RESUMO
BACKGROUND: The aim of this study was to assess health-related quality of life (HRQOL) among chronic hepatitis B (CHB) patients in Turkey and to study related factors. METHODS: This multicenter study was carried out between January 01 and April 15, 2015 in Turkey in 57 centers. Adults were enrolled and studied in three groups. Group 1: Inactive HBsAg carriers, Group 2: CHB patients receiving antiviral therapy, Group 3: CHB patients who were neither receiving antiviral therapy nor were inactive HBsAg carriers. Study data was collected by face-to-face interviews using a standardized questionnaire, Short Form-36 (SF-36) and Hepatitis B Quality of Life (HBQOL). Values equivalent to p < 0.05 in analyses were accepted as statistically significant. RESULTS: Four thousand two hundred fifty-seven patients with CHB were included in the study. Two thousand five hundred fifty-nine (60.1 %) of the patients were males. Groups 1, 2 and 3, consisted of 1529 (35.9 %), 1721 (40.4 %) and 1007 (23.7 %) patients, respectively. The highest value of HRQOL was found in inactive HBsAg carriers. We found that total HBQOL score increased when antiviral treatment was used. However, HRQOL of CHB patients varied according to their socio-demographic properties. Regarding total HBQOL score, a higher significant level of HRQOL was determined in inactive HBV patients when matched controls with the associated factors were provided. CONCLUSIONS: The HRQOL score of CHB patients was higher than expected and it can be worsen when the disease becomes active. Use of an antiviral therapy can contribute to increasing HRQOL of patients.
Assuntos
Hepatite B Crônica , Qualidade de Vida , Adulto , Idoso , Antivirais/uso terapêutico , Estudos Transversais , Feminino , Indicadores Básicos de Saúde , Hepatite B Crônica/tratamento farmacológico , Hepatite B Crônica/psicologia , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , TurquiaRESUMO
BACKGROUND AND AIMS: Many studies have focused on the role of pathogen infection in hypertension (HT). It has been postulated that increased vascular tonus in HT is basically related to the imbalance between vasodilator, such as nitric oxide (NO), and vasoconstrictor, such as endothelin-1 (ET-1), substances secreted by endothelium. The aim of the present study was to investigate the seroprevalence of human parvovirus B19 (HPV B19) in the etiology of essential HT and the effect of HPV B19 on ET-1 and NO levels in this disorder. MATERIALS AND METHODS: A total of 135 participants were enrolled in the study (90 patient and 45 controls). Antibodies to HPV B19 and ET-1 were measured by enzyme-linked immunosorbent assay method. Nitric oxide levels were calculated according to the Griess reaction. RESULTS: Of the total participants, 27 patients (30%) and 7 control subjects (15.6%) had IgM positive (P = .068), whereas 27 patients (30%) and 14 control subjects (31.1%) had IgG positive (P = .895). There was no statistical difference between patients and control subjects in terms of serum ET-1 and NO levels. CONCLUSIONS: The role of HPV B19 in the etiology of essential HT was not shown in the present study. A larger sample may be needed for the investigation of these relations.
Assuntos
Endotelina-1/sangue , Hipertensão/etiologia , Óxido Nítrico/sangue , Infecções por Parvoviridae/complicações , Parvovirus B19 Humano , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antivirais/sangue , Estudos de Casos e Controles , Feminino , Humanos , Hipertensão/sangue , Hipertensão/virologia , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , Infecções por Parvoviridae/epidemiologia , Parvovirus B19 Humano/imunologia , Parvovirus B19 Humano/patogenicidade , Estudos Soroepidemiológicos , Turquia/epidemiologiaRESUMO
BACKGROUND: Recurrent urinary tract infections are important in children and adults with diabetes mellitus and/or incontinence due to risk of pyelonephritis (PYN) and renal damage. There is a positive correlation released free radicals during PYN and renal damage. Experimental studies showed that antioxidant agents improve renal damage when used immediately after bacterial inoculation. OBJECTIVE: The aim of the present study was to evaluate whether treatment by thymoquinone (TQ) before or during Escherichia coli inoculation prevents oxidative damage in acute pyelonephritis (PYN) in an ascending obstructive rat model. METHODS: In this study, 42 Wistar rats were grouped as follows: control, PYN (24, 48, and 72 hours), and TQ-PYN (24, 48, and 72 hours). E. coli (1 ×10(9) colony forming units) was inoculated into the bladder via urethral catheterization in both the PYN and TQ groups. TQ injections were performed 24 hours before bacteria inoculation and repeated at 24-hour intervals during the indicated time at a dose of 10 mg/kg body weight intraperitoneally in TQ groups. RESULTS: Superoxide dismutase activity was statistically lower in the TQ-PYN-48 and -72 groups than the PYN-48 and -72 groups (P < 0.001, P = 0.004, respectively). Catalase activity was significantly higher in PYN-24, -48, and -72 groups than the control group (P < 0.001). In addition, there was a significant difference between the TQ-PYN-24, -48, and -72 groups and PYN groups in terms of glutathione peroxidase activity (P < 0.001, P = 0.026, P = 0.046, respectively). When the TQ-PYN-72 group was compared with the PYN-72 group, malondialdehyde levels were significantly lower in the TQ-PYN-72 group than in the PYN-72 group (P = 0.033). A histologic examination also confirmed the protective effect of TQ. In statistical analysis of histopathologic findings, there were significant differences between the PYN-24 and TQ-PYN-24, PYN-48 and TQ-PYN-48, and PYN-72 and TQ-PYN-72 groups (P = 0.008, P < 0.001, P < 0.001, respectively). CONCLUSIONS: The results indicate that TQ administration attenuated the oxidative damage that occurred in PYN and, therefore, could be used as a supportive agent to protect the kidneys from oxidative damage caused by PYN.
