Naiv hepatit C enfeksiyonlu hastaların on-altı yıllık prognozu

Objectives: In this study, we aimed to evaluate the clinical course of treatment-naive patients infected with hepatitis C virus (HCV) who were followed up in various centers in Turkey. Materials and Methods: This was a retrospective study performed with the participation of 15 centers. Patients aged 18 years and older with HCV infection were included. Results: A total of 391 treatment-naive patients infected with HCV were included in this study. During the follow-up period, the final values of alanine aminotransferase, aspartate transaminase, and total protein were significantly decreased when compared to the initial values (p<0.001, p<0.001, and p=0.005, respectively). In the study group, 19.2% of the patients underwent liver biopsy and 4.1% underwent transient elastography (FibroScan). An increased histological activity index (HAI) score and fibrosis in the second biopsy were observed in one patient, only increased HAI in two patients and increased fibrosis in one patient, as shown on the FibroScan. In the 16 years of the study period, cirrhosis was radiologically detected in only one patient. Conclusion: Even if rapid progression is not observed, close monitoring of the clinical findings related to liver failure and fibrosis with invasive or non-invasive methods may be useful.Amaç: Bu çalışmada ülkemizin çeşitli merkezlerinde takip edilen naiv hepatit C virüs (HCV) ile enfekte hastaların klinik seyrini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Bu çalışma retrospektif olarak 15 merkezin katılımıyla gerçekleştirilmiştir. Çalışmaya 18 yaş üstü, HCV enfeksiyonu olan hastalar dahil edilmiştir. Bulgular: Çalışmada 391 tedavi-naiv HCV enfeksiyonlu hasta yer almıştır. Hastaların takip süresinde son alanine aminotransferase, aspartate transaminase ve total protein değerleri ilk düzeyine göre önemli düzeyde azalmıştır (sırasıyla p<0,001, p<0,001, p=0,005). Çalışma grubunda hastaların %19,2’sine karaciğer biyopsisi, %4,1’ine elastografi (FibroScan) uygulanmıştır. Takip esnasında bir hastada ikinci biyopside histolojik aktivite indeksi (HAI) ve fibroziste artma, iki hastada sadece HAI’da artma, birinde FibroScan ile fibrozis değerinde artma olduğu gözlenmiştir. Bir hastada 16 yıl içinde radyolojik olarak siroz saptanmıştır. Sonuç: Hızlı progresyon gözlenmemekle birlikte hastaların izleminde karaciğer yetmezliği ile ilgili klinik bulguların ve invaziv veya noninvaziv yöntemlerle fibrozisin yakın takibi yararlı olabilir

Elektrik dağıtım servislerinde performans tabanlı derecelendirme.

Regulation is one of the main elements in electric distribution services. The objective of the regulation is to maintain the balance between the rates and the service quality of electric distribution on behalf of both utilities and customers. In rapidly changing world the regulation regimes are also changing .In this thesis, an increasingly implemented regulation model in electric distribution, performance based ratemaking is studied. Its advantages and disadvantages, implementing methods and its quality effects are analyzed.M.S. - Master of Scienc

Changes in Antibiotic Susceptibilities of the Most Frequently Used Empirical Therapies for Nosocomial Uropathogenic Escherichia coli Strains Over Time

Introduction: The aim of this study was to investigate the resistance of Escherichia coli isolates to the most frequently used antibiotics in empirical therapy of urinary tract infections. Materials and Methods: E. coli species were isolated from urine samples using standard isolation and identification procedures between January 2006-December 2008. The antibiotic susceptibilities were determined by disk diffusion tests according to the Clinical and Laboratory Standards Institute (CLSI) criteria. The most frequently used antibiotics for empirical therapy -ciprofloxacin, ceftriaxone, gentamicin, amikacin, trimethoprim-sulfamethoxazole and nitrofurantoin- were investigated for susceptibility and resistance patterns. Results: Five hundred ninety-eight E. coli isolates were investigated in this study. The resistance rates to ciprofloxacin and ceftriaxone were found to increase when compared to 2006 (p= 0.007, p= 0.002 and p< 0.001, p= 0.014, respectively), while increases in the resistance to the other antibiotics were not significant. E. coli isolates were mostly sensitive to amikacin, followed by nitrofurantoin. Conclusion: Each institution should assess resistance profiles with respect to the frequently isolated microorganisms at the related center

Antimicrobial Resistances of Escherichia coli Isolates Causing Bacteremia (2004-2009)

