Discordant Hepatitis B Serology in Twins Despite Active and Passive Immunoprophylaxis: A Case Report

Hepatitis B virus (HBV) infection is still one of the most important causes of liver disease. In highly endemic areas, infection occurs mainly in infancy and early childhood with mother-to-child transmission, accounting for more than half of chronic infections. In this manuscript, discordant manifestations and evolution of HBV infection in a pair of monozygotic twins are reported. A 8-year-old child was admitted to our clinic with HbsAg positivity. She had a history of normal vaginal delivery without any complications. HBV vaccine and HBIG were administered to the newborn within the first hour of life. HBV vaccination series were completed with the administration of second and third doses during one month and 6 months of age. HBsAg positivity was determined in a different center and referred to our clinic. In laboratory analysis, HBsAg was (+), anti-HBs (-), HBeAg (-), anti-HBe: (+), AST was 39 IU/L, ALT: 20 IU/L and HBV-DNA: 203 IU/mL by real time polymerase chain reaction (RT-PCR). However, in the tests of the twin sister of the patient HBsAg was (-), anti-HBs > 1000 mIU/mL. In the mother’s laboratory analysis HBsAg was (+), anti-HBe (-), HBeAg (+), HBV-DNA > 108 IU/mL, AST: 34 IU/L, ALT: 34 IU/L. In order to decrease the rate of perinatal transmission, an oral antiviral agent may be administered during the third trimester of the pregnancy in order to reduce the level of maternal viremia. Although administration of HBIG with hepatitis B vaccine is the most effective way of preventing the perinatal transmission, HBV infection may occur in 5%-10% of cases

Şanlıurfa'da mevsimlik tarım işçilerinin yoğun olarak yaşadıkları bir aile sağlığı merkezi bölgesinde gebelerde HbsAg pozitifliği düzeyi ve etkileyen faktörler/HbsAg seropositivity and other related factors among pregnant women in crowded living condition

Özet Amaç: Bu araştırmada, mevsimlik tarım işçilerinin yoğun olarak yaşadıkları bir aile sağlığı merkezi bölgesinde gebelerde HbsAg pozitifliği düzeyini ve etkileyen faktörleri ortaya koymak amaçlanmıştır. Yöntem: Kesitsel tipteki bu çalışma, Şanlıurfa Zeliha Öncel Aile Sağlığı Merkezi (ASM) bölgesinde Ekim 2011-Ocak 2012 tarihleri arasında yapılmıştır. Çalışmaya kayıtlı ve takipli olan tüm gebeler(N=261) dahil edilmiştir. Gebelere yapılandırılmış soru formu uygulanmıştır. HBsAg ve anti-HBs sonuçları ASM kayıtlarından alınmıştır. Bulgular: Tüm gebelerde Hepatit B sıklığı %3.2’ dir.  HBsAg pozitifliği mevsimlik tarım işçilerinde 5.1 kat, ailesinde hepatit B hastalığı bulunan gebelerde 18.9 kat daha fazla görülmektedir (P&lt;0.05). Sonuç: Mevsimlik tarım işçileri hepatit B açısından önemli bir risk grubudur. Temel sağlık hizmetleri mevsimlik tarım işçileri için erişilebilir hale getirilmeli ve hizmet taleplerini arttırmak için sağlık eğitimleri yapılmalıdır. Tüm gebelere doğum öncesi bakım hizmeti sağlanmalı ve hepatit B'ye karşı duyarlı olanlara aşı önerilmelidir. Anahtar Kelimeler: Gebe, hepatit B sıklığı, mevsimlik tarım işçiliğiAbstract Objective: This study determined the HbsAg seropositivity and other related factors among women living in the Sanliurfa district among seasonal farm workers. Methods: This cross-sectional study was carried out within the service area of the Zeliha Öncel Family Health Center between October 2011-January 2012 in the Sanliurfa district. All pregnant women (N=261) enrolled by a family health center were included in the study. A structured questionnaire was applied. The levels of HBsAg and anti-HBs measures were taken from family health centers records. Results: HbsAg seropositivity was 3.2% in pregnant women. HBsAg seropositivity was 5.1 times in seasonal farmworker and 18.9 times greater in families with a history of hepatitis B (p&lt;0.05).Conclusions: Seasonal farworkers are an important risk group for hepatitis B. Primary health care should be made accessible to seasonal farmworkers and the demands for health care should be increased through health education. Antenatal care should be provided to all pregnant women and hepatitis B vaccine should be advised for those who are susceptible to HBV. Key Words: Seasonal farmworker, primary health care, Hepatitis B risk factors </p