RESUMO
Hydatid cyst disease is a parasitic illness that is rarely located in the brain. We present a case of a 26-year-old female who complained of headache, nausea, and vomiting. The diagnosis was intracranial hydatid cyst disease and was confirmed with radiological and serological tests. Neurological examination revealed papilloedema and left-sided pyramidal signs. She was operated on using the Dowling-Orlando technique. The cyst was removed without rupture, and therapy was completed with albendazole for a period of four weeks. In this article, we discuss the application of the Dowling-Orlando technique, microsurgery, the Valsalva manoeuvre and the positioning of the patient such that gravity could facilitate surgical removal of a giant cerebral hydatid cyst.
Assuntos
Encefalopatias/parasitologia , Encefalopatias/cirurgia , Equinococose/diagnóstico , Equinococose/cirurgia , Adulto , Encéfalo/parasitologia , Encéfalo/cirurgia , Feminino , Humanos , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/métodos , Resultado do TratamentoRESUMO
BACKGROUND/AIM: Broad-spectrum antibiotics have become available for use only with the approval of infectious disease specialists (IDSs) since 2003 in Turkey. This study aimed to analyze the tendencies of doctors who are not disease specialists (non-IDSs) towards the restriction of antibiotics. MATERIALS AND METHODS: A questionnaire form was prepared, which included a total of 22 questions about the impact of antibiotic restriction (AR) policy, the role of IDSs in the restriction, and the perception of this change in antibiotic consumption. The questionnaire was completed by each participating physician. RESULTS: A total of 1906 specialists from 20 cities in Turkey participated in the study. Of those who participated, 1271 (67.5%) had ≤5 years of occupational experience (junior specialists = JSs) and 942 (49.4%) of them were physicians. Specialists having >5 years of occupational experience in their branch expressed that they followed the antibiotic guidelines more strictly than the JSs (P < 0.05) and 755 of physicians (88%) and 720 of surgeons (84.6%) thought that the AR policy was necessary and useful (P < 0.05). CONCLUSION: This study indicated that the AR policy was supported by most of the specialists. Physicians supported this restriction policy more so than surgeons did.
Assuntos
Anti-Infecciosos/farmacologia , Médicos , Inquéritos e Questionários , TurquiaRESUMO
The clinical utility of two complementary tests for brucellosis, the Brucella IgM and IgG flow assays, was evaluated in a hospital in eastern Turkey. The results show that the flow assays are convenient diagnostic tests for use in endemic areas. A positive result in the flow assays was obtained in 91% and 97% of the admission sera from adult and pediatric patients with brucellosis, respectively, and the sensitivity at admission was 100% for culture-confirmed brucellosis. The assay system performed equally well in diagnosing patients at different stages of illness including patients with acute, subacute, or chronic disease and with relapse. The results of the flow assays correlated well with those of a serum agglutination test at a cut-off > or =1:160. The agreement was 92%. Application of the flow assays on serum samples collected during a village survey for brucellosis after an outbreak demonstrated their diagnostic potential as field tests.
