Adherence to Nucleoside/Nucleotide Analogue Treatment in Patients with Chronic Hepatitis B.

BACKGROUND: Adherence to medication is an important aspect of preventing drug resistance and treatment failure in patients receiving nucleos(t)ide analogues for chronic hepatitis B. AIMS: To assess adherence to nucleoside/nucleotide analogues in chronic hepatitis B treatment and to determine factors associated with non-adherence. STUDY DESIGN: Cross-sectional study. METHODS: The study enrolled 85 chronic hepatitis B patients who had been receiving nucleoside/nucleotide analogues for ≥3 months. A questionnaire was completed by patients themselves, and adherence was evaluated based on patients' self-reporting. The use of at least 95% of the drugs in the previous month was considered as adequate adherence. RESULTS: Adherence was adequate in 82.4% of patients. Female gender (p=0.003), unemployment (p=0.041) and lower monthly family income (p=0.001) were related to lower adherence. Better adherence was significantly linked to adequate basic knowledge regarding chronic hepatitis B (p=0.049), longer treatment duration than 12 months (p<0.001), previous use of other medications for chronic hepatitis B (p=0.014) and regular follow-up by the same physician (p<0.001). CONCLUSION: Counselling patients about their disease state and the consequences of non-adherence is an important intervention for enhancing adherence. Naïve patients should be followed up more frequently to reinforce adherence.

Assessment of Aflatoxin M1 and Heavy Metal Levels in Mothers Breast Milk in Famagusta, Cyprus.

Breast milk contributes towards optimal nutrition for infants. However, studies showed that it can also contain different toxins and heavy metals, which reduce its health benefits. The aim of this study is to determine the level of contaminants such as aflatoxin M1 (AFM1), Pb, Cd, As, and Hg in breast milk samples from Famagusta, Cyprus. Correlations between moldy food consumption, smoking habits of the mothers, and contaminant levels in breast milk were also investigated. Breast milk samples from 50 lactating mothers in rural and urban areas of Famagusta District were analyzed for AFM1 by ELISA. Eighty percent of them were found to be contaminated with AFM1 with the mean measurement of 7.84 ± 1.72 ng/l. Socio-demographic status, moldy food consumption habits, and smoking status do not have any effect on the AFM1 levels observed in breast milk. Heavy metal levels in breast milk were examined by inductively coupled plasma mass spectrometry, and the mean measurements were1.19 ± 1.53 ppm for Pb, 0.73 ± 0.58 ppm for As, 0 ± 0.20 ppm for Hg, and 0.45 ± 0.23 ppm for Cd. This study indicates that the levels of these contaminants in breast milk samples obtained in Famagusta District are well within the acceptable levels. However, the presence of AFM1 and heavy metals still may pose risks for infant health.

Acute carbon monoxide poisoning alters hemorheological parameters in human.

Acute carbon monoxide (CO) poisoning seriously hinders oxygen delivery to tissues. This harmful effect of CO may be aggravated by accompanying changes in the viscosity of blood. We had previously reported increased plasma viscosity in people chronically exposed to CO. This study was planned to test our hypothesis that acute CO poisoning increases blood viscosity. For this purpose four main parameters contributing to blood viscosity - hematocrit, erythrocyte deformability, erythrocyte aggregation and plasma viscosity - were determined in patients with acute CO poisoning and compared with healthy controls. Plasma viscosity and erythrocyte aggregation tendency were lower in the CO group (p <  0.05). Erythrocyte deformability was also lower in CO group (p <  0.05). Our results indicate that acute CO poisoning has diverse effects on hemorheological parameters such as attenuating hematocrit value, plasma viscosity, erythrocyte aggregation tendency and erythrocyte deformability.

