A small water-borne tularemia outbreak

Bu çalışmada 22 Ocak – 8 Mart 2005 tarihleri arasında Kocaeli ili, Karamürsel ilçesi Pazarköy köyünde saptanan küçük bir tularemi salgının incelenmesi ve alınan kontrol önlemlerinin sunulması amaçlanmıştır. Aynı köyden gelen iki hastaya orofarinjiyal tularemi tanısı konulmasının ardından, o bölgede saha taraması yapılmış, hastalar muayene edilmiş, hastalardan ve salgının kaynağı olabileceği düşülen pınar sularından örnekler alınmıştır. Boğaz sürüntüsü, lenf nodu aspiratları ve filtre edilen su örneklerinden kültür yapılmış, hastaların serum örneklerinde mikroaglütinasyon (MA) testi ile Francisella tularensis antikorları taranmıştır. Filtre edilmiş su örneklerinde gerçek zamanlı polimeraz zincir reaksiyonu (PCR) ile F.tularensis DNA’sı araştırılmıştır. Klinik özellikleri ve MA test sonuçlarına (≥1/80) dayanarak toplam 17 hastaya tularemi tanısı konulmuş; hastaların 16’sı orofarinjiyal, biri ülseroglandüler tularemi olarak tanımlanmıştır. Hastaların yaşları 27-80 yıl arasında değişmekte olup (ortalama yaş: 48±17 yıl), 10’u (%59) kadındır. En yaygın saptanan semptomlar halsizlik (%100), boyunda şişlik (%94) ve boğaz ağrısı (%88), en sık belirlenen klinik bulgu ise servikal lenfadenopati (%94) olmuştur. Yapılan kültürlerin hiçbirisinde F.tularensis üretilememiş, buna karşın pınar sularından alınan örneklerde gerçek zamanlı PCR ile F.tularensis DNA’sı gösterilmiştir. Hastalar streptomisin, doksisiklin ya da siprofloksasin ile tedavi edilmiş ve tümünde iyileşme saptanmıştır. Pınar sularının toplandığı deponun temizlenmesi ve suların klorlanması ile salgın kontrol altına alınmıştır.The aim of this study was to investigate a small tularemia outbreak in a village of Karamursel county of Kocaeli province (located in North-west part of Turkey), between 22 January - 8 March 2005 and to present the anti-epidemic measures implemented. Following diagnosis of oropharyngeal tularemia in two patients living in the same village, a field investigation was performed at this region. All patients have undergone physical examination. Blood samples and if possible throat swabs and lymph node aspirates were taken from the patients and water samples from the natural spring water suspected to be the source of the infection, were also taken. Cultures were performed from the clinical samples and filtrated water samples. Francisella tularensis antibodies were screened by microagglutination (MA) test in the serum samples of the patients. F.tularensis DNA was investigated in the filtrated water samples by real-time PCR assay. A total of 17 patients were diagnosed as tularemia with their clinical features and MA test results (>= 1/80). All the patients had oropharyngeal tularemia except one who had ulceroglandular form. The age range of the patients was 27-80 years (mean age: 48 +/- 17 years), and 10 (59%) were female. Weakness (100%), swelling on the neck (94%) and sore throat (88%) were the most common symptoms, whereas cervical lymphadenopathy (94%) was the most frequently seen clinical finding. F.tularensis could not be grown in the cultures, however F.tularensis DNA was detected in the samples of the natural spring water by real time PCR. The patients were treated with streptomycin, ciprofloxacin, or doxycycline, and all the patients have recovered. The outbreak was taken under control after cleaning the spring water tank and chlorination of the water

HIV care in Istanbul, Turkey: How far is it from the UNAIDS 90-90-90 targets?

