Effectiveness and safety of elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate single-tablet combination among HIV-infected patients in Turkey: results from a real world setting

Background: Efficacy of elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil (E/C/F/TDF) in treatment-naïve and experienced patients with HIV infection was demonstrated in phase 3 trials. The primary objective of this study was to evaluate effectiveness and safety of E/C/F/TDF in real world settings. Methods: Retrospective, observational data collected by the Turkish ACTHIV-IST study group between May 2015 and December 2016 were analysed. Results: A total of 387 patients were prescribed E/C/F/TDF; 210 patients with available data at 6th month were eligible; 91.5% were male, and mean age was 35.2 (SD: 10.8) years; 54.0% of males identified themselves as MSM. Sixty-three percent (133) of the study population were treatment-naïve patients, and 37% (77) were treatment experienced. HIV RNA level was below 100 copies/mL in 78.9% of treatment-naïve patients and 89.9% of treatment experienced patients at month 6. Median increase in CD4 T lymphocyte count was 218 copies/mL in treatment-naïve patients and remained stable or increased in treatment experienced patients. Adverse events were observed in 15% of the patients, and the regimen was discontinued in only six patients. Conclusion: Real world data on the effectiveness and safety of E/C/F/TDF is comparable with the phase 3 trial results Adverse events are uncommon and manageable. Keywords: Elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate; HIV; effectiveness; safety

The effect of renin-angiotensin blockers on COVID-19 related mortality: A tertiary center's experience

Background: The first reports on coronaviruse disease 2019 (COVID-19) revealed an exaggerated mortality rate in hypertensive patients. In this regard, concerns about angiotensin-converting enzyme (ACE) inhibitors’ and angiotensin-receptor blockers’ (ARBs) have been aroused. Our aim in this study was to evaluate the potential bad outcome effect of hypertension and anti-hypertensive therapy on COVID-19. Methods: 183 patients with polymerase-chain-reaction (PCR)-proven COVID-19, who were admitted to our hospital and consulted to cardiology department between 15th of March and 15th of April 2020 were included. Data were recruited from hospital records. Results: Thirty-two out of 183 patients with COVID-19 died in hospital. Hypertension incidence was not statistically different between patients who survived and died (76 [50.3%] vs 19 [59.4%, p = 0.352]). Although the usage rate of ACEI were similar among groups, ARB usage rate was significantly higher in patients who died than survived (11 [34.4%] vs 23 [15.2%], p = 0.011). Binary regression analysis showed an association between ARBs and mortality (OR: 0.032, 95% CI 1.045–2.623, p = 0.032). Conclusion: Our study confirmed previous concerns regarding a potential harmful effects of ARBs on COVID-19 related mortality.Kontext: První zprávy o onemocnění koronavirem v roce 2019 (coronavirus disease 2019, COVID-19) ukazovaly na zvýšenou mortalitu jedinců s hypertenzí, což vyvolalo obavy ohledně užívání inhibitorů angiotenzin konvertujícího enzymu (ACEI) a blokátorů receptoru AT1 pro angiotenzin II (ARB). Cílem naší studie bylo posoudit možnost nepříznivého vlivu onemocnění covid-19 na závažnost hypertenze a účinnost antihypertenzní léčby. Metody: Do studie bylo zařazeno 183 pacientů s onemocněním covid-19 prokázaným PCR testem, kteří byli v období od 15. března do 15. dubna 2020 přijati do naší nemocnice a následně odesláni na kardiologickou kliniku. Údaje byly získány z nemocničních záznamů. Výsledky: Celkem 32 ze 183 pacientů s onemocněním covid-19 zemřelo v nemocnici. Incidence hypertenze se mezi pacienty, kteří přežili a zemřeli, statisticky významně nelišila (76 [50,3 %] vs. 19 [59,4 %]; p = 0,352). I když podíly pacientů užívajících inhibitory ACE byly v obou skupinách podobné, léčiva ze skupiny ARB užívalo statisticky významně více pacientů, kteří zemřeli, než těch, kteří přežili (11 [34,4 %] vs. 23 [15,2 %]; p = 0,011). Binární regresní analýza prokázala souvislost mezi užíváním ARB a mortalitou (OR: 0,032; 95% CI 1,045–2,623; p = 0,032). Závěr: Naše studie potvrdila původní obavy týkající se možných škodlivých účinků lékové skupiny ARB na mortalitu v souvislosti v onemocněním covid-19

