Giriş: Sepsis infeksiyona karşı gelişen patolojik, biyokimyasal ve fizyolojik anormalliklerle seyreden sendrom olup yüksek mortalite ve morbiditeyle seyretmektedir. Çalışmamızda gram-negatif bakteriyemi ile ilişkili sepsiste Pitt bakteriyemi skoru, sistemik inflamatuvar yanıt sendromu (SIRS) kriterleri ve quick Sequential Organ Failure Assessment (qSOFA) skorlarının mortaliteyi öngörme gücünü sapta mayı amaçladık. Materyal ve Metod: Mart 2016-Mart 2018 tarihleri arasında acil servisten sepsis tanısıyla yatışı yapılan hastalardan kan kültüründe gram-negatif bakteri üremesi olanlar retrospektif olarak incelendi. Hastaların komorbiditeleri, klinik ve laboratuvar verileri, antimikrobiyal tedavileri, SIRS, Pitt bakteriyemi skoru, qSOFA skorları değerlendirildi. Bulgular: Sepsis-2 tanı kriterlerini karşılayan 106 gram-negatif bakteriyemi ilişkili sepsis tanılı hasta çalışmaya dahil edildi. Otuz günlük mortalite oranı %20.8’di. Çok değişkenli analiz sonucuna göre Pitt bakteriyemi skoru (OR:1.63, %95 GA: 1.29-2.05, p< 0.001) mortaliteyi öngörmede anlamlı bağımsız risk faktörü olarak saptandı. Yapılan ROC eğri analizinde Pitt bakteriyemi skoru için eğri altında kalan alan 0.885 (%95 GA: 0.737-0.933), qSOFA skoru için 0.808 (%95 GA: 0.713-0.904) ve SIRS için 0.623 (%95 GA: 0.492-0.753) olarak bulundu. Pitt bakteriyemi skoru diğer skorlamalara göre; en yüksek özgüllüğe (%71.4) ve en yüksek pozitif prediktif değere (%40.0) sahipti. Sonuç: Sonuç olarak çalışmamızda; Pitt bakteriyemi skoru gram-negatif bakteriyemi ilişkili sepsis hastalarında mortaliteyi öngörmede SIRS kriterleri ve qSOFA skoruna göre daha yüksek performansa sahip bulunmuştur.
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Neşe DEMİRTÜRK , Bilgehan AYGEN,
İhami ÇELİK , Reşit MISTIK, Sıla AKHAN, Şener BARUT,
Onur URAL ,
Ayşe BATIREL , Funda ŞİMŞEK, Gülden ERSÖZ, Dilara İNAN, Sami KINIKLI, Nesrin TÜRKER, Hüseyin BİLGİN, Yunus GÜRBÜZ,
Necla TÜLEK , Hüseyin TARAKÇI, Orhan YILDIZ, Emine TÜRKOĞLU, Deniz KOMALAK GÜZEL, Sümeyra ŞİMŞEK, Nazan TUNA,
Nazlım Aktuğ DEMİR , Atahan ÇAĞATAY,
Rıza Aytaç ÇETİNKAYA ,
FARUK KARAKEÇİLİ ,
İsmail Necati HAKYEMEZ ,
Günay ERTEM , Bahar ÖRMEN,
Pınar KORKMAZ , Uluhan SİLİ, Ziya KURUÜZÜM, Alper ŞENER, Selcan ARSLAN ÖZEL, Sinan ÖZTÜRK,
Kaya SÜER , Mustafa Kemal ÇELEN, Petek KONYA, Ali ASAN, Neşe SALTOĞLU, Nurhan DOĞAN
Background: In this study, we aimed to investigate the efficacy and safety of sofosbuvir-based therapies in the treatment of chronic
hepatitis C in real-world clinical practice.
Methods: Data from patients with chronic hepatitis C treated with SOF/LDV ± RBV or SOF/RBV in 31 centers across Turkey between April
1, 2017, and August 31, 2018, were recorded in a nationwide database among infectious disease specialists. Demographics, clinical, and
virological outcomes were analyzed.
Results: A total of 552 patients were included in the study. The mean age of the patients was 51.28 ± 14.2, and 293 (55.8%) were female.
