[Effect of IL-28B polymorphisms on the natural course of HBV infection]. / HBV enfeksiyonun dogal seyrine IL-28B gen polimorfi zminin etkisi.

The prediction of the consequences of disease is important to determine the therapy approaches and prevention of the chronical state in patients infected with hepatitis B virus (HBV). In recent years various studies are carried on to investigate the effect of IL-28B gene polymorphisms on the clinical course or therapy response in patients with chronic hepatitis B infection. The aim of the study was to evaluate the influence of IL-28B rs12979860 polymorphisms on the natural course of HBV infection. The study was designed prospectively, and the subjects were randomly selected among patients admitted to infectious disease outpatient clinics of Kocatepe University Medical School Hospital and Yunus Emre State Hospital located at provinces in Central Anatolia, Turkey. A total of 99 cases were included in the study and evaluated into three groups, namely, chronic hepatitis B patients (group 1, n= 43); inactive HBV carriers (group 2, n= 34) and subjects with acquired immunity after native infection (group 3, n= 22). There were no significant differences regarding the age and gender distribution between the groups (p> 0.05). All subjects were investigated for the IL-28B promoter single nucleotide polymorphism rs12979860 at position 3176 C/T, by real-time polymerase chain reaction (RT-PCR). Evaluation of the range of IL-28B rs12979860 C/T polymorphisms observed in the study groups showed that, the frequency of CC, CT and TT allels were as follows; 34.9%, 48.8% and 16.3 % in group 1; 47.1%, 35.3% and 17.6% in group 2; 63.6%, 27.7% and 13.6% in group 3, respectively. No significant differences were observed between the groups in terms of C/T allel distriubution (p> 0.05). However, in spite of statistical insignificance, the rate of CC allel in IL-28B rs12979860 gene was the highest in immune subjects (63.6%), while it was the lowest in chronic hepatitis B patients (34.9%). According to our data, IL-28B rs12979860 gene polymorphisms were not effective on the clinical course of HBV infection. In conclusion, further studies with large numbers of patients are needed to support these data.

Elevated serum levels of high mobility group box protein 1 (HMGB1) in patients with ankylosing spondylitis and its association with disease activity and quality of life.

This study was carried out to determine the serum levels of high mobility group box protein 1 (HMGB1) in patients with ankylosing spondylitis (AS) and to evaluate its correlation with disease activity and quality of life. According to our knowledge, it is the first trial evaluating HMGB1 levels in AS. Serum samples of 30 patients (18 males and 12 females) with AS and 29 healthy controls (HC) (15 females and 14 males) were collected. HMGB1 levels were measured by enzyme-linked immunosorbent assay, activity of disease was assessed according to the Bath AS Disease Activity Index (BASDAI), and functional status of patients was evaluated with Bath AS Functional Index (BASFI). Modified Schober, chest expansion values and AS Quality of Life Questionnaire (ASQoL) scores were noted. The serum levels of HMGB1 were obtained significantly increased in AS patients compared to HC (p < 0.05). There was no significant correlation between HMGB1 levels and ESR (p > 0.05), and CRP (p > 0.05) values. BASDAI, BASFI and ASQoL scores were also not correlated with serum levels of HMGB1 (p > 0.05). Our results suggest that HMGB1 might play an important role in the pathogenesis of AS; however, it seems not to be a good candidate for reflecting disease activity, functional abilities and the quality of life in patients with AS; on the other hand, the increased levels of HMGB1 in patients may open a new dimension for targeting this cytokine as a new therapy option in AS.

Retinal microvascular changes in patients with familial mediterranean fever: a study based on optical coherence tomography angiography.