Introduction: Escherichia coli is the most frequently isolated microorganism causing nosocomial and community-onset bacteremia. The aim of the present study was to investigate antimicrobial resistance trends of E. coli isolates causing bacteremia. Materials and Methods: In this retrospective study conducted at the University of Mersin, antimicrobial resistances were evaluated in a total of 323 E. coli isolates causing bacteremia between January 2004 and January 2010. All E. coli species were isolated from the blood using the BACTEC 9240 system (Becton Dickinson, INC, Sparks, MD). Isolates were identified and antimicrobial susceptibility testing was performed using standard techniques. Extended-spectrum beta-lactamase production was assessed by the double-disk synergy test. Nosocomial bacteremia was defined as an infection not present or incubating at the time of hospital admission, with onset at least 48 hours after admission to the hospital. Antimicrobial resistance trends of E. coli isolates during two three-year periods (2004- 2006 and 2007-2009) were prospectively recorded, evaluated and compared. SPSS ver. 16 (Chicago, IL) statistical package program was used for statistical analysis. Results: Patients were analyzed; 58.2% were male, the mean age was 52.7 ± 24.7 (1-96) years, and duration of bacteremia was 7.9 ± 4.6 (1-23). Of these patients, 92.3% had nosocomial bacteremia due to E. coli. Overall mortality was 27.2%. Extended-spectrum beta-lactamase-producing strains were reported in 136 (42.1%) cases. During the six-year study period, resistance rates of E. coli isolates causing bacteremia increased from 42.6% to 67.9% for cefuroxime axetil (p=0.002), from 42.3% to 62.3% for trimethoprimsulfamethoxazole (p=0.003), from 37% to 57.9% for ciprofloxacin (p= 0.018), and from 29.6% to 53.6% for gentamicin (p=0.004). Resistance rates to imipenem remained very low and stable (from 1.1% to 1.9%). Quinolone resistance was significantly associated with extended- spectrum beta-lactamase-production (p=0.0001). Conclusion: We demonstrated a trend of increasing resistance among E. coli isolates causing bacteremia to four different classes of antimicrobials. Increasing resistance may have an impact on the choice of empirical antimicrobial therapy in patients with bacteremia

Paradigm shifts in terms of vascular emergencies during COVID-19 outbreak: An Expert Opinion report

Coronavirus disease-2019 (COVID-19) has become a global threat. The entire population is now under the risk. Healthcare providers areconcerned about handling an increased number of COVID-19 patients in limited capacities of facilities. Some therapies are being postponedindefinitely. Patients with vascular diseases usually have multiple comorbidities and, therefore, many of them are prone to infection.However, vascular surgical pathologies are usually related to progressive diseases. Postponement may not be possible for every patient inthis group of patients. Thus, prioritization is crucial and a specialized algorithm is needed. In this review, we provide a succinct overview ofarterial and venous emergencies and present a classification system and treatment algorithm on an individual basis

How Aware are We of the Immune Status of Hepatitis B and Hepatitis A in Chronic Hepatitis C Patients? A Multicenter Retrospective Study from Turkey

