Positive effect of restrictions on antibiotic consumption

Conclusion: Hospital-acquired Acinetobacter infections, antibiotic consumption, and infection-related mortality were decreased significantly with the restriction of G2C. Positive behaviors that were obtained during the restricted period were continued with release of restriction

Evaluation of epidemiologic characteristics and theraphy of chronic hepatitis B and C patients in Duzce

YÖK Tez No: 242931Giriş ve Amaç: Hepatit B ve hepatit C dünyada yaygın olarak görülen enfeksiyon hastalıklarındandır. Ülkemizde HBsAg pozitifliği %5 bulunurken, HCV prevelansı %1-2,4 aralığındadır. Kronik hepatit B (KHB) tedavisinde standart interferon-alfa (sİFN), pegile interferon-alfa (pegİFN-?) ile nükleozit/nükleotid analogları; kronik hepatit C (KHC) tedavisinde pegİFN-? ile ribavirin (RBV) kombinasyonu kullanılmaktadır. Bu çalışmada Düzce Üniversitesi Hastanesi (DÜH) Enfeksiyon Hastalıkları Kliniğinde takip ve tedavisi yapılan KHB ve KHC hastalarının epidemiyolojik özellikleri ve tedavilerinin değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: DÜH Enfeksiyon Hastalıkları Kliniğinde sİFN veya pegİFN-? tedavisi alan KHB ile pegİFN-? + RBV tedavisi başlanılan KHC olguları çalışmaya alındı. KHB olgularından 26'sı ve KHC olgularından 19'u retrospektif değerlendirilirken, 7 KHB ve 2 KHC olgusu prospektif olarak takip edildi. Olguların epidemiyolojik özellikleri, ilk başvuru ve tedavi döneminde ki laboratuvar değerleri ile tedaviye bağlı görülen yan etkiler hasta takip kartlarına kaydedildi. Verilere ait tanımlayıcı istatistikler, sayı, yüzde, ortalama±SD, ortanca (min-max) olarak tablolar halinde verildi. Kategorik değişkenlerin karşılaştırılmasında Likelihood Ki-Kare testi, sürekli değişkenlerin karşılaştırılmasında Mann-Whitney U testi kullanıldı.Bulgular: KHB olgularının %66,3'ü HBeAg ? negatif hastalardı. Olguların birinci derece yakınlarında %63 oranında Hepatit B virüsüyle teması gösteren serolojik test pozitifliği vardı. KHB ve KHC bulaş risk faktörlerinden diş tedavisi hikâyesi; KHB'li olguların %64'ünde ve KHC'li olguların %81'inde saptandı. PegİFN-? tedavisiyle alınan virolojik ve biyokimyasal yanıt HBeAg-negatif hastalarda, HBeAg-pozitif hastalardan daha iyi bulundu. HBeAg-negatif hastalarda; kalıcı biyokimyasal yanıt (KBY) %55, kalıcı virolojik yanıt (KVY) %4,5 saptandı. HBeAg-pozitif olgularda KBY %9 bulunurken KVY görülmedi. HBeAg serokonversiyonu olguların %18'inde tespit edildi ancak HBsAg serokonversiyonu saptanmadı.KHC olgularında; %75 tedavi sonu biyokimyasal yanıt (TSBY) ve tedavi sonu virolojik yanıt (TSVY), %45 KBY ve KVY tespit edildi. Erken virolojik yanıt (EVY) olguların %90'ında görüldü. KHC tedavisinde pegİFN-? 2a + RBV ve pegİFN-? 2b + RBV kombinasyonu kullanan olgularda alınan TSBY ve TSVY arasındaki fark istatistiksel olarak anlamlı bulundu (p=0.001). TSBY ve TSVY pegİFN-? 2a başlanılan olgularda %100, pegİFN-? 2b başlanılan olgularda %44 tespit edildi. PegİFN-? 2a başlanılan olgularda yanıtsızlığa bağlı tedavi sonlandırılması görülmezken, pegİFN-? 2b başlanılan olgularda %55'ti.Sonuç: KHB tedavisinde İFN'lara yanıt oranlarının düşük çıkmasında, yüksek viral yük, düşük ALT düzeyi ve hastaların çoğunluğunun erkek olması etkili olmuş olabilir. HbeAg negatif KHB olgularında PegİFN'lara alınan iyi yanıtlar daha büyük hasta serileri ile doğrulanmalıdır. KHC tedavi yanıtları, PegİFN-? 2a kullanılan olgularda daha iyi olmakla birlikte pegİFN-? 2a ve 2b formlarının bire bir karşılaştırıldığı çok merkezli çalışmaların yapılması gereklidir.Background/Aims: Hepatitis B and hepatitis C are common infectious diseases all over the world. In our country, HBsAg positivity was found 5%, and the prevalence of anti HCV was detected between 1% and 2.4%. In chronic hepatitis B (CHB) treatment, standard interferone alpha (sIFN), pegylated interferone alpha (pegIFN-?), and nucleoside/nucleotide analogs, and in chronic hepatitis C (CHC) treatment pegIFN-? and ribavirin (RBV) combination were used. In this study, evaluation of epidemiological characteristics and therapy of CHB, and CHC patients in Clinical Microbiology and Infectious Diseases clinic in Düzce University Hospital (DUH) was aimed.Material and Method: CHB patients who received sIFN or pegIFN-?, and CHC patients who received pegIFN-? and RBV in Clinical Microbiology and Infectious Diseases clinic in DUH were included in the study. The 7 patients of CHB and the 2 patients of CHC were evaluated prospectively, while the 26 CHB and the 19 CHC patients were following up prospectively. Epidemiologic characteristics of patients, laboratory parameters at baseline and during the treatment, and side effects due to therapy were noted to patient cards. Descriptive statistics of data were given as numbers, percentages, mean±standart deviation, and median (minimum-maximum) in tables. In order to compare the categorical variables, Likelihood chi-square test, and in comparing continuous variables, Mann-Whitneyy U test were used.Results: Twenty two (66,3%) of CHB patients were HBeAg-negative. In first-degree close relatives of patients, hepatitis B virus contaction seropositivity was present in 63%. History of dental extraction, which is one of the risk factors of CHB and CHC, was determined 64% in CHB and 81% in CHC patients. Virological and biochemical response with pegİFN-? therapy in HBeAg negative patients was found higher than HBeAg positive patients. In HBeAg negative patients; sustained biochemical response (SBR) and sustained virological response (SVR) were determined 55%, and 4.5% respectively. In HBeAg positive patients; SVR was not detected, while SBR was determining 9%. HBeAg seroconversion were determined 18% in the overall patients but HBsAg seroconversion was not established.In CHC patients; 75% biochemical and virologic response at the end of treatment, and 45% SBR and SVR were found. Early virological response (EVR) was seen in 90% patients. In CHC therapy, difference in biochemical and virological response at the end of treatment between pegİFN-? 2a + RBV and pegİFN-? 2b + RBV was found statistically significant (p<0.001). Biochemical and virologic response rate at the end of treatment were determined 100% in patients who received pegİFN-? 2a and 44% in patients who received pegİFN-? 2b. Treatment cessation was not observed in pegİFN-? 2a group, while therapy discontinuation was determining 55% in pegİFN-? 2b patients.Conclusion: In CHB therapy, high viral load, low ALT levels, and male predominancy have been effective in low response rates to interferones. Good response rates for pegİFN-? in HBeAg negative CHB patients, should be confirmed on a cohort of naive patients. Although, responses in CHC with pegİFN-? 2a were better; multicenter and head-to-head comparative studies which were comparing pegİFN-? 2a and 2b forms are necessary