PURPOSE: In this study, we aimed to show whether a difference exists between retinal and choroidal microcirculation findings between patients with familial Mediterranean fever and healthy controls. METHODS: Thirty-two patients with familial Mediterranean fever and 30 healthy controls were included in the study. All the patients underwent a complete ophthalmologic examination, including best-corrected visual acuity and intraocular pressure measurement. The AngioVue optical coherence tomography angiography device (Optovue, Fremont, CA) with split-spectrum amplitude-decorrelation angiography was used to evaluate and examine the retinal microvascular structure. Three-dimensional en face Optical coherence tomography angiography images were obtained by examining the macula using the 3 x 3 mm scanning protocol in the Angio Retina mode and the optic nerve using the 3 x 3 mm scanning protocol in the Angio Disk mode. All the patients' right eyes were examined. RESULTS: A total of 62 subjects were included in the study, of whom 32 (53.3%) were female and 30 (46.7%) were male. No statistically significant difference was found between the two groups in terms of optic nerve head or radial peripapillary capillary vessel density. On examination, the superficial capillary plexuses were statistically similar between the two groups, but the deep capillary plexus vessel density in the parafovea, superior hemi, temporal, and superior areas were significantly lower in the patients with familial Mediterranean fever. CONCLUSIONS: We found that the capillary plexus vessel density was significantly lower in the parafovea, superior hemi, temporal, and superior regions in the patients with familial Mediterranean fever than in the control group. Therefore, OCTA, a noninvasive study, may be useful for understanding the systemic effects of familial Mediterranean fever.

Brucellosis in central Anatolia: evaluation of complications and relapse.

Brucellosis is an infectious disease involving many organs and tissues. We investigated retrospectively the brucellosis cases at our hospital, in order to study the relationship between clinical, laboratory and therapy findings, and relapse rates. We found that relapse was related to a positive family history, living in a rural area and the presence of complications.

Serum neopterin levels in patients with HBV infection at various stages.

BACKGROUND/AIMS: Neopterin (NPT) level is elevated in a number of situations in which cellular immunity is active. In the present study, levels of serum NPT were measured in patients who were in different phases of hepatitis B virus (HBV) infection in order to determine if the NPT level can be considered a predictor for the stage of this infection. METHODOLOGY: A total of 120 patients were included in the study, patients were divided equally in four groups; each group consisted of 30 patients. Group I were non-replicative HBV carriers, Group II were immune to HBV, Group III were chronically infected with HBV, and the Group IV were healthy controls. Five ml of blood was drawn from each patient and serum NPT levels were measured by the ELISA technique. RESULTS: Mean NPT levels were found to be 14.80 +/-11.20 nmol/L, 19.73 +/- 18.40 nmol/L, 24.73+/-20.77 nmol/L, and 8.66 +/- 10.03 nmol/L in Group I, II, III and Group IV (the control group) respectively. The mean NPT levels were significantly higher in Group I, II and III than in the control group (Group IV) (p = 0.036, p = 0.010 and p = 0.001 respectively). CONCLUSIONS: Serum levels of NPT are elevated in all the patients in Group I, II and Group III as an indicator of cellular immunity which is activated in different levels. However, an increased level of NPT does not seem to be a sufficient indicator in determining the immunopathogenetic stages of this infection.

Psychological health of caregivers and association with functional status of stroke patients.

OBJECTIVE: Stroke does not only affect the physical state of patients but also the emotional state of their relatives, most effectively their caregivers. The study aims to examine the mood of caregivers experienced with care for patients with stroke who are highly dependent on the assistance and also to establish the relationship between the emotional state of caregivers and the severity of disability of the patients. METHODS: This study contained a total of 76 patients with sufficient cognitive functions and severe physical disabilities with hemiplegia caused by a cerebrovascular accident and their caregivers and 94 controls. The functional state of patients was assessed by the Barthel Index (BI). Furthermore, emotional state of the caregivers was assessed by the Hospital Anxiety and Depression Scale (HADS) and their life quality was assessed by the SF36 Health Survey. RESULTS: The mean anxiety (9.73 ± 4.88) and depression rates (9.81 ± 5.05) in the caregivers were significantly higher than those in controls (p<0.001, respectively). Significant impairments were observed in both their mental and physical health. Regression analysis also showed a significant negative correlation between the BI scores and the HADS scores. CONCLUSION: Caregivers had an impaired emotional state and the level of their anxiety was associated with the severity of functional disability of the patients. Therefore, the support provided to the caregiver might be influential on the functional recovery of the patients.

