Efficacy and Safety of Direct-Acting Antivirals in Elderly Patients with Chronic Hepatitis C: A Nationwide Real-Life, Observational, Multicenter Study from Turkey.

BACKGROUND: The number and proportion of elderly patients living with chronic hepatitis C are expected to increase in the coming years. We aimed to compare the real-world efficacy and safety of direct-acting antiviral treatment in elderly and younger Turkish adults infected with chronic hepatitis C. METHODS: In this multicenter prospective study, 2629 eligible chronic hepatitis C patients treated with direct-acting antivirals between April 2017 and December 2019 from 37 Turkish referral centers were divided into 2 age groups: elderly (≥65 years) and younger adults (<65 years) and their safety was compared between 2 groups in evaluable population. Then, by matching the 2 age groups for demographics and pretreatment risk factors for a non-sustained virological response, a total of 1516 patients (758 in each group) and 1244 patients (622 in each group) from the modified evaluable population and per-protocol population were included in the efficacy analysis and the efficacy was compared between age groups. RESULTS: The sustained virological response in the chronic hepatitis C patients was not affected by the age and the presence of cirrhosis both in the modified evaluable population and per-protocol population (P = .879, P = .508 for modified evaluable population and P = .058, P = .788 for per-protocol population, respectively). The results of the per-protocol analysis revealed that male gender, patients who had a prior history of hepatocellular carcinoma, patients infected with non-genotype 1 hepatitis C virus, and patients treated with sofosbuvir+ribavirin had a significantly lower sustained virological response 12 rates (P < .001, P = .047, P = .013, and P = .025, respectively). CONCLUSION: Direct-acting antivirals can be safely used to treat Turkish elderly chronic hepatitis C patients with similar favorable efficacy and safety as that in younger adults.

Predictors of histological indication for treatment in HBeAg negative chronic HBV infection.

In this study, we evaluated the relationship of hepatitis B virus (HBV) DNA levels with liver histology and various other liver related parameters and the predictors of histologically active liver disease requiring treatment (Histological activity ≥6 and/or grade ≥2 by Ishak's classification) in patients with HBeAg negative chronic HBV infection. Demographic data, laboratory findings and liver histology findings of patients with no clinical cirrhosis who underwent liver biopsy considering HBeAg negative chronic hepatitis (HBV DNA >2000 IU/mL) were analyzed. Two hundred and fifteen patients were included in this retrospective study. Treatment indication by histologic findings were 85.7%, 61.2%, and 64%, respectively, in group 1 (HBV DNA ≥200 000), group 2 (HBV DNA 20 000-200 000), and group 3 (HBV DNA 2000-20 000 IU/mL) (P = 0.001). Group 1 was different from other groups in terms of aspartate aminotransferase (AST), alanine aminotransferase (ALT), fibrosis stage, necroinflammatory activity, and platelet count. Multiple logistic regression analysis revealed that, advanced age (cut-off was 46 years), higher than normal AST and HBV DNA ≥200 000 IU/mL (compared to group 3) were found to be the predictors of histologically active disease with treatment indication. Conclusively, most of the patients with HBV DNA ≥200 000 IU/mL showed treatment requiring liver injury, but also a significant portion of the patients with HBV DNA 2000-200 000 IU/mL carried an indication for treatment. Although age (>46 years) and AST (>40 IU/L) can be helpful to predict treatment requirement in patients with HBV DNA 2000-200 000 IU/mL, sufficient effort should be made to find out the significant liver damage.

The IL4-VNTR P1 Allele, IL4-VNTR P2P2 Genotype, and IL4-VNTR_IL6-174CG P2P1-GG Genotype Are Associated with an Increased Risk of Brucellosis.

