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WOS: 000388326300001, PubMed: 27401586, Background: Drug resistance development is an expected problem during treatment with protease inhibitors (PIs), this is largely due to the fact that Pls are low-genetic barrier drugs. Resistance-associated variants (RAVs) however may also occur naturally, and prior to treatment with Pls, the clinical impact of this basal resistance remains unknown. In Turkey, there is yet to be an investigation into the hepatitis C (HCV) drug associated resistance to oral antivirals. Materials and methods: 178 antiviral-naive patients infected with HCV genotype 1 were selected from 27 clinical centers of various geographical regions in Turkey and included in the current study. The basal NS3 Pls resistance mutations of these patients were analyzed. Results: In 33 (18.5%) of the patients included in the study, at least one mutation pattern that can cause drug resistance was identified. The most frequently detected mutation pattern was T54S while R109K was the second most frequently detected. Following a more general examination of the patients studied, telaprevir (TVR) resistance in 27 patients (15.2%), boceprevir (BOC) resistance in 26 (14.6%) patients, simeprevir (SMV) resistance in 11 (6.2%) patients and faldaprevir resistance in 13 (7.3%) patients were detected. Our investigation also revealed that rebound developed in the presence of a Q80K mutation and amongst two V55A mutations following treatment with TVR, while no response to treatment was detected in a patient with a R55K mutation. Conclusion: We are of the opinion that drug resistance analyses can be beneficial and necessary in revealing which variants are responsible for pre-treatment natural resistance and which mutations are responsible for the viral breakthrough that may develop during the treatment. (C) 2016 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases., Department of Scientific Research Project of Kocaeli University; Turkish Society of Clinic Microbiology and Infectious Diseases, This study was funded by Department of Scientific Research Project of Kocaeli University and Turkish Society of Clinic Microbiology and Infectious Diseases.

WOS: 000429311800001, Background: Hepatitis B virus (HBV) has a high mutation rate due to its unusual replication strategy leading to the production of a large number of virions with single and double mutations. The mutations, in turn, are associated with the development of drug resistance to nucleos(t)ide analogs (NUCs) in patients before and during NUCs therapy. Objectives: The current study aimed at investigating the molecular characterization of HBV in Turkish patients with chronic hepatitis B (CHB) infection. Methods: Polymerase chain reaction (PCR) amplification and direct sequencing procedures were used to analyze mutations. The detected drug resistance mutations were divided into the nucleos(t) ide analogs primary, partial, and compensatory resistance groups. The amino acid substitutions of hepatitis B surface antigen (HBsAg) were categorized into antiviral drug - associated potential vaccine-escape mutations (ADAPVEMs) and typical HBsAg amino acid substitutions, which included hepatitis B hyperimmunoglobulin (HBIg) - selected escape mutation, vaccine escape mutation, hepatitis B misdiagnosis, and immune - selected amino acid substitutions. Results: The number of patients included in the study was 528 out of which 271 (51.3%) were treatment - naive and 351 (66.3%) were hepatitis B e antigen (HBeAg) - negative. Moreover, 325 (61.6%) were males with a mean age of 38 years (range: 18 - 69). Primary, partial, and compensatory resistance to NUCs was reported in 174 (32.9%) patients. Six different ADAPVEM motifs were determined in both treatment - naive and treatment - experienced patients, namely, sF161L/rtI169X, sE164D/rtV173L, sL172L/rtA181T, sL173F/rtA181V, sS195M/rtM204V, and sS196L/rtM204I. The prevalence of ADAPVEMs and typical HBsAg escape mutations was 5.3% (n = 28) and 34.8% (n = 184), respectively. Conclusions: The analysis of drug resistance should constitute a fundamental part of the follow - up period of patients with CHB undergone treatment with NUCs. The surveillance of development of drug resistance mutations, while receiving treatment for hepatitis B is of paramount importance to monitor and control the emerging resistance.

Aim The aim of the present study was to assess the potential risk of hepatitis B virus (HBV) vertical transmission among Turkish parturient women and to evaluate the efficacy and safety of antiviral agents. Material and Methods Data were collected retrospectively from 114 HBV-infected pregnant women and their infants in eight health institutions in Turkey. Results The baseline characteristics of the women were: mean age, 28.3 ± 5.2 years; alanine aminotransferase, 57.4 ± 139.0 U/L; aspartate aminotransferase, 56.6 ± 150.0 U/L; and HBV DNA, 8.3 × 107 ± 2.6 × 108 copies/mL. Family history of HBV infection was detected in 53.5% (n = 61). In total, 60 (52.6%) pregnant women received tenofovir (60.0%), lamivudine (33.3%) or telbivudine (6.7%) therapy at the median gestational age of 22.2 ± 8.5 (1–36) weeks. All infants were vaccinated and hepatitis B immune globulin was administered, with 81 of them (71.1%) available for follow-up. After completion of HBV vaccination course, 71 (87.7%) infants had protective anti-HBs levels, three (3.7%) were hepatitis B surface antigen-positive, and seven (8.6%) were hepatitis B surface antigen-negative with nonprotective anti-HBs levels. Five of the infants had low gestational birthweight but no other birth defects were observed. Conclusion According to our results, viral load may not be the only effecting factor for transmission of HBV to children of infected mothers. Pregnant women with high viral load should be followed-up closely during pregnancy. They should begin to take tenofovir or telbivudine, which are category B drugs for pregnancy, at the beginning of the third trimester at the latest. We need new treatment strategies; and close follow-up of mothers and children is another important issue.