Assuntos
Brucella/imunologia , Brucelose/diagnóstico , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Adolescente , Adulto , Anticorpos Antibacterianos/sangue , Criança , Pré-Escolar , Doenças Endêmicas , Ensaio de Imunoadsorção Enzimática , Humanos , Lactente , Recém-Nascido , Sensibilidade e Especificidade , Testes SorológicosRESUMO
We report a case of a 23-year-old man with a cardiac hydatid cyst involving the left ventricle wall. The diagnosis of the cyst was obtained by magnetic resonance (MR) imaging. He was operated on for cardiac hydatid cyst using enucleation and capitonnage procedure under extracorporeal circulation. Histopathologic study confirmed hydatid cyst diagnosis.
Assuntos
Cardiomiopatias/diagnóstico , Equinococose/diagnóstico , Adulto , Cardiomiopatias/cirurgia , Equinococose/cirurgia , Humanos , Imageamento por Ressonância Magnética , MasculinoRESUMO
INTRODUCTION: In this study, we aimed to evaluate the knowledge, attitudes, and behaviors concerning the transmission routes of an H1N1 pandemic and the protective measures of health professionals at a university hospital in Turkey. METHODOLOGY: A stratified systematic sampling method was used to select the sample size of the study group. A total of 22 professors, 29 researchers, and 26 nurses were included in the study. RESULTS: The mean scores of the individuals were 8.4±2.5 (over 20) for knowledge about H1N1 transmission, 27.6±4.0 (over 60) for knowledge about protection against H1N1, 25.8±4.2 (over 45) for correct or appropriate attitudes, and 33.6±8.9 (over 60) for correct behaviors. A negative correlation between total knowledge and behavior was found (p < 0.001, r = -0.543). CONCLUSIONS: In epidemics, standard protection measures should be known and applied. Regarding this topic, the web page of the Ministry of Health comes to the forefront as a reliable source of information in addition to scientific explanations.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/epidemiologia , Influenza Humana/transmissão , Pandemias , Competência Profissional , Adulto , Feminino , Hospitais Universitários , Humanos , Controle de Infecções/métodos , Influenza Humana/prevenção & controle , Influenza Humana/virologia , Masculino , Pessoa de Meia-Idade , Turquia , Adulto JovemRESUMO
INTRODUCTION: Although pegylated interferons (pegIFNs) alpha-2a and alpha-2b have been used in chronic hepatitis B (CHB) treatment for many years, there are few studies concerning predictors of sustained virologic response (SVR) to pegIFN therapy. In this study, we aimed to investigate the predictors of response to pegIFN treatment in cases with HBeAg-negative CHB infection. METHODOLOGY: Seventeen tertiary care hospitals in Turkey were included in this study. Data from consecutively treated HBeAg-negative CHB patients, who received either pegIFN alpha-2a or alpha-2b, were collected retrospectively. SVR is defined as an HBV DNA concentration of less than 2,000 IU/mL six months after the completion of therapy RESULTS: SVR was achieved in 40 (25%) of the 160 HBeAg-negative CHB patients. Viral loads in patients with SVR were lower compared to those with no SVR, beginning in the third month of treatment (p < 0.05). The number of cases with a decline of 1 log10 IU/mL in viral load after the first month of treatment and with a serum HBV DNA level under 2,000 IU/mL after the third month of treatment was higher in cases with SVR (p < 0.05). The number of patients who had undetectable HBV DNA levels at week 48 among responders was significantly greater than among post-treatment virological relapsers (p < 0.05). CONCLUSIONS: Detection of a 1 log10 decline in serum HBV DNA level at the first month of treatment and a serum HBV DNA level < 2000 IU/mL at the third month of therapy may be predictors of SVR.
Assuntos
Antivirais/uso terapêutico , Hepatite B Crônica/tratamento farmacológico , Interferon-alfa/uso terapêutico , Polietilenoglicóis/uso terapêutico , Carga Viral , Adolescente , Adulto , Idoso , DNA Viral/sangue , Feminino , Hepatite B Crônica/diagnóstico , Humanos , Interferon alfa-2 , Masculino , Pessoa de Meia-Idade , Prognóstico , Proteínas Recombinantes/uso terapêutico , Estudos Retrospectivos , Centros de Atenção Terciária , Resultado do Tratamento , Turquia , Adulto JovemRESUMO
Hydatid disease (HD) is a worldwide parasitic disease. Echinococcosis may involve many organs but affect most commonly liver and lungs. The location of echinococcal cysts inside pulmonary artery is extremely rare. Radiologic findings range from purely cystic lesions to a completely solid appearance. Hydatid cysts (HC) can be solitary or multiple and varies size. Pulmonary artery embolism of HC can be symptomatic or asymptomatic. When symptomatic, we see the chest pain, dyspnea, cough, hemoptysis and sometimes acute cor pulmonale or sudden death secondary to massive giant pulmonary artery embolism of HC.
