[Show abstract][Hide abstract] ABSTRACT: In patients with chronic hepatitis C, triple drug regimens containing a protease inhibitor, peginterferon and ribavirin were found to significantly increase sustained virologic response rates compared to dual drug regimen containing pegylated interferon and ribavirin, especially in genotype 1.
In Turkey, telaprevir has been used since March 2013. We aimed to evaluate results of patients with chronic hepatitis C treated with telaprevir, peginterferon and ribavirin.
We evaluated 28 patients with genotype 1 chronic hepatitis C infection treated with triple drug regimen containing telaprevir, in three medical centers in Turkey, retrospectively. Demographic data of patients, treatment indications, adverse events and outcomes were recorded.
Of 28 patients intended to treat, 25 (89.2%) patients completed the treatment. Overall, 21 (82.1%) patients had relapse and five patients were non-responder. Regarding the treatment outcomes of Telaprevir based regimen, 20/26 patients achieved sustained virological response. Pruritus, rash, dysgeusia, anorectal discomfort and anemia were main adverse effects. Blood transfusion and ribavirin dose reduction required for 7 and 11 patients, respectively. Due to several adverse effects, 10 patients were hospitalized.
Although more frequent and severe adverse effects, telaprevir has been promising for patients with treatment-experienced hepatitis C.
[Show abstract][Hide abstract] ABSTRACT: Toxocariasis in man is associated with three syndromes which are visceral larva migrans, ocular larva migrans and covert toxocariasis. Although neurotoxocariasis is defined as the fourth syndrome of toxocariasis, it is usually considered as a neurological disease which is usually concomitant with visceral larva migrans. In this report, a case of brain abscess caused by toxocariasis was presented. A 56 years-old female patient was admitted to our hospital with headache, pain referring to right side of her face and teeth, numbness of forth and fifth finger of her right hand. Cranial diffusion weighted, dynamic magnetic resonance imaging (MRI) revealed a few non-specific intensities at supratentorial white matter, an approximately 13 x 12 mm lesion without contrast enhancement and a significant edema around the white matter in the left frontal cortex. Histologic examination after stereotactic biopsy of the lesion revealed diffuse histiocyte infiltration. A specific agent could not be detected in the histochemical examination. Western-blot test for toxocariasis in serum and cerebrospinal fluid samples were found positive. She was transferred to the infectious diseases clinic, and albendazole therapy (400 mg, q12h) was started. Albendazole treatment was completed for a total of one month following the regression of the cranial MRI findings on the 14th day of therapy. The patient is recalled for cranial MRI control three months later. However, it was noted that she continued albendazole for three months. Compared to the previous MRI, there were two stabilized T2A hyperintense lesions in left cranial hemisphere and minimally regressed lesions at the level of left frontal centrum semiovale. The patient was successfully treated with albendazole. There was no relapse after six month follow-up. This case was presented to withdraw attention to neurotoxocariasis which may be encountered although rarely in the etiology of encephalitis/ brain abscess.
[Show abstract][Hide abstract] ABSTRACT: Background
Tigecycline is a relatively new glycylcycline antimicrobial, active in vitro against a variety of Gram-positive and Gram-negative organisms. In this study we evaluated the outcomes of spondylodiscitis cases treated with tigecycline-including therapies retrospectively.
All adult (age >18 years) cases with a diagnosis of spondylodiscitis, who were treated with a tigecycline-including therapy between 2007 and 2011, were included in the study. The primary efficacy outcome was clinical success with tigecycline at the end of induction, while the secondary efficacy outcome was maintenance of success through 3 months following completion of induction. Success through induction was also compared by dosing strategy.
A total of eight spondylodiscitis cases fulfilled the study inclusion criteria. All cases had back pain, restricted mobility, magnetic resonance findings associated with spondylodiscitis, and microbiology or pathological findings related to spondylodiscitis. All had post-neurosurgical spondylodiscitis. In five cases, tigecycline was started in accordance with the antibacterial susceptibility results from intervertebral tissue biopsy cultures, whereas in three it was started empirically. All cases had received several different antibacterials with failure before receiving tigecycline. The mean duration of tigecycline treatment was 37 ± 21 days. One case was lost to follow-up after 2 days of tigecycline. Primary and secondary success was achieved in the remaining seven cases.
