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Liver biopsy is still the gold standard for the determination of liver fibrosis and necroinflammatory activity. It is an invasive method and may lead to severe complications. The aim of this study was to determine the evaluation of percutaneous liver biopsy complications in patients with chronic viral hepatitis.1165 patients, who were followed with the diagnosis of chronic viral hepatitis and who were applied percutaneous liver biopsy between January 2000 and February 2013 at the out-patient clinic of Infectious Diseases and Clinical Microbiology, were included in the study.Of 1165 patients who underwent liver biopsy, 196 (86 male, 110 female) were diagnosed with chronic hepatitis C, 969 (559 male, 410 female) were diagnosed with chronic hepatitis B. The mean age was 43.3 and 55.4% were male. 11% of the patients were diagnosed with chronic renal failure and underwent haemodialysis. Minor complication rate was about 20% (severe pain required usage of analgesic drugs in 19.8%, abdominal pain in 22.6%) whereas major complication rate was 1.15% (pneumothorax in 0.17%, heamobilia in 0.08%, hematoma in 0.9%). We did not observe severe complications such as fever, abscess, anaphylaxis, bacteraemia, organ perforations, sepsis or death.Despite being an invasive procedure, percutaneous liver biopsy can be considered a safe method because of the low rates of severe complications observed in our patients.Karaciğer biyopsisi karaciğer fibrozisi ve nekroinflamatuvar aktivitesini belirlemede günümüzde halen altın standart olarak kabul edilmektedir. Ancak invaziv olması nedeniyle ciddi komplikasyonları olabilen bir işlemdir. Bu çalışma ile perkütan karaciğer biyopsisi yapılan kronik viral hepatitli hastalarda biyopsiye bağlı komplikasyonların değerlendirilmesi amaçlanmıştır.Ocak 2000–Şubat 2013 tarihleri arasında İzmir Tepecik Eğitim ve Araştırma Hastanesi Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Kliniğinde kronik viral hepatit tanısı ile izlediğimiz ve karaciğer biyopsisi yapılan 1165 hasta retrospektif olarak incelendi.Karaciğer biyopsisi yapılan 1165 hastanın 196’sı (86 erkek, 110 kadın) kronik hepatit C, 969’sı (559 erkek, 410 kadın) kronik hepatit B tanılı idi. Hastaların yaş ortalaması: 43,3, %55,4’ü erkek, %11’i kronik böbrek yetmezliği tanısı ile hemodiyalize giriyordu. Hastaların yaklaşık beşte birinde minör komplikasyonlar gözlenirken (%19,8’inde analjezik gereksinimi olan ağrı, %22,6’sında sağ üst kadran ve sağ kola vuran ağrı), majör komplikasyon oranı %1,15 idi (%0,17’sinde pnömotoraks, %0,08’inde hemobiliya, %0,9’unda hematom). Ateş, abse, anaflaksi, bakteriyemi, organ perforasyonu, sepsis, ölüm gibi komplikasyonlar görülmedi.Perkütan karaciğer biyopsisi invaziv bir işlem olmasına rağmen hastalarımızda görülen ciddi komplikasyon oranı düşüktür, bu nedenle güvenli bir işlem olarak kabul edilebilir.

WOS: 000347140200009, PubMed ID: 25622485, The purpose of this study was to determine prevalence of natural rubber latex (NRL) allergy among healthcare employees and identify sensitive individuals. A total of 1,115 healthcare workers (HCWs) employed in Izmir Tepecik Education and Research Hospital participated in the study. Information on age, gender, occupation, history of allergy, and complaints were collected through a questionnaire. Serum latex-specific IgE level was determined. Among HCWs enrolled in the study, prevalence of latex sensitization was determined as 4.2%. More frequent occurrence of latex allergy was detected among nurses. Family history of allergy and history of personal food allergy were significantly more often noted among individuals with latex allergy. Latex is considered to be the leading source of occupational health problems.

Background: The aim of this study is to investigate the association between hepatic activity index (HAI) and fibrosis score (FS) with inflammation biomarkers in non-uremic and uremic hepatitis C positive patients. Methods: Fifty chronic hepatitis C (cHepC) positive patients, having a liver biopsy were included in this study. Liver biopsies were scored according to modified ISHAC scoring system. 25 healthy controls of similar age and gender were also enrolled as control group. Serum YKL-40, neutrophil/lymphocyte ratio (NLR), thrombocyte/lymphocyte ratio (PLR), CRP and Immunoglobulin (IgG, A and M) levels were used to determine inflammation. AST to Platelet Ratio Index (APRI) score was also evaluated. According to biopsy findings patients were divided into 2 groups: low (0–2) and severe (3–6) FS. Results: Patients with cHepC had increased inflammation compared to the healthy controls. End-stage renal disease (ESRD) patients had higher levels of inflammation markers (NLR, IgG, CRP and YKL-40) and lower HCV RNA levels, HAI and FS compared to non-uremic patients. When patients were grouped into 2 according to FS as mild and severe, IgG (p < 0.001), YKL-40 (p = 0.02) levels and APRI score (p = 0.002) were significantly higher compared to mild FS (p = 0.002). YKL-40 levels (t value: 3.48; p = 0.001) and APRI score (t value: 4.57, p < 0.001) were found as independent associated with FS in non-uremic patients. However, in adjusted models, only APRI score (t value: 3.98, p = 0.002) was an independent associated with FS in ESRD patients. Conclusion: In non-uremic cHepC patients, YKL-40 levels and APRI score may be valuable markers of FS. In ESRD patients, there is not sufficient data for prediction of HAI and FS. In these patients, APRI score may provide better information.

