In a Real-Life Setting, Direct-Acting Antivirals to People Who Inject Drugs with Chronic Hepatitis C in Turkey.

BACKGROUND: People who inject drugs (PWID) should be treated in order to eliminate hepatitis C virus in the world. The aim of this study was to compare direct-acting antivirals treatment of hepatitis C virus for PWID and non-PWID in a real-life setting. METHODS: We performed a prospective, non-randomized, observational multicenter cohort study in 37 centers. All patients treated with direct-acting antivirals between April 1, 2017, and February 28, 2019, were included. In total, 2713 patients were included in the study among which 250 were PWID and 2463 were non-PWID. Besides patient characteristics, treatment response, follow-up, and side effects of treatment were also analyzed. RESULTS: Genotype 1a and 3 were more prevalent in PWID-infected patients (20.4% vs 9.9% and 46.8% vs 5.3%). The number of naïve patients was higher in PWID (90.7% vs 60.0%), while the number of patients with cirrhosis was higher in non-PWID (14.1% vs 3.7%). The loss of follow-up was higher in PWID (29.6% vs 13.6%). There was no difference in the sustained virologic response at 12 weeks after treatment (98.3% vs 98.4%), but the end of treatment response was lower in PWID (96.2% vs 99.0%). In addition, the rate of treatment completion was lower in PWID (74% vs 94.4%). CONCLUSION: Direct-acting antivirals were safe and effective in PWID. Primary measures should be taken to prevent the loss of follow-up and poor adherence in PWID patients in order to achieve World Health Organization's objective of eliminating viral hepatitis.

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.

[A negleted bacteria with a case: Bartonella henselae]. / Bir olgu ile ihmal edilen bir etken: Bartonella henselae.

Bartonella henselae the causative agent of cat scratch disease (CSD), is a gram-negative, coccobacillus, facultative intracellular bacterium CSD usually presents as a clinical form of benign local lymphadenopathy (LAP) but sometimes it may progress to severe life threatening complications. Despite the fact that CSD is known to be a common disease, which is one of the important causes of local LAPs in the world, there are few publications in our country. For the diagnosis, the clinician should suspect for CSD and has to ask to the patient whether there is a story of cat scratch or not. In our country the diagnosis of CSD is usually done by invasive pathological examination instead of simple serological tests. In this report, a 14 years old case with CSD with antibody titers of 1/384 IgM, 1/2048 IgG B.henselae antibody determined by indirect fluorescent antibody (IFA) method in serum and B.henselae positivity by polymerase chain reaction (PCR) from LAP sample of the patient with axillary LAP was presented. Even though molecular techniques have been used for the diagnosis of the previous reported cases, it is the first B.henselae positive case in our country detected with PCR. In the history of the case it was learned that the patient was scratched by a street cat few months ago and the axillary LAP developed 4-5 weeks later. Axillary ultrasonography shawed abscesses with the largest 22 x 44 mm compatible with LAP. No growth was detected in the LAP biopsy specimen culture. Leucocyte count was normal but sedimentation rate (68 mm/h), and C-reactive protein (41.7 mg/L) were higher.Therapy was started with azitromycin 500 mg/day but two weeks later as there was no regression of LAP, considering the development of resistance, the treatment was changed to doxycycline 2 x 100 mg/day and rifampicin 1 x 300 mg/day. As the LAP was in abscess formation and the titers found in IFA was higher than the predictive value of B.henselae antibody titer for endocarditis, the treatment has been extended to four weeks and the patient has been cured. Especially children and adolescents are at very high risk for zoonotic infections transmitted from pets in our country due to the intense immigration to the city from the rural areas and the unconscious and uncontrolled livelihood of friendship with street animals. We should accept that this is not a rare condition, as the cat scratch disease can change from harmless to very serious forms the diagnosis and treatment should be quickly and carefully performed. Currently, serological examinations for Bartonella are rarely done in some certain reference laboratories in our country. The number of these laboratories should be increased or the usage of the tests in these reference laboratories should be at least expanded.

Urogenital myiasis caused by Psychoda albipennis.

Myiasis is a parasitic infestation of vertebrate animals caused by the eggs and larvae of flies within the Diptera species. Psychoda albipennis is a rare cause of urogenital myiasis in humans. We present the case of a 42-year-old male diagnosed with urogenital myiasis caused by Psychoda albipennis.

Quality of life and related factors among chronic hepatitis B-infected patients: a multi-center study, Turkey.

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.

Risk-Factors and Awareness of HPV in Turkish people with Anogenital Warts in Bagcilar district: a Cross-Sectional Study.

