Adverse Effects of Two Different Peginterferon Molecules with Ribavirin Combination Therapy Used To Treat Chronic Hepatitis C

Peginterferon alfa (PEG-IFN-α) and ribavirin combination treatment may cause flu like symptoms, hematologic, neuropsychiatric, autoimmune adverse effects. This study aimed to compare adverse effects of two different PEG-IFN molecules used to treat chronic hepatitis C patients. 40 chronic hepatitis C patients followed by our clinic were enrolled to study. Twenty two patients were treated with PEG-IFN-α 2a and ribavirin combination, 18 patients were treated with PEG-IFN-α 2b and ribavirin combination for 48 weeks. Adverse effects were noted during treatment period. Flu like symptoms were the most frequent adverse effects observed in both treatment groups. Treatment was stopped because of adverse effects in 13.6% of PEG-IFNα 2a and ribavirin combination group and 11.1% of PEG-IFN-α 2b and ribavirin combination group. There was no statistically significant difference between frequency of advers effects and discontinuation rate of two therapy modalities. Finally, both of PEG-IFN molecules were found similar about frequency of adverse effects, reducing dose and discontinuation of treatment

A Case of Oropharyngeal Tularemia Associated with Erythema Multiforme

Tularemia is a zoonosis caused by Francisella tularensis. Oropharyngeal tularemia is due to bacteria penetrating the oral mucosa during intake of contaminated water and food and is the common form seen in our country. A case of oropharyngeal tularemia associated with erythema multiforme is reported herein. Physicians should recognize the cutaneous lesions of tularemia and consider tularemia in patients with eruptions having an epidemiological history

Complicated Upper Urinary Tract Infections Followed in Our Clinic

In this study, the clinical and epidemiologic spectrum of 200 cases of complicated upper urinary tract infection which treated at a university hospital were evaluated, retrospectively. The mean age was 62.9 years and female/male ratio was 118/82. The most common complaints were fever (n= 131) and disuria (n= 71). Bacteriuria was detected in 119 patients and bacteremia was detected in 20 patients. The most common etiologic agent was Escherichia coli (%63). Advanced age, recent antimicrobial usage and diabetes mellitus were found as common complicating factors. Fourty-six patients had urosepsis and 17 patients were died. The rates of susceptibility of E. coli isolated from urine samples were detected as 100% to imipenem, meropenem & fosfomycin, 98% to amicasin, 70% to gentamycin, 73% to ciprofloxacin, to ofloxacin 56%, to nitrofurantoin 93%, to ceftriaxone 88% and to piperacilin-tazobactam 86%. Trimethoprim/sulfamethoxazole and ampicilin demonstrated the fewest susceptibility (46% and 47%, respectively). Consequently, the patients with complicated upper urinary tract infections should be treated in hospital. A third generation cephalosporin or fluoroquinolones may be suitable choices for ampiric treatment of the patients without urosepsis; and a third generation cephalosporin or beta-lactam with beta-lactamase inhibitor combined with aminoglycosides and carbapenemes may be suitable choices for the patients with urosepsis

Several Cytokines and Protein C Levels with the Apache II Scoring System for Evaluation of Patients with Sepsis

Objective: We investigated whether determination IL-6, IL-8, IL-1beta and TNF-alpha at baseline, total protein C (PC) levels at time of admission and 48 hours after initiation could complement the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system to identify patients with sepsis, severe sepsis or septic shock for clinical outcome.Material and Methods: The study was carried out prospectively. 60 consecutive patients with sepsis, severe sepsis or septic shock were included. Blood samples were obtained at baseline and 48 hours after initiation. Cytokines and PC levels in plasma were measured with an enzyme-linked immunoabsorbent assay (ELISA). APACHE II score was calculated on admission.Results: Baseline IL-6 levels and PC levels 48 hours after initiation were predictive of increased mortality (p=0.016, p=0.044 respectively). Baseline IL-6, IL-8 and TNF-alpha baseline levels correlate with the severity of physiologic insult, as determined by the APACHE II score. However, our multiple logistic regression analysis of these did not reveal any predictive value in combination with the APACHE II score.Conclusion: Determination of baseline IL-6 and PC 48 hours after initiation were of predictive value for prognostic evaluation of septic patients, but did not significantly increase predictive power of the APACHE scoring system to identify patients with sepsis for fatal clinical outcome

