAg zabilježen je u 7,1% bolesnika u 96. tjednu te u 12,5% bolesnika u 48. mjesecu. Stopa serokonverzije HBeAg iznosila je 4,8% u 96. tjednu i 7,5% u 48. mjesecu. Stopa serokonverzije HBsAg bila je 2,1% u 96. tjednu i 2,5% u 48. mjesecu. Sigurnost terapije bila je dobra. Bolesnici su dobro podnosili entekavir, snažan i siguran lijek koji dovodi do ustaljenog suzbijanja virusa

Četverogodišnja studija učinkovitosti i sigurnosti entekavira u bolesnika s kroničnim hepatitisom B pozitivnih na HBeAg bez prethodne nukleoz(t)idne terapije

Entecavir is a guanosine analogue with activity against hepatitis B virus. The aim of this 4-year trial was to evaluate entecavir treatment in nucleos(t)ide-naive HBeAg-positive chronic hepatitis B patients. Forty-nine patients received entecavir and nine of them withdrew from the trial at the end of week 96. The initial mean value of alanine aminotransferase was 79.4}41.5 IU /L, and at the end of the 4-year study period, 90% of patients had alanine aminotransferase values within the normal range. At week 96, 91.7% of patients had HBV DNA <300 copies; at month 48, 90% of patients had HBV DNA <50 IU /mL. HBeAg loss was recorded in 7.1% of patients at week 96 and in 12.5% at month 48. The rate of HBeAg seroconversion was 4.8% at week 96 and 7.5% at month 48. The rate of HBsAg seroconversion was 2.1% at week 96 and 2.5% at month 48. Entecavir as a potent and safe agent leading to continuous viral suppression proved to be safe and well tolerated therapy.Entekavir je analog gvanozina koji djeluje protiv virusa hepatitisa B. Cilj ove četverogodišnje studije bio je procijeniti liječenje entekavirom kod bolesnika s kroničnim hepatitisom B pozitivnih na HBeAg bez prethodne nukleoz(t)idne terapije. Ukupno je 49 bolesnika primalo entekavir, a devetoro ih se povuklo s terapije na kraju 96. tjedna. Početna srednja vrijednost alanin aminotransferaze bila 79,4}41,5 IU /L, dok je nakon 4 godine vrijednost alanin aminotransferaze bila u normalnim granicama kod 90% bolesnika. U 96. tjednu je <300 kopija HBV DNA zabilježeno u 91,7% bolesnika, a u 48. mjesecu je 48,90% bolesnika imalo <50 IJ/mL HBV DNA. Gubitak HBeAg zabilježen je u 7,1% bolesnika u 96. tjednu te u 12,5% bolesnika u 48. mjesecu. Stopa serokonverzije HBeAg iznosila je 4,8% u 96. tjednu i 7,5% u 48. mjesecu. Stopa serokonverzije HBsAg bila je 2,1% u 96. tjednu i 2,5% u 48. mjesecu. Sigurnost terapije bila je dobra. Bolesnici su dobro podnosili entekavir, snažan i siguran lijek koji dovodi do ustaljenog suzbijanja virusa

Involvement and Complications Associated with Brucellosis Connected Rare Evaluation of 46 Cases