The prevalence of human immunodeficiency virus (HIV) infection is low but it is steadily increasing in Turkey. In the current study, we aimed to assess the status of HIV infection management with the proposed 90-90-90 targets in a large HIV cohort in Istanbul, Turkey. The cohort included 2382 patients (2082 male, 300 female, mean age was 36.3 +/- 11.3 years). Mean CD4 cell count was 399 cells/mm(3) and HIV-RNA level was 576,235 copies/ml. According to the modeling by the Modeling tool of European Center for Diseases Control Software, 72 and 74% of all HIV patients had been diagnosed in 2016 and 2017, respectively (the first target). Among 2382 patients, 2191 (92%) were on antiretroviral therapy (the second target). The third target of virally suppressing those on treatment was achieved among 70.2% of the patients. The current study suggests that both the fraction of those living with undiagnosed HIV and the proportion of those on treatment who are virally suppressed should be targeted to sustain optimal HIV care. Efforts should continue to surpass the targets of 90-90-90

Transforming a U.S. scholarly concentrations program internationally: lessons learned

Abstract Background Scholarly Concentrations programs in U.S. medical schools aim to instill passion for critical thinking and promote careers in academic medicine. The rise of these programs has seen variable goals, structure, and outcomes. Transformation of these programs internationally is in its infancy. Methods We describe implementation of the Johns Hopkins School of Medicine Scholarly Concentrations program, offering Basic Science, Clinical Science, Medical Ethics/Healing Arts, History of Medicine, and Public Health/Community Service, at Bezmiâlem Vakif University in Istanbul, Turkey. Over six modules in the preclinical years, students develop a faculty-mentored experience which encourages the acquisition of attitudes and skills for self-directed, lifelong learning and scholarship. This culminates in abstract and project presentation. We report program characteristics (context and logistics) and outcomes (student engagement and experiences). Results The Scholarly Concentrations program at Bezmiâlem began in 2014, with nearly two completed cohorts of students. In comparison to Johns Hopkins, students at Bezmiâlem begin at an earlier age (thus do not have as much prior research experience) and are subsequently evaluated for residency in terms of test scores rather than scholarship and publications, but have a similar level of intellectual curiosity and desire to take ownership of their project. Eighty-two percent of Bezmiâlem students stated the project they pursued was either their own idea or was an idea they formed after meeting with their mentor. Students at Bezmialem were more likely to choose Clinical Science projects (p = 0.009). Only 5% of Bezmiâlem students in end-of-course survey felt dissatisfied with the level of ownership they experienced with their project, a frequency similar to that seen by Johns Hopkins students (2%). Conclusions Scholarly Concentrations programs play an important role in U.S. medical schools, and these programs can be successfully implemented internationally. The Scholarly Concentrations program at Johns Hopkins has been transformed to a program at Bezmiâlem in Istanbul, the first program outside North America or the European Union. When designing these programs, one must consider the context, logistics, student engagement, and outcomes. While long-term outcomes are needed, this can serve as a model for implementation elsewhere

Efficacy and safety of co-formulated elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide in HIV-positive patients: real-world data