WOS: 000357330600005, PubMed: 26185714, Background: The use of pegylated interferon alpha and ribavirin (PegIFN/RBV) for the retreatment of chronic hepatitis C virus (HCV) infection without a sustained virological response (SVR) prior to PegIFN/RBV treatment has resulted in low success rates. Aims: To investigate the efficacy and safety of telaprevir (TVR) in combination with PegIFN/RBV in patients infected with HCV genotypes 1 and 4 who were previously treated with PegIFN/RBV and failed to achieve SVR. Study Design: Multi-center, retrospective, cross-sectional study. Methods: The study included 111 patients: 80 prior relapsers, 25 prior null responders, and six prior partial responders to PegIFN/RBV treatment. The patients were given TVR/PegIFN/RBV for 12 weeks, followed by a 12-week PegIFN/RBV treatment; virological response results were assessed at weeks 4, 12, and 24. Treatment was discontinued in patients with HCV RNA >1000 IU/mL at week 4 or with negative RNA results at week 4 but >1000 IU/mL at week 12. Rapid virological response (RVR), early virological response (EVR), extended rapid virological response (eRVR), and virological response at 24th week of treatment were evaluated. The side effects of combination therapy and the rates of treatment discontinuation were investigated. Results: The mean age of the patients was 56.02 +/- 9.96 years and 45.9% were male. Ninety-one percent of the patients were infected with viral genotype 1, 69.6% with the interleukin (IL) 28B genotype CT and 20.2% were cirrhotic. The RVR rate was 86.3% in prior relapsers, 56% in prior null responders, and 50% in prior partial responders (p=0.002). EVR rates in those groups were 91.3%, 56%, and 83.3%, respectively (p

1Buldan Chest Diseases Hospital, Clinic of Infectious Diseases and Clinical Microbiology, Denizli, Turkey 2Harran University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sanliurfa, Turkey 3Yozgat Hospital, Clinic of Infectious Diseases and Clinical Microbiology, Yozgat, Turkey Dermatological Side Effects in a Patient with Hepatitis C Infection During Treatment with Pegylated Interferon/ Ribavirin+Telaprevir: A Case Report

Background: Chronic infections and liver diseases may influence the growth and development of children by leading to malnutrition. In this study, demographic characteristics, anthropometric measurements and laboratory findings for children with hepatitis B positivity were analyzed. Methods: A total of 43 cases were admitted to our clinic between January 2012 and February 2013 and detected to have HBsAg positivity. Results: Malnutrition was detected in 11 cases (25.6%) and obesity in three cases (6.9%). Aspartate aminotransferase (AST) levels were significantly higher in malnourished patients compared to those without malnutrition. The weight to height was significantly higher in patients with positive HBeAg compared to children with negative HBeAg. We found that the weight standard deviation scores (SDS) ratios dropped as alanine aminotransferase (ALT) and AST levels increased and height SDS ratios decreased. In addition, body mass index (BMI) decreased as AST and alpha feto protein (AFP) values increased. While a significant relationship was not detected between insulin-like growth factor binding protein-3 (IGFBP-3) and insulin-like growth factor-1 (IGF-1) and ALT, a significantly negative correlation was detected between IGFBP-3 and IGF-1 and AST. We found a malnutrition rate of 25.6% in children with HBsAg positivity. We also found that weight and height SDS rates decreased as ALT and AST levels increased. In addition, we detected that BMI decreased as AST and AFP values increased. Conclusion: We consider that hepatic inflammation is the factor that affects growth. Monitoring of growth and development during follow-up of children who are detected to have HBsAg positivity would be beneficial to determine the mechanism and causes of growth retardation. Gastroenterol Res. 2014;7(5-6):131-136 doi: http://dx.doi.org/10.14740/gr628e

HIV-1 replication is rapid and highly error-prone. Transmission of a drug-resistant HIV-1 strain is possible and occurs within the HIV-1-infected population. In this study, we aimed to determine the prevalence of transmitted drug resistance mutations (TDRMs) in 1,306 newly diagnosed untreated HIV-1-infected patients from 21 cities across six regions of Turkey between 2010 and 2015. TDRMs were identified according to the criteria provided by the World Health Organization's 2009 list of surveillance drug resistance mutations. The HIV-1 TDRM prevalence was 10.1% (133/1,306) in Turkey. Primary drug resistance mutations (K65R, M184V) and thymidine analogue-associated mutations (TAMs) were evaluated together as nucleos(t)ide reverse transcriptase inhibitor (NRTI) mutations. NRTI TDRMs were found in 8.1% (107/1,306) of patients. However, TAMs were divided into three categories and M41L, L210W, and T215Y mutations were found for TAM1 in 97 (7.4%) patients, D67N, K70R, K219E/Q/N/R, T215F, and T215C/D/S mutations were detected for TAM2 in 52 (3.9%) patients, and M41L + K219N and M41L + T215C/D/S mutations were detected for the TAM1 + TAM2 profile in 22 (1.7%) patients, respectively. Nonnucleoside reverse transcriptase inhibitor-associated TDRMs were detected in 3.3% (44/1,306) of patients (L100I, K101E/P, K103N/S, V179F, Y188H/L/M, Y181I/C, and G190A/E/S) and TDRMs to protease inhibitors were detected in 2.3% (30/1,306) of patients (M46L, I50V, I54V, Q58E, L76V, V82A/C/L/T, N83D, I84V, and L90M). In conclusion, long-term and large-scale monitoring of regional levels of HIV-1 TDRMs informs treatment guidelines and provides feedback on the success of HIV-1 prevention and treatment efforts. © Copyright 2016, Mary Ann Liebert, Inc. 2016.