Evaluation of Prognostic Values of Tissue Plasminogen Activator and Plasminogen Activator Inhibitor-1 in Crimean-Congo Hemorrhagic Fever Patients.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) is a widespread disease in Turkey, and was responsible for many deaths in endemic regions during the last decade. The pathogenesis of the disease is not fully understood yet. OBJECTIVES: In this study we aimed to determine the levels of tissue plasminogen activator (tPA) and Plasminogen activator inhibitor-1 (PAI-1) as predictors of prognosis in CCHF. PATIENTS AND METHODS: Patients who were diagnosed by the polymerase chain reaction (PCR) and IgM positivity in the reference laboratory were included in this study. Tissue Plasminogen activator and PAI-1 levels were measured by the enzyme linked immunosorbent assay (ELISA) using a commercial kit (human t-PA ELISA and human PAL-1 ELISA; BioVendor research and diagnostic products, BioVendor-Laboratorni medicina a.s., Brno, Czech Republic). RESULTS: A total of 46 patients participated in this study. The significant differences between recovering patients and the patients who died, regarding Aspartate aminotransferase (AST), Creatine Phosphokinase (CPK), Lactate Dehydrogenase (LDH), Prothrombin Time (PT), activated Partial Thromboplastin time (aPTT), and thrombocyte and fibrinogen levels, were consistent with many clinical studies in the literature. The fatal cases were found to have higher tPA and PAI-1 levels in contrast to the patients who completely recovered. CONCLUSIONS: We think that these findings may help the progress of understanding of CCHF pathogenesis.

Seroprevalence of brucellosis among children in the Middle Anatolia Region of Turkey.

Brucellosis is an important public-health problem in Turkey. Children may constitute 20 to 30% of all brucellosis cases in the world, especially in the endemic regions. Data on the seroprevalence of brucellosis in childhood are very limited. In this study, we aimed to evaluate the seroprevalence of brucellosis among a child population. One thousand one hundred and ten subjects were included in the study. Blood samples were collected and tested with Rose Bengal (RB) and standard tube agglutination test (SAT). RB test results were positive for 6 patients, and SAT was negative for all patients. Our findings suggest that seroprevalence of brucellosis is decreasing in Middle Anatolia due to a new cattle vaccination and eradication programme which was initiated in 2009.

Gallbladder volvulus.

Gallbladder volvulus or torsion; is an uncommon cause of acute abdomen and occurs by rotation of the gallbladder on its mesentery. The entity commonly misdiagnosed as cholecystitis before laparatomy, although it has some critical findings that alert physician for correct diagnosis. A 47 years old male patient admitted to our emergency department with right upper quadrant pain, and then progressed through abdominal rigidity indicating acute abdomen, was subjected to laparatomy. At surgery; gangrenous and rotated gallbladder was observed and cholecystectomy was performed. Early diagnosis and prompt surgical treatment is mandatory to lower the complications of this entity. Clinical signs and radiographic studies should guide physicians for proper diagnosis of gallbladder torsion.

Health-related quality of life and the prevalence of post-traumatic stress disorder among Crimean-Congo hemorrhagic fever survivors.

Crimean-Congo hemorrhagic fever (CCHF) is a potentially fatal infectious disease, and it is endemic in Turkey. Patients are placed in isolation when hospitalized, and some may require blood transfusions. Moreover, some patients may require admission to intensive care units (ICU). CCHF is not a recurrent disease, and relapses are not expected. Therefore, no medical follow-up is conducted on recovery from CCHF. In this study, health-related quality of life (HRQL) and the presence of post-traumatic stress disorder (PTSD) among CCHF survivors were evaluated 12 months after recovery from the disease. PTSD diagnosis was established by DSM-IV-TR criteria and HRQL was investigated by using the Medical Outcomes Study Short Form 36. This study included 54 patients. Our results showed that 48.1% of the patients had PTSD symptoms and 18.5% had PTSD. PTSD incidence was higher among patients who required an ICU stay, who had bleeding, and who required blood transfusion. In addition, 4 out of 8 dimensions of HRQL were impaired. However, none of these patients admitted psychiatric problems to health care professionals. Our findings revealed that periodic psychiatric evaluation should be performed on CCHF patients, and they should be provided medical support, if required.

