In a real-life setting, direct-acting antivirals to people who inject drugs with chronic hepatitis c in Turkey

Background: People who inject drugs (PWID) should be treated in order to eliminate hepatitis C virus in the world. The aim of this study was to compare direct-acting antivirals treatment of hepatitis C virus for PWID and non-PWID in a real-life setting. Methods: We performed a prospective, non-randomized, observational multicenter cohort study in 37 centers. All patients treated with direct-acting antivirals between April 1, 2017, and February 28, 2019, were included. In total, 2713 patients were included in the study among which 250 were PWID and 2463 were non-PWID. Besides patient characteristics, treatment response, follow-up, and side effects of treatment were also analyzed. Results: Genotype 1a and 3 were more prevalent in PWID-infected patients (20.4% vs 9.9% and 46.8% vs 5.3%). The number of naïve patients was higher in PWID (90.7% vs 60.0%), while the number of patients with cirrhosis was higher in non-PWID (14.1% vs 3.7%). The loss of follow-up was higher in PWID (29.6% vs 13.6%). There was no difference in the sustained virologic response at 12 weeks after treatment (98.3% vs 98.4%), but the end of treatment response was lower in PWID (96.2% vs 99.0%). In addition, the rate of treatment completion was lower in PWID (74% vs 94.4%). Conclusion: Direct-acting antivirals were safe and effective in PWID. Primary measures should be taken to prevent the loss of follow-up and poor adherence in PWID patients in order to achieve World Health Organization’s objective of eliminating viral hepatitis

Operatıonal model analysıs of symmetrıc and asymmetrıc three dımensıonal steel structures

Bu çalışmada laboratuarda inşa edilen biri simetrik diğeri simetrik olmayan iki çelik yapının operasyonel modal analizleri yapılarak dinamik karakteristikleri belirlenmiştir. Bunun için her iki çelik yapıda da altı adet tek eksenli ivmeölçer kullanılmıştır. Çevresel etkilerden yararlanılarak yapılan deneysel ölçüm sonucu elde edilen verilerin değerlendirilmesinde ARTEMİS programında mevcut frekans tanım alanında ayrıştırma ve stokastik altalan belirleme yöntemleri kullanılmıştır. Ayrıca sözkonusu çelik yapılar nümerik olarak da modellenerek mod şekilleri ve doğal frekansları belirlenmiştir. Nümerik ve deneysel sonuçların karşılaştırılmasında birbirine yakın sonuçlar elde edilmiştir.In this study, symmetric and asymmetrical steel structures were constructed in the laboratory and analyzed using operational modal analysis to determine the dynamic characteristics. Six different single-axis accelerometers were used for both steel structures. The test results obtained from the environmental excitation were evaluated by ARTEMIS software package which can perform Stochastic Subspace Identification Method and Peak Picking Method. Mode shapes and natural frequencies of the two steel structures were also calculated numerically. A good agreement was observed when the results obtained from experimental and numerical analysis were compared

Çürümeye Başlamış Bir Cesette Hidrojen Sülfür ile İntiharın Tespiti

Hidrojen sülfür (H2S) zehirlenmeleri nadir olarak görülmektedir. Sıklıkla kanalizasyon işlerinde ve endüstriyel kaynaklı kazalarda karşımıza çıkmaktadır. H2S zehirlenmesine bağlı ölümler gazın inhalasyonu sonucu meydana gelmektedir. H2S'nin ortam havasındaki seviyesi 500 ppm’den yüksek olduğu durumlarda dakikalar içinde ölüm meydana gelmektedir. Olgumuz evinde ölü olarak bulunan ve çürümeye başlamış 23 yaşında erkektir. Olgumuzda çürüme bulguları da bulunduğundan ilk yapılan toksikolojik analizde kanda saptanan hemoglobin metabolitlerinin çürümeye bağlı olarak da oluşabileceği düşünülerek kesin ölüm sebebi hakkında bir yorum yapılmamıştır. Olay yerinde bulunan şişelerde sülfür saptanması ve ölen kişi tarafından  “Dikkat!, H2S çok zehirli, notu al, dışarı çık, kapıyı kapat” yazılı notun evin kapısına iliştirilmiş olması kişinin ölümünün H2S zehirlenmesi sonucu meydana geldiği kanaatini oluşturmuştur. Çürümenin başladığı ve zehirlenme şüphesi bulunan bu gibi olgularda, ölüm nedeninin aydınlatılmasında ayrıntılı olay yeri incelemesinin önemi, otopsi ve postmortem toksikolojik analizlerin önüne geçebilmektedir. Anahtar kelimeler: Hidrojen sülfür; İntihar; Ölüm; Otops

Radiological hip indices correlate with GMFCS level I and GMFM-66 scores in cerebral pasy

