Association of insulin resistance, viral load, and adipokine levels with liver histology in patients with chronic hepatitis C: An observational, multicenter study in Turkey

PubMedID: 23114743OBJECTIVE: To evaluate the association of insulin resistance (IR), viral load, and adipokine levels with liver histology in patients with chronic hepatitis C (CHC). PATIENTS AND METHODS: In this noninterventional, multicenter study carried out at 11 infectious diseases clinics in Turkey, 103 CHC patients [mean (SD) age: 50.2 (11.0) years, 60 (58.3%) women] planned to be treated by ribavirin and peginterferon-?2a were included. Data on hepatic fibrosis and steatosis, IR, viral load, and hepatitis C virus-RNA genotyping, adipokine, and cytokine levels were collected. RESULTS: The mean (SD) Knodell score was 8.1 (3.6); grade I steatosis was evident in 46 (44.7%) patients and IR was identified in 56 (54.9%). There was a significant positive correlation of the homeostasis model assessment-IR index with Knodell fibrosis (r=0.235; P=0.027) and hepatic steatosis (r=0.435; P<0.001). There was a significant positive correlation of leptin levels with Knodell fibrosis (r=0.265; P=0.013) and hepatic activity index (r=0.218; P=0.041). Hepatic steatosis was correlated negatively with adiponectin (r=-0.320; P=0.001) and positively with leptin (r=-0.368; P<0.001) levels. Logistic regression analysis showed that increase in age [odds ratio (OR), 1.056; 95% confidence interval (CI), 1.005-1.110; P=0.030] was the only significant predictor of hepatic fibrosis (OR, 1.056; 95% CI, 1.005-1.110; P=0.030), whereas increase in age (OR, 1.066; 95% CI, 1.006-1.130; P=0.030), the presence of IR (OR, 5.621; 95% CI, 1.547-20.425; P=0.009), and decrease in adiponectin levels (OR, 0.808; 95% CI, 0.682-0.957; P=0.013) were the significant predictors of hepatic steatosis. CONCLUSION: Our findings indicate a significant relationship of hepatic fibrosis and hepatic steatosis with IR and leptin levels, but not with the viral load in Turkish patients with CHC. © 2012 Wolters Kluwer Health / Lippincott

The clinical features, diagnosis, treatment, and prognosis of neuroinvasive listeriosis: a multinational study

The aim of this study was to determine the independent risk factors, morbidity, and mortality of central nervous system (CNS) infections caused by Listeria monocytogenes. We retrospectively evaluated 100 episodes of neuroinvasive listeriosis in a multinational study in 21 tertiary care hospitals of Turkey, France, and Italy from 1990 to 2014. The mean age of the patients was 57 years (range, 19–92 years), and 64% were males. The all-cause immunosuppression rate was 54 % (54/100). Forty-nine (49 %) patients were referred to a hospital because of the classical triad of symptoms (fever, nuchal rigidity, and altered level of consciousness). Rhombencephalitis was detected radiologically in 9 (9 %) cases. Twenty-seven (64 %) of the patients who had cranial magnetic resonance imaging (MRI) performed had findings of meningeal and parenchymal involvement. The mean delay in the initiation of specific treatment was 6.8 ± 7 days. Empiric treatment was appropriate in 52 (52 %) patients. The mortality rate was 25 %, while neurologic sequelae occurred in 13 % of the patients. In the multivariate analysis, delay in treatment [odds ratio (OR), 1.07 [95 % confidence interval (CI), 1.01–1.16]] and seizures (OR, 3.41 [95 % CI, 1.05–11.09]) were significantly associated with mortality. Independent risk factors for neurologic sequelae were delay in treatment (OR, 1.07 [95 % CI, 1.006–1.367]) and presence of bacteremia (OR, 45.2 [95 % CI, 2.73–748.1]). Delay in the initiation of treatment of neuroinvasive listeriosis was a poor risk factor for unfavorable outcomes. Bacteremia was one of the independent risk factors for morbidity, while the presence of seizures predicted worse prognosis. Moreover, the addition of aminoglycosides to ampicillin monotherapy did not improve patients’ prognosis. © 2015, Springer-Verlag Berlin Heidelberg

Invasive Aspergillosis Due to Aspergillus Section Usti: A Multicenter Retrospective Study.

Aspergillus spp. of section Usti (A. ustus) represent a rare cause of invasive aspergillosis (IA). This multicenter study describes the epidemiology and outcome of A. ustus infections. Patients with A. ustus isolated from any clinical specimen were retrospectively identified in 22 hospitals from 8 countries. When available, isolates were sent for species identification (BenA/CaM sequencing) and antifungal susceptibility testing. Additional cases were identified by review of the literature. Cases were classified as proven/probable IA or no infection, according to standard international criteria. Clinical report forms were obtained for 90 patients, of whom 27 had proven/probable IA. An additional 45 cases were identified from literature review for a total of 72 cases of proven/probable IA. Hematopoietic cell and solid-organ transplant recipients accounted for 47% and 33% cases, respectively. Only 8% patients were neutropenic at time of diagnosis. Ongoing antimold prophylaxis was present in 47% of cases. Pulmonary IA represented 67% of cases. Primary or secondary extrapulmonary sites of infection were observed in 46% of cases, with skin being affected in 28% of cases. Multiple antifungal drugs were used (consecutively or in combination) in 67% of cases. The 24-week mortality rate was 58%. A. calidoustus was the most frequent causal agent. Minimal inhibitory concentrations encompassing 90% isolates (MIC90) were 1, 8, &gt;16, and 4 µg/mL for amphotericin B, voriconazole, posaconazole, and isavuconazole, respectively. Aspergillus ustus IA mainly occurred in nonneutropenic transplant patients and was frequently associated with extrapulmonary sites of infection. Mortality rate was high and optimal antifungal therapy remains to be defined