Conference of the Asian-Pacific-Association-for-the-Study-of-the-Liver (APASL) -- MAR 12-15, 2014 -- Brisbane, AUSTRALIA, WOS: 000370967500005, PubMed: 26966614, Background: Before the introduction of direct-acting antivirals in the treatment of chronic hepatitis C patients, the combination of peginterferon alpha and ribavirin was the standard therapy. Observational studies that investigated sustained virological response (SVR) rates by these drugs yielded different outcomes. Aims: The goal of the study was to demonstrate real life data concerning SVR rate achieved by peginterferon alpha plus ribavirin in patients who were treatment-naive. Study Design: A multicenter, retrospective observational study. Methods: The study was conducted retrospectively on 1214 treatment naive-patients, being treated with peginterferon alpha-2a or 2b plus ribavirin in respect of the current guidelines between 2005 and 2013. The patients' data were collected from 22 centers via a standard form, which has been prepared for this study. The data included demographic and clinical characteristics (gender, age, body weight, initial Hepatitis C virus RNA (HCV RNA) level, disease staging) as well as course of treatment (duration of treatment, outcomes, discontinuations and adverse events). Renal insufficiency, decompensated liver disease, history of transplantation, immunosuppressive therapy or autoimmune liver disease were exclusion criteria for the study. Treatment efficacy was assessed according to the patient's demographic characteristics, baseline viral load, genotype, and fibrosis scores. Results: The mean age of the patients was 50.74 (+/- 0.64) years. Most of them were infected with genotype 1 (91.8%). SVR was achieved in 761 (62.7%) patients. SVR rate was 59.1% in genotype 1, 89.4% in genotype 2, 93.8% in genotype 3, and 33.3% in genotype 4 patients. Patients with lower viral load yielded higher SVR (65.8% vs. 58.4%, p=0.09). SVR rates according to histologic severity were found to be 69.3%, 66.3%, 59.9%, 47.3%, and 45.5% in patients with fibrosis stage 0, 1, 2, 3 and 4, respectively. The predictors of SVR were male gender, genotype 2/3, age less than 45 years, low fibrosis stage, low baseline viral load and presence of early virological response. SVR rates to each peginterferon were found to be similar in genotype 1/4 although SVR rates were found to be higher for peginterferon alpha-2b in patients with genotype 2/3. The number of patients who failed to complete treatment due to adverse effects was 33 (2.7%). The number of patients failed to complete treatment due to adverse effects was 33 (2.7%). Conclusion: Our findings showed that the rate of SVR to dual therapy was higher in treatment-naive Turkish patients than that reported in randomized controlled trials. Also peginterferon alpha-2a and alpha-2b were found to be similar in terms of SVR in genotype 1 patients., Asian Pacific Assoc Study Liver

The aim of this study was to evaluate oxidative stress and to determine the activity of paraoxonase and arylesterase in patients with osteomyelitis compared to healthy controls.In total, 30 patients diagnosed with osteomyelitis and 30 healthy volunteers were enrolled in the study. Paraoxonase and arylesterase activities were measured spectrophotometrically. Serum lipid hydroperoxide (LOOH) concentrations were measured by ferrous oxidation with xylenol orange (FOX) assay as markers of oxidative stress.Serum paraoxonase and arylesterase activities were significantly lower in patients with osteomyelitis compared to control individuals (all p0.05). Serum LOOH concentrations were significantly higher in patients with osteomyelitis than those in controls (p0.05). Arylesterase activity was inversely correlated with triglyceride (r =- 0.49; p = 0.005) and cholesterol concentrations (r =- 0.41; p = 0.025).In light of the findings obtained from the present study, it may be assumed that decreased activity of serum paraoxonase and increased concentrations of LOOH observed in osteomyelitis patients appear to be related to the increased oxidative stress and inflammatory conditions present in these patients, and may cause a much more severe status of the disease.

Background Hepatitis C infection represents a common healthcare issue worldwide. The present trial was designed to investigate the role of prolidase, an enzyme that is significantly involved in the biosynthesis of collagen, and of the oxidative stress that is considered to be involved in the pathogenesis of various diseases, in the chronic hepatitis C infection. The trial was performed to assess the serum prolidase enzyme level and the oxidative–antioxidative status and to determine the relation between the serum prolidase activity and the oxidative stress parameters. Methods A total of 95 individuals, including 55 patients with chronic hepatitis C infection (CHC) and 40 healthy adults, were enrolled in the trial. The values for prolidase, the total antioxidant status (TAS), the total oxidative stress (TOS), the oxidative stress index (OSI), sulfhydryl (SH), lipid peroxidation LOOH, catalase (CAT), and ceruloplasmin were measured and compared between the patient groups. Results The prolidase, TOS, LOOH, CAT, and the OSI values were higher in the chronic hepatitis C group compared to the control group (P < 0.001). The TAS, SH, and ceruloplasmin levels were lower in the CHC group relative to the control group (P < 0.001). Conclusion We suppose that the values of prolidase and the oxidative stress are increased while the antioxidant levels are decreased in CHC. As a result, prolidase and the oxidative stress seem to be related with the progression of the disease. J. Clin. Lab. Anal. 26:232-237, 2012. © 2012 Wiley Periodicals, Inc.

Our study aims to determine the efficacy of infectious dis- ease consultations and the interrelations between doctors in this social laboratory. This study was conducted at 34 centers located in 22 cities across Turkey and contributed by 210 infectious disease specialists (IDSs) and 970 nonYinfectious disease specialists (NIDSs), totaling 1180 medical doctors. Infectious disease specialists and NIDSs have sepa- rately contributed by responding to questionnaires designed specifically for the consultation process. It appears that a satisfactory collaboration has been established between IDSs and NIDSs during the consultation practices. There are some discrepancies in the perceptions of some of the NIDSs. These are the evaluation of patients holistically, the expec- tation of NIDSs in critical infection cases to start the therapy immedi- ately, losing the support of drug companies by NIDSs, and the restriction of NIDSs in routine medical practice. On the other hand, NIDSs seem to have real problems in the diagnosis or treatment of infectious diseases. The consultation service provided by the IDSs in Turkey is widely ac- cepted among other clinicians and appears to be of a crucial importance.

Cutaneous anthrax is well known, unlike anthrax of the lumbar region, which is not reported elsewhere. We present a case of anthrax of the lumbar region in a 50-year-old man. The infection was characterised by a wide, black eschar and oedema on an erythematous ground. After isolation of the Gram-positive bacilli from the skin lesions, prompt antibiotic treatment (intravenous sulbactam-ampicillin 1.5 g every six hours) was initiated. Following eradication of the bacilli after 14 days of antibiotic treatment, a split-thickness skin graft was applied. A diagnosis of anthrax depends on clinical suspicion. Early diagnosis, antibiotic and surgical treatment can facilitate the treatment and prevent development of complications.

