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    Antiviral Treatment Results and Side Effects During Treatment in Chronic Hepatitis B Patients
    (Doc Design Informatics Co Ltd, 2021) Bulut, Rukiyye; Kurt, Esma Kepenek; Kandemir, Bahar; Erayman, Ibrahim; Bitirgen, Mehmet
    Objective: Hepatitis B virus is an important health problem leading to chronic hepatitis, cirrhosis, and hepatocellular carcinoma. This study aimed to compare the efficacy and side effects of antiviral drugs used in chronic hepatitis B (CHB). Methods: Five hundred seventy-two patients who were followed and treated with CHB in our clinic were evaluated retrospectively. Results: Fifty-six point five of 572 patients were male, 43.5% were female, and the mean age of the patients was 43.4 +/- 12.4. Of the patients, 153 (26.8%) used tenofovir disoproxil fumarate (TDF), 134 (23.4%) telbivudine (LdT), 114 (20%) entecavir (ETC), 92 (16%) lamivudine (LAM), 26 (4.5%) adefovir (ADV), 27 (4.7%) pegylated interpheron alpha (PEG-IFN-alpha), and 26 (4.6%) used PEG-IFN-alpha + nucleoside analogue (NA). No significant difference was detected between the treatment groups in terms of age, sex ratio, fibrosis, histological activity index (HAI) score, baseline platelet, international normalized ratio (INR), alpha-fetoprotein (AFP) values (p>0.05). Seventy (12.3%) of 568 patients were HBeAg (+), 498 (87.7%) were HBeAg (-). At the end of the first year, the virological response rates were 92.5% in LdT, 82.6% in LAM, 72.8% in ETV, 60.7% in TDF, 26.9% in ADV, 22.2% in PEG-IFN-alpha, 65.3% in PEG-IFN-alpha+NA groups. Twenty-three point eight of the patients had treatment changes, and 76.3% of these patients preferred TDF as a new treatment. Virological breakthrough was observed at 43.5% in LAM, 13.4% in LdT, 7% in ETV and 0.6% in TDF groups. At the end of 3, 4, and 5 years without treatment change, all patients who continued TDF, ETV, LdT, ADV, and LAM treatment were HBV DNA negative. HBsAg clearance developed in 13 (2.3%) patients. At least one side effect was observed in 169 (29.5%) of all patients, and the group with the most frequent side effects was PEG-IFN-alpha+NA (92.3%) and PEG-IFN-alpha (77.8%). Amylase increase in LAM (%3.2), CPK increase in LdT (%27.6), CPK increase in TDF (%3.2) groups were the most common side effects. Conclusions: The drug with the lowest virological response rate and the most common side effect is PEG-IFN-alpha, so its use should be limited to selected patient groups. Treatments with the lowest incidence of side effects and development of resistance were found to be with TDF and ETV. Considering the high virological response rates, TDF and ETV should be preferred in the treatment of CHB. When all treatments are evaluated, HBsAg loss and cure rates are inadequate.
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    An association between immune status and chest CT scores in COVID-19 patients
    (Wiley, 2021) Colkesen, Fatih; Poyraz, Necdet; Arslan, Sevket; Yilmaz, Pinar Diydem; Kurt, Esma Kepenek; Korkmaz, Celalettin; Yildiz, Eray
    Background The characteristic features of the immune responses of COVID-19 patients and how they reflect lung involvement have not been clearly elucidated. Aim The aim of this study was to examine the immune status and the correlations thereof with chest CT scores and lung involvement of patients with COVID-19. Methods In this retrospective and single-center study, 72 patients with laboratory-confirmed COVID-19 were recruited. The counts of peripheral lymphocyte subsets (CD3(+) T cells, CD4(+) T cells, CD8(+) T cells, CD19(+) B cells and CD16(+) 56(+) NK cells) and those of serum immunoglobulins (IgA, IgG, IgM) were measured and their associations with chest CT scores analysed. Results The proportions of lymphopenia in patients with extensive lung involvement were twice that in the general study population. In the severe disease group, the levels of total lymphocytes, T cells, B cells, NK cells; and serum IgA levels, were significantly lower than in the mild disease group (all P < .05). We found that the numbers of lymphocyte subsets and the IgA level negatively correlated with the chest CT scores. On multivariate regression analysis, pretreatment decreases in total lymphocytes, CD3(+) T cells, CD4(+) T cells, and CD19(+) B cells, and serum IgA levels, were independent predictors of severe lung involvement. Conclusions The cell numbers of peripheral lymphocyte subsets and the serum IgA level were negatively correlated with the chest CT scores in COVID-19 patients. These parameters tended to independently predict severe lung involvement in such patients.