In this study, associations between IL-4, IL-6, and macrophage migration inhibitory factor (MIF) polymorphisms and susceptibility to brucellosis were investigated. Consecutive adult patients with no known treatment against brucellosis and who did not have any other autoimmune and/or chronic disorders, were included in this study (n = 120, Group I). Age and sex-matched controls who had no other autoimmune and/or chronic disorders were also included (n = 120, healthy volunteers, Group II). The IL4_P2P2 genotype, IL4_P1 allele, and IL4_variable number of tandem repeats (VNTR)_IL6-174CG compound genotype were found to be more frequent in the patient group than in control subjects. There were significant differences between the patients and controls with respect to the frequencies of the IL4_P2P2 genotype (77.5% versus 87.5%; p = 0.001; OR, 0.36; 95% confidence interval [CI], 0.21-0.62) and the IL4_P1 allele (12.1% versus 6.7%; p = 0.030; OR, 0.92; CI, 1.02-3.64). The IL4-VNTR_IL6-174CG compound genotype was also present at a significantly higher frequency in the patient group than in control subjects (11.7% versus 4.2%; p = 0.027, OR, 3.04; CI, 1.06-8.68). No statistically significant differences in the frequencies of the IL-6-174, MIF-173, IL-4_P1P1, and IL4_P2P1 genotypes were observed between patients and control subjects. The IL4_VNTR P1 allele, P2P2 genotypes, and IL4-VNTR_IL6-174CG P2P1-GG genotypes are common in southern Turkey, and carriers of these polymorphisms are susceptible to brucellosis.

Which method is the most effective for preventing postoperative infection in spinal surgery?

BACKGROUND: Several methods have been used to reduce the infection rate in spinal surgeries with instrumentation. PURPOSE: Which method is the most effective for preventing postoperative infection? STUDY DESIGN: Basic science, animal model. OBJECTIVE: In the present study, the efficiency of antibiotic prophylaxis, silver-plated screws, and local rifamycin application to the surgical site was investigated in an experimental animal model. Staphylococcus aureus was used as the pathogen. METHODS: Fifty 6-month-old female Wistar albino rats were used. The animals were randomly numbered and divided into five groups of ten rats each (Group 1, control group; Group 2, titanium screw and S. aureus inoculation; Group 3, titanium screw, 0.1 ml rifamycin application to the surgical area, and bacterial inoculation; Group 4, titanium screw, single preoperative dose of IM cefazolin, and bacterial inoculation; Group 5, silver-plated screw and bacterial inoculation). Titanium micro-screws were placed into the pedicles. The control group received a sterile isotonic solution, and the other four groups received bacterial suspensions containing S. aureus. The animals were killed 15 days later. RESULTS: Intensive S. aureus growth was observed in all tissue and screw samples from Group 2. The results for Group 3 were similar to those for Group 1, no growth was observed in the screw cultures. Intensive growth was observed in the five screw samples in Group 4 and in the eight samples in Group 5. CONCLUSION: Our study suggests that rifamycin application to the surgical area in spinal operations with instrumentation is an effective method to prevent S. aureus infections.

Thyroid dysfunction in Turkish patients with chronic hepatitis C receiving peginterferon plus ribavirin in the period of 2005-2010

Interferon-α based therapy for chronic hepatitis C (CHC) is associated with thyroiditis and thyroid dysfunction (TD). This study investigated whether TD during pegylated interferon-a (PEG-IFN) plus ribavirin treatment favors sustained viral response (SVR), and also the association between TD and PEG-IFN formulations. This retrospective study was performed in CHC patients who had received PEG-IFN plus ribavirin and had been followed for six months after treatment. Several factors were compared between patients with and without TD. 119 patients were included in the study. De novo incidence of TD was found to be 16.8%, and 16 of the 18 patients with TD achieved SVR. Although this rate was higher than patients without TD according to univariate analysis, logistic regression analysis revealed that there was not a significant association between TD and SVR, whereas baseline thyroperoxidase antibody (anti-TPO) positivity was the only significant predictor of TD. Moreover, TD was not associated with PEG-IFN type. Both interferon-a and hepatitis C virus (HCV) contribute to TD during antiviral therapy. It seems that there is no association between thyroid toxicity and viral clearance or type of PEG-IFN; however, anti-TPO positivity before treatment is the strongest predictor for TD during antiviral therapy.