Objective The aim of this study was to determine the level of knowledge of rabies transmission and control among physicians practicing in healthcare centers in Sanliurfa, Turkey where 2 cases of human rabies were reported in the past 12 months. Implementation issues regarding the current guidelines will also be discussed. Methods A cross-sectional study was conducted among 84 physicians practicing in healthcare centers in Sanliurfa, located in the Southeastern Anatolian region of Turkey. Results Among physicians, average duration of medical practice was 8.5 ± 6.7 years. The correct incubation period of rabies cases was known by 57.1% of the physicians. While 88.1% of physicians were aware of possible exposure routes, only 44.0% of them had the information that mucosal contact may also lead to transmission. While 96.4% of the physicians correctly indicated that cats and dogs can transmit the disease, the fact that foxes also have a role in transmission was known by only 48.8%. Post-exposure prophylaxis was correctly indicated by 65.5% of participants, but only 17.9% had correct information about pre-exposure prophylaxis. Conclusion An important approach in rabies control is to increase community awareness, particularly among healthcare providers. It was found that basic management issues and insufficient awareness still exist despite the presence of legal regulations. To control rabies, the issue must be dealt with locally, through both economic and social means, by supporting rabies control efforts of local health and agricultural directorate managers and by encouraging collaboration with academics.

Objectives: This study was conducted to determine the effectiveness of a multicomponent intervention in Sanliurfa Gynecology and Obstetrics Hospital (SGOH), which is designed to overcome the obstacles encountered in the application of HBsAg testing to all delivering women, the administration of hepatitis B vaccine and Hepatitis B Immunglobulin(HBIG) to newborns of HBsAg positive pregnant women. Methods: This is an intervention study, conducted between December 15, 2007 and December 30, 2008. Intervention procedure is composed of four methods; namely, motivation of all parties through academic leadership, implementation of workshops to determine the obstacles, provision of administrative commitment, and training of healthcare personnel. Results: In 2007, a total of 18,709 deliveries were realized in SGOH; HBsAg testing was performed in only 16.5% of the pregnant women and 0.8% of these women were found to be HBsAg positive. It was determined that HBIG was administered to 28.2% of newborns of HBsAg positive mothers and hepatitis B vaccine was given to 71.4% (n=13349) of all newborns. After the intervention, the increase in HBsAg test application status, HBsAg positivity, HIBG administration and hepatitis B vaccination was 6.0, 5.8, 2.0 and 1.2 fold, respectively (P

SummaryObjectivesThe aims of this study were to evaluate oxidant and antioxidant status in patients with acute brucellosis before and after therapy, and to determine whether this index could be used to monitor the treatment of brucellosis.MethodsThirty patients with a diagnosis of acute brucellosis and 37 healthy volunteers were enrolled in the study. Total antioxidant status (TAS) and total oxidant status (TOS) were measured in patients before and after therapy, and an oxidative stress index (OSI) was calculated. These measurements were also taken for the healthy control group and the values were compared.ResultsPlasma levels of TOS and OSI were significantly higher in patients with brucellosis before therapy as compared to the treated group (t: 11.19, p

The aim of this study was to determine and evaluate the activity of paraoxonase and arylesterase enzymes in various clinical forms of hepatitis B infection and to investigate the correlation between these parameters and chronic disease course/fibrosis. Overall, 40 patients diagnosed as hepatitis B carriers (CIHBV), 40 chronic active hepatitis B (CAHBV) patients, and 40 healthy adults (control group) between 18 and 65 years of age were enrolled the study. Serum paraoxonase and arylesterase activities were measured spectrophotometrically. Their activities were significantly lower in patients with CAHBV compared with CIHBV patients or with control group patients (P0.05). The histology activity index of CAHBV patients did not correlate with paraoxonase and arylesterase activities (P>0.05). In light of these findings, it may be assumed that during the progression of an inactive hepatitis B carrier to being actively infected, reduced paraoxonase and arylesterase activities may be observed. J. Clin. Lab. Anal. 25:311–316, 2011. © 2011 Wiley‐Liss, Inc.

AIM: Tetanus is a vaccine-preventable disease that yearly causes a total of 180.000 deaths. The objective of this study was to examine the coverage vaccination of tetanus in women aged 15-49 years after the national vaccination campaigne and to determine related factors to vaccination in order to establish approaches for improving vaccination services in Sanliurfa. METHOD: In this cross-sectional survey, after a national tetanus vaccination campain, a population-based sample of 511 women aged 15–49 year was selected from rural and urban areas of Sanliurfa, between November 2006-January 2007, by using LOT (Lot Quality Sampling Method), at %95 confidence level. ‘Socio-demographic Information Form’, ‘Women Vaccination Form’, and ‘Reasons for Vaccination Failure Form’ were used to data collection. RESULTS: The TT vaccination coverage rate (with two or more doses) fluctuated from 15% to 70.5%. We did not meet the aim of the EPI with the national campaign in this a high risk area. The majority of the barriers are related to knowledge, and health management. Education of women and antenatal care were found significant predictors (p

Kirim-Kongo kanamali atesi (KKKA) esas olarak endemik bolgede yasayanlara kene temasiyla bulasan viral kanamali ates sendromlarindan biridir. Turkiye’de ilk olgular 2002 ve 2003 yillarinda ilkbahar ve yaz aylarinda, kene isirigi sonrasi basta Tokat, Yozgat ve Sivas illerinde gorulmeye baslamistir. Son yillarda ulkemizde sayisi artan KKKA olgularina, ilimizin de icinde bulundugu Guneydogu Anadolu Bolgesi’nde daha az rastlanmaktadir. Bu yazida Sanliurfa’da tani konulan ve takip edilen ilk KKKA olgusu sunulmaktadir. Klimik Dergisi 2012; 25(1): 44-6.

Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases set up a task force to develop a consensus report focused on chronic hepatitis B in pregnancy, a complex issue for both the mother with an advanced liver disease and the unborn child who is under the risk of hepatitis B virus (HBV) transmission. Relevant literature and international guidelines were reviewed, and recommendations agreed are presented in the report. An algorithm adapted from actual publications is also proposed for management of chronic hepatitis B in the pregnant patient. Since many women of childbearing age are in the immune tolerant phase of infection, there is generally no need for therapy and no indication to start therapy during the early stages of pregnancy. Initiation of antiviral therapy in the beginning of the third trimester in highly viremic (HBV DNA > 200 000 IU/mL) pregnant women can prevent mother-to-child-transmission of HBV despite postnatal passive and active immunoprophylaxis provided. Given its potency and its high genetic barrier to resistance, tenofovir might be an appropriate option for mothers who might need to continue their treatment for active hepatitis B after delivery.

The Expanded Program on Immunization has proven to be one of the most effective public health strategies. However, the literature contends that medically disadvantaged groups have been associated with less compliance with vaccination calendars and schedules. The aim of this cross-sectional survey was to investigate the vaccination coverage of the children of migrant and seasonal farmworkers (MSFs) and to identify their specific barriers to vaccination. Materials and methods: A total of 168 children aged 12-23 months were recruited to the study from a primary healthcare center. Data were collected through a structured questionnaire targeting the issues of infant vaccination status, the reasons for vaccination failure, and sociodemographic data about the children and their families. Results: Childhood vaccination coverage in MSF children was found to be low (49.4%). Significantly, a relationship was found between having a vaccination card and vaccination coverage (P < 0.05). The majority of reasons for a child's vaccination failure as reported by caregivers were related to overall insufficient knowledge of vaccination. Other important reasons for failures in the vaccination of MSF children that were reported by caregivers were neglect and laboring in the agricultural field. Conclusion: Migrant and seasonal farmwork seems to be a barrier in accessing primary healthcare services.

Ergonul, Onder/0000-0003-1935-9235 WOS: 000346883000006 PubMed: 25132061 Veterinarians and veterinary technicians are at risk for occupational brucellosis. We described the risk factors of occupational brucellosis among veterinary personnel in Turkey. A multicenter retrospective survey was performed among veterinary personnel who were actively working in the field. Of 712 veterinary personnel, 84(11.8%) had occupational brucellosis. The median number of years since graduation was 7 (interquartile ranges [IQR], 4-11) years in the occupational brucellosis group, whereas this number was 9 (IQR, 4-16) years in the non-brucellosis group (p < 0.001). In multivariable analysis, working in the private sector (odds ratio [OR], 2.8; 95% confidence interval [95% CI], 1.55-5.28, p = 0.001), being male (OR, 4.5; 95% CI, 1.05-18.84, p = 0.041), number of performed deliveries (OR, 1.01; 95% CI, 1.002-1.02, p = 0.014), and injury during Brucella vaccine administration (OR, 5.4; 95% CI, 3.16-9.3, p < 0.001) were found to be risk factors for occupational brucellosis. We suggest that all veterinary personnel should be trained on brucellosis and the importance of using personal protective equipment in order to avoid this infection. (C) 2014 Elsevier B.V. All rights reserved.

Introduction : The objective of this study was to determine the transmitted drug resistance mutations (TDRMs) in newly diagnosed HIV-1 positive patients in Turkey. Material and Methods : The study was carried out between 2009 and 2014 and antiretroviral naive 774 HIV-1 infected patients from 19 Infectious Diseases and Clinical Microbiology Departments in Turkey were included; gender: 664 (86%) male, median age: 37 (range; 1–77), median CD4+T-cell: 360 (range; 1–1320) count/mm 3 , median HIV-RNA load: 2.10+E6 (range; 4.2+E2–7.41+E8) IU/mL. HIV-1 drug resistance mutations were detected by population based sequencing of the reverse transcriptase (codon 41–238) and protease (codon 1–99) domains of pol gene of HIV-1, and analyzed according to the criteria by the World Health Organization 2009 list of surveillance drug resistance mutations [1]. Results : The patients had TDRMs to NRTIs (K65R, M184V), NNRTIs (K101E, K103N/S, G190A/E/S, Y181I/C, Y188H/L) and PIs (M46L, I54V, L76V, V82L/T, N83D, I84V, L90M). The prevalence of overall TDRMs was 6.7% (52/774). Resistance mutations were found to be 0.7% (6/774), 4.1% (32/774) and 2.1% (17/774) to NRTIs, NNRTIs and PIs drug groups, respectively. Three patients had NRTIs+NNRTs resistance mutations (M184V+K103N) as multi-class drug resistance. However, thymidine analogue resistance mutations (TAMs) determined two distinct genotypic profiles in the HIV-1 reverse transcriptase: TAM1: M41L, L210W and T215Y, and TAM2: D67N, K70R, K219E/Q, and T215F. The prevalence of TAM1 and TAM2 were 7.7% (60/774) and 4.3% (34/774), respectively. Conclusions : The TDRMs prevalence of antiretroviral naive HIV-1 infected patients may be suggested current situation of Turkey. These long-term and large-scale results show that the resistance testing must be an integral part of the management of HIV infection in Turkey. (Published: 2 November 2014 ) Citation: Abstracts of the HIV Drug Therapy Glasgow Congress 2014 Sayan M et al. Journal of the International AIDS Society 2014, 17(Suppl 3) :19750 http://www.jiasociety.org/index.php/jias/article/view/19750 | http://dx.doi.org/10.7448/IAS.17.4.19750

Neurobrucellosis is one of the complications of brucellosis. We report a rare case of a 17-year-old girl with seronegative neurobrucellosis and depression and diplopia. Results of agglutination tests for Brucella both in serum and CSF were negative. Diagnosis was made only by positive culture of Brucella mellitensis with inoculation of the patient′s cerebrospinal fluid in a BACTEC 9050 System. The patient was successfully treated using ceftriaxone, doxycycline and rifampicin therapy for six months.