Retinal microvascular changes in patients with familial mediterranean fever: a study based on optical coherence tomography angiography / Alterações microvasculares da retina em pacientes com febre mediterrânea familiar: estudo baseado em angiotomografia de coerência óptica

ABSTRACT Purpose: In this study, we aimed to show whether a difference exists between retinal and choroidal microcirculation findings between patients with familial Mediterranean fever and healthy controls. Methods: Thirty-two patients with familial Mediterranean fever and 30 healthy controls were included in the study. All the patients underwent a complete ophthalmologic examination, including best-corrected visual acuity and intraocular pressure measurement. The AngioVue optical coherence tomography angiography device (Optovue, Fremont, CA) with split-spectrum amplitude-decorrelation angiography was used to evaluate and examine the retinal microvascular structure. Three-dimensional en face Optical coherence tomography angiography images were obtained by examining the macula using the 3 x 3 mm scanning protocol in the Angio Retina mode and the optic nerve using the 3 x 3 mm scanning protocol in the Angio Disk mode. All the patients' right eyes were examined. Results: A total of 62 subjects were included in the study, of whom 32 (53.3%) were female and 30 (46.7%) were male. No statistically significant difference was found between the two groups in terms of optic nerve head or radial peripapillary capillary vessel density. On examination, the superficial capillary plexuses were statistically similar between the two groups, but the deep capillary plexus vessel density in the parafovea, superior hemi, temporal, and superior areas were significantly lower in the patients with familial Mediterranean fever. Conclusions: We found that the capillary plexus vessel density was significantly lower in the parafovea, superior hemi, temporal, and superior regions in the patients with familial Mediterranean fever than in the control group. Therefore, OCTA, a noninvasive study, may be useful for understanding the systemic effects of familial Mediterranean fever.

RESUMO Objetivos: Este estudo teve como objetivo mostrar se há diferença entre os achados da microcirculação retiniana e coroidal entre pacientes com febre mediterrânica familiar e um grupo controle saudável. Métodos: Trinta e dois pacientes com febre mediterrânica familiar e 30 controles saudáveis foram incluídos neste estudo. Todos os pacientes foram submetidos a um exame oftalmológico completo, incluindo a acuidade visual melhor corrigida e medida da pressão intraocular. O aparelho AngioVue Optical coherence tomography angiography (Optovue, Fremont, CA) com angiografia de correlação de amplitude de espectro dividido foi utilizado para avaliar e examinar a estrutura microvascular da retina. As angiotomografias de coerência ópticas en face tridimensionais foram obtidas examinando o protocolo de varredura macular 3 x 3 mm (modo angio retina) e o nervo óptico com o protocolo de varredura 3 x 3 mm (modo angio-disco). Todos os olhos direitos dos pacientes foram examinados. Resultados: Foram incluídos neste estudo, 62 sujeitos, dos quais 32 (53,3%) eram do sexo feminino e 30 (46,7%) do sexo masculino. Não houve diferença estatisticamente significativa entre os dois grupos quanto à densidade dos vasos da cabeça do nervo óptico ou da densidade dos vasos capilares peripapilares radiais. Durante o exame, os plexos capilares superficiais foram estatisticamente semelhantes entre esses dois grupos, mas a densidade profunda dos vasos do plexo capilar nas areas parafovea, hemi superior, temporal e superior foram significativamente menores nos pacientes com febre mediterrânica familiar. Conclusões: Verificamos que a densidade dos vasos do plexo capilar foi significativamente menor nas regiões parafovea, hemi superior, temporal e superior em pacientes com febre mediterrânica familiar em comparação com o grupo controle. Portanto, pode ser útil usar a angiotomografia de coerência óptica, por tratar-se de um estudo não invasivo, para melhor compreensão dos efeitos sistêmicos da febre mediterrânica familiar.