These limited data suggest that tigecycline may have a role in the treatment of refractory spondylodiscitis cases.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 06/2014; 23. DOI:10.1016/j.ijid.2014.01.027 · 1.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Writing a thesis is mandatory for getting a postgraduate medical degree in Turkey. Publication of the results of the thesis in an indexed journal makes the results available to researchers, however publication rate is usually low. The aim of this retrospective observational study was to investigate the publication rate of Turkish Infectious Diseases and Clinical Microbiology, Medical Microbiology specialty theses and Microbiology doctorate theses in international peer-review journals. On August 17th 2007, the thesis database of the Council of Higher Education of the Republic of Turkey (YOK) where all specialization and doctorate theses are recorded obligatorily, was searched for Infectious Diseases and Clinical Microbiology and Medical Microbiology specialty and Microbiology doctorate theses. Assuming that publication of a thesis would last at least six months, theses dated to February 2007 and after were excluded. The publication rate of those theses was found out by searching Science Citation Index-Expanded database for thesis author and supervisor between August 17-September 12, 2007. Chi-square test was used for statistical analysis. Our search yielded a total of 834 theses dated from 1997 to 2007, however 10 of them were excluded, since they were dated to February 2007 or after. It was found that the overall publication rate was 11.4% (94/824). The publication rates for Microbiology doctorate, Medical Microbiology and Infectious Diseases and Clinical Microbiology specialty theses were 13.7% (34/249), 10.7% (33/309) and 10.2% (27/266), respectively, with no statistical significance (p> 0.05). It was determined that nine (9.6%) of the 94 published theses belonged to 1997-2001 period, whereas 85 (80.4%) were in 2002-2007 period (p< 0.05). The probable reason for this increase was thought to be related with the updated criteria of YOK carried out in 2000 for academic promotions, nevertheless the publication rate of the investigated theses in international peer-review journals was still low. Thesis is an important part of specialty and doctorate education and necessitates intense work. The created knowledge usually contains important data about the country and the world. Publication of the theses supplies dissemination of new knowledge and completes the process of a scientific study. Solutions must be generated to promote the publication of specialty and doctorate theses.
[Show abstract][Hide abstract] ABSTRACT: Dear Editor,Sarcoidosis is a systemic inflammatory disorder of unknown etiology characterized by the formation of non-caseating granulomas in the involved tissues and lymph nodes. It usually involves multiple organs, including the lungs, skin, bones, muscles, eyes, heart, liver, spleen and lymph nodes . Although liver is an important site of sarcoidosis, isolated hepatic involvement is quite rare . In this paper it is aimed to present a case of sarcoidosis with isolated liver microabscesses.A 51-year-old woman with no known prior disease admitted to our outpatient clinic with the complaints of fever persisting for 20 days and abdominal pain. In the physical examination her length was 150 cm and her weight was 65 kg. She had fever (38 °C) and abdominal tenderness on palpation in the upper right quadrant. She had malaise and 8 kg weight loss within the previous month. Her main laboratory findings were: hemoglobin 9.7 g/dl, leukocyte 15.57 × 103/mm3, neutrophil 80.9 %, C reactive pr
Irish Journal of Medical Science 02/2014; 183(3). DOI:10.1007/s11845-014-1074-7 · 0.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to compare the efficacy of piperacillin/tazobactam (P/T) and cefoperazone/sulbactam (C/S) in the empirical treatment of adult neutropenic fever.
Data and outcomes of low-risk adult cases with neutropenic fever and treated with P/T (4.5 g q6h) or C/S (2 g q8h) between 2005 and 2011 June were extracted from our database. Risk evaluation was made according to criteria of Multinational Association for Supportive Care in Cancer (MASCC) and a score of ≥ 21 was considered as low risk. Data were collected prospectively by daily visits and evaluated retrospectively. Primary outcome was - fever defervescence at 72 h in combination with success without modification (referring to episodes where the patient recovered from fever with disappearance of signs of infection without modification to initial empirical treatment). All-cause mortality referred to death resulting from a documented or presumed infection or unidentified reason during the treatment and 30-day follow-up period.
A total of 172 patients (113 cases P/T and 59 cases C/S) fulfilled the study inclusion criteria. Persistent response in P/T arm was 73.5%, whereas it was 64.5% in C/S arm (p > 0.05). Rates of any modification were also similar in both treatment arms. All-cause mortality during the treatment and 30-day follow-up period was not significantly different (P/T: 4/113 vs. C/S: 2/59, p > 0.05). There was no severe adverse effect requiring antibiotic cessation in both cohorts.
In conclusion, our data suggest that C/S may be a safe alternative to P/T in the empirical treatment of adult low-risk febrile neutropenia cases.
