Clinical follow-up of patients with HBeAg positive chronic hepatitis B infection: A long-term observational study

Background and Aim: We aimed to analyze the demographic, laboratory, and clinical characteristics of patients with HBeAg positive chronic hepatitis B infection in tertiary care centers in Istanbul. Materials and Methods: We conducted an observational cohort with >= 18-year-old patients with HBeAg positive chronic hepatitis B infection, who were followed up in three tertiary care centers in Istanbul between January 2000 and August 2018, were evaluated by reviewing electronic and recorded files. The Ethical Committee of Istanbul Medipol University approved this study (Protocol no: 10840098-604.01.01-E.44136). During the polyclinic interview, consent was obtained from patients for analysis and publication. Results: The mean age of the 64 patients was 30 (range 18-39) years, and 50% (32) of them were males. The mean follow-up period of the patients was 67 (18-180) months. Twenty-four patients were treated with at least one antiviral in their follow-up, and only 2 (3.1%) of these patients developed HBeAg seroconversion without antiviral treatment. HBeAg (+) chronic hepatitis B developed in 4 of the patients after the immune-active period. None of the patients and first-degree relatives had hepatocellular carcinoma (HCC). Conclusion: The rationality of antiviral treatment and HCC development risk in these patients still remains elusive

Tick-related facial cellulitis caused by francisella tularensis

Tick-borne illnesses have diverse biological and clinical features that make recognition and appropriate treatment challenging. Arthropod-transmitted (ticks, fleas and deer flies) tularaemia remains a concern worldwide. Generally, two kinds of tularaemia manifestations, namely ulceroglandular and glandular infections, can arise from the bite of an infected arthropod vector. If the ulceroglandular or glandular form is not treated, suppuration can arise from the gland. In addition, cellulitis is rarely observed around the ulcers. In our case, with the knowledge of tick exposure to the scalp, tularaemia was not initially considered for facial cellulitis without regional lymphadenopathy and also due to apparent failure to respond to doxycycline and gentamicin therapy. Serological confirmation in the late stages of the disease suggests the importance of clinical suspicion in such rare conditions

Single Dose Benzathine Penicillin G in the Treatment of Acute Tonsillopharyngitis Due to Group A Beta-Hemolytic Streptococci

The success rate of single dose benzathine penicillin G intramuscular (IM) injection in the treatment of tonsillopharyngitis caused by group A beta-hemolytic streptococci (GABHS) was investigated. Totally 179 patients in the acute phase of tonsillopharyngeal infection with physical findings of; tonsillar redness, edema, grayish white exudate, enlarged lymph nodes were enrolled into this prospective study. Throat cultures and rapid immunoassay test for the qualitative detection of group A streptococcus antigen was used for all patients. Throat cultures were found positive in 74 (41.4%) patients, whereas rapid immunoassay test was found positive in 69 (38.5%) patients. Single injection dose of benzathine penicillin G was administered to the patients with positive antigen test. Patients were checked with throat samples at 3 and 17 days after injection. The failure rate of this treatment was found as 5% at the end of 17 days

Evaluation of Resistance Transfer by Conjugation, in Escherichia coli, Klebsiella and Salmonella Species, on Solid Phase at Different Temperatures

Conjugation means transfer of genetic material via bacterial membranes. Fimbrial characters that are responsible for this transfer are coded by conjugative plasmids that multiply in the cytoplasm. This transfer efficiency may be different in solid, liquid phases or on membranes. Conjugation in some of the members of Enterobacteriaceae family is also temperature dependant. This study was carried out to determine the optimal temperature and donor-acceptor ratios for transconjugation in Escherichia coli, Klebsiella and Salmonella species which belong to Enterobacteriaceae family. Fifteen strains, five from each of these species that mentioned above, which were determined to be multiresistant, were introduced to standart recipient E. coli J53-2 in two different concentration [(a) donor:recipient ratio 4:1; and (b) donor:recipient ratio is 1:4] and three different temperatures 32°C, 37°C and 42°C. “Multivariate” analysis was done with “repeated measures one way ANOVA test” whereas “univariate” analysis was done with “Wicoxon Sign Rank” tests. The results of these two tests correlated well and the results were found to be statistically different. In conclusion, transconjugation on solid phase was found to be optimal for group (b) where the recipient:donor ratio was 4:1 and the temperature was 37°C

The Direct Medical Cost of Regular Monitoring of Patients with HBeAg-Negative Chronic Hepatitis B Virus Infection

Objectives: Patients with hepatitis B e antigen-negative chronic infection (inactive carriers) account for most of the people living with hepatitis B virus (HBV). This study investigated the direct medical cost of monitoring patients within this group.Materials and Methods: A total of 293 outpatients receiving regular monitoring in a large university hospital were included in the study. Direct medical costs included laboratory tests, imaging, liver biopsies and co-payments. Linear mixed effect models were applied to investigate the effect of follow-up time on the annual cost of monitoring. We made quarterly, semi-annual and annual monitoring cost trajectories in accordance with international guideline recommendations.Results: The average annual direct medical cost per patient was 160 USD and the average laboratory visit cost per patient was 68.5 USD. HBV DNA testing contributed to a majority percentage of the total cost (59.6%). As follow-up time increased, the total annual cost (beta=-2.07) and annual cost for DNA testing (beta=-1.03) decreased. The cost trajectory of the first two years of monitoring remained above the semi-annual follow-up strategy. After three years, the cost trajectory of monitoring, while reducing slightly, remained between the semi-annual and annual follow-up strategy trend lines. Conclusion: Due to high-patient numbers, the total cost of monitoring presents a large economic burden. Taking into consideration the generally benign nature of the disease; the length of intervals between outpatient hospital visits could be reviewed and alternative strategies implemented with the aim of reducing expenditure

Comparison of Different Methods Used in Typing of Brucella Species That Cause Disease in Humans and Investigation of a Possible Relationship Between Biotypes and Phage Types of These Species

This study was planned to identify the species, biotype and phage type of Brucella spp. isolated gram blood, bone marrow and knee punction fluid of 29 patients from three different cities of Turkey. First isolation were done with standart methods and 3 of 29 (10.34%) isolates were found to be ‘’rough’’ as colony morphology and excluded from the study. Twenty-two (75.86%) isolates were found to be Brucella melitensis biotype 3 and 4 (13.79%) were B. melitensis biotype 1. None of the investigated isolates were B. melitensis Rev 1 which is also known as an isolate used for animal vaccination. As a result, B. melitensis biotype 3 was found to be the most prevalent biotype and followed by B. melitensis biotype 1. We found that B. melitensis Rev 1 biotype was not responsible from human brucellosis in our country. All of the results we got by the dye disc and conventional methods were found parallel. Dye disc method when compared with standart isolation method, were found to be easy to read and fast. Phage biotyping of all isolates were done to search a possible relation between the biotypes and phage types. Weybridge, Berkeley and Izatnagar were the phages that we used and fifteen of the isolates were found to belong to phage type C, whereas eleven of them were belong to phage type B. As a result, phage biotyping were found to be a good discrimination parameter between the same biotypes. We though that phage biotyping is an important method for epidemiologic studies and to understand the origin of a known isolate in an epidemic