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Aim of the study The quantitative hepatitis B surface antigen (qHBsAg) level indicates the amount of transcriptional activity of covalently closed circular DNA (cccDNA) and integrated DNA in hepatocytes which plays a role in development of chronic hepatitis B (CHB) and may help decide whether the treatment is necessary or not. The aim of this study is to evaluate the association between serum qHBsAg levels and viral replication and stage of liver fibrosis in treatment-naive CHB patients and to determine the role of qHBsAg levels in predicting when liver biopsy is necessary. Material and methods 967 patients were included in the study. Because of refusal of liver biopsy the study was conducted on 123 patients. The association between qHBsAg levels with HBV DNA, a-fetoprotein, fibrosis stage and histology activity index was evaluated. Results Of the patients, mean age was 48 ±11.2 years and 56.1% were male. We found that patients with HBV DNA ≥ 2000 IU/ml had a higher qHBsAg titer in comparison with HBV DNA < 2000 IU/ml. However, there was no relationship between qHBsAg titer and liver necroinflammation or fibrosis stage. Conclusions Monitoring of qHBsAg together with HBV DNA may be helpful in CHB management. However, qHBsAg level does not provide knowledge about the timing of biopsy or the decision of CHB treatment.

Background: Infective endocarditis (IE) is an infection of the heart’s endocardial surface. In recent years, nuclear imaging methods have gained importance in the diagnosis of IE. The present study aims to investigate the imaging potential of 99mTc-labeled vancomycin (99mTc-Vancomycin) as a new agent that would enable the diagnosis of IE in its early stages when it is difficult to diagnose or has small vegetation in the experimental rat model. Methods: 99mTc-Vancomycin scintigraphy was evaluated for its accumulation in IE with Staphylococcus aureus performed in an experimental rat model. Serial planar scintigraphic and biodistribution analysis of infected vegetations are compared to rats with sterile vegetations. The heart was identified as an infected organ, the liver was identified as a non-infected organ and the heart/liver uptake ratio (T / NT ratio) was compared between infective endocarditis and sterile endocarditis groups. Results: Planar scintigrams (in vivo measurements) showed more uptake in the heart of rats in the infective endocarditis group compared to the uptake in the heart of rats in the sterile endocarditis group, but this difference was not statistically significant (p>0.05). From the ex vivo measurements, the 99mTc-Vancomycin heart uptake increased significantly (p = 0.016), liver uptake was significantly decreased (p = 0.045) and the T/NT ratio was significantly higher (p = 0.014) in the infective endocarditis group compared to the sterile endocarditis group. Conclusions: In this experimental study, 99mTc-Vancomycin scintigraphy ensured the detection of ex vivo infected tissue in a rat model of IE. In addition, the absence of significant 99mTc-Vancomycin uptake in the sterile endocarditis group indicates that this agent targeted the infected tissue instead of the sterile inflammatory tissue. Finally, this agent should also be evaluated with animal- specific imaging devices.

Background and study aims Rapid virologic response (RVR) is defined as undetectable hepatitis C virus (HCV) RNA in serum after 4 weeks of treatment for chronic hepatitis C (CHC). Paritaprevir/ritonavir/ombitasvir (PRO) and/or dasabuvir (D), with or without ribavirin [PRO (D) ± ribavirin], which are direct-acting antivirals (DAAs), is the currently approved treatment regimen for CHC genotype 1; this regimen can also be used in patients with end-stage renal failure (ESRF). In this study, we aimed to evaluate the effect of pretreatment factors on RVR in patients treated with PRO (D) ± ribavirin. Patients and methods This study included 60 patients with CHC genotype 1 who were treated with PRO (D) ± ribavirin and achieved RVR. Patients’ demographic data; baseline HCV RNA levels; HCV genotype information; biochemical, histologic, and radiologic results; and previous treatment history were recorded. Patients were categorized into two groups: virologic responses achieved in the first week (group 1) and in the first to the fourth week (group 2). Pretreatment factors were compared between the groups. Results Patients in group 1 who achieved ultraRVR (undetectable HCV RNA after 1 week of treatment) had significantly lower mean pretreatment HCV RNA levels and lower prevalence of ESRF than patients in group 2. Conclusions RVR has been indicated to be a robust positive predictor of sustained virologic response. We concluded that some pretreatment factors such as low HCV RNA level and absence of ESRF might lead to faster RVR and shorter treatment duration with DAAs for CHC.