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

Physicians’ Knowledge, Behaviour and Attitude About Hepatitis B

Aim: Hepatitis B (HBV) infection is one of the most important public health problems throughout the world. Healthcare workers are at risk for hepatitis B infection. Methods: In this study, we aimed to evaluate about HBV immune status, knowledge, attitude and behaviour of the physicians at the Haseki Training and Research Hospital using a structured questionnaire. Results: 150 individuals were included in the study. 9 (%6) physicans had no idea about their own immune status. Of total, 133 (%89) had received HBV vaccination and 110 (%83) have had sufficient immune response. 69 (%46) had a history of needle stick injury. All participants reported that the major trsnsmission routes were blood and sexual contact but only %15 had the knowledge about intrafamilial transmission. Conclusion: These results indicate that there is a need for development of effective educational programs to improve HBV knowledge among health professionals. (The Medical Bulletin of Haseki 2010; 48: 153-5

Seroprevalence of HBsAg and Anti-HCV among HIV Positive Patients

Objectives: The study aimed to investigate the seroprevalence of hepatitis B surface antigen (HBsAg) and hepatitis C virus (anti-HCV) in human immunodeficiency virus (HIV) infected patients and to evaluate the results according to risk factors in our hospital in Istanbul, which was one of the centers where HIV-infected patients were followed up the most in our country. Materials and Methods: The medical files of 611 HIV-infected patients who were followed up in our infectious diseases and clinical microbiology outpatient clinic between 1999 and 2016, were analyzed to determine the seroprevalence of HBsAg and anti-HCV retrospectively. HIV-monoinfected patients, HIV+HBV-coinfected patients, and HIV+HCV-coinfected patients were examined separately in terms of demographic characteristics and risk factors, and compared with each other. Results: Of the patients 86.6% were male. The mean age of the patients was 37.0 +/- 11.2 (16-83). More than one-third of patients were 30-39 years old. Of the patients 43.7% were men who had sex with men (MSM). Of the patients, 5.8% were HBsAg-positive and 14.7% (236) of patients were positive for isolated anti-HBc IgG. The HBV-DNA positivity ratio was determined as 8.7% in the isolated anti-HBc IgG positive group. Of the patients 2% were anti-HCV positive, and 0.9% were HCV-RNA positive. The prevalence of HIV/HCV coinfection was statistically significantly higher in intravenous (IV) drug users than HIV-monoinfected patients (p<0.001). Conclusion: It is not sufficient to evaluate HBsAg alone in HIV-infected individuals. Anti-HBc IgG and HBV-DNA should also be evaluated. Anti-HCV antibody must be tested especially in patients with IV drug addiction.WOS:00064768810000

Reservoir quality analysis of the Triassic sandstones in the Nederweert and Naaldwijk areas: A post-mortem study

With an increase in the demand for heat energy, and the growing conscience of the world to reduce CO2 emissions, the transition to cleaner energy alternatives has gained momentum. In the Netherlands, the potential for cost-effective geothermal heat extraction from sedimentary aquifers has led to the exploration of siliciclastic Triassic reservoirs in the West Netherlands Basin and Roer Valley Graben for their suitability. This thesis primarily focuses on two geothermal target wells namely NDW-01 and NLW-GT-01. These wells lie in the Nederweert and Westland areas respectively.NDW-01 comprises of 292m thick sandstone package which is scarcely studied. While the NLW-GT-01 well was drilled tapping depths of over 4000 meters and encountering temperatures of about 100°C. In contradiction to the pre-drill expectations of having appreciable porosity and permeability values between 10-500mD, the Upper Volpriehausen sandstones in NLW-GT-01 exhibited porosity and permeabilities ranging between 1.4% to 3.9% and ≤0.02mD respectively. The sandstones were highly compacted and severely cemented by dolomite and quartz. These cements blocked all the macropores leaving no visible porosity in the thin sections. Although, the cored interval was extensively fractured the measured permeability values were negligible. This thesis presents the results of an assessment of the factors leading to the deterioration of intrinsic porosity and permeability of Triassic aquifers lying in the Westland and Nederweert regions. In this project, grain-size analysis using core plugs, thin-section study, petrophysical data analysis, and FMI log interpretation were conducted to understand the depositional environment of the Lower Germanic Trias Group precisely the cored sections of the Nederweert Sandstone Member in NDW-01 well and the Volpriehausen sandstones in NLW-GT-01 borehole. Due to the complex tectonic history coupled with locally different paleoenvironments, the current depths of the Triassic deposits in the investigated area did not correlate with the reservoir quality of the adjacent shallower wells. In addition to the local depositional conditions in the basin, the variable precipitation in the source area, and the distance of sediment transport have defined the rock characteristics. The primary grain-textures, such as roundness, sorting, packing, as well as the detrital framework and authigenic minerals, were found to influence the sandstone porosity. The tightness of the reservoir was due to significant mechanical compaction and cementation described by a diagenetic reconstruction explaining the evolution of porosity with depth with a negligible generation of secondary porosity. The deterioration of the reservoir quality is correlatable to the burial history and its resulting consequences, namely mechanical and chemical compaction endured by the rock during periods of basin subsidence and uplift. These analyses have put the deviation of pre-drill results from those that were obtained through post-drill evaluations into perspective.Petroleum Engineering and Geo-science