[Obturatory abscess and pelvic pain caused by Brucella melitensis]. / Brucella melitensis'in neden oldugu obturator apse ve pelvik agri.

Brucellosis which is a systemic infection, is seen endemically in Turkey. Although there a lot of complications related to brucellosis, soft tissue involvement is rare. In this case report a patient with mature cystic teratoma and a Brucella related obturatory abscess, was presented. A 21-year-old female patient with bilateral pelvic pain was admitted to the hospital with complaints of weakness, backache and ab- dominal swelling. Pelvic examination revealed bilateral adnexial sensitive masses. There were no history of systemic complaints or other organ involvement. The patient had no history of contact with infected animals, intramuscular injections or consumption of non-pasteurized foods. A mass of 56 x 63 mm with regular margins and hyperechogenic segments at the left side was detected at ultrasonographic examination. Left ovarian cystectomy and mass excision at the left side were performed during laparotomy. Histopathological examination of the mass revealed chronic granulomatous inflammation characterized by central necrosis, histiocyte and lymphocyte infiltration and formation of giant cells, compatible with brucellosis. Brucella melitensis was isolated from the capsule of pelvic mass on the fifth day of culture in BacT/ALERT Selectlink (Organon Teknika, U.S.A.) system. Brucella Wright agglutination titer which was 1:80 at the admittance, rose to 1:2560 at the sixth week of the follow-up. The patient was treated successfully with the excision of the abscess and 6 weeks course of oral doxycycline and rifampicin. Brucellosis should be considered in the differential diagnosis of pelvic pain and obturatory abscess, especially in endemic areas for brucellosis.

[Analysis of risk factors in anti-HCV positive patients in Gaziosmanpasa University Hospital, Tokat, Turkey]. / Tokat Gaziosmanpasa Universitesi Hastanesinde anti-HCV pozitif hastalarda risk faktörlerinin analizi.

Transmission routes and seroprevalence of hepatitis C virus (HCV) may vary between countries and geographic regions. In this study, we aimed to investigate the risk factors associated with the transmission of HCV in our region, Tokat (located at middle Black Sea region of Turkey). Ninety-seven patients (age range: 16- 78-years-old, mean age: 53.6 +/- 10 yrs; 15 male, 82 female) who were admitted to Infectious Diseases Clinics between September 2004 and February 2007 and found to be anti-HCV positive by microparticle enzyme immunoassay (Abbott, Axsym) were enrolled in this study. The patients were evaluated for the risk factors including blood transfusion, past surgery, medical abortion, dental therapy, history of endoscopy/bronchoscopy, intravenous (i.v.) drug use, hospitalization exceeding one week and hemodialysis. "Sexual contact with multiple partners" has not been evaluated as a risk factor since the sociocultural features of this specific region would possibly prevent obtaining true data. Overall, history of previous dental therapy (68%), medical abortion (63.4%), prolonged hospitalization (60%), and surgery (59.8%) were found to be the most prevalent risk factors, followed by blood transfussion (25.8%) and endoscopy (14.1%). The evaluation of the risk factors according to gender revealed that prolonged hospitalization (65.7%) was the most frequently detected risk factor in females and dental operations (86.7%) in males. Previous hospitalization was a more common risk factor in female cases compared to males (p< 0.05), however, there were no statistically significant differences for the other risk factors in terms of gender. No risk factor was identified in one patient (1%). Of the patients, 15.3% had one, 27.1% had two, 35.3% had three, 18.8% had four, and 2.4% had five different risk factors. None of the patients had a history of i.v. drug use. The results of this study demonstrated that dental therapy, prolonged hospitalization, surgery and medical abortus were the most frequently associated risk factors for HCV transmission. Thus, preventive measures that target these specific risk factors should be taken into consideration to prevent HCV transmission.