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    Comparison of Clinical and Laboratory Findings and Computed Tomography Findings of SARS-CoV-2 Infected Patients Followed-up in a Tertiary University Hospital
    (Galenos Publ House, 2021) Kurt, Esma Kepenek; Kandemir, Bahar; Erayman, Ibrahim; Vatansev, Hulya; Zamani, Adil; Yosunkaya, Sebnem; Demirbas, Soner
    Introduction: The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection is a pandemic, a major global health concern. In this study, it was aimed to compare the clinical, laboratory and computed tomography (CT) findings of patients with SARS-CoV-2 infection followed up in our hospital. Materials and Methods: In this study, reverse transcriptase-polymerase chain reaction (RT-PCR) positive patients hospitalized between 01.03.2020-31.05.2020 were retrospectively analyzed. Computed tomography images of the patients were grouped as typical, indeterminate, atypical, and no pneumonia based on the Radiological Society of North America. After recording patient information on SPSS, clinical and laboratory findings of the patients were analyzed by comparing them to CT findings. Results: Among 237 RT-PCR positive patients, 104 (43.9%) were female and 133 (56.1%) were male. The mean age of the patients was 50.46 +/- 17.26 (18-92) years and the mean symptom onset time of the patients was 3.75 +/- 2.72 (median: 3) days. Eighty-seven of the patients (36.7%) had contact stories. Twenty-three (9.7%) patients were healthcare professionals. Of the patients, 49.8% had a comorbid disease. The most common referral complaint was cough with 66.7%. The most common treatment that patients received was hydroxychloroquine (96.2%). Anemia was detected in 61 (25.7%) patients, leukopenia in 104 (43.9%), lymphopenia in 25 (10.5%) and thrombocytopenia in 14 (5.9%). High rates were detected for C-reactive protein (CRP) in 221 (84%) patients, ferritin in 190 (80.2%) patients, D-dimer in 144 (60.8%) patients, fibrinogen in 147 (62%) patients and sedimentation (SED) in 172 (72.6%) patients. Headache was detected higher in patients with typical pneumonia findings in thorax CT (p=0.006). A statistically significant difference wasn't detected between other symptoms and CT findings. Leukocyte and neutrophil counts, SED, CRP, ferritin, D-dimer, fibrinogen, aspartate aminotransferase, and lactate dehydrogenase (p=0.001) levels were observed to be higher in patients with typical pneumonia findings on thorax CT. Conclusion: Some laboratory parameters, especially acute phase reactants, were found to be higher in patients with typical pneumonia on thorax CT compared to patients without pneumonia. In this viral infection, patients should be evaluated together with clinical, laboratory and CT findings.
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    Evaluation of Patients Infected with Human Immunodeficiency Virus Followed in Our Clinic
    (Bilimsel Tip Yayinevi, 2020) Kurt, Esma Kepenek; Kandemir, Bahar; Erayman, Ibrahim; Bulut, Rukiyye; Bitirgen, Mehmet
    Introduction: The number of people infected with human immunodeficiency virus (HIV) in our country is increasing day by day. In this study, epidemiological, clinical, laboratory features, treatment regimens and side effects of HIV/AIDS cases followed in our clinic were evaluated. Materials and Methods: Fifty-four patients who were followed up with HIV infection in our clinic between 2000-2018 were examined retrospectively. Results: Of the 54 patients, 18 (33.3%) were females and 36 (66.7%) were males. Mean age was 42.0 +/- 15.2 (18-70) years. Mean duration of the disease was median 3 (0.5-28) and the duration of clinical follow-up was 3.3 +/- 2.7 (0.5-10) years. A total of 44 (88%) patients had risky sexual contact, and nine women were infected by her husband. The first complaint of the patients for admission to our clinic was weakness (22.2%) and fever (9.3%). Patients were diagnosed most frequently during routine examinations (48%). Mean CD4 count of the patients at the time of admission was 317.2 +/- 247.7 (7-918) cell/mm(3), and HIV-RNA was median 61000 (0-30000000) copy/mL. The most frequent treatment was tenofovir disoproxil fumarate-emtricitabine and lopinavir/ritonavir (TDF-FTC and LPV/r) in 24.4% of the patients. Treatment was changed in 14 (25.9%) patients. In five patients, noncompliance to treatment and in five patients, side effects were encountered, and treatment was changed. Hyperlipidemia was the most common side effect (52.9%) in patients receiving treatment. Prophylaxis was given to 50% of the patients in terms of opportunistic infections at the beginning of treatment. One patient had gonococcal urethritis and one patient had HPV infection in the cervix. Four patients discontinued treatment and 46 patients continued treatment. One female patient was exitus. Conclusion: The number of HIV/AIDS patients, a chronic disease, is increasing also in our country. Early diagnosis of these patients should be made, and the disease should be controlled by providing access to treatment and suppression of viral load.
