Diagnostic value of combined serum biomarkers for the evaluation of liver fibrosis in chronic hepatitis C infection: A multicenter, noninterventional, observational study

Background/Aims: The hepatitis C virus (HCV) infection is important cause of chronic hepatitis. Liver biopsy is considered the gold standard for assessment of fibrosis but this procedure is an invasive procedure. We aimed to evaluate the diagnostic efficiency of non-invasive serum biomarkers, separately and in combinations, on liver fibrosis in treatment-naive chronic hepatitis C (CHC) patients. Materials and Methods: Two hundred and sixteen treatment-naive CHC patients were enrolled from 32 locations across Turkey in this open-labelled, non-interventional prospective observational study. FibroTest®, aspartate aminotransferase-to-platelet ratio index(APRI), aspartate aminotransferase and alanine aminotransferase ratio (AAR), fibrosis index based on four factors (FIB-4), Age-platelet(AP) index and Forns index were measured and compared with Metavir scores got from liver biopsies. Results: Data from 182 patients with baseline liver biopsy were suitable for analysis. One hundred and twenty patients (65.9%) had F0-F1 fibrosis and 62 patients (34.1%) had F2-F4 fibrosis. APRI 0.732 area under the curve(AUC) indicated advanced fibrosis with 69% sensitivity and 77% specificity. FIB-4 0.732 AUC and FibroTest 0.715 AUC indicated advanced fibrosis with 69% and 78.4% sensitivity, and 75% and 71.4% specificity, respectively. The combined use of tests also led to an increase in AUC and specificity. Combinations of FibroTest with APRI and/or FIB-4, and FIB-4 with APRI were optimal for the evaluation of liver fibrosis. Conclusion: Fibrotest, FIB-4, APRI, AP index and Forns index exhibit good diagnostic performance for determining liver fibrosis in CHC patients, and the use of at least two tests together will increase their diagnostic value still further. © Copyright 2018 by The Turkish Society of Gastroenterology

Evaluation of nosocomial infections in intensive care unit Yoǧun bakim ünitesindeki hastane infeksiyonlarinin deǧerlendirilmesi

Nosocomial infections (NI) constitute an important health problem with prolongation of hospital stay, increased costs of direct care, morbidity and high mortality. The aim of this study was to evaluate the general features of NI in Mikail Yüksel Intensive Care Unit (ICU) in Ondokuz Mayis University. A cross sectional research was performed between 1st September 1998 and 28th February 1999 in Mikail Yüksel ICU in Ondokuz Mains University. Medians of age and total length of hospital stay in patients with NI were 47 years (18-67 years) and 28 days (12-84 days), respectively. Medians of total length of hospital in patients without NI were 6 days (2-21 days) and there was a statistically significant difference between two group (p<0.001). The patient's day was found 332 days. NI rate was found 10.7% and the principal sites of NI were the urinary tract (36.4%), bacteriemia (27.3%), pneumonia (18.2%) and local vascular cathater (18.2%). Vascular cathaterization was performed on 100.0% and urinary cathaterization, entubation and mechanic ventilation were performed on 90.9% of the patients. We conclude that the high economic expense, long hospitalization periods, high mortality rates which NI represent emphasized the necessity of carefully designed and conducted studies in the control of these infections

The place and the efficacy of infectious disease consultations in the hospitals

Our study aims to determine the efficacy of infectious disease consultations and the interrelations between doctors in this social laboratory. This study was conducted at 34 centers located in 22 cities across Turkey and contributed by 210 infectious disease specialists (IDSs) and 970 non-infectious disease specialists (NIDSs), totaling 1180 medical doctors. Infectious disease specialists and NIDSs have separately contributed by responding to questionnaires designed specifically for the consultation process. It appears that a satisfactory collaboration has been established between IDSs and NIDSs during the consultation practices. There are some discrepancies in the perceptions of some of the NIDSs. These are the evaluation of patients holistically, the expectation of NIDSs in critical infection cases to start the therapy immediately, losing the support of drug companies by NIDSs, and the restriction of NIDSs in routine medical practice. On the other hand, NIDSs seem to have real problems in the diagnosis or treatment of infectious diseases. The consultation service provided by the IDSs in Turkey is widely accepted among other clinicians and appears to be of a crucial importance. Copyright © 2012 by Lippincott Williams & Wilkins