Evaluation of factors predictive of the prognosis in Crimean-Congo hemorrhagic fever: new suggestions.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) is one of the viral hemorrhagic fevers caused by tick bites. Common symptoms of the infection are fatigue, high fever, headache, and myalgia. In some patients hemorrhage may accompany these symptoms and is a sign of a poor prognosis. Typical laboratory changes are thrombocytopenia, leukopenia, elevation of aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatine phosphokinase (CPK), and lactate dehydrogenase (LDH), and prolongation of prothrombin time (PT) and activated partial thromboplastin time (aPTT). Mortality rates vary between 3% and 30%. The aim of this study was to determine the factors affecting the prognosis of CCHF. METHODS: A total of 70 patients with a diagnosis of CCHF who were followed at our clinic between 2005 and 2008 were included in this study. As well as patient clinical history, biochemical parameters tested during the first 5 days and the prognosis were evaluated. Findings were compared between patients who died and those who recovered. Non-parametric statistical tests were used for the statistical analysis. RESULTS: When the laboratory parameters of patients who died and recovered were compared, PT, aPTT, international normalized ratio (INR), AST, LDH, fibrinogen, C-reactive protein (CRP), high-sensitivity CRP (hs-CRP), D-dimer, IgM, IgG, C3 and C4 levels, and platelet count were found to be positively related with fatality. On the other hand, there was no significant difference between groups regarding ALT, CPK, prealbumin, ceruloplasmin, protein C, protein S, and antithrombin III levels, and white blood cell counts. CONCLUSIONS: It is essential to determine the possibility of a fatal prognosis in CCHF patients using clinical history and biochemical parameters so that the necessary precautions can be taken.

Device-associated infection rates and bacterial resistance in the intensive care units of a Turkish referral hospital.

OBJECTIVE: To determine device-associated infection (DAI) rates, and the microbiological and antibiotic resistance profiles of infecting pathogens in our hospital. METHODS: Prospective surveillance of healthcare-associated infections was performed from January 2007 to March 2010 in 4 different intensive care units (ICUs) of SB Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey. RESULTS: During the study period, 6,005 patients were followed-up in ICUs for a total of 46,355 patient-days. The total number of DAIs was 969. Catheter-associated urinary tract infection (CAUTI) was the most common DAI (55.3% of DAIs; 11.9 cases per 1000 catheter-days), followed by ventilator-associated pneumonia (VAP) (38.9% of DAIs; 21.2 cases per 1000 ventilator-days), and central line-associated blood stream infection (CLABSI) (5.8% of DAIs; 2.8 cases per 1000 central line-days). The most frequently isolated pathogens in patients with VAP were Acinetobacter species (24.5%) and Escherichia coli in CAUTI (24.2%). Coagulase negative Staphylococci and Candida species were the leading pathogens in patients with CLABSI. CONCLUSION: We observed considerably high rates of VAP and CAUTI and a high rate of CLABSI in our ICUs when compared with the National Healthcare Safety Network data. These findings emphasize the need to improve infection control practices and management of invasive device use in our hospital.

Clinical characteristics of 74 pandemic H1N1 influenza patients from Turkey. Risk factors for fatality.

OBJECTIVE: To evaluate the clinical characteristics and certain risk factors that may be associated with fatal outcome in patients with H1N1 influenza. METHODS: This retrospective study was conducted between October and December 2009 in the Department of Infectious Diseases and Clinical Microbiology, SB Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey. Data regarding the epidemiological and clinical characteristics of 74 hospitalized cases of confirmed pandemic H1N1 influenza were reviewed. RESULTS: The median age was 49 (18-83) years, and 34 (46%) were males. The most common symptom and signs on admission were cough (91.9%) and fever more than 38 degrees Centigrade (71.7%). More than two-thirds of patients (68.9%) had at least one underlying condition; most frequently chronic respiratory disease, including asthma and diabetes. Seventy-seven percent had evidence of pneumonia on their chest x-rays at presentation. Of the 74 cases, 16 (21.6%) were followed up in the Intensive Care Unit, and 10 (13.5%) died. Obesity and oxygen saturation below 92% at the time of admission were found to be significantly related with fatal outcome. In addition, fatal patients had significantly higher levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), urea, creatinine, d-dimer on admission and prothrombin time (PT), activated partial thromboplastin time, and the international normalized ratio (INR) was longer. CONCLUSION: Timely identification and management of patients with higher risk for fatality may improve outcomes.