Temporal Trends in the Epidemiology of HIV in Turkey

Objective: The aim of this study was to analyze the temporal trends of HIV epidemiology in Turkey from 2011 to 2016.Methods: Thirty-four teams from 28 centers at 17 different cities participated in this retrospective study. Participating centers were asked to complete a structured form containing questions about epidemiologic, demographic and clinical characteristics of patients presented with new HIV diagnosis between 2011 and 2016. Demographic data from all centers (complete or partial) were included in the analyses. For the cascade of care analysis, 15 centers that provided full data from 2011 to 2016 were included. Overall and annual distributions of the data were calculated as percentages and the Chi square test was used to determine temporal changes.Results: A total of 2,953 patients between 2011 and 2016 were included. Overall male to female ratio was 5:1 with a significant increase in the number of male cases from 2011 to 2016 (p500 cells/mm(3) while 46.7% presented with a CD4 T cell count of <350 cells/mm(3). Among newly diagnosed cases, 79% were retained in care, and all such cases initiated ART with 73% achieving viral suppression after six months of antiretroviral therapy.Conclusion: The epidemiologic profile of HIV infected individuals is changing rapidly in Turkey with an increasing trend in the number of newly diagnosed people disclosing themselves as MSM. New diagnoses were mostly at a young age. The late diagnosis was found to be a challenging issue. Despite the unavailability of data for the first 90, Turkey is close to the last two steps of 90-90-90 targets.C1 [Erdinc, F. S.; Hatipoglu, C. A.] Ankara Numune Training & Res Hosp, Infect Dis & Clin Microbiol, Ankara, Turkey.[Dokuzoguz, B.; Inkaya, A. C.] Ankara Numune Training & Researh Hosp, Infect Dis & Clin Microbiol, Ankara, Turkey.[Unal, S.] Hacettepe Univ Hastaneleri, Dept Infect Dis & Clin Microbiol, Ankara, Turkey.[Komur, S.] Cukurova Univ, Dept Infect Dis & Clin Microbiol, Adana, Turkey.[Inan, D.] Akdeniz Univ, Dept Infect Dis & Clin Microbiol, Antalya, Turkey.[Karaoglan, I] Gaziantep Univ, Dept Infect Dis & Clin Microbiol, Gaziantep, Turkey.[Deveci, A.] Ondokuz Mayis Univ, Dept Infect Dis & Clin Microbiol, Samsun, Turkey.[Celen, M. K.] Dicle Univ, Dept Infect Dis & Clin Microbiol, Diyarbakir, Turkey.[Kose, S.] Izmir Tepecik Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Izmir, Turkey.[Erben, N.] Eskisehir Osmangazi Univ, Dept Infect Dis & Clin Microbiol, Fac Med, Eskisehir, Turkey.[Senturk, G. C.] Diskapi Yildirim Beyazit Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Ankara, Turkey.[Heper, Y.; Yilmaz, E.; Kazak, E.] Uludag Univ, Dept Infect Dis & Clin Microbiol, Bursa, Turkey.[Kutlu, S. S.] Pamukkale Univ, Dept Infect Dis & Clin Microbiol, Denizli, Turkey.[Sumer, S.] Selcuk Univ, Dept Infect Dis & Clin Microbiol, Konya, Turkey.[Kandemir, B.] Necmettin Erbakan Univ, Meram Med Fac Hosp, Dept Infect Dis & Clin Microbiol, Konya, Turkey.[Sirmatel, F.] Abant Izzet Baysal Univ, Dept Infect Dis & Clin Microbiol, Bolu, Turkey.[Bayindir, Y.; Ersoy, Y.; Yetkin, F.] Inonu Univ, Dept Infect Dis & Clin Microbiol, Malatya, Turkey.[Yildirmak, M. T.] Okmeydani Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey.[Kayaaslan, B.] Yildirim Beyazit Univ, Dept Infect Dis & Clin Microbiol, Fac Med, Ankara, Turkey.[Ozden, K.] Ataturk Univ, Dept Infect Dis & Clin Microbiol, Erzurum, Turkey.[Sener, A.] Canakkale Onsekiz Mart Univ, Dept Infect Dis & Clin Microbiol, Canakkale, Turkey.[Kara, A.] Hacettepe Univ, Dept Infect Dis, Ihsan Dogramaci Childrens Hosp, Ankara, Turkey.[Gunal, O.] Samsun Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Samsun, Turkey.[Birengel, S.] Ankara Univ, Dept Infect Dis & Clin Microbiol, Fac Med, Ankara, Turkey.[Akbulut, A.] Firat Univ, Dept Infect Dis & Clin Microbiol, Elazig, Turkey.[Cuvalci, N. O.] Antalya Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Antalya, Turkey.[Sargin, F.] Medeniyet Univ, Dept Infect Dis & Clin Microbiol, Goztepe Training & Res Hosp, Istanbul, Turkey.[Pullukcu, H.; Gokengin, D.] Ege Univ, Dept Infect Dis & Clin Microbiol, Izmir, Turkey

Central Nervous System Infections In The Absence Of Cerebrospinal Fluid Pleocytosis

Previous multicenter/multinational studies were evaluated to determine the frequency of the absence of cerebrospinal fluid pleocytosis in patients with central nervous system infections, as well as the clinical impact of this condition. It was found that 18% of neurosyphilis, 7.9% of herpetic meningoencephalitis, 3% of tuberculous meningitis, 1.7% of Brucella meningitis, and 0.2% of pneumococcal meningitis cases did not display cerebrospinal fluid pleocytosis. Most patients were not immunosuppressed. Patients without pleocytosis had a high rate of unfavorable outcomes and thus this condition should not be underestimated.Scopu