Background and Aim: Hepatitis C virus transmission continues to be a significant public health concern in patients undergoing hemodialysis and occasionally causes outbreaks despite risk reduction after the anti-HCV screening. This study aimed to investigate an outbreak of hepatitis C virus in the hemodialysis unit to identify the infection source and underline lapses in the infection control practices. Material and Methods: Patients and staff were assessed for hepatitis C virus infection after the outbreak. All anti‐HCV-positive patients were tested for genotype or subtypes by performing a phylogenetic analysis of NS3 sequences. The current infection control applications and possible risk factors in the unit were examined to determine the source of infection. Results: Overall, 115 patients, including three patients who were followed up for chronic hepatitis C infection, were evaluated. Anti‐HCV seroconversion was detected in 10 new patients. All patients were in the same room and during the same shift. Several lapses in infection control practices were observed. Phylogenetic analysis showed that the outbreak was caused by the same viral strain. Notably, all patients were infected with genotype 1a, and mutations in the NS3 region, subgenotype, and drug resistance were identical to one of the three patients with chronic hepatitis C. Conclusion: Direct observation and molecular test results indicated a transmission from patient to patient, thereby highlighting the importance of infection control.

Background: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are widespread health problems all over the world and have high morbidity and mortality. Hemodialysis patients are more frequently exposed to these viruses as they have poor immune system and frequently undergo parenteral interventions. The vaccination against HBV prevents infection and it has been recommended for the prevention of HBV infection in all susceptible dialysis patients. This study aimed to determine the seroprevalence of HBV and HCV infections and analyzed the factors affecting inadequate response to HBV vaccine in dialysis patients. Methods: The data for 584 dialysis patients that were followed up at seven dialysis centers were analyzed. The patients received four doses of 40 μg recombinant hepatitis B vaccine at 0, 1, 2, and 6 months and were tested for anti-HBs titer after one month of completion of vaccination. If patients showed a titer of anti-HBs 30 (p = 0.019), over the age of 65 years (p = 0.009), and duration of dialysis treatment >5 years (p = 0.001). There was no statistically significant difference between gender, causes of renal disease, erythropoietin treatment, and the type of dialysis. Conclusion: Hepatitis C infection, obesity, being elderly, and having long hemodialysis period reduced the hepatitis B vaccination response in hemodialysis patients. © 2017, Springer Science+Business Media Dordrecht.