Serum nitric oxide levels in patients with Crimean-Congo haemorrhagic fever.

Crimean-Congo haemorrhagic fever (CCHF) is an acute disease affecting multiple organ systems and is characterized by fever and haemorrhages. The pathogenesis of CCHF has not been well described. Nitric oxide (NO) is an important regulator of a number of different biological processes and can participate in antimicrobial defence. In this study, we measured the level of NO in the serum of patients with CCHF and healthy controls to define the possible role of NO in the control of infection. Sixty-two patients with CCHF and 31 controls were included in the study. NO levels in CCHF patients and the control group were found to be a mean of 40.49 microM (standard deviation (SD) 23.00) and 14.89 microM (SD 7.94), respectively. NO levels were significantly higher in CCHF patients with respect to controls (p < 0.001). NO levels in the patients with non-fatal CCHF and fatal CCHF were compared and found to be a mean of 43.57 microM (SD 22.70) and 26.23 microM (SD 19.43), respectively; this difference was statistically significant (p=0.009). In conclusion, elevated levels of NO may play a protective role in CCHF.

Is long-term hunger (Ramadan model) a risk factor for acute appendicitis?

OBJECTIVE: To investigate whether long-term hunger and the changes in nutritional routines during Ramadan constitute risk factors in acute appendicitis on the model of Ramadan fasting in this study. METHODS: This retrospective study was carried out in 2 different hospitals (Istanbul Haydarpasa Numune Training and Research Hospital and Kars State Hospital, Kars, Turkey) between January 2004 and December 2007. The data obtained from the patients were classified according to age, gender, age group, and pathological characteristics of the appendix. The data obtained during the Ramadan fasting period was compared with the periods before and after. RESULTS: Nine hundred and ninety-two of the 4288 patients who received a diagnosis of acute appendicitis during the 4 years received their diagnosis during the 3 periods. Three hundred sixty-eight (37.1%) patients underwent surgery before Ramadan, 318 (32.1%) during, and 306 (30.8%) after. No significant difference was observed in terms of perforated and non-perforated AA frequency, age, age group, and gender (p>0.05). CONCLUSION: There are changes in the nutritional routines during the Ramadan fasting period due to long-term hunger; and limitations were seen in the fluid and food intake. We detected that these changes did not constitute risk factors for acute appendicitis formation as a result of our study.

Tigecycline use in two cases with multidrug-resistant Acinetobacter baumannii meningitis.

The treatment of post-surgical meningitis due to multidrug-resistant (MDR) Acinetobacter baumannii is a therapeutic dilemma. The cases of two patients with MDR A. baumannii meningitis secondary to surgical site infections, successfully treated with combination regimens including tigecycline, are presented.

Evaluation of the association of serum levels of hyaluronic acid, sICAM-1, sVCAM-1, and VEGF-A with mortality and prognosis in patients with Crimean-Congo hemorrhagic fever.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral hemorrhagic disease. Pathogenesis of the disease has not been well described yet. A well-known pathogenic feature of CCHF virus is its capability to damage endothelium. Increased hyaluronic acid (HA) levels indicate liver sinusoidal endothelial damage. Soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1) and vascular endothelial growth factor-A (VEGF-A) play a role in the inflammatory process, vascular damage and plasma leakage. OBJECTIVES: To investigate whether or not there is a relationship between HA, sICAM-1, sVCAM-1 and VEGF-A serum levels and fatality in CCHF. STUDY DESIGN: Sixty-one patients who were confirmed by RT-PCR and serological tests for CCHF, included in the current study. HA, sICAM-1, sVCAM-1, VEGF-A levels in serum samples were analyzed by ELISA. RESULTS: There were statistically significant differences between fatal and non-fatal CCHF patients in terms of HA, sICAM-1, sVCAM-1, and VEGF-A levels. In addition, AST and ALT levels were positively correlated with HA, sICAM-1, sVCAM-1, and VEGF-A levels. CONCLUSION: HA, sICAM-1, sVCAM-1, and VEGF-A levels of the patients that died during hospitalization were statistically significantly higher than the patients that survived, and this finding suggests that the level of these molecules could be used as a prognostic marker in CCHF.