Tetanoz, siddetli solunum sikintisi ve persistan tonik spazmlarla karakterize, akut seyirli bir santral sinir sistemi enfeksiyonudur (1). Sporlari, insan ve hayvanlarin intestinal sisteminde ve toprakta bulunan Clostridium tetani’nin toksinleri hastaliga neden olur. Aktif immunizasyon programlarina ragmen gelismekte olan ulkelerde mortalite hizi yuzbinde 28’dir (1, 2). Dogumdan once bakim hizmetlerinin sinirli verildigi, uygun olmayan ortamlarda dogumlarin yaptirildigi ulkelerde yenidoganlar icin neonatal tetanoz onemli sorun olurken, eriskinlerde genellikle alt ekstremitelere metal, diken veya tahta batmalari sonrasi gelisen jeneralize form gorulmektedir (3, 4). Tetanoz kliniginden asil sorumlu olan bakteri toksini, merkezi ve otonom sinir sistemi ile noromuskuler kavsakta etkili olan tetanospazmindir. Hastada bu norotoksine bagli tonik kasilmalar, solunum sikintisi, kalpte ritim bozukluklari gibi ciddi bulgular ortaya cikabilir (4). Tani esas olarak oyku ve fizik muayene ile konulur. Yaralanmadan ortalama 15 gun (2 gun-2 ay) sonra ilk semptomlar ortaya cikar (1). Inkubasyon suresinin kisaligi olumsuz yonde bir prognostik faktordur (5). Bu yazida, acil servise yaygin kas agrisi ve kasilma sikayetleriyle basvuran, en son 25 yil kadar once immunprofilaksi uygulanan ve klinigi cok hizli ilerleyerek fatal seyreden bir tetanoz olgusunun sunulmasi amaclanmistir.

To evaluate the characteristics of patients with hepatitis B virus (HBV) infection and summarize the treatment modalities.By September 30, 2011 the data of 7871 HBsAg (+) patients were complied and analysed according to demographic and medical records (age, sex, laboratory tests, treatment with antiviral agents) in thirty centres of Turkey.Of the 7871 patients 3078 (39.1%) were females; mean (standard deviation) age was 35 (14) years, 3180 (40.4%) were HBsAg positive (+) after admission to a hospital, 1488 (18.9%) after blood donation and 967 (11.9%) were found during routine screening. The HBV prevalence among relatives of HBsAg (+) patients was 1764 (22.4%), and most frequently infected family members were siblings and mothers, 4961 (63.0%) and 2149 (27.3%), respectively). Anti-HDV was negative in 7407 94.1% of patients. Three-fourths of the patients 6383 (81.1%) were HBeAg negative (-). Mean (SD) ALT was 85.8 (266.4) U/L. Majority of patients, 5588 (71.0%) were chronic hepatitis-B patients under treatment, while 2283 (29.0%) were asymptomatic carriers without treatment and only 165 (2.1%) of patients were cirrhotic and 6612 (84.0%) of those were compensated. One-third of the patients 2983 (37.9%) were under a combined treatment, while others were under monotherapy. Lamivudine, entecavir and adefovir were the most frequently used oral therapies, used for 2583 (32.8%), 11.6% and 787 (10.0%) of patients, respectively), while 2975 (37.8%) of patients were under interferon treatment.Hepatitis B is still a problem in our country. First task of the physicians and our state should be to prevent the development and spread of the disease with education and vaccination programs, safe blood transfusions, and control of barbers.

Tufan, Zeliha Kocak/0000-0002-3294-014X; demirdal, tuna/0000-0002-9046-5666; Inal, Ayse Seza/0000-0002-1182-7164; ULCAY, ASIM/0000-0003-0531-0668; Pappas, Georgios/0000-0002-8425-6091; Mete, Bilgul/0000-0001-9091-6087; Karakas, Ahmet/0000-0002-0553-8454 WOS: 000314656100004 PubMed: 23210984 No detailed data exist in the literature on the accurate diagnosis of chronic brucellar meningitis or meningoencephalitis. A multicentre retrospective chart review was performed at 19 health centres to determine sensitivities of the diagnostic tests. This study included 177 patients. The mean values of CSF biochemical test results were as follows: CSF protein, 330.64 +/- 493.28mg/dL; CSF/ blood-glucose ratio, 0.35 +/- 0.16; CSF sodium, 140.61 +/- 8.14mMt; CSF leucocyte count, 215.99 +/- 306.87. The sensitivities of the tests were as follows: serum standard tube agglutination (STA), 94%; cerebrospinal fluid (CSF) STA, 78%; serum Rose Bengal test (RBT), 96%; CSF RBT, 71%; automated blood culture, 37%; automated CSF culture, 25%; conventional CSF culture, 9%. The clinician should use every possible means to diagnose chronic neurobrucellosis. The high seropositivitiy in brucellar blood tests must facilitate the use of blood serology. Although STA should be preferred over RBT in CSF in probable neurobrucellosis other than the acute form of the disease, RBT is not as weak as expected. Moreover, automated culture systems should be applied when CSF culture is needed.