Etiology of Fever of Unknown Origin in Eskisehir

Introduction: Fever of unknown origin is first defined in 1961 as a temperature higher than 38.3°C lasting longer than 3 weeks, with a diagnosis that remains uncertain after 1 week of investigation. In this study, it’s aimed to evaluate etiology of fever of unknown origin cases hospitalized in department of infectious diseases and clinical microbiology. Patients and Methods: Fifty three fever of unknown origin cases hospitalized at our department between January 2002-August 2007 were evaluated retrospectively. Fever of unknown origin was diagnosed according to the criteria described by Petersdorf and Beeson. Patients with a history of immunosuppressive disease and nosocomial fever were excluded. Results: Median days with fever was 15.8 days (20-160 days), median days for diagnosis was 4.8 days (3-120 days). Seventeen (32.1%), 10 (18.9%) and 5 (9.4%) of the 53 cases were diagnosed as infection, collagen vascular disease and malignancy respectively. Eight (15.1%) of all cases were diagnosed as other diseases such as thyroiditis, pheochromocytoma, ulcerative collitis, and familial mediterrenean fever. Origins of the fever was not defined for 13 (24.5%) of the patients. Fever decreased spontaneously in 61.5% of undiagnosed patients at follow up. Invasive procedures were performed at 20.8% of whole cases. Conclusion: As a result infectious diseases are the leading causes of fever of unknown origin. For diagnosis routine tests should be performed first and then if necessary, more complicated or invasive tests may be performed. Endemic, regional infectious diseases should be considered primarily

Risk of Occupational Infections Due to Occupational Exposures in Medical Students

Medical students are exposed to the risk of occupational infections due to accidental exposures such as needlestick injuries, sharps injuries and mucosal exposure of contaminated blood or body fluids. A questionnaire was devised to determine occupational exposures (OEs) they had experienced, behaviours following OE, their knowledge and compliance on universal precautions. One hundred and fourteen medical students filled out the questionnaire. 31.6% were in 3rd, 22.8% in 4th, 35.1% in 5th, and 10.5% in 6th class. 61.4% of students had history of occupational injuries at least once. Rate of sharps injuries, needlestick injuries and mucosal exposure were 30%, 82.9%, 35.7% respectively. Rate of OEs was higher and statistically significant in 5th, 6th classes compared to 3rd, 4th.The most common way for exposure was recapping the needle. Rate of underreporting was 74.2%. 53.5% of the participants were vaccinated with complete dose of hepatitis B virus vaccine. 28.9% declared they always wore gloves prior to any percutaneus procedures. Medical students should be educated for the risk and encouraged to report OEs for their own safety

Risk of Occupational Infections Due to Occupational Exposures in Health Care Workers

Health care workers (HCWs) are exposed to the risk of occupational infections due to accidental exposures such as needlestick injuries, sharp injuries and mucosal exposure of contaminated blood or body fluids. A questionnaire was devised to determine occupational exposures (OEs) they had experienced, behaviours following OE, condition of hepatitis B virus immunization, their knowledge and compliance on universal precautions. One hundred and thirty HCWs filled out the questionnaire. One hundred and three (79.2%) of participants determined at least one or more occupational exposure during last one year. Eighteen (17.5%) of participants exposed to accidental exposure during last one year reported these exposures. One hundred and nine (83.8%) of participants had history of hepatitis B virus vaccination. Results showed that only 30 (23.1%) followed universal precautions completely

Rehabilitation of Hearing Loss in Acute Bacterial Meningitis

In this article, a patient in whom cochlear implant was administered following hearing loss associated with acute bacterial meningitis is presented. The 57-year-old male patient presented due to fever, ear pain and hearing loss for the past three days. On physical examination, the patient was conscious, had a moderate general condition, and fever of 37.7°C. There was total hearing loss and aphasia. Neck stiffness was positive during neurological examination. During non-stained microscopic examination of the cerebrospinal fluid, 1900 cells/mm3 (89% PMNL, 11% lymphocyte) were detected. During gram staining, gram-positive diplococcus was seen. Ceftriaxone was started with the diagnosis of acute bacterial meningitis. On day 2 of the treatment, his fever decreased, but hearing loss and speech and balance disorder continued. On day 4 of the treatment, vancomycin was added due to newly developed fever. Response to fever was achieved on day 2 of the combination treatment. During audiological examination of the patient with ongoing hearing loss, very severe bilateral sensorineural hearing loss was detected. 1 mg/kg prednisolone was started for the patien,t and cochlear implant was planned by the otorhinolaryngology department. Cochlear implant was performed as the patient’s complaint did not regress after one month of prednisolone treatment. Monitoring of the patient is ongoing. In conclusion, hearing loss developing in acute bacterial meningitis should be detected promptly, and rehabilitated as required

Case Report: Granulicatella elegans Causing Native Valve Endocarditis

Infective endocarditis is a life threatening disease of endocardium of the heart. Viridans streptococci are the most common reported isolates among patients with infective endocarditis. Abiotrophia and Granulicatella species form part of the normal flora of the oral cavity. They are infrequently isolated in patients with infective endocarditis. We report a case of native valve endocarditis attributed to Granulicatella elegans. We isolated G. elegans in two blood samples of the patient. Patient was successfully treated with ceftriaxone and gentamycin