International Journal of Clinical Practice 12/2013; 68(2). DOI:10.1111/ijcp.12279 · 2.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In this study, we aimed to evaluate the 1-year post-treatment follow-up results of 112 patients who received pegylated interferon (PEG-IFN) for 52 weeks. HBeAg negativity/seroconversion and/or negative HBV-DNA at the end of the treatment were considered as response. Patients who had response at the end of treatment but had HBV-DNA breakthrough during 1-year follow-up were considered as relapse. The study group comprised 112 cases (34 HBeAg-positive, 78 HBeAg-negative). In HBeAg-positive and ?negative cases, end-of-treatment response rates were 2.9% and 60.2%, whereas 1-year sustained virological response rates were 0 and 33.3%, respectively. When we compared relapse cases versus cases with response at the end of 1-year follow-up, being female and having low viral load were the two parameters associated with higher response rates (Chi-square, P = 0.028; Mann?Whitney U test, P = 0.023). Overall non-response rates to PEG-IFN were high (57.1%). Results in HBeAg-positive cases were disappointing.
[Show abstract][Hide abstract] ABSTRACT: Zygomycosis is a rapidly-progressive invasive fungal disease with high mortality rates. Mucor, Rhizopus, Rhizomucor and Absidia species classified in Mucorales order, are the main causative agents of zygomycosis. Uncontrolled diabetes, hematologic malignancies, long term corticosteroid use and immunosuppressive therapies are the main predisposing factors for mucormycosis. In this study, we aimed to evaluate the mucormycosis cases from Turkey published in national and international databases in the last 17 years by means of age, gender, co-morbidities, signs and symptoms, diagnostic methods, therapeutic modalities, and mortality rate by pooling analysis. In our study, two national (http://uvt.ulakbim.gov.tr, http://www.turkmedline.net) and two international (www.ncbi.nlm.nih.gov, http://apps.webofknowledge.com) databases were used. A total of 64 manuscript (34 from national and 30 from international databases) published between 1995 and 2012, which were eligible for the study criteria and accessible as full text were included in the study. A total of 151 mucormycosis patients (71 female, 80 male; mean age: 45.4 ± 21.4 years) from these studies, with definitive diagnosis of invasive fungal infections according to the criteria of European Organization for Research and Treatment of Cancer (EORTC) have been evaluated. Of 151 patients 91 (60%) were diagnosed as rhinocerebral, 42 (%27.8) were sinoorbital, 7 (4.6%) were pulmonary, 6 (3.9%) were disseminated, 3 (1.9%) were skin, and 2 (1.3%) were gastrointestinal mycormycosis. The most common symptoms and signs were; swelling of eye and face (n= 95, 63%), fever (n= 72, 48%), nasal obstruction (n= 60, 40%), headache (n= 58, 38%) and opthtalmoplegia (n= 48, 32%). The most common co-morbidity was diabetes (49%) followed by hematological malignancies (39.7%). Mycological cultures were performed for 82 patients, and fungal growth were detected in the clinical specimens of 51 cases. The distribution of strains isolated in culture were as follows: Mucor spp. (n= 19, 37.2%), Rhizopus spp. (n= 13, 25.5%), Zygomycetes (n= 9, 17.6%), Rhizopus oryzae (n= 4, 7.8%), Rhizopus spp. + yeast (n= 3, 5.9%), Rhizomucor spp. (n= 2, 3.9%) and Rhizosporium spp. (n= 1, 1.9%). In 133 patients, histopathological investigation and in 126 patients radiological examinations were performed for diagnosis. Both surgical debridement and antifungal therapy were employed in 115 patients. Four patients had received only surgical debridement and 30 only antifungal therapies. Classical amphotericin B (AMP-B) therapy for 77 cases, liposomal AMP-B for 60 cases, liposomal AMP-B + posaconazole for six cases and lipid complex AMP-B for two cases have been started as antifungal therapies. Total mortality rate was detected as 54.3% (82/151). In conclusion, despite new diagnostic tools and therapeutic agents, mortality rates in mucormycosis are still very high. For the management, mucormycosis should be considered early in risky patients, and surgical debridement together with effective antifungal therapy should be applied as soon as possible.
[Show abstract][Hide abstract] ABSTRACT: international nursing review
Preliminary results of this study were presented as a poster presentation in 19th European Congress of Clinical Microbiology and Infectious Diseases, Helsinki 16–19 May 2009.