The clinical and laboratory characteristics, treatments, and outcomes of patients with Brucella epididymo-orchitis (BEO) compared to those without BEO.

BACKGROUND/AIM: We aim to describe the clinical and laboratory characteristics, treatment, and outcomes of 21 patients with Brucella epididymo-orchitis (BEO) from Eskisehir Yunus Emre State Hospital, Turkey. MATERIALS AND METHODS: A total of 21 patients with BEO who were diagnosed and followed in the Infectious Diseases Clinic between June 2001 and June 2013 were evaluated retrospectively. RESULTS: One hundred and twenty-eight of 192 patients evaluated throughout the study were male and BEO was determined in 21 (16.4%) patients. A total of 18 (85.7%) patients had a titer of b1:160 in standard agglutination test (STA). Three patients with STA `160 were diagnosed by blood culture. When all the male patients were evaluated in terms of demographic, clinical, and laboratory findings, animal contact, rural living, and subacute clinical type were statistically significantly higher in the group that developed epididymo-orchitis. None of the patients underwent surgery after medical treatment, but due to a delay in diagnosis of brucellosis, orchiectomy was performed in 1 patient with the suspicion of tumor. CONCLUSION: In endemic countries like Turkey, BEO should be considered in the differential diagnosis of epididymo-orchitis. In uncomplicated patients, medical treatment is adequate for BEO.

Acute osteomyelitis of the symphysis pubis after inguinal hernia surgery.

Osteomyelitis of pubic symphysis is infectious inflammatory condition of the symphysis pubis and rare complication of surgery around inguinal and groin region. It should be kept in mind in the differential diagnosis of lower pelvic pain and should be sought in cases of pelvic insufficiency fractures. Herein, we present a case of a 55-year-old man with osteomyelitis of the symphysis pubis following inguinal hernia surgery for diagnosis and management of this rare condition.

Bilateral Knee Pain Associated with Bone Infarction in a Patient with Behcet's Disease.

We describe a 31-years-old female patient with severe pain in both knees who had been diagnosed as Behcet's disease (BD) for 12 years. She had had a history of complications due to BD including superior vena cava thrombosis, pulmonary thromboembolism, uveitis, and erythema nodosum and has reported the administration of corticosteroid therapy irregularly. After radiologic evaluation, she has been diagnosed with bone infarction of both left and right knee with the existance of lupus anticoagulants (LA) positivity. Severe joint pain without the evidence of arthritis must alert the clinician to the possibility of bone necrosis of the extremity, although those may rarely occur bilateral in BD.

Complications and efficiency of liver biopsies using the Tru-Cut biopsy Gun.

OBJECTIVES: The study aimed to evaluate the complications and quality of the specimens of percutaneous liver biopsy in patients with chronic viral hepatitis who were scheduled for treatment and also to evaluate the contribution of the knowledge of ultrasound guided (USG) biopsy localization to the existing data. METHODOLOGY: Liver biopsies conducted at our clinic between 2003 and 2008 were retrospectively evaluated. In 53.8% of the cases, hepatobiliary USG was performed to mark the localization of the biopsy site. An automatically triggered Tru-Cut biopsy gun was used. RESULTS: Biopsies were taken from the livers of 236 patients (46.6% male, 53.4% female) with a mean age of 47.1 +/- 12.5 years. The majority of patients had hepatitis C (61.9%); 1.6% experienced major complications (3 patient biliary peritonitis, 1 patient liver bleeding); 52.1% of the samples were > or = 1 cm in length; And 69.7% of the biopsy samples with specified portal area had > or = 4 portal areas. There was no statistically significant difference between the patients with localized and non-localized biopsy site in terms of major complications and length of biopsy samples ( respectively p = 1.000, p = 0.209 ). CONCLUSION: We believe that percutaneous liver biopsy using Tru-Cut biopsy gun can be performed safely, with complications in 1.6% of the procedures. The length of the biopsy specimen is shorter than ideal values. Evaluation of the patients with and without USG-guided biopsy revealed no significant difference in terms of major complications and specimen size.