Objectives: Patients with chronic hepatitis C virus (HCV) infectionand superinfection by hepatitis A or hepatitis B virus have highermorbidity and mortality when compared with those without HCVinfection. The aim of this study was to determine hepatitis A and Bseroprevalence rates and immunity in patients with chronic HCV indifferent regions of TurkeyMaterials and Methods: This multi-center study involving HCVinfected chronic cases was conducted between July 2016 andOctober 2017. Serological tests of Hepatitis B surface antigen, antiHBs, hepatitis B core antibody (anti-HBc) immunoglobulin G (IgG)and anti-HAV IgG were evaluated by ELISA, and the files of HCVinfected patients at the age of 18 or over who applied to 15 hospitalsin 13 different cities of our country were screened.Results: Three hundred sixty-two of the 828 patients were menand 466 were women. The prevalence of HBV/HCV coinfection was2.4%, while the anti-HBs positivity rate was 46.9%. Of the 610patients evaluated in terms of anti-HAV IgG serology, 88.8% wereanti-HAV IgG positive, while 11.1% were anti-HAV IgG negative.Isolated anti-HBc IgG positivity was detected in 5.8% of patients.Conclusion: Revealing the serological status of other hepatitisagents, such as hepatitis A and B, in patients with chronic hepatitisC is important in terms of providing the opportunity to immunize ortreat when requiredGereç ve Yöntemler: HCV ile enfekte kronik olguları içeren çok merkezli bu çalışma Temmuz 2016-Ekim 2017 tarihleri arasında yapıldı. Hepatit B yüzey antijeni (HBsAg, antiHBs, antiHBcIgG ve antiHAVIgG’nin serolojik testleri ELISA ve 18 yaşında HCV ile enfekte hastaların dosyaları veya Ülkemizin 13 farklı ilinde 15 hastaneye başvuranlar tarandı. Ülkemizin 13 farklı ilindeki 15 hastanenin HCV ile enfekte hastalarının dosyaları tarandı ve ELISA yöntemi ile değerlendirilen HBsAg, anti-HBs, anti-HBc IgG ve antiHAV IgG bakıldı. Bulgular: Sekiz yüz yirmi sekiz hastanın üç yüz altmış ikisi erkek, 466 kadındı. HBV/HCV koenfeksiyon prevalansı %2,4 iken antiHBs pozitiflik oranı %46,9 idi. Anti-HAV IgG serolojisi açısından değerlendirilen 610 hastanın %88,8’i anti-HAV IgG pozitif, %11,1’i anti-HAV IgG negatif idi. Hastaların %5,8’inde izole anti-HBc IgG pozitifliği saptandı. Sonuç: Kronik hepatit C’li hastalarda hepatit A ve B gibi diğer hepatit ajanlarının serolojik durumunun ortaya konması, gerektiğinde aşılama veya tedavi fırsatı sağlama açısından önemlidirWOS:00060535030000

Benign Paroksismal Pozisyonel Vertigolu Hastalarda, Anksiyete, Duygudurum ve Kişilik Bozuklukları

WOS:000450095400009PubMed ID: 30042641Introduction: This study presents the current prevalence of anxiety,mood, and personality disorders as well as factors associated with theexistence of psychiatric disorders in patients with benign paroxysmalpositional vertigo (BPPV).Methods: The study sample comprised 46 patients with BPPV and 74control subjects. Anxiety and mood disorders were ascertained via theStructured Clinical Interview for the Diagnostic and Statistical Manual(DSM) of Mental Disorders, Fourth Edition/Clinical Version. Personalitydisorders were diagnosed via the Structured Clinical Interview for DSM,Revised Third Edition, Personality Disorders.Results: Of the 46 patients, 18 (39.1%) had at least one mood or anxietydisorder and 13 (28.3%) had at least one personality disorder. The mostcommon Axis I and Axis II disorders in the patient group were majordepression in 8 (17.4%) and obsessive–compulsive personality disorderin 10 (21.7%) patients, respectively. It was found that major depression(p0.021), generalized anxiety disorder (p0.026) and obsessive–compulsive personality disorder (p0.001) were more prevalent in theBPPV group compared with the control group.Conclusion: Results suggest that psychiatric disturbances should becarefully checked in patients with BPPV due to the relatively high rateof comorbidity.Amaç: Bu çalışma benign paroksismal pozisyonel vertigo (BPPV)hastalarında psikiyatrik bozuklukların varlığı ile ilişkili faktörlerin veanksiyete, duygudurum ve kişilik bozukluklarının mevcut yaygınlığınısunmaktadır.Yöntem: Araştırma örneklemi 46 BPPV hastası ve 74 kontrol olgusundanoluşmuştur. Anksiyete ve duygudurum bozuklukları Structured ClinicalInterview for the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition/Clinical Version yoluyla tespit edildi. Kişilik bozukluklarıtanısı Structured Clinical Interview for DSM, Revised Third EditionPersonality Disorders ile konuldu.Bulgular: Kırk altı hastanın 18’in (%39,1) de en az bir duygudurum yada anksiyete bozukluğu ve 13’ün (%28,3) de en az bir kişilik bozukluğuvardı. Eksen I ve Eksen II tanıları olarak en sık, sırasıyla 8 (%17,4)hastada majör depresyon ve 10 (%21,7) hastada obsesif kompulsifkişilik bozukluğu vardı. Major depresyon (p:0,021), yaygın anksiyetebozukluğu (p:0,026) ve obsesif kompulsif kişilik bozukluğu (p:0,001)yaygınlığının kontrol grubu ile karşılaştırıldığında BPPV grubunda dahasık görüldüğü bulunmuştur.Sonuç: Sonuçlar; BPPV tanılı hastaların, psikiyatrik bozuklukların yüksekoranlı komorbiditeleri nedeniyle dikkatle değerlendirilmeleri gerektiğiniortaya koymaktadır