Hepatitis B Vaccination Results Which dose is Sufficient for Immunosuppressive Patients? Single or Double?

Aim: Despite effective HBV vaccine and vaccination programs, Hepatitis B still causes nearly one million deaths annually, according to the World Health Organization. The immunization rates are high by hepatitis B vaccination especially in young healthy population. However, advanced age, comorbidities and immune deficiency affect the rates of vaccine response negatively. We aimed to evaluate the factors affecting the vaccine response in the patients who received hepatitis B vaccine in our hospital retrospectively.Materials and Methods: Patients who received hepatitis B vaccine and followed-up for immunization status were evaluated retrospectively in our vaccination unit. The patients were examined in terms of age, comorbidities, vaccine scheme, vaccine dose, utilization of immunosuppressive-biological agents, immunization success, and common characteristics of patients who did not develop immunity.Results: Anti-HBs titers were significantly lower in patients over 50 years old. In addition, lower Anti-Hbs titers were detected in patients with comorbidity and who received immunosuppressive therapy. Statistically higher Anti-HBs titers were obtained with double dose vaccination than single dose vaccination in patients receiving immunosuppressive treatment. Moreover, it was documented that a single dose vaccination protocol was applied to all seven patients who failed vaccination. Six of these patients were over 50 years old, two were diabetic, five were diagnosed with rheumatic disease and all of them were using biological agents.Conclusion: Vaccination before treatment in patients who will receive immunosuppressive therapy, administration of high dose vaccines in patients under immunosuppressive therapy or delaying immunosuppressive therapy during vaccination may be considered as appropriate alternatives. Considering the safety and cost-effectiveness of high-dose hepatitis B vaccine, it should be preferred in the immunosuppressive patient group

Malaria: An evaluation of 40 cases

Bu çalışmada, Şubat 1996- Ekim 2009 yılları arasında kliniğimizde izlenen 40 erişkin malaryalı olgu, retrospektif olarak değerlendirilmiştir. Tanı, tüm olgularda Giemsa ile boyanan kalın ve ince yayma preparatlarda parazitin gösterilmesi ile konulmuştur. Otuz dört olgu erkek, 6 olgu kadın olup; ortalama yaş 31.1 olarak belirlenmiştir. Tüm olgularda endemik bölgelere (24 olguda Afrika, Afganistan, Azerbaycan ve Arap Yarımadası'na, 16 olguda Güneydoğu Anadolu Bölgesi'ne) seyahat öyküsü vardı ve hiçbirine kemoproflaksi uygulanmamıştı. Olguların 20'sinde Plasmodium vivax, 18'inde P. falciparum, ikisinde P. vivax ve P. falciparum saptanmıştır. Hastalarda ateş (%100), splenomegali (%72,5), hepatomegali (%45,0), anemi (%67,5), lökopeni (%32,5), trombositopeni (%75,0), sedimantasyon yüksekliği (%65,0), karaciğer fonksiyon testlerinde anormallikler (%62,5), serum kreatininde artış (%27,5) belirlendi. P. vivax sıtması olgularına klorokin ve primakin, P. falciparum olgularına meflokin veya kinin sülfat ile doksisiklin, mikst olgulara kinin sülfat ile doksisiklin, sonrasında primakin tedavisi uygulandı. İki olguda akut böbrek yetmezliği, iki olguda serebral tutulum; bir olguda akut böbrek yetmezliği, serebral tutulum, yaygın damar içi koagülasyon ve erişkin solunum yetmezliği sendromu gelişti. P. falciparum sıtmalı iki olgu kliniğimize yatırıldıkları gün kaybedildi, hastalık diğer olgularda şifa ile sonlandı. Sonuç olarak, endemik bölgelere seyahat öyküsü olan her ateşli olguda sıtma ayırıcı tanıda mutlaka yer almalıdır. Bu bölgelere seyahat edecek bireylere kemoproflaksi uygulanması ve kişisel korunma önlemlerinin sağlanması çok önemlidir.In this study, the epidemiological, clinical, laboratory and therapeutic features of forty adult malaria patients referred our clinic between February 1996-September 2009, were assessed retrospectively. Diagnosis was established by Giemsa-stained thick and/or thin blood smears in all cases. Thirty-four patients were male and 6 patients were female and mean age was 31.1 years. All patients had a history of travel to endemic areas (24 cases to Africa, Afghanistan, Azerbaijan, Arabian Peninsula, 16 cases to Southestern Anatolia Region), and none of them had chemoprophylaxis. Plasmodium vivax was detected in 20 patients, and P.falciparum in 18 and mixed (P. vivax and P. falciparum) in two. Parasitemia ranged from 0.5%- 25%. Fever (100%), periodic fever (62.5%), splenomegaly (72.5%), hepatomegaly (45.0%), anemia (67.5%), leukopenia (32.5%), thrombocytopenia (75.0%), a rise in erytrocyte sedimentation rate (65.0%), abnormalities in hepatic enzymes (62.5%), hyponatremia (32.5%), hypoglisemia (25%) and an elevated serum creatinine level (27.5%) were determined in the patients. Two patients with P. falciparum developed acute renal failure and cerebral involvement died soon after admission. Acute renal failure, acute respiratory distress syndrome, cerebral involvement and dissemine intravasculer coagulation were observed in one patient with falciparum malaria who recovered completely. In conclusion, every febril patients with a history of travel to the endemic regions should raise the suspicion of malaria. Effective pre-exposure chemoprophylaxis and personal protection measures should be provided to travellers visiting endemic regions