Assuntos
Equinococose Hepática/complicações , Equinococose Hepática/diagnóstico , Equinococose Pulmonar/complicações , Equinococose Pulmonar/diagnóstico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/parasitologia , Veia Cava Inferior/parasitologia , Idoso , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética , Masculino , Radiografia Torácica , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
OBJECTIVE: To evaluate the association of insulin resistance (IR), viral load, and adipokine levels with liver histology in patients with chronic hepatitis C (CHC). PATIENTS AND METHODS: In this noninterventional, multicenter study carried out at 11 infectious diseases clinics in Turkey, 103 CHC patients [mean (SD) age: 50.2 (11.0) years, 60 (58.3%) women] planned to be treated by ribavirin and peginterferon-α2a were included. Data on hepatic fibrosis and steatosis, IR, viral load, and hepatitis C virus-RNA genotyping, adipokine, and cytokine levels were collected. RESULTS: The mean (SD) Knodell score was 8.1 (3.6); grade I steatosis was evident in 46 (44.7%) patients and IR was identified in 56 (54.9%). There was a significant positive correlation of the homeostasis model assessment-IR index with Knodell fibrosis (r=0.235; P=0.027) and hepatic steatosis (r=0.435; P<0.001). There was a significant positive correlation of leptin levels with Knodell fibrosis (r=0.265; P=0.013) and hepatic activity index (r=0.218; P=0.041). Hepatic steatosis was correlated negatively with adiponectin (r=-0.320; P=0.001) and positively with leptin (r=-0.368; P<0.001) levels. Logistic regression analysis showed that increase in age [odds ratio (OR), 1.056; 95% confidence interval (CI), 1.005-1.110; P=0.030] was the only significant predictor of hepatic fibrosis (OR, 1.056; 95% CI, 1.005-1.110; P=0.030), whereas increase in age (OR, 1.066; 95% CI, 1.006-1.130; P=0.030), the presence of IR (OR, 5.621; 95% CI, 1.547-20.425; P=0.009), and decrease in adiponectin levels (OR, 0.808; 95% CI, 0.682-0.957; P=0.013) were the significant predictors of hepatic steatosis. CONCLUSION: Our findings indicate a significant relationship of hepatic fibrosis and hepatic steatosis with IR and leptin levels, but not with the viral load in Turkish patients with CHC.
Assuntos
Adipocinas/sangue , Fígado Gorduroso , Hepatite C Crônica , Resistência à Insulina , Cirrose Hepática , Fígado/patologia , Carga Viral , Adulto , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Fígado Gorduroso/sangue , Fígado Gorduroso/diagnóstico , Fígado Gorduroso/epidemiologia , Fígado Gorduroso/virologia , Feminino , Hepacivirus/genética , Hepatite C Crônica/sangue , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/epidemiologia , Humanos , Fígado/virologia , Cirrose Hepática/sangue , Cirrose Hepática/diagnóstico , Cirrose Hepática/epidemiologia , Cirrose Hepática/virologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Valor Preditivo dos Testes , RNA Viral/sangue , Turquia/epidemiologiaRESUMO
Brucellosis is an infectious disease, frequently encountered in developing countries. It may involve multiple organ systems of the human body. However, neurobrucellosis is a rare complication of brucellosis. The most frequent events of cranial involvement are meningitis and meningoencephalitis. In the present case, a 10-year-old girl was referred to our clinic with fever, headache, nausea, and vomiting. The patient's blood and cerebrospinal fluid cultures were found positive for brucellosis. Communicating hydrocephalus was also present in the cranial computed tomography as a complication of neurobrucellosis. The patient was successfully treated by external ventricular drainage and triple antibiotic therapy. There was no need to insert a ventriculo-peritoneal shunt.