Neurobrucellosis (NB) is a rare, but important complication of brucellosis. The clinical features vary greatly and, in general, tend to be chronic. Many laboratory procedures are usually employed in the diagnosis of NB. Even though the culture method is the gold standard, growth rate is low and time consuming. Thus the rate of sequelae and mortality increase in case of a delay in treatment. Therefore it is necessary to perform serological tests in both serum and cerebrospinal fluid (CSF) in suspected patients. In this study we aim to evaluate clinical features, diagnosis, and treatment of patients with NB.We enrolled 17 patients diagnosed with NB. Clinical features, cultures, serological tests, additional laboratory findings, and CSF analyses were recorded for all patients.There were 14 female and 3 male patients. Ten patients presented with neuropsychiatric symptoms and signs (aphasia, diplopia, hemiparesis, facial paralysis, tremor, ataxia, depression, personality disorder, and hallucinations). Serum standard agglutination test (SAT) was negative in 4 (23.5%) patients and serum Coombs' test was negative in 2 (11.7%). CSF SAT was negative in 4 (23.5%) patients and CSF Coombs was negative in 3 (17.6%) patients. B. melitensis grew in the blood of 6 (35.2%) patients and in the CSF of 3 (17.6%). Treatment protocol for 11 patients consisted of ceftriaxone, rifampicin, and doxycyline for a period of four weeks, followed by rifampicin and doxycyline for an additional four weeks. The remaining patients were given different treatment combinations. One patient died, mild sequelae was present in another patient and the remaining patients recovered without any sequelae.NB should be considered in the differential diagnosis of neurological and psychiatric cases that are encountered in endemic areas for brucellosis. In order to prevent overlooking this diagnosis, Coombs' test should be performed in both CSF and serum.

WOS: 000306663800009, PubMed ID: 22727531, Brucella endocarditis (BE) is a rare but life-threatening complication of human brucellosis. The aim of this study was to investigate the course of BE along with the therapeutic interrelations. A total of 53 patients with BE hospitalised in 19 health institutions between 2006 and 2011 were included in the Gulhane study. Diagnosis of brucellosis was established by either isolation of Brucella sp. or the presence of antibodies, and the definition of endocarditis was made according to Duke's criteria. There were four treatment groups: ceftriaxone combined with oral antibiotics (Group 1); aminoglycosides combined with oral antibiotics (Group 2); oral antibiotic combinations (Group 3); and aminoglycoside plus ceftriaxone combined with an oral antibiotic (Group 4). Involvement rates of the aortic, mitral and tricuspid valves were 49.1%, 43.4% and 5.7%, respectively. Thirty-two patients (60.4%) had an underlying cardiac valvular problem, including previous prosthetic valve replacement (n = 18). Medical treatment was provided to 32 patients (60.4%), whilst concordant medical and surgical approaches were provided to 21 patients (39.6%). Mortality in Group 1 was 15% (3/20), whilst in Group 2 it was 5.3% (1/19). In Group 3, 25.0% (3/12) of the cases died, whereas none of the cases in Group 4 died. In conclusion, mortality increased 47-fold with pericardial effusion and 25-fold due to congestive heart failure that developed after BE. Although mortality was lower in the aminoglycoside-containing arm (Groups 2 and 4), statistical analysis could not be performed owing to the small number of patients. (C) 2012 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

The aim of the study was to investigate the mast cell (MC) concentration in the liver tissue of patients diagnosed with chronic hepatitis C and to determine whether there was a correlation with clinical and pathological characteristics of patients.The study was conducted on liver biopsy samples from 60 patients with chronic hepatitis C. Clinical and laboratory data were obtained from follow-up records. Stained liver biopsies were examined. Immunohistochemical staining was performed by using an anti-c-kit antibody. Patients were divided into four groups (minimal, mild, moderate, and severe) based on the intensity of inflammation and their hepatic activity index scores and into two groups (no-mild, moderate-severe) according to fibrosis grade.Among patients enrolled, 60.0% (n=36) were men with a mean age of 48.3 ± 12.7 (range 18-64) years. The mean number of mast cells per portal area in the liver was 0.87 ± 0.86 (0-4.0). No correlation was found between alanine aminotransferase (ALT) and hepatitis C virus (HCV). Ribonucleic acid ( RNA ) levels and the degree of inflammation of cases with number of mast cells and liver steatosis (P0.05). As the degree of fibrosis increased in the liver so did the number of mast cells in portal areas (P=0.001). On the other hand, no correlation was found between the degree of fibrosis and the number of MCs in the sinusoids and steatosis (P0.05). The increase in the number of MCs in the portal areas correlated with an increase in liver steatosis (t: 0.02, P=0.04).In light of these findings, it appears possible that MC accumulation in chronic HCV patients may be used as an indicator of fibrosis and possibly be considered in the follow-up of these patients.

PubMed ID: 22155822, No data on whether brucellar meningitis or meningoencephalitis can be treated with oral antibiotics or whether an intravenous extended-spectrum cephalosporin, namely, ceftriaxone, which does not accumulate in phagocytes, should be added to the regimen exist in the literature. The aim of a study conducted in Istanbul, Turkey, was to compare the efficacy and tolerability of ceftriaxone-based antibiotic treatment regimens with those of an oral treatment protocol in patients with these conditions. This retrospective study enrolled 215 adult patients in 28 health care institutions from four different countries. The first protocol (P1) comprised ceftriaxone, rifampin, and doxycycline. The second protocol (P2) consisted of trimethoprim-sulfamethoxazole, rifampin, and doxycycline. In the third protocol (P3), the patients started with P1 and transferred to P2 when ceftriaxone was stopped. The treatment period was shorter with the regimens which included ceftriaxone (4.40 ± 2.47 months in P1, 6.52 ± 4.15 months in P2, and 5.18 ± 2.27 months in P3) (P = 0.002). In seven patients, therapy was modified due to antibiotic side effects. When these cases were excluded, therapeutic failure did not differ significantly between ceftriaxone-based regimens (n = 5/166, 3.0%) and the oral therapy (n = 4/42, 9.5%) (P = 0.084). The efficacy of the ceftriaxone-based regimens was found to be better (n = 6/166 [3.6%] versus n = 6/42 [14.3%]; P = 0.017) when a composite negative outcome (CNO; relapse plus therapeutic failure) was considered. Accordingly, CNO was greatest in P2 (14.3%, n = 6/42) compared to P1 (2.6%, n = 3/117) and P3 (6.1%, n = 3/49) (P = 0.020). Seemingly, ceftriaxone-based regimens are more successful and require shorter therapy than the oral treatment protocol. Copyright © 2012, American Society for Microbiology. All Rights Reserved.