Comparison of brucellar and tuberculous spondylodiscitis patients: results of the multicenter "Backbone-1 Study"

CONCLUSIONS: The results of this study show that TSD is a more suppurative disease with abscess formation requiring surgical intervention and characterized with spinal complications. We propose that using a constellation of constitutional symptoms (fever, back pain, and weight loss), pulmonary involvement, high inflammatory markers, and radiological findings will help to differentiate between TSD and BSD at an early stage before microbiological results are available. (C) 2015 Elsevier Inc. All rights reserved

The effect of severe sepsis on platelet count and their indices.

Conclusions: Platelet indices are important laboratory findings in the diagnosis of sepsis and severe sepsis. Severe sepsis patients who have greater than 18 % PDW levels have a higher risk of death. Therefore, PDW, which is part of an inexpensive, easily accessible and routinely performed test for almost all patients admitted to health facilities may be used for predicting mortality

Choice of drugs in the treatment of chronic hepatitis B in pregnancy

The selection of antiviral drugs for chronic hepatitis B (CHB) treatment in pregnancy is very difficult since none of the drugs have been approved for use in pregnancy. Transmission from mother to newborn remains the most frequent route of infection in mothers with high viral load and positive hepatitis B e antigen status, even with the use of appropriate prophylaxis with hepatitis B virus (HBV) immunoglobulin and HBV vaccination. We read from the article written by Yi et al that lamivudine treatment in early pregnancy was safe and effective. However, we could not understand why adefovir dipivoxil (ADV) was used in three pregnancy cases, since ADV has been classified as pregnancy category C. In pregnancy, telbivudine or tenofovir should be selected when the treatment of CHB is necessary, since these drugs have been classified as Food and Drug Administration pregnancy risk category B. (c) 2013 Baishideng. All rights reserved