Background: Leptospirosis is a zoonotic disease caused by spirochetes of the genus Leptospira. While the majority of leptospirosis cases occur in the tropics, some cases are also observed in temperate regions of developing countries. The disease has various clinical presentations ranging from a mild influenza-like form to a severe potentially fatal illness accompanied by multi-organ failure. However, atypical presentations of leptospirosis have occasion­ally been described. Here, a case of leptospirosis presenting as thrombotic thrombocytopenic purpura (TTP) is reported. Case Report: A 58-years-old male presented with fever, oliguria, darkening of urine, and visual hallucinations. Laboratory investigations revealed anaemia, severe thrombocytopaenia, elevated total bilirubin with indirect predominance, high lactate dehydrogenase, and increased urea (293 mg/dL) and creatinine (7.6 mg/dL) levels. He was diagnosed with TTP. Patient was thought leptospirosis due to atypical clinical manifestations. Leptospirosis was confirmed by strongly positive Microscopic Agglutination Test. Patient recovered completely with antibiotics and plasmapheresis. Conclusion: Leptospirosis may be accompanied by thrombotic thrombocytopenic purpura in particular subtropic regions. Turkish Başlık:Trombotik Trombositopenik Purpurayla Seyreden Bir Leptospiroz Olgusu Anahtar Kelimeler:Leptospiroz, Weil hastalığı, trombotik trombositopenik purpura Arkaplan: Leptospiroz, leptospira cinsi spiral mikroorganizmalar tarafından oluşturulan bir zoonozdur. Leptospiroz sıklıkla tropikal bölgelerde görülmesine rağmen, gelişmekte olan ülkelerde ılıman bölgelerde de rastlanabilmektedir. Hastalık asemptomatik enfeksiyondan ciddi, ölümcül seyredebilen çoklu organ yetmezliğine kadar geniş klinik yelpaze görülür. Bununla birlikte atipik başvuru nadiren görülmektedir Olgu Sunumu: Elli sekiz yaşında erkek olgu ateş yüksekliği, idrar renginde koyulaşma ve görsel halüsinasyonla başvurdu. Laboratuvar incelemesinde anemi, ciddi trombositopeni,indirek hakimiyeti olan bilirubin yüksekliği, yüksek laktat dehidrogenaz, yüksek üre (293 mg/dL) ve kreatinin (7.6 mg/dL) düzeyleri mevcuttu. TTP tanısı aldı. Atipik klinik şekilli leptospiroz düşünüldü. Leptospirozis tanısı yüksek pozitif mikroskopik aglütinasyon testi ile doğrulandı. Hasta antibiyotik tedavisi ve plazmaferezle tamamen iyileşti. Sonuç: Özellikle subtropik bölgelerde, leptospiroz trombotik trombositopenik purpurayla birliktelik gösterebilir.

Objective: This study was designed to determine the efficacy and safety of Entecavir (ETV) after 96 weeks treatment in patients with chronic viral hepatitis B (CHB). Methods: Thirty-eight patients were included into the study. The criteria for starting ETV treatment were as follows: elevated ALT levels >upper limit of normal (ULN) two times, with HBV-DNA levels ≥5 log10 copies/ml (≥20000 IU/mL), in HBe Ag positive patients, ≥4log10 copies/ml (≥2000IU/mL) in HBe Ag negative patients and liver damage was confirmed by histopathology (Knodell HAI ≥4 or fibrosis ≥1). Patients were followed up every 12 weeks by virological and biochemical tests. Results: Twenty-four of 38 patients (63.2%) were male. Mean age of patients were 38.6 years, 14 of them were HBeAg positive (36.8%). At baseline, median ALT level was detected as 106.7 IU/ml, median HBV DNA levels were 4.8 x 107 copy/ml, and mean Knodell HAI score was nine. Eleven of 14 HBe Ag positive patients (78.6%) were treatment-naïve. No resistance mutation was determined during treatment. Biochemical responses (BR) at 48th and 96th week were 100% and virologic response (VR) were 57.1%, and 50%, respectively. Serological response (SR) at 48th and 96th weeks were 35.7% and 42.8% respectively. Fifteen (62.5%) of 24 HBe Ag negative patients were treatment-naïve; two patients were detected to have lamivudine resistance mutation. At 48th and 96th week, BR was 95.8%, and 100%, respectively; and VR were 83.3% both. Conclusion: In our study, virologic response was significantly high after two years of therapy with Entecavir in HBe Ag negative patients., Amaç: Bu çalışmada kronik hepatit B hastalarında 96 haftalık Entekavir (ETV) tedavi etkinliğinin ve güvenliğinin değerlendirilmesi amaçlandı.Yöntemler: Kronik Hepatit B tanısıyla 38 hasta çalışmaya alındı. Entekavir tedavisine başlama kriterleri: yükselmiş ALT düzeyleri, (>normalin iki katında fazla), HBe Ag pozitif hastalarda HBV DNA ≥5 log10 kopya/ml (≥20000 IU/ml), HBe Ag negatif hastalarda ≥4 log10 kopya/ml (≥ 2000 IU/ml) karaciğer hasarının histopatolojik olarak gösterilmesi (Knodell HAİ ≥4, fibrozis ≥1). Hastalar 12 haftada bir biyokimyasal ve virolojik testlerle takip edildi. Bulgular: Hastaların 24’ü (%63,2) erkekti. Yaş ortalaması 38,6 yıldı. Tüm hastaların 14’ünde (%36,8) HBe Ag pozitifti. Başlangıç ortalama ALT düzeyleri 106,7 IU/ml, HBV DNA düzeyleri 4,8 x 107 kopya/ml ve Knodell HAI skoru dokuz idi. HBe Ag pozitif hastaların 11’i (%78,6) naivdi. Hiçbirinde direnç mutasyonu yoktu. Biyokimyasal yanıt (BY) 48. ve 96. haftalarda %100, virolojik yanıt (VY) sırasıyla %57,1 ve %50 idi. Serolojik yanıt (SY) sırasıyla %35,7 ve %42,8 olarak saptandı. HBeAg negatif hastaların 15’i (%62,5) naivdi; iki hastada lamuvidin direnç mutasyonu saptandı. Kırksekizinci ve 96. haftalarda sırasıyla BY %95,8 ve %100, VY %83,3 saptandı.Sonuç: Çalışmamızda iki yıllık entakavir tedavisi sonucunda, özellikle HBe Ag negatif hastalarda tedaviye yüksek oranda yanıt sağlanmıştır