Evaluation of the Continuous Ambulatory Peritoneal Dialysis Related Peritonitis Attacks

Peritonitis is a common clinical problem that occurs in patients with end stage renal disease treated by peritoneal dialysis. The aims of this study were to assess demographic aspects, rates of peritonitis, causative organisms, clinical outcomes and treatment approach for continuous ambulatory peritoneal dialysis (CAPD) -related peritonitis of patients undergoing CAPD. Seventy cases of peritonitis occurred in 55 patients treated in Infectious Diseases and Clinical Microbiology Department of Ankara Training and Research Hospital between May 2003 and April 2004 were enrolled into this study. Cloudiness of the peritoneal dialysis fluid and/or abdominal pain were considered suggestive of peritonitis and were confirmed by cell count and culture. The overall incidence of peritonitis was 2.46 ± 2.52 episodes/patient-year. Age, gender, education and profession of the patients have not been found as a risk factor in peritonitis attacks. The most common presentations of peritonitis included abdominal pain, cloudiness of the peritoneal dialysis fluid, nausea and vomiting. Peritoneal dialysate fluid white blood cell count was 1773 ± 1224/mm3 in 70 episodes. Cultures were positive in 51 (%72.9) peritonitis episodes; coagulase-negative staphylococci was the most common organism (%22.8), followed by Staphylococcus aureus (%21.4), 19 episodes (%27.2) had negative culture results. At the end of the study, 61 episodes of peritonitis in 55 patients were treated with intraperitoneal cefazolin and gentamicin protocol. Seven of the patients did not respond to initial therapy and the therapy was converted to intravenous protocol. Nine episodes were treated with IV antibiotics on admission for medical reasons (systemic infection and/or concurrent exit-side or tunnel infection). There were two deaths. Two catheters were removed and the patients were transferred to haemodialysis programme. Despite all technical improvements during recent decades, peritonitis and exit-side infections are still the major complication of CAPD. For the optimizing complication rates in individual centers, causative organisms and their antimicrobial susceptibilities must be known

Retreatment of Chronic Hepatitis C Infection with Telaprevir: Preliminary Results in Turkey