The epidemiology, Clinical Manifestations, radiology, microbiology, treatment, and prognosis of echinococcosis: Results of NENEHATUN study

Aim: Echinococcosis, caused by Echinococcus species, is an important zoonotic disease causing major health problems in humans and animals. Herein, we aimed to evaluate the epidemiology, clinical and laboratory parameters, radiological, serological, pathological, and treatment protocols of followed-up cases of hydatidosis. Methods: A total of 550 patients diagnosed with hydatid cyst disease were included in this study. Patients who were positive for one or more of the enzyme-linked immunosorbent assay or indirect hemagglutination test, pathological results, or radiological findings were examined. The data analyzed were collected from nine centers between 2008 and 2020. Records were examined retrospectively. Results: Among the patients, 292 (53.1%) were women and 258 (46.9%) were men. The patients' mean age was 44.4 +/- 17.4 years. A history of living in rural areas was recorded in 57.4% of the patients. A total of 435 (79.1%) patients were symptomatic. The most common symptoms were abdominal pain in 277 (50.4%), listlessness in 244 (44.4%), and cough in 140 (25.5%) patients. Hepatomegaly was found in 147 (26.7%), and decreased breath sounds were observed in 124 (22.5%) patients. Radiological examination was performed in all cases and serological methods were also applied to 428 (77.8%) patients. The most frequently applied serological test was IHA (37.8%). A single cyst has been found in 66% patients. Hepatic involvement occurred in 327 (59.4%), pulmonary involvement was found in 128 (23.3%), whereas both of them were recorded in 43 (7.8%) patients. Splenic involvement was only detected in nine (1.6%) patients. Echinococcus granulosus (72.5%) was most frequently detected. Cyst diameters of 56.9% of the patients were in the range of 5-10 cm. A total of 414 (75.2%) patients received albendazole as an antiparasitic. Mortality was noted in nine (1.6%) patients. Conclusion: Echinococcosis is an important public health problem in Turkey. It can affect the social, economic, and political structures of the community. Public education and awareness are extremely important

The frequency of Duchenne muscular dystrophy/Becker muscular dystrophy and Pompe disease in children with isolated transaminase elevation: results from the observational VICTORIA study

IntroductionElevated transaminases and/or creatine phosphokinase can indicate underlying muscle disease. Therefore, this study aims to determine the frequency of Duchenne muscular dystrophy/Becker muscular dystrophy (DMD/BMD) in male children and Pompe disease (PD) in male and female children with isolated hypertransaminasemia.MethodsThis multi-center, prospective study enrolled patients aged 3–216 months with serum alanine transaminase (ALT) and/or aspartate transaminase (AST) levels >2× the upper limit of normal (ULN) for ≥3 months. Patients with a known history of liver or muscle disease or physical examination findings suggestive of liver disease were excluded. Patients were screened for creatinine phosphokinase (CPK) levels, and molecular genetic tests for DMD/BMD in male patients and enzyme analysis for PD in male and female patients with elevated CPK levels were performed. Genetic analyses confirmed PD. Demographic, clinical, and laboratory characteristics of the patients were analyzed.ResultsOverall, 589 patients [66.8% male, mean age of 63.4 months (standard deviation: 60.5)] were included. In total, 251 patients (188 male and 63 female) had CPK levels above the ULN. Of the patients assessed, 47% (85/182) of male patients were diagnosed with DMD/BMD and 1% (3/228) of male and female patients were diagnosed with PD. The median ALT, AST, and CPK levels were statistically significantly higher, and the questioned neurological symptoms and previously unnoticed examination findings were more common in DMD/BMD patients than those without DMD/BMD or PD (p < 0.001).DiscussionQuestioning neurological symptoms, conducting a complete physical examination, and testing for CPK levels in patients with isolated hypertransaminasemia will prevent costly and time-consuming investigations for liver diseases and will lead to the diagnosis of occult neuromuscular diseases. Trial RegistrationClinicaltrials.gov NCT04120168

Unusual central nervous system involvement of rheumatoid arthritis: successful treatment with steroid and azathioprine