Amac: Bu arastirmada, mevsimlik tarim iscilerinin yogun olarak yasadiklari bir aile sagligi merkezi bolgesinde gebelerde HbsAg pozitifligi duzeyini ve etkileyen faktorleri ortaya koymak amaclanmistir. Yontem: Kesitsel tipteki bu calisma, Sanliurfa Zeliha Oncel Aile Sagligi Merkezi (ASM) bolgesinde Ekim 2011-Ocak 2012 tarihleri arasinda yapilmistir. Calismaya kayitli ve takipli olan tum gebeler(N=261) dahil edilmistir. Gebelere yapilandirilmis soru formu uygulanmistir. HBsAg ve anti-HBs sonuclari ASM kayitlarindan alinmistir. Bulgular: Tum gebelerde Hepatit B sikligi %3.2’ dir. HBsAg pozitifligi mevsimlik tarim iscilerinde 5.1 kat, ailesinde hepatit B hastaligi bulunan gebelerde 18.9 kat daha fazla gorulmektedir (P < 0.05). Sonuc: Mevsimlik tarim iscileri hepatit B acisindan onemli bir risk grubudur. Temel saglik hizmetleri mevsimlik tarim iscileri icin erisilebilir hale getirilmeli ve hizmet taleplerini arttirmak icin saglik egitimleri yapilmalidir. Tum gebelere dogum oncesi bakim hizmeti saglanmali ve hepatit B'ye karsi duyarli olanlara asi onerilmelidir.

Summary AIM: The purpose is to determine the cut-off value of adenosine deaminase (ADA) activity in cerebrospinal fluid (CSF) of patients with tuberculous and non-tuberculous meningitis, and to assess its value in differential diagnosis. MATERIAL AND METHODS: This study was conducted in 91 patients with meningitis in two university hospitals in Turkey. 24 patients had tuberculous meningitis (TBM), 25 purulent meningitis (PM), 25 aseptic meningitis (AM) and 17 neurobrucellosis (BM). ADA activity of CSF was quantified by colorimetry. RESULTS: In our study, mean ADA values in CSF were 28.34 ± 14.83 IU/L in TB cases, 8.71 ± 5.83 IU/L in BM, 6.18 ± 2.54 IU/L in PM and 3.43 ± 3.48 U/L in AM cases. If we accept for CSF ADA an activity cut-off value of 12.5 IU/L for differential diagnosis of TBM and BM, its sensitivity was 92% and specificity was 88%. If we accept 12.35 IU/L for differential diagnosis of TBM and PM, its sensitivity was 92% and specificity was 100%. If we accept 6.45 IU/L for differential diagnosis of TBM and AM, its sensitivity was 100% and specificity was 92%. Additionally, we examined the cases after dividing them into two groups, viz. TB and non-TB. If we accept an ADA activity cut-off level of 11 IU/L for differential diagnosis of TB and nonTB by applying ROC analysis, its sensitivity was 92% and specificity was 90%. CONCLUSION: The sensitivity and specificity for CSF ADA activity are markedly high in differential diagnosis of TB from non-TB. Hence CSF ADA activity may be used as a simple, cost-effective and reliable test for early differential diagnosis of TB.

Amac: Bu calismada Guneydogu Anadolu Bolgesinde yer alan Sanliurfa'da HBV ve HCV seroprevalansinin ve iliskili risk faktorlerinin saptanmasi amaclandi. Gerec ve Yontemler: Kesitsel tipteki bu arastirma, Nisan 2008-Mayis 2008 tarihleri arasinda Sanliurfa il merkezinde yapildi. Kume ornekleme yontemi ile 19 farkli saglik ocagi bolgesinden toplumu temsil eden katilimcilar (N=1070) randomize secildi. Katilimcilara demografik ozelliklerini ve HBV ile HCV bulasmasinda risk olusturabilecek durumlari irdeleyen bir anket uygulandi ve HBsAg ve anti-HCV testleri yapildi. Bulgular: Arastirmaya dahil edilen 1070 kisinin %33.1'i (n=354) erkek, %66.9'u (n=716) kadin idi. Katilimcilarin yas ortalamasi 35.4p13.5 (15-90) yil idi. HBsAg seropozitifligi %4.2 (n=45), anti-HCV seropozitifligi ise %1.0 (n=11) olarak bulundu. Katilimcilardan sarilik gecirme oykusu verenlerde ve ailede sarilik olanlarda, olmayanlara gore HBsAg pozitifligi yuksek saptandi (pl0.05). HCV bulasina yonelik risk faktorlerinin anti-HCV pozitifligine etkisi istatistiksel olarak anlamli bulunmadi. Sonuc: Bu calisma, Sanliurfa il merkezinden yapilan ilk hepatit seroprevalans calismasidir ve HBV enfeksiyonu sikligi acisindan orta endemisite gostermektedir.

Summary Leptospirosis is an acute generalized infectious disease, caused by spirochaetes, Leptospira interrogans . The severity of the disease ranges from an asymptomatic subclinical course to a fatal outcome. The three cases presented here were diagnosed serologically and had thrombocytopenia and acute renal failure as complication of anicteric leptospirosis. Our first case admitted with clinical presentation of pneumonia but clinical progress and laboratory findings made us to consider leptospirosis. The other two cases presented with aseptic meningitis were diagnosed as anicteric leptospirosis by the serological test results. One of the cases had fatal outcome but could not be strictly correlated with leptospirosis.

Juniper tar (cade oil) is distilled from the branches and wood of Juniperus oxycedrus. It contains etheric oils, triterpene and phenols, and is used for many purposes in folk medicine. A case is reported of a previously healthy man who ingested a spoonful of home-made extract of Juniperus oxycedrus. The poisoning caused fever, severe hypotension, renal failure, hepatotoxicity, and severe cutaneous burns on the face. After supportive and symptomatic treatment, the patient improved and was discharged in a good condition on the eleventh day.