The majority had HCV genotype 1b infection (65%), 75.04% of the patients underwent treatment, and non-cirrhosis was present at
baseline in 381 patients (72.6%). SOF/LDV ± RBV treatment was given to 477 patients and 48 patients received SOF/RBV according to
HCV genotype. The total SVR12 rate was 99% in all patients. Five patients experienced disease relapse during the study and all of them
were genotype 2. In patients infected with HCV GT2, SVR12 was 77.3%. SVR was 100% in all patients infected with other HCV genotypes.
All treatments were well tolerated by patients without causing severe adverse events. Side effects and side effects-associated
treatment discontinuation rates were 28.2% and 0.4%, respectively. Weakness (13.7%) was the common side effect.
Conclusion: The present real-world data of 525 patients with HCV genotypes 1, 1a, 1b, 3, 4, and 5 who underwent SOF/LDV ± RBV treatment
in Turkey demonstrated a high efficacy and safety profile. HCV GT2 patients should be treated with more efficacious treatment.
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OBJECTIVE: Implementation of strategies to prevent vertical transmission is highly important steps in
reducing the global burden of chronic hepatitis B. We conducted this prospective study to observe the
clinical course and outcomes of untreated and treated HBV in pregnant.
STUDY DESIGN: HBsAg-positive pregnants were prospectively enrolled from 2013 to 2016 and antiviral therapy was administered to eligible patients. Pregnancy and neonatal outcomes were determined in
the treated (n=29) and untreated group (n=136). Active-passive immunoprophylaxis was administered
to infants and they were tested for HBsAg.
RESULTS: The risk factors for transmission (HBeAg positivity, history of previously-born HBsAg-positive child) were significantly higher in the treated group. All participants under treatment had sufficient
viral suppression. Half of the pregnant women for whom the treatment was withheld at the postpartum
period, experienced increased viral load. The treated group had significantly higher pre- and postpartum
alanine aminotransferase levels more than the untreated group, although there were no significant differences in other biochemical parameters. There were no significant differences regarding fetal outcomes between the two groups. All infants were HBsAg-negative at seven months postpartum.
CONCLUSION: While the untreated group included inactive carriers, there were more patients at risk for
transmission of HBV to their offsprings in the treated group. Half of the pregnant women for whom the
treatment was withheld at the postpartum period, experienced increased viral load. Antiviral therapy did
not adversely affect the outcomes of infants. As a result, we successfully prevented perinatal HBV transmission by close monitoring of participant pregnant women and starting antiviral therapy when needed.
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Fehmi TABAK ,
Göktuğ ŞİRİN , Mehmet DEMİR,
Murat ALADAĞ ,
Şua SÜMER ,
Behice KURTARAN ,
Selma TOSUN , Tansu YAMAZHAN,
Ilkay BOZKURT ,
Yunus GÜRBÜZ ,
Ayşe BATIREL ,
Ebubekir SENATES , Fatma Özlem KANDEMİR,
Firdevs TOPAL ,
Hamdi Levent DOĞANAY ,
Orhan SEZGİN ,
Reşit MISTIK ,
Şükran KÖSE ,
YUSUF YILMAZ ,
Dilara İNAN ,
İftihar KÖKSAL ,
Emine PARLAK ,
Meral AKDOĞAN KAYHAN ,
Rahmet GÜNER
Objectives: To describe the prevalence of risk factors in patients infected with hepatitis C virus (HCV). Materials and Methods: Patients who were aged >18 years visiting outpatient clinics and diagnosed as having HCV infection were enrolled in this cross-sectional, multicenter study conducted in 71 cities. Patient data on socio-demographic and clinical characteristics and pre-defined risk factors were collected. Results: Among 1,018 patients, 53.0% were women. The mean age was 57.2±14.3 years and 34.8% had been diagnosed as having HCV infection >10 years before enrollment. Almost half of the patients (45.5%) were diagnosed during their regular check-up visits, and only 16.8% were diagnosed because of signs or symptoms of HCV. Genotype 1 and sub-genotype 1 b were detected in 87.9% and 73.7% of the patients, respectively. At least one risk factor was present in 94.8% of the patients. The most frequently reported risk factor was major dental procedures (79.2%), followed by major surgical operations (56.9%) and minor surgical interventions (42.3%). Conclusion: Our results revealed that most of the patients with HCV infection underwent major dental procedures