Objectives: The aim of this study was to evaluate the certain radiological hip parameters and the effects of these parameters on the functional capacity of cerebral palsy (CP) children, to compare the Gross Motor Function Measure (GMFM-66 scores) of hemiparetic and diparetic children with spastic CP in Gross Motor Function Classification System (GMFCS) level 1, and to define possible differences or similarities with the control group. Methods: The radiographic parameters measured for CP and control groups were caput-collum-diaphyseal angle (CCD), migration index (MI), center edge angle (CEA), acetabular index (AI) and pelvic obliquity. The functional capacity of the CP group was assessed by GMFM-66. Results: No significant differences were found in terms of sides of the same individual in each group. Significant differences were found between groups for left CCD, right MI, right and left AI, and right and left CEA. Correlation analyses revealed significant relationships between radiological parameters. Hemiparetics had statistically higher GMFM-66 dimension E score than diparetics. Conclusion: The threshold values for hip parameters were determined with CP in GMFCS level 1. The hemiparetic and diparetic children with CP, who were at the GMFCS level I and age group, had similar hip morphology. Development of femoral head and acetabulum in these children were not different from control group. Evaluating the functional levels of patients according to GMFM-66 scores with radiographic parameters is believed to contribute to the monitoring CP children

Efficacy and safety of direct-acting antivirals in elderly patients with chronic Hepatitis C: A nationwide real-life, observational, multicenter study from Turkey

Background: The number and proportion of elderly patients living with chronic hepatitis C are expected to increase in the coming years. We aimed to compare the real-world efficacy and safety of direct-acting antiviral treatment in elderly and younger Turkish adults infected with chronic hepatitis C. Methods: In this multicenter prospective study, 2629 eligible chronic hepatitis C patients treated with direct-acting antivirals between April 2017 and December 2019 from 37 Turkish referral centers were divided into 2 age groups: elderly (≥65 years) and younger adults (<65 years) and their safety was compared between 2 groups in evaluable population. Then, by matching the 2 age groups for demographics and pretreatment risk factors for a non-sustained virological response, a total of 1516 patients (758 in each group) and 1244 patients (622 in each group) from the modified evaluable population and per-protocol population were included in the efficacy analysis and the efficacy was compared between age groups. Results: The sustained virological response in the chronic hepatitis C patients was not affected by the age and the presence of cirrhosis both in the modified evaluable population and per-protocol population (P = .879, P = .508 for modified evaluable population and P = .058, P = .788 for per-protocol population, respectively). The results of the per-protocol analysis revealed that male gender, patients who had a prior history of hepatocellular carcinoma, patients infected with non-genotype 1 hepatitis C virus, and patients treated with sofosbuvir+ribavirin had a significantly lower sustained virological response 12 rates (P < .001, P = .047, P = .013, and P = .025, respectively). Conclusion: Direct-acting antivirals can be safely used to treat Turkish elderly chronic hepatitis C patients with similar favorable efficacy and safety as that in younger adults

Re-examining the characteristics of pediatric multiple sclerosis in the era of antibody-associated demyelinating syndromes.

Background: The discovery of anti-myelin oligodendrocyte glycoprotein (MOG)-IgG and anti-aquaporin 4 (AQP4)-IgG and the observation on certain patients previously diagnosed with multiple sclerosis (MS) actually have an antibody-mediated disease mandated re-evaluation of pediatric MS series. Aim: To describe the characteristics of recent pediatric MS cases by age groups and compare with the cohort established before 2015. Method: Data of pediatric MS patients diagnosed between 2015 and 2021 were collected from 44 pediatric neurology centers across Turkiye. Clinical and paraclinical features were compared between patients with dis-ease onset before 12 years (earlier onset) and >= 12 years (later onset) as well as between our current (2015-2021) and previous (< 2015) cohorts. Results: A total of 634 children (456 girls) were enrolled, 89 (14%) were of earlier onset. The earlier-onset group had lower female/male ratio, more frequent initial diagnosis of acute disseminated encephalomyelitis (ADEM), more frequent brainstem symptoms, longer interval between the first two attacks, less frequent spinal cord involvement on magnetic resonance imaging (MRI), and lower prevalence of cerebrospinal fluid (CSF)-restricted oligoclonal bands (OCBs). The earlier-onset group was less likely to respond to initial disease-modifying treatments. Compared to our previous cohort, the current series had fewer patients with onset < 12 years, initial presentation with ADEM-like features, brainstem or cerebellar symptoms, seizures, and spinal lesions on MRI. The female/male ratio, the frequency of sensorial symptoms, and CSF-restricted OCBs were higher than reported in our previous cohort. Conclusion: Pediatric MS starting before 12 years was less common than reported previously, likely due to exclusion of patients with antibody-mediated diseases. The results underline the importance of antibody testing and indicate pediatric MS may be a more homogeneous disorder and more similar to adult-onset MS than previously thought