Objectives: Elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF) is a recommended and widely used regimen for HIV infection. In this study, we aimed to determine the efficacy and safety of E/C/F/TAF in people living with HIV (PLWH), who are either treatment-naive or switched from any tenofovir disoproxil fumarate-containing regimen. For switched patients, we aimed to determine the impact of switching from tenofovir disoproxil fumarate (TDF) to TAF on lipid profile and kidney functions. Methods: ACTHIV-IST Study Group produced a database, and five dedicated HIV centres in Istanbul entered data of PLWH who switched from any TDF-containing regimen to E/C/F/TAF and treatment-naive patients who were initiated with the E/C/F/TAF regimen between January 2017 and December 2019. Clinical findings, viral parameters, lipid studies, renal function tests, adverse events and adherence to the treatment were recorded in this prospective observational study. Results: The study included a total of 614 switched and treatment-naive patients. Of 430 treatment-experienced patients, 89% (382) were men, and the mean age was 42 +/- 12 years. Among them, 47% (181/382) self-identified as men who have sex with men (MSM). The median duration of HIV diagnosis was 54 +/- 29 months. The median duration of E/C/F/TAF use was 20 +/- 36 months and that of previous treatment was 23 +/- 18 months. HIV-RNA was undetectable at baseline and month 12 in 84.1% (360/428) and 86.1% (328/381) of patients, respectively (p > 0.05). Mean CD4 counts were 708 +/- 287 cells/mu L and 802 +/- 305 cells/mu L at baseline and month 12, respectively (p < 0.001). Serum creatinine levels remained stable during the treatment period. Mean total cholesterol levels at baseline and month 12 were 172 and 211 mg/dL (p < 0.01), LDL-cholesterol 104 and 138 mg/dL (p < 0.01), HDL-cholesterol 39 and 49 mg/dL (p < 0.01) and triglycerides 134 and 174 mg/dL (p < 0.01), respectively. The treatment was generally well tolerated. Eight patients discontinued the therapy (drug interaction: 3; lost to follow-up: 1; pregnancy: 1; pulmonary tuberculosis: 1; side effect: 1; patient's decision: 1). Of 184 treatment-naive patients, 88% (162) were men, and the mean age was 36.5 +/- 12 years. Among them, 50% (81/162) self-identified as MSM. The mean duration of HIV infection was 21.6 +/- 17.1 months. The mean duration of E/C/F/TAF use was 16 +/- 4 months. HIV-RNA was undetectable at baseline and month 12 in 1% and 89.1% of patients, respectively. Mean CD4 counts at baseline and month 12 were 469 +/- 223 cells/mu L and 740 +/- 298 cells/mu L, respectively. During the treatment period, creatinine levels remained stable. Total cholesterol, LDL-cholesterol, triglyceride and also HDL-cholesterol levels increased. Mean total cholesterol levels at baseline and month 12 were 167 and 211 mg/dL (p < 0.01), LDL-cholesterol 108 and 143 mg/dL (p < 0.01), HDL-cholesterol 41 and 47 mg/dL (p < 0.01) and triglycerides 136 and 172 mg/dL, respectively (p < 0.01). The treatment was generally well tolerated. Three patients discontinued the therapy (drug interaction: 1; non-responder: 1; patient's decision: 1). Conclusion: Starting with or switching to E/C/F/TAF in PLWH effectively suppresses HIV infection, is associated with an increase in CD4 cell count and is well tolerated in a real-life setting. Renal functions remained stable during the treatment

Non-inferiority of Generic Tenofovir Disoproxil Fumarate/ Emtricitabine, Hivent® to Brand Name, Truvada® in HIV-Infected Patients

Objective: Antiretroviral agents provided a significant improvement in HIV-related mortality. Generic drugs decrease the cost and provide easieraccess to treatment. However, there are concerns about efficacy and safety. We assessed non-inferiority of generic tenofovir disoproxil fumarate/emtricitabine, Hivent® to brand name drug, Truvada® in a retrospective cohort.Methods: Nine centers from Turkey were enrolled and the study included 457 patients followed up between May 2015 and April 2017 with Truvada®(n = 227) and Hivent® (n = 230) in combination with other antiretrovirals. Baseline characteristics were comparable in both groups. Demographiccharacteristics and laboratory values at baseline and during treatment were recorded. The primary endpoint was virologic response after 12 monthsof therapy, as determined by Snapshot algorithm from Food and Drug Administration (FDA). The sample size calculation was based on the primaryendpoint. Non-inferiority margin was taken as 10%.Results: After 12 months of therapy, both drugs provided a comparable decline in HIV-RNA: The values at baseline, 1st, 3rd, 6th, 9th, and 12th monthby Truvada® were 6.32, 3.62, 2.52, 3.53, 3.01, and 1.71 log10 copies/mL, respectively and values by Hivent® were 5.93, 3.89, 2.18, 1.72, 3.63, and1.54 log10 copies/mL, respectively (P = .33). Both drugs provided a comparable significant increase in CD4+ cell count: values By Truvada® were338, 412, 472, 497, 511, and 580 cells/mL, respectively and values by Hivent® were 337, 503, 531, 553, 644, and 660 cells/mL (P = .13). The rateand severity of side effects were similar and the changes in biochemical parameters were not different.Conclusion: This retrospective cohort study showed that Hiv</p

Effect of Hepatosteatosis on the Virological Response in Entecavir and Tenofovir Therapies

Objective: Both chronic hepatitis B (CHB) and hepatosteatosis may lead to necroinflammation in liver. Therefore, the presence of hepatosteatosis might negatively affect the efficacy of antiviral therapy. We aimed to determine the effect of hepatosteatosis on virological response in patients with CHB receiving entecavir (ETV) and tenofovir (TDF) treatment