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    The Evaluation of the Relation Between Drug Compliance and Psychometric Tests in Chronic B Hepatitis Patients Who are Treated with Oral Antivirals
    (Galenos Yayincilik, 2019) Kurt, Esma Kepenek; Kandemir, Bahar
    Objectives: Hepatitis B is a viral infection that causes acute and chronic hepatitis and serious complications such as cirrhosis and hepatocellular cancer. Several psychiatric symptoms and depression, particularly anxiety, can be seen in patients. Evaluation of the relation between medication adherence and psychometric tests in patients with Chronic hepatitis B (CHB) who are treated with oral antivirals is aimed in this study. Materials and Methods: Two hundred and fifty-nine patients were included in this study. Sociodemographic data form, Morisky 8 scale, Beck Anxiety scale (BAS) and Beck Depression scale (BDS) have been applied to the patients. Results: The age of the patients vary from 17 to 80, average age of the patients is foud as 46.04. A hundred eleven of the patients were women (42.9%). Two hundred and seven patients had no sign of depression (79.9%) and 52 of the patients (20.1%) had depression. The drug compliance was low in patients whose BDS scores were decreased. It has been found out that 195 of the patients had low-grade of anxiety (75.3%), 26 of the patients had midgrade of anxiety (10%), and 38 of the patients had high-grade of anxiety (14.7%). The medication adherence was low in patients whose BAS scores were decreased. Conclusion: Anxiety and depression are frequent in CHB patients. Therefore, CHB patients should be followed up psychiatrically and should be addressed to the psychiatry specialist when necessary. Depression and anxiety influences the drug compliance. Further studies are required for evaluation the relation between the medication adherence and the level of anxiety and depression in CHB patients.
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    Investigating Hepatitis C, D and HIV Prevalance in Cases with Positive Hepatitis B Virus Antigen in a Tertiary Hospital and Examining Anti-HDV Positive Cases
    (Galenos Publ House, 2021) Kurt, Esma Kepenek; Bulut, Rukiyye; Kandemir, Bahar; Erayman, Ibrahim; Bitirgen, Mehmet; Tasbent, Fatma Esenkaya
    Objectives: Hepatitis B infection has a faster and more progressive course in the presence of hepatitis C virus (HCV), HDV and human immunodeficiency virus (HIV) infections. The aim of this study was to determine anti-HCV, anti-HDV and anti-HIV prevalance in hepatitis B surface antigen (HBsAg) (+) positive patients and to examine patients with positive anti-HDV. Materials and Methods: Data were obtained through scanning hepatitisB patient follow-up files and the hospital automation system. Descriptive data was expressed in numbers and percentages (%). Results: Mean age of 1829 HBsAg positive patients was 42.65 +/- 14.83 (7-95) and 1099 (60.1%) were male and 730 (39.9%) were female. 30 patients (1.64%) had anti-HCV and 28 patients (1.53%) had anti-HDV while 1 patient (0.055%) had positive anti-HIV. The mean age of the patients with positive anti-HDV was 53.16 +/- 15.46 and 12 of these (42.9%) were female and 16 (57.1%) were male. Fifteen HDV positive patients were given peginterferon and 10 patients had relapse and 4 patients had hepatocellular cancer during the follow-up. A patient died due to the quick progression of the disease after deciding upon transplantation. Conclusion: Patients should also be scanned for hepatitis C, D and HIV in the presence of hepatitis B infection and the patient should be followed up and treated accordingly if coinfection is detected.
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    Urogenital Myiasis Caused by Psychoda spp. in Female Patient with No Risk Factor for Myiasis
    (Ankara Microbiology Soc, 2020) Tasbent, Fatma Esenkaya; Dik, Bilal; Kurt, Esma Kepenek
    Myiasis is defined as follows; some flies lay their eggs and larvae on live organs and tissues or on cavities of nose, eye, ear and etc of humans or animals and the larvae develop there and cause pathological disorders. One of the rare types of myiasis is the urogenital myiasis. This condition has been associated with covering urogenital area with clothes in almost all populations and therefore, less chance for flies to reach this site and lay their eggs. Low socio-cultural level and poor hygiene conditions are stated as the most important risk factors of myiasis. On the other hand, toilets within the human living spaces are ideal environments for fly larvae that are fed on bacteria as they contain moisture and a microbial environment. It is stated that especially in case of the presence of an underlying infection, flies are more prone to lay their eggs or larvae on this area due to the bad smell. In this case report, a patient with a moderate sociocultural level with no underlying chronic disease, no open wound in the genital area and no urinary tract infection was presented. A 53-year-old female patient living with her family in an apartment flat in the city center of Konya admitted to the outpatient clinic of infectious diseases with the complaint of moving worms in her urine. The patient stated that she had seen maggots while urinating for two weeks and that she passed her urine into a container to be sure that the maggots were coming from her urine, upon seeing the maggots there she has admitted to the hospital. The Larvae were defined as the fourth stage larvae of Psychoda spp. No open lesions or wounds were seen in genitourinary area of the patient who had no complaints other than mild urinary burning. Complete blood count test results of the patient were normal and there was no growth in her urine culture. It was stated that other family members whom she lived with did not have similar complaints. The patient was diagnosed as genitourinary myiasis caused byPsychoda spp. and informed about the relationship between hygiene and the disease. And urinary antiseptics were initiated as the treatment for the patient. After the treatment, no larvae were seen in the urine of the patient. In conclusion, many regions are suitable for Psychoda type of adult flies to live in our country due to the climate conditions. It is considered that infestation may develop in patients with less risk factors in terms of urogenital myiasis, that larvae may increase in number of patients who are not treated or followed up and that the infestation may become chronic and results in more serious clinical conditions. The necessary treatment and follow-up must be performed in such cases and the patients should be educated about the relationship between infestation and hygiene.