Influenza vaccination in healthcare workers.

BACKGROUND: This study aims to determine side effects in healthcare workers receiving influenza vaccination, and to scrutinize the opinion of and attitude toward vaccination of healthcare workers. METHODS: Five hundred forty-seven hospital personnel employed by the Eskisehir Yunus Emre State Hospital were included in the study which was conducted in November 2006,. Hospital personnel were administered 0.5 ml inactivated influenza vaccine consisting of 2006/2007 strains. Inoculations were given intramuscularly into the deltoid muscle. A specially designated area in the emergency unit was used for the procedure. RESULTS: An evaluation on Day 10 following influenza vaccination demonstrated at least one adverse effect in 197 (36%) hospital personnel. There was no statistical relationship between side effects and age or gender (p=0.860, p=0.929), while side effects were significantly more frequent among subjects receiving their first vaccination (p=0.008) and nurses (p=0.021). The reasons for the lack of prior immunization in 420 (76.8%) HCWs included not considering influenza a serious disease in 124 (29.5%), disbelief in the efficacy of vaccination in 109 (26%), the lack of reimbursement of vaccination in 105 (25%), fear of the side effects of vaccination in 45 (10.7%), preference for other methods of protection in 75 (17.9%), and fear of injection in 29 (6.9%). CONCLUSIONS: The increase in the rate of influenza immunization among healthcare personnel is possible through education, contestation of fear, amelioration of misconceptions, solution of financial issues, constitution of a registry system, and tracking of vaccination.

Anti-HCV positivity in sexual partners and offspring of patient with chronic hepatitis C.

We investigated the seroprevalence of HCV in stable sexual partners and offspring of chronic hepatitis C patients, and aimed to determine the risk factors involved. 191 anti-HCV and HCV RNA positive subjects who coinhabited with their spouse and/or offspring were included. Risk factors of index cases for disease transmission, liver biopsy results, anti-HCV and HCV-RNA in spouses and/or offspring were evaluated. Together with index cases, a total of 404 family members including 174 stable sexual partners and 230 offspring were included. The most common risk factors among index cases were dental procedures (73.8%), history of surgery (64.9%), and blood transfusions (24.1%). Anti-HCV positivity was established in 11 (2.7%) of the total 404 family contacts--6 sexual partners and 5 offspring. HCV seropositivity was significantly higher in the spouses of index cases with severe hepatitis C compared to those with mild to moderate hepatitis C (p=0.008), but there was no statistically significant correlation between the severity of liver disease in index cases and anti-HCV positivity in their offspring. In conclusion, anti-HCV seropositivity in the spouses and children of patients who are HCV-RNA positive HCV carriers does not appear to be higher than the HCV seroprevalence in our country.

Autoimmune thrombocytopenia induced by PEG-IFN-alpha plus ribavirin in hepatitis C.

Mild thrombocytopenia is a common adverse effect of interferon-alpha and pegylated interferon-alpha, largely ascribed to bone marrow suppression. Nevertheless, rare cases of autoimmune thrombocytopenia following standard or pegylated interferon treatment have been reported in the literature. In this report, we have presented a patient who developed an immune-mediated thrombocytopenia during the course of therapy with pegylated interferon/ribavirin for hepatitis C virus infection. After cessation of pegylated interferon/ribavirin treatment, thrombocytopenia was treated successfully with danazol and intravenous gamma-globulin.