Plasmodium falciparum may cause serious and sometimes even fatal cerebral malaria. Cerebral malaria is a disease characterized by alterations in consciousness and epileptic attacks; therefore, it requires a rapid evaluation and quick intervention. It may progress to a fatal outcome despite administering targeted therapeutic interventions. There are studies indicating that erythrocyte exchange (erythrocytapheresis) can be a treatment modality for managing severe malaria patients. In this case report, the successful management of a cerebral malaria patient by the combination of antimalarial drug therapy and erythrocyte exchange is presented.

Objectives: The aim of this study was to evaluate histopathological improvement and virological, biological and serological response rates in patients receiving long-term entecavir therapy who were followed with the diagnosis of chronic hepatitis B (CHB).Materials and Methods: Ninety-eight nucleoside(t)e-naive CHB patients who were receiving 0.5mg/day entecavir (ETV) were included in the study. Virological, serological and biochemical test results were assessed baseline and every 12-week intervals. Liver biopsy specimens were assessed according to the modified Ishak scoring.Results: Forty-six CHB patients receiving ETV treatment underwent liver biopsy. The mean age of the patients was 4412.9, 26.1% of them were female. The mean duration of follow-up was 44.9 +/- 10.8months. All patients had hepatitis B virus (HBV) genotype D infection. Of 21 patients who were HBeAg positive at baseline, HBeAg loss occurred in 9 and seroconversion occurred in 5. HBsAg loss occurred in none of the patients. Serum HBV DNA levels became undetectable in 93.5% patients. Of the patients, 50% achieved2 point improvement in HAI scores and 30.4% achieved1 point improvement in fibrosis scores with treatment. The mean improvement in HAI and fibrosis score were 1.94 +/- 1.93 and 0.11 +/- 0.9 points, respectively.Conclusion: ETV is an effective treatment in histological improvement and virological response in CHB patients. Large-scale, long-term studies are still warranted to evaluate the long-term outcomes of entecavir therapy.

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: Recently, the prevalence of infections by multi-drug resistant Gram-positive cocci has increased. This leads to therapeutic problems in conditions caused by these organisms. Quinupristin/dalfopristin, which is not in clinical use in Turkey, is the first parenteral streptogramin antibiotic. We aimed to investigate the susceptibility of quinopristin/dalfopristin to Gram-positive cocci isolated from clinical samples and compare it with susceptibility to other antibiotics that are used to treat Gram-positives cocci, aiming to determine the efficacy of this antibiotic. Materials and Methods: Between June 2008 and June 2009, 279 Gram-positive cocci isolated from clinical samples were included in the study. Bacteria were identified by conventional methods and automatized Vitek 2 (Biomerieux, France) system. Antimicrobial susceptibility was measured by Kirby-Bauer disk diffusion test. Methicillin resistance was detected by measuring sefoxitin susceptibility according to Clinical and Laboratory Standards Institute (CLSI) criteriae. The minimum inhibitory concentration (MIC) of penicillin, vancomycin, teikoplanin, linezolide and quinupristin-dalfopristin was detected by the E-test (AB Biodisk, Solna, Sweden). Results: Coagulase negative staphylococcus (CoNS) (103), Staphylococcus aureus (94), enterococci (50), Streptococcus pneumoniae (21) and other streptococcal strains (11) were included in the study. The susceptibility rates were 100% for methicillin sensitive staphylococci, 93% for methicillin resistant Staphylococcus aureus (MRSA), 98.1% for methycilline resistant coagulase negative staphylocci (MRCoNS), 17.1% for Enterococus faecalis, 80% for Enterococcus faecium, 85.7% for Streptococcus pneumoniae and 100% for other streptococci. All Gram-positive cocci were susceptible to glycopeptides except the two vancomycin resistant E. faecieum isolates. Conclusion: We investigated the susceptibility of Gram-positive cocci to quinupristin/dalfopristin and other antibiotics. High susceptibility of Gram-positive cocci to quinupristin/dalfopristin may allow the use of this drug as an alternative in infections due to multidrug resistant pathogens. However, further studies are required to evaluate the clinical use.

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