Purpose: The present study of us assesses brucellosis with atypical involvement and its complications aimed to draw attention to the infection that may interfere with many diseases related to infection or not. Material and method: In our clinic, a total of 447 cases of brucellosis between March 2004 - March 2011 were followed retrospectively. 46 of these cases included in this study which have not specific terms of brucellosis symptoms, signs and / or laboratory data as well as non expected involvement during the course of the disease and / or complications. Results: A total of 46 patients in terms of disease and / or complications evaluated atypical Brucellosis, 17 (39.9%) female and 29 (63.04%) were male. Mean age was 40.8 +/- 10.2. 19 patients (41.3%) blood, 2 cases (4.3%) urine, 4 patients (8.6%), abscess, 1 patient pleural fluid, 1 case (2.1%) mitral valve, 1 patient joint fluid aspiration while 1 patient (2.1%) both peritoneal and pleural fluid samples of Brucella spp . were isolated. Brucellosis related atypical involvement and / or complication was observed in particularly the musculoskeletal system, the central nervous system, cardiovascular system, genitourinary system, and hematologic system, as well as in the skin and mucous membrane of the serous tissues. However, it is found that 37 cases (80.4%) applied for the different sections outside the Department of Infectious Diseases and evaluated respectively. Conclusion: In this study, it is determined that cases were followed with brucellosis (10.2%) atypical disease and / or complications, and the first assesses made by outside the Department of Infectious Diseases. For this reason, we think not only experts in Infectious Diseases, all other branches of physicians should keep in mind in the differential diagnosis of brucellosis. [Cukurova Med J 2014; 39(4.000): 829-839

Endovascular treatment of an iliac artery rupture caused by invasive Salmonella spondylodiscitis

The rate of non-typhoid Salmonella infections has increased remarkably in recent years. Endovascular system infection is one of the most serious forms of extraintestinal Salmonella infection. The abdominal aorta is frequently involved, while bone and joint involvement are rarely seen. We present a rare case of successful endovascular treatment of a left iliac artery rupture and pseudoaneurysm both occurring due to the direct invasion of lumbar spondylodiscitis caused by Salmonella typhimurium

Comparative Evaluation of Cases with Community-Acquired Infective Endocarditis and Health Care-Associated Infective Endocarditis

Purpose: The present study aimed to comparatively evaluate the cases with health care-associated infective endocarditis and the cases with community-acquired infective endocarditis. Material and Methods: Of the cases followed for infective endocarditis (IE), 21 (40 %) had health care-associated infective endocarditis and 31 (60 %) community-acquired infective endocarditis. Results: Comparing the cases with community acquired infective endocarditis and the cases with health care-associated infective endocarditis, it was determined that advanced age (58.0 +/- 15.1 years vs. 41.3 +/- 14.4 years, P=0.000), presence of chronic renal insufficiency (P=0.001) and diabetes mellitus (P=0.016) as concomitant diseases, being previously hospitalized (P=0.0001), hemodialysis in terms of diagnostic and therapeutic interventions (P=0.022), presence of central venous catheter (P=0.022), and undergone intervention for gastrointestinal system (P=0.060), as well as laboratory results including positive blood culture growth for S. aureus and Enterococcus (P=0.037), and complications such as development of embolic event (P=0.008), spondylodiscitis (P=0.034) and stroke (P=0.007) were statistically significantly more common in health care-associated infective endocarditis cases. Whilst mortality was higher in health care-associated infective endocarditis cases (28.6 %), it was determined that there was no statistically significant difference between the groups. Conclusion: Health care-associated infective endocarditis is a disease that is more common in the patients at advanced age, with concomitant disease and the history of exposing invasive procedures in the past for diagnostic and therapeutic purpose, and it is a disease with high morbidity and mortality that courses with serious complications

Mucormycosis with Orbital Apex Syndrome in a Renal Transplant Recipient

Mucormycosis is a rarely encountered invasive fungal infection with high mortality. Solid organ transplantation is one of the risk factors for mucormycosis. Mucormycosis can be classified in six different groups according to the anatomical localization; rhinocerebral, pulmonary, cutaneous, gastrointestinal, disseminated, and other less common involvements. This paper presented a mucormycosis case with rhinoorbitocerebral involvementin a renal transplantation receiver, which manifested with orbital apex syndrome

Clinical characteristics and in-hospital outcomes of acute decompensated heart failure patients with and without atrial fibrillation

Objective: Atrial fibrillation (AF) and heart failure (HF) are common cardiovascular diseases. The impact of AF on in-hospital outcomes in acute decompensated heart failure (ADHF) is controversial. The aim of this study is to determine the prevalence of AF among hospitalized patients with ADHF and describe the clinical characteristics and in-hospital outcomes of these patients with and without AF