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Background/aim: The aim of this current study was to describe the neuroimaging findings among patients with COVID-19 and to compare them with thorax CT imaging findings and clinicobiological profiles. Materials and methods: Between the period March 11 and December 31, 2020, we evaluated brain computed tomography (CT) and magnetic resonance (MR) images of patients with COVID-19. A total of 354 patients (mean age 65.2 ± 16.6, 52% female, 42% male) who had brain imaging were included in the study. Of this total sample, 218 had thorax CT scanning (65.5%). Neuroimaging and thorax CT findings, clinical course, neurologic findings, and laboratory data were evaluated. White matter lesions (WML) and thorax CT scans were scored. Participants were divided according to whether or not they had an infarction. Results: The neuroimaging findings indicated infarcts, parenchymal hemorrhage, encephalitis, cortical signal abnormality, posterior reversible encephalopathy syndrome (PRES), and cranial nerve involvement. WML significantly positively correlated with age (p < 0.01) but not with sex (p > 0.05). Thorax CT findings did not demonstrate significant correlations with infarcts, WML, or hemorrhages (p > 0.05). D-dimer and ferritin levels were significantly higher among patients with infarcts (p < 0.05). Conclusion: Immune-mediated prothrombic state and cytokine storm appear to be more responsible for etiopathogenesis than direct viral neurotropism. Neuroimaging and thorax CT findings were not correlated among patients with COVID-19 in our study. These results suggest that neurological manifestations may occur independently of pulmonary involvement and age. Key words: COVID-19, brain, CT, MR
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Bilgehan AYGEN,
Neşe DEMİRTÜRK , Orhan YILDIZ,
Mustafa Kemal ÇELEN ,
İhami ÇELİK ,
Şener BARUT ,
Onur URAL ,
Ayşe BATIREL ,
Reşit MISTIK ,
Funda ŞİMŞEK ,
Ali ASAN ,
GÜLDEN ERSÖZ ,
Nesrin TÜRKER ,
Hüseyin BİLGİN ,
Sami KIRIKLI ,
FARUK KARAKEÇİLİ ,
Gökmen ZARARSIZ , The Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious DİSEASES
Background/Aims: mbitasvir/paritaprevir/ritonavir (OMV/PTV/r) ± dasabuvir (DSV) ± ribavirin (RBV) combination has demonstrated excellent rates of sustained virologic response (SVR) and a very good safety profile in patients with the chronic hepatitis C virus (HCV) genotype 1 or 4 infections. We aimed to investigate the effectiveness and safety of OMV/PTV/r ± DSV ± RBV combination regimen in a real-world clinical practice.Materials and Methods: Data from HCV genotype 1 and 4 patients treated with OMV/PTV/r ± DSV ± RBV (n=862) in 34 centers across Turkey between April 1, 2017 and August 31, 2018 were recorded in a large national database. Demographic, clinical, and virologic data were analyzed.Results: The mean age of the patients was 55.63, and 430 patients (49.9%) were male. The majority had HCV genotype 1b infection (77.3%), and 66.2% were treatment-naïve. Non-cirrhosis was present at baseline in 789 patients (91.5%). SVR12 rate was 99.1% in all patients. Seven patients had virologic failure. No significant differences were observed in SVR12 according to HCV genotypes. HCV RNA was undetectable at treatment week 4 in 90.9%, at treatment week 8 in 98.5%, and at the end of treatment (EOT) in 98.9%. SVR12 ratio was significantly higher in the non-cirrhotic patients compared to that in the compensated cirrhotic patients. Rates of adverse events (AEs) in the patients was 59.7%.Conclusion: The present real-life data of Turkey for the OBV/PTV/r ± DSV ± RBV treatment of patients with HCV genotype 1b, 1a, or 4 infection from 862 patients demonstrated high efficacy and a safety profile.
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