Central nervous system involvement of rheumatoid arthritis (RA) frequently develops in patients who had a long-term history of RA, irrespective of the disease activity of systemic arthritis, and it has a high mortality rate despite treatment. Since clinical symptoms and radiologic signs are rather nonspecific, in short of doing biopsy, the diagnosis of rheumatoid meningitis is one of exclusion. However, the strongly positive rheumatoid factor in the cerebrospinal fluid is quite specific. We here report a 70-year-old man who had not been diagnosed as RA before he was admitted with neurological findings, who was diagnosed as RA later and successfully treated with prednisolone and azathioprine

Determining the Optimum Layer Combination for Cross-Laminated Timber Panels According to Timber Strength Classes Using Artificial Neural Networks

The primary aim of this work was to determine the effects of production parameters, such as wood species and timber strength classes, on some mechanical properties of cross-laminated timber (CLT) panels using artificial neural network (ANN) prediction models. Subsequently, using the models obtained from the analyses, the goal was to identify the optimum layer combinations of timber strength classes used in the middle and outer layers that would provide the highest mechanical properties for CLT panels. CLT panels made from spruce and alder timbers, as well as hybrid panels created from combinations of these two wood species, were produced. The strength classes of the timbers were determined non-destructively according to the TS EN 338 (2016) standard using an acoustic testing device. The bending strength and modulus of elasticity values of the CLT panels were determined destructively according to the TS EN 408 (2019) standard. According to ANN results, the optimum timber strength classes and layer combinations were determined for bending strength as C24-C27-C24 for spruce CLT, D18-D24-D18 for alder CLT, C30-D40-C30 and D18-C30-D18 for hybrid panels; and for modulus of elasticity, C22-C27-C22 for spruce, D35-D30-D35 for alder, C16-D24-C16, and D24-C24-D24 for hybrid panels

Determining the Optimum Layer Combination for Cross-Laminated Timber Panels According to Timber Strength Classes Using Artificial Neural Networks

The primary aim of this work was to determine the effects of production parameters, such as wood species and timber strength classes, on some mechanical properties of cross-laminated timber (CLT) panels using artificial neural network (ANN) prediction models. Subsequently, using the models obtained from the analyses, the goal was to identify the optimum layer combinations of timber strength classes used in the middle and outer layers that would provide the highest mechanical properties for CLT panels. CLT panels made from spruce and alder timbers, as well as hybrid panels created from combinations of these two wood species, were produced. The strength classes of the timbers were determined non-destructively according to the TS EN 338 (2016) standard using an acoustic testing device. The bending strength and modulus of elasticity values of the CLT panels were determined destructively according to the TS EN 408 (2019) standard. According to ANN results, the optimum timber strength classes and layer combinations were determined for bending strength as C24-C27-C24 for spruce CLT, D18-D24-D18 for alder CLT, C30-D40-C30 and D18-C30-D18 for hybrid panels; and for modulus of elasticity, C22-C27-C22 for spruce, D35-D30-D35 for alder, C16-D24-C16, and D24-C24-D24 for hybrid panels

Results of a Multinational Study Suggest the Need for Rapid Diagnosis and Early Antiviral Treatment at the Onset of Herpetic Meningoencephalitis

Beraud, Guillaume/0000-0002-4705-0916; Ghaydaa, Shehata/0000-0002-3631-893X; Senbayrak, Seniha/0000-0002-4983-6613; Gunst, Jesper/0000-0002-3787-0259; Kanj, Souha/0000-0001-6413-3396; Karabay, Oguz/0000-0003-0502-432X; Larsen, Lykke/0000-0002-4113-4182; Stahl, Jean Paul/0000-0002-0086-3557; johansen, isik somuncu/0000-0002-2189-9823; VAHABOGLU, Haluk/0000-0001-8217-1767WOS: 000358623200015PubMed: 25779579Data in the literature regarding the factors that predict unfavorable outcomes in adult herpetic meningoencephalitis (HME) cases are scarce. We conducted a multicenter study in order to provide insights into the predictors of HME outcomes, with special emphasis on the use and timing of antiviral treatment. Samples from 501 patients with molecular confirmation from cerebrospinal fluid were included from 35 referral centers in 10 countries. Four hundred thirty-eight patients were found to be eligible for the analysis. Overall, 232 (52.9%) patients experienced unfavorable outcomes, 44 died, and 188 survived, with sequelae. Age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02 to 1.05), Glasgow Coma Scale score (OR, 0.84; 95% CI, 0.77 to 0.93), and symptomatic periods of 2 to 7 days (OR, 1.80; 95% CI, 1.16 to 2.79) and >7 days (OR, 3.75; 95% CI, 1.72 to 8.15) until the commencement of treatment predicted unfavorable outcomes. The outcome in HME patients is related to a combination of therapeutic and host factors. This study suggests that rapid diagnosis and early administration of antiviral treatment in HME patients are keys to a favorable outcome