Background: The use of pegylated interferon alpha and ribavirin (PegIFN/RBV) for the retreatment of chronic hepatitis C virus (HCV) infection without a sustained virological response (SVR) prior to PegIFN/RBV treatment has resulted in low success rates. Aims: To investigate the efficacy and safety of telaprevir (TVR) in combination with PegIFN/RBV in patients infected with HCV genotypes 1 and 4 who were previously treated with PegIFN/RBV and failed to achieve SVR. Study Design: Multi-center, retrospective, cross-sectional study. Methods: The study included 111 patients: 80 prior relapsers, 25 prior null responders, and six prior partial responders to PegIFN/RBV treatment. The patients were given TVR/PegIFN/RBV for 12 weeks, followed by a 12-week PegIFN/RBV treatment; virological response results were assessed at weeks 4, 12, and 24. Treatment was discontinued in patients with HCV RNA >1000 IU/mL at week 4 or with negative RNA results at week 4 but >1000 IU/mL at week 12. Rapid virological response (RVR), early virological response (EVR), extended rapid virological response (eRVR), and virological response at 24th week of treatment were evaluated. The side effects of combination therapy and the rates of treatment discontinuation were investigated. Results: The mean age of the patients was 56.02±9.96 years and 45.9% were male. Ninety-one percent of the patients were infected with viral genotype 1, 69.6% with the interleukin (IL) 28B genotype CT and 20.2% were cirrhotic. The RVR rate was 86.3% in prior relapsers, 56% in prior null responders, and 50% in prior partial responders (p=0.002). EVR rates in those groups were 91.3%, 56%, and 83.3%, respectively (p<0.001). eRVR rates were 83.8% in prior relapsers, 48% in prior null responders, and 50% in prior partial responders (<0.001). The virological response at the 24th week of treatment was found to be the highest in prior relapsers (88.8%); it was 56% in prior null responders and 66.7% in prior partial responders (p<0.001). Common side effects were fatigue, headache, anorexia, malaise, anemia, pruritus, dry skin, rash, dyspepsia, nausea, pyrexia, stomachache, and anorectal discomfort. All treatments were discontinued due to side effects in 9.9% of patients. Conclusion: High virological response rates were obtained with TVR/PegIFN/RBV treatment. Although side effects were frequently observed, the discontinuation rate of combination therapy was low

Evaluation of Dual Therapy in Real Life Setting in Treatment-Naïve Turkish Patients with HCV Infection: A Multicenter, Retrospective Study

Background: Before the introduction of direct-acting antivirals in the treatment of chronic hepatitis C patients, the combination of peginterferon alpha and ribavirin was the standard therapy. Observational studies that investigated sustained virological response (SVR) rates by these drugs yielded different outcomes. Aims: The goal of the study was to demonstrate real life data concerning SVR rate achieved by peginterferon alpha plus ribavirin in patients who were treatment-naïve. Study Design: A multicenter, retrospective observational study. Methods: The study was conducted retrospectively on 1214 treatment naïve-patients, being treated with peginterferon alpha-2a or 2b plus ribavirin in respect of the current guidelines between 2005 and 2013. The patients’ data were collected from 22 centers via a standard form, which has been prepared for this study. The data included demographic and clinical characteristics (gender, age, body weight, initial Hepatitis C virus RNA (HCV RNA) level, disease staging) as well as course of treatment (duration of treatment, outcomes, discontinuations and adverse events). Renal insufficiency, decompensated liver disease, history of transplantation, immunosuppressive therapy or autoimmune liver disease were exclusion criteria for the study. Treatment efficacy was assessed according to the patient’s demographic characteristics, baseline viral load, genotype, and fibrosis scores. Results: The mean age of the patients was 50.74 (±0.64) years. Most of them were infected with genotype 1 (91.8%). SVR was achieved in 761 (62.7%) patients. SVR rate was 59.1% in genotype 1, 89.4% in genotype 2, 93.8% in genotype 3, and 33.3% in genotype 4 patients. Patients with lower viral load yielded higher SVR (65.8% vs. 58.4%, p=0.09). SVR rates according to histologic severity were found to be 69.3%, 66.3%, 59.9%, 47.3%, and 45.5% in patients with fibrosis stage 0, 1, 2, 3 and 4, respectively. The predictors of SVR were male gender, genotype 2/3, age less than 45 years, low fibrosis stage, low baseline viral load and presence of early virological response. SVR rates to each peginterferon were found to be similar in genotype 1/4 although SVR rates were found to be higher for peginterferon alpha-2b in patients with genotype 2/3. The number of patients who failed to complete treatment due to adverse effects was 33 (2.7%). The number of patients failed to complete treatment due to adverse effects was 33 (2.7%). Conclusion: Our findings showed that the rate of SVR to dual therapy was higher in treatment-naïve Turkish patients than that reported in randomized controlled trials. Also peginterferon alpha-2a and alpha-2b were found to be similar in terms of SVR in genotype 1 patients