BACKGROUND: Anogenital warts (AGWs) are epithelial tumors which develop as a result of human papilloma virus (HPV) infection. We aimed to assess the sociodemographic, sexual and other possible risk-factors, and awareness of the HPV infection among Turkish people with AGW in the Bagcilar district of Istanbul. METHODS: A cross-sectional study was conducted on 273 patients (183 men, 90 women) with AGW between October 2014 - March 2015. The patients' sociodemographics were recorded along with their possible risk-factors and clinical findings. The patients' answers to questions regarding HPV/AGW were checked for awareness. Data were analyzed by Chi-square test using SPSS (Statistical Package for the Social Sciences) version 15.0. The results were evaluated with P < 0.05 considered significant. RESULTS: The major parameters detected were 26-39 age-range (52.6%), self-employed (54.6%), primary school graduate (44,7%), low/middle income (91.2%), married (59.3%), heterosexual (98.9%), sexually active (93.8%), sex in previous 3 months (87,6%), multi-partners (53.5%), partners without AGW (60.8%), mixed location (32.2%), concomitant verruca on hands (26%), 3-6 month duration (38.8%), non-recurrent lesion (98.2%), tinea cruris [TC](25.3%) and smoking (54.2%). However, self-employed (70.5%), middle-income (47%), polygyny (71.6%), pubic-location (43.2%), long-duration (46.4%), concomitant TC (31.7%) diabetes mellitus (9.8%), and verruca on hands (33.3%) were mostly encountered in males, while housewife (57.7%), low-income (60%), monoandry (67.8%), perianal-location (48.9%), short-duration (58.9%), smoking (64.4%), concomitant candidiasis (15.6%) and  depression (31.1%) were mostly found in females. Awareness of HPV hearing, HPV-AGW and HPV-cancer relationships, transmission-routes, risk-factors (each at 5.5%), and prevention methods (2.2%) was very low. CONCLUSIONS: AGWs are seen in sexually-active, less-educated, married heterosexuals in Bagcilar. Self-employed, middle-income, polygyny, pubic-location, long-duration, concomitant TC and diabetes mellitus, and verruca on hands are mostly seen in males, while housewife, low-income, monoandry, perianal-location, short-duration, smoking, candidiasis and depression are more common in females. Awareness is very low.

Entecavir treatment may be associated with decreased libido in male patients with chronic hepatitis B: report of two cases.

Various types of drugs are being used to treat patients with chronic hepatitis B infection. However, these treatment modalities are not without side effects, which may result in decreased patient adherence. Entecavir is an oral reverse transcriptase inhibitor, which is widely used in patients with hepatitis B. Although headache, fatigue and nausea are well-documented side effects of entecavir, its sexual side effects have not been reported yet. We here report on two male patients with chronic hepatitis B infection who reported decreased libido under entecavir treatment.

Dystrophic-Anagen Effluvium Occurring During Pegylated Interferon-α-2a/Ribavirin Therapy.

INTRODUCTION: Various types of dermatological manifestations have been reported due to hepatitis C virus (HCV) infection and anti-HCV therapy. Some of them have been described during IFN-based therapies. PEG-IFN-α-2a/RBV combination is used as the international standard of treatment for HCV infection for a long time. The combination therapy yields an adverse-event profile similar to standard interferon (IFN) therapy. Some of these adverse effects are rheumatologic, neuropsychiatric and dermatological manifestations including alopecia. CASE PRESENTATION: We reported a 43-year-old woman with dystrophic anagen effluvium (DAE), rheumatoid arthritis and Hashimoto thyroiditis, which were developed under the combination therapy for chronic HCV infection. CONCLUSIONS: Although some cases of alopecia areata (AA) and telogen effluvium (TE) were reported in literature, no case of DAE associated with PEG-INF-α-2a /RBV combination therapy was reported previously.

Entecavir as a first-line treatment for hepatitis B virus reactivation following polychemotherapy for chronic lymphocytic leukemia and invasive ductal carcinoma: a report of two cases and review of the literature.

OBJECTIVE: Hepatitis B reactivation has been reported in chronic carriers of hepatitis B [hepatitis B surface antigen (HBsAg)] or in patients with prior hepatitis B virus (HBV) infection who are HBsAg-negative and have antibodies against hepatitis B core antigen (anti-HBc) with or without antibodies to HBsAg (anti-HBs). Lamivudine has been the first and commonly used nucleoside analog to inhibit HBV replication; however, prolonged therapy has been associated with an increased risk for drug-resistant mutations and mortality rates. Entecavir, a deoxyguanosine analog, offers several advantages over lamivudine for the treatment of HBV reactivation following chemotherapy while exhibiting more potent antiviral activity and a lower resistance rate. METHODS: Herein, we report rapid and sustained suppression of polychemotherapy-related HBV reactivation by entecavir administered as a prompt antiviral therapy in the cases of two patients with chronic lymphocytic leukemia and invasive ductal carcinoma. A review of the literature is discussed. RESULTS: Entecavir produced a rapid and sustained suppression of polychemotherapy-related HBV reactivation as a prompt antiviral therapy in the cases of two patients with chronic lymphocytic leukemia and invasive ductal carcinoma. CONCLUSION: Allowing a rapid and sustained control of HBV replication, entecavir seems to be a promising drug for first-line prompt treatment of HBV reactivation in patients undergoing chemotherapy for hematological as well as solid organ malignancies, with safe long-term use enabling maintenance of resolved hepatitis.