RESUMO
INTRODUCTION: Brucellosis is the most prevalent bacterial zoonosis worldwide. In this study, we aimed to compare our 1028 brucellosis cases with other big series in the literature in view of epidemiological, clinical, and laboratory findings and therapeutic features. METHODS: A total of 1028 brucellosis cases admitted to the Department of Infectious Diseases and Clinical Microbiology over a 10-year period were included in the study. A retrospective analysis was undertaken and patient files were reviewed for history, clinical and laboratory findings, and therapeutic features, as well as complications. RESULTS: Of the 1028 patients, 539 (52.4%) were female and 489 (47.6%) were male. The mean age of patients was 33.7+/-16.34 years and 69.6% of cases were aged 13-44 years. Four hundred and thirty-five cases (42.3%) had a history of raising livestock and 55.2% of the cases were found to have no occupational risk for brucellosis. Six hundred and fifty-four of the cases (63.6%) had a history of raw milk and dairy products consumption. The most frequently seen symptoms were arthralgia (73.7%) and fever (72.2%), while the most common clinical findings were fever (28.8%) and hepatomegaly (20.6%). The most frequent laboratory finding was a high C-reactive protein level (58.4%). The standard tube agglutination (STA) test+Coombs STA test was positive in 1016 cases (98.8%). Focal involvement was present in 371 (36.1%) cases. The most frequent involvement was osteoarticular involvement with 260 cases (25.3%). The overall relapse rate for patients with brucellosis was 4.7%. The highest relapse rate, 8.5%, was observed in the group of patients with osteoarticular involvement. Regimens including doxycycline and streptomycin with or without rifampin appeared more effective than other regimens in osteoarticular involvement. CONCLUSIONS: In humans, brucellosis may lead to serious morbidity, and it continues to be a major health problem in Turkey. There is no recommended treatment protocol for complicated brucellosis. Large multicenter studies are needed to determine the most appropriate treatment choices and durations in complicated brucellosis.
Assuntos
Brucelose/complicações , Brucelose/diagnóstico , Adolescente , Adulto , Idoso , Artralgia/diagnóstico , Artralgia/microbiologia , Artrite/microbiologia , Doenças Ósseas/diagnóstico , Doenças Ósseas/microbiologia , Brucelose/tratamento farmacológico , Brucelose/epidemiologia , Criança , Pré-Escolar , Laticínios/microbiologia , Feminino , Febre/diagnóstico , Febre/microbiologia , Hepatomegalia/diagnóstico , Hepatomegalia/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/microbiologia , Doenças Profissionais/epidemiologia , Doenças Profissionais/microbiologia , Estudos Retrospectivos , Fatores de Risco , Turquia/epidemiologiaRESUMO
Pericardial hydatid cyst is rare. We present a 32-year-old man with a pericardial hydatid cyst. Chest x-ray film showed a spherical mass located left mediastinum. A pericardial cyst with low signal intensity was noted on T1 weighted magnetic resonance (MR) images. The cyst had high signal intensity, but signal intensity of folded parasitic membranes in the cyst were seen lower intensity on T2 weighted MR images. Based on these MR findings, pericardial hydatid cyst was diagnosed. The patient underwent surgical removal of the cyst. Histologic study of the cyst confirmed hydatid cyst diagnosis.
Assuntos
Cisto Mediastínico/diagnóstico , Adulto , Equinococose , Humanos , Imageamento por Ressonância Magnética , Masculino , Cisto Mediastínico/diagnóstico por imagem , Cisto Mediastínico/patologia , Radiografia Torácica , Fatores de Tempo , Raios XRESUMO
Levamisole is an immunopotenciator drug which is used as an antihelmintic drug as well as very effective remedy on cellular immunity compared with humoral immunity. A total 71 patients (37 men, 34 women) who referred to our department between March 1997 and December 2001, with a history of the disease for about 1 year, were diagnosed as having chronic brucellosis through those tests brucella serum agglutination test (SAT), SAT with Coombs and SAT with 2-mercaptoethanol. The patients were randomly divided into levamisole group (36 patients) and control group (35 patients). All patients were given rifampicin 600 mg/day + doxycycline 200 mg/day for 6 weeks as a standard classical combined therapy for brucellosis. In the levamisole group, oral levamisole 80 mg every other day for 6 weeks was added to the treatment. There was a statistically significant difference between two groups, in complaints of arthralgia, fatigue and sweats before and 6 months after treatment, as well as in erythrocyte sedimentation rate and C-reactive protein elevations and lymphomonocytosis finding. While it was provided both clinical and serological improvement in all patients in the levamisole group; 11 patients in the control group did not improve both clinically and in view of specific and nonspecific laboratory findings and a recurrence occurred in one case, in this group. In conclusion, levamisole added to classical antibiotic therapy in treatment of chronic brucellosis was found quite efficient in all patients in providing adequate clinical and laboratory response in comparison to classical antibiotic therapy alone.