Objective: In this study, we aimed to determine the rate of spontaneous hepatitis B sur - face antigen (HBsAg) seroclearance in inactive chronic hepatitis B virus (HBV) carriers. We com - pared demographic and laboratory characteristics between the patients with and without seroclearance. Material and Methods: This study included retrospective evaluation of 2428 patients with chronic hepatitis B (CHB). The patients with HBsAg positivity for at least 6 months with HBV- DNA levels lower than 104 copies/ml, with normal serum alanine transaminase (ALT) levels, neg - ative for HBeAg, and with detectable anti-HBe antibodies were enrolled in the study. HBsAg seroclearence rates were determined, and the groups with and without seroclearance were com - pared in demographic and laboratory aspects. Results: The annual rate of spontaneous HBsAg se - roclearance in the study group was 0.17%. Among patients with seroclearance, the annual rate of seroconversion was 1%. There was no statistically significant difference between groups for demo - graphic characteristics. HBV DNA levels were significantly lower in patients with seroclearance (p

Hepatitis B infection is one of the infectious diseases quite common in Turkey and around the world. Hepatitis B virus infection is a significant health problem which may cause chronic hepatitis, cirrhosis and hepatocellular carcinoma. With the introduction of Hepatitis B vaccine, a significant progress has been made in the prevention of HBV infections. The purpose of the study was to evaluate the characteristics of the individuals included in the risk group who admitted to our vaccination clinic, as well as their immune responses following the vaccination. Among the patients admitted to the vaccination clinic of our hospital between January 2003-December 2005 and that were included in the risk group (patients who have family members with chronic Hepatitis B infection, healthcare workers, hemodialysis patients, etc.,) those who were included in the vaccination program by examining the results of HBs Ag, anti-HBc and anti-HBs were evaluated in terms of their characteristics (age, gender, smoking, etc.,) and results of Anti-HBs score. A total of 958 people were included in the vaccination program. Upon evaluation in terms of risk factors, presence of patients with chronic hepatitis B infection in the family was found to be 80.6% (772/958), being healthcare worker was 9.2% (88/958), HCV positivity and chronic liver disease was 3.0% (29/958), being a hemodialysis patient was 2.8% (27/958), and being an oncology patient was 2.1% (20/958). Post-vaccination immune response could be evaluated in 69.8% (669/958) of patients and no responsiveness to vaccine was detected only in 8.1% (54/669) of them. Of the non-responders, 64.8% (35/54) were hemodialysis and oncology patients. Anti-HBs positivity rate following hepatitis B vaccination program was found compatible with the results of previous studies. With this vaccine of considerably high effectiveness, immunization of the entire community including primarily the risk groups should be targeted.