Crimean Congo haemorrhagic fever, precautions and ribavirin prophylaxis: a case report.

Crimean Congo haemorrhagic fever (CCHF) is a viral haemorrhagic disease, mostly transmitted by tick bites. It is clear that ignorance of the necessary precautions results in nosocomial infections in health care settings. Post exposure ribavirin prophylaxis is not well described. We report 2 cases of nosocomial CCHF infections.

A case of nosocomial transmission of Crimean-Congo hemorrhagic fever from patient to patient.

Crimean-Congo hemorrhagic fever (CCHF) is an acute, tick-borne viral disease, with the potential for human to human transmission. Infection often has severe hemorrhagic manifestations and considerable mortality. Healthcare workers (HCWs) caring for patients with CCHF constitute a major risk group for infection. Although nosocomial transmission from patients to HCWs accounts for a significant proportion of CCHF cases and outbreaks worldwide, transmission of CCHF from patient to patient has not previously been reported. A case of nosocomial transmission of CCHF from patient to patient at a hospital is described.

A rare case of distal one-third of the transverse colon supplied by a branch from splenic artery.

We observed a rare variation of splenic artery during the routine dissection in the Laboratory of the Anatomy Department. It arose from the splenic artery toward the distal part of transverse colon which typically supplied by the inferior mesenteric artery. Embryologically distal part of the transverse colon is a segment of hindgut. In this case, splenic artery which an artery of foregut supplies an area of hindgut. The knowledge of splenic artery variations has significant importance during surgery of the organs of the upper abdominal region. In this study, we discussed clinical significance and embryological aspects of this anomalous artery.

Comparative study on apoptosis in the testes of normal and alcoholic rats.

OBJECTIVES: To investigate the tissue injury associated with long-term alcohol consumption in male gonads. To this end, apoptotic testicle tissues of alcoholic rats were compared with the testicle tissues of the control rats. METHODS: This study was conducted in the Department of Anatomy and Division of Pathology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey during the period 2002 to 2003. We used Sprague-Dawley rats as the subject material in the investigation of apoptosis. We divided the rats into 2 groups: alcoholic rats and the control group, with 10 adult male rats in each group. We housed the subjects in each group under controlled temperature (22 +/- 3 degrees C) and humidity (62 +/- 7%) and lighting (12 hours darkness and 12 hours daylight per day). We fed the rats in the alcoholic group by ethanol in liquid diet for 12 weeks while the control rats received the normal isocaloric diet. We fixed the testicle tissues of both groups by perfusion of 10% formaldehyde through left ventricle and then removed. We further fixed the tissues in formaldehyde solution for at least 2 days. After dehydration by ethanol, we embedded the tissue in paraffin and used serial paraffin sections (5 micron thickness) for immunohistochemistry. We used Caspase-3 Ab-4 (CPP32) antibody to identify caspase reaction in apoptotic regions. Hence, we observed the stained sections and photographed the apoptotic seminiferous tubules (ST). For comparison of apoptosis in the alcoholic group and control group, we counted the apoptotic germ cells in x 400 magnification under light microscope. RESULTS: The diameters of seminiferous tubules were measured using light microscope with micrometre. The findings were compared by computer and significant differences in apoptosis between 2 groups (p<0.01) were detected. CONCLUSION: Apoptosis is significantly induced in ethanol treated rat related to the overuse of ethanol. The findings indicate the tissue injury of testicles associated with alcohol consumption.