Evaluation of extensively drug-resistant gram-negative bacteremia among solid-organ transplant recipients: a multicenter study

Background/aim: The aim of this study is to evaluate the distribution, sources, clinical features, and mortality rates of bacteremia due to evaluation of extensively drug-resistant (XDR) gram negative among solid-organ transplant (SOT) recipients. Materials and methods: A retrospective study of SOT recipients with bacteremia due to XDR gram-negative pathogens in 11 centers between 2016 and 2018 was conducted. Patients' records were evaluated. Results: Of 171 bacteremia that occurred in 164 SOT recipients, 93 (56.7%) were liver, 46 (28%) kidney, 14 (8.5%) heart, and 11 (6.7%) lung recipients. Bacteremia episodes were recorded in the first year in 63.7% of the patients (n = 109), early-onset bacteremia was recorded in 45% (n = 77) of the episodes. In multivariate analysis, catheter-associated bacteremia was an independent risk factor for 7-day mortality (p = 0.037), and early-onset bacteremia was found as an independent risk factor for 30-day mortality (p = 0.017). Conclusion: Difficult-to-treat infections due to XDR bacteria in SOT recipients shadow the success of transplantation. Central venous catheters seem to be the main risk factor. Judicious use of medical devices is of pivotal importance

Antituberculosis drug resistance patterns in adults with tuberculous meningitis: results of haydarpasa-iv study

Background: Tuberculous meningitis (TBM) caused by Mycobacterium tuberculosis resistant to antituberculosis drugs is an increasingly common clinical problem. This study aimed to evaluate drug resistance profiles of TBM isolates in adult patients in nine European countries involving 32 centers to provide insight into the empiric treatment of TBM

The diagnostic utility of the "Thwaites' system" and "lancet consensus scoring system" in tuberculous vs. non-tuberculous subacute and chronic meningitis: multicenter analysis of 395 adult patients

Background Tuberculous meningitis (TBM) represents a diagnostic and management challenge to clinicians. The "Thwaites' system" and "Lancet consensus scoring system" are utilized to differentiate TBM from bacterial meningitis but their utility in subacute and chronic meningitis where TBM is an important consideration is unknown. Methods A multicenter retrospective study of adults with subacute and chronic meningitis, defined by symptoms greater than 5 days and less than 30 days for subacute meningitis (SAM) and greater than 30 days for chronic meningitis (CM). The "Thwaites' system" and "Lancet consensus scoring system" scores and the diagnostic accuracy by sensitivity, specificity, and area under the curve of receiver operating curve (AUC-ROC) were calculated. The "Thwaites' system" and "Lancet consensus scoring system" suggest a high probability of TBM with scores = 12, respectively. Results A total of 395 patients were identified; 313 (79.2%) had subacute and 82 (20.8%) with chronic meningitis. Patients with chronic meningitis were more likely caused by tuberculosis and had higher rates of HIV infection (P < 0.001). A total of 162 patients with TBM and 233 patients with non-TBM had unknown (140, 60.1%), fungal (41, 17.6%), viral (29, 12.4%), miscellaneous (16, 6.7%), and bacterial (7, 3.0%) etiologies. TMB patients were older and presented with lower Glasgow coma scores, lower CSF glucose and higher CSF protein (P < 0.001). Both criteria were able to distinguish TBM from bacterial meningitis; only the Lancet score was able to differentiate TBM from fungal, viral, and unknown etiologies even though significant overlap occurred between the etiologies (P < .001). Both criteria showed poor diagnostic accuracy to distinguish TBM from non-TBM etiologies (AUC-ROC was <. 5), but Lancet consensus scoring system was fair in diagnosing TBM (AUC-ROC was .738), sensitivity of 50%, and specificity of 89.3%. Conclusion Both criteria can be helpful in distinguishing TBM from bacterial meningitis, but only the Lancet consensus scoring system can help differentiate TBM from meningitis caused by fungal, viral and unknown etiologies even though significant overlap occurs and the overall diagnostic accuracy of both criteria were either poor or fair