Nursing Hepatitis Study Group (2011) Nursing students' immunisation status and knowledge about viral hepatitis in Turkey: a multi-centre cross-sectional study. International Nursing Review 58, 181–185 Background: The aims of this multi-centre cross-sectional survey were to detect Turkish nursing students' level of knowledge on viral hepatitis, to evaluate their rates of exposure to blood and to find out their hepatitis A (HAV), hepatitis B (HBV) vaccination status. Methods: This multi-centre cross-sectional study was conducted in 14 nursing schools located in the seven geographical regions of Turkey. A questionnaire composed of 47 questions on socio-demographic factors, level of knowledge on HAV, HBV, hepatitis C (HCV) immunisation status, exposure history and attitudes was applied to the study group. Results: A total of 1491 third-and fourth-year nursing students participated with an 89% response rate. The mean age of the participating students was 21.4 1.3. Their mean knowledge score was 23.7 4.6 (71/100) and was significantly higher in fourth-year students than third-year students. There were significant differences in mean scores among nursing schools. Among the participants, 85.3% had received HBV vaccine and 9.1% had received HAV vaccine. The percentage of students who signify themselves at increased risk of acquiring viral hepatitis was 97.3%. Of the students, 28.1% had sustained a needle-stick injury and 5.4% had experienced conjunctival exposure to blood. 181 Conclusions: Curriculum differences among nursing schools have a significant effect on nursing students' level of knowledge. For this reason, nursing schools should organize HBV immunisation programmes for their students to increase vaccination coverage.
[Show abstract][Hide abstract] ABSTRACT: In this study, we aimed to compare the antibacterial activities of daptomycin and vancomycin in the treatment of methicillin-resistant
Staphylococcus aureus (MRSA) meningitis (induced by MRSA strain ATCC 43300) in an experimental rabbit meningitis model. After an 8-h period of
treatment, bacterial counts decreased significantly in both treatment groups compared to the control group (P < 0.05). However, there was no statistically significant difference between treatment groups. Our results suggest that the
antibacterial activity of daptomycin is similar to vancomycin for treatment in the experimental MRSA meningitis model in rabbits.
[Show abstract][Hide abstract] ABSTRACT: Clinicians have usually considered malignancies during follow up of patients who have infectious diseases as a pre-diagnosis. However, malignancy and an infectious disease are seen together more rarely, with the exception of immunosuppressed patients. This presentation is a case report followed up for fever of unknown origin. The patient was admitted to the hospital with the symptoms of fever, weight loss, abdominal pain and weakness. Anemia and hypergamaglobulinemia by biochemical analyses and splenomegaly by total body computed tomography were detected. Amastigotes were seen in bone marrow aspiration smears and promastigotes were isolated in NNN medium. At the end of the Liposomal Amphotericin B treatment, control bone marrow aspiration was applied. Leishmania amastigotes were not seen, while patient was diagnosed as diffuse B cell lymphoma pathologically. (Turkiye Parazitol Derg 2013; 37: 282-4).
Turkiye parazitolojii dergisi / Turkiye Parazitoloji Dernegi = Acta parasitologica Turcica / Turkish Society for Parasitology 01/2013; 37(4):282-4. DOI:10.5152/tpd.2013.3211
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the effect of nitrofurantoin (NFT) in the treatment of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli-related lower urinary tract infection (LUTI). The hospital records of all patients aged >18 years with dysuria or problems with frequency or urgency in passing urine, >20 leukocytes/mm(3) in urine microscopy and culture-proven ESBL-producing NFT-sensitive E. coli in the urine (>10(5)CFU/mm(3)), no leukocytosis or fever and who were treated with NFT between January 2006 and May 2011 in our outpatient clinic or in the hospital were evaluated. All patients had received a NFT 50mg capsule every 6h for 14 days and had a control urine culture taken 7-9 days after therapy. Clinical success was defined as resolution of symptoms at the control visit, and microbiological success was defined as a sterile control urine culture. A total of 75 patients (mean±standard deviation age, 54±17 years; 45 females, 30 males, all but 14 with complicated LUTI) fulfilled the study inclusion criteria. Overall clinical and microbiological success rates were 69% (52/75) and 68% (51/75), respectively. Control urine culture performed 28-31 days after the end of therapy was available in 31/51 patients (61%) with microbiological success. Re-infection and relapse rates were 6.5% (2/31) and 3.2% (1/31), respectively. In conclusion, these results suggest that NFT may be an alternative in the treatment of ESBL-producing E. coli-related LUTI. This is the first study in which NFT was used in the treatment of LUTI due to ESBL-producing E. coli as well as in patients with complicated UTI.
International journal of antimicrobial agents 10/2012; 40(6). DOI:10.1016/j.ijantimicag.2012.08.003 · 4.30 Impact Factor