Epidemiological findings on Hepatitis C infection in a tertiary level hospital in mid-northern Anatolia in Turkey: A four-year analysis.

The hepatitis C virus (HCV) is a blood-borne pathogen that causes acute or chronic infection of the liver, sometimes leading to serious liver damage and fatality. The objective of this study was to evaluate HCV prevalence in patients attending the Regional Training and Research Hospital for Medical Examination and Surgery in Samsun Province of Turkey between 2014 and 2017. Blood specimens taken from 152 596 patients were screened for HCV infection by using the anti-HCV assay. Seropositive samples were subjected to polymerase chain reaction (PCR) testing in order to determine whether the HCV infection was active. Genotyping was then performed. Overall, HCV seropositivity and active HCV infection were 2.76% and 2.05%, respectively. Foreign nationals accounted for 5.61% of the seropositive samples and 1.37% of active HCV infective samples. We further report that 2017 was the year with the highest seroprevalence which was 3.64%. HCV genotype 1 was the most common genotype detected in residents of Samsun Province at 89.86%, followed by Genotype 3 at 4.54%. This study provides important information on the levels of HCV infection in the Samsun region of Turkey. The data indicate that there was a rising trend of HCV infection between 2014 and 2017.

Epidemiological findings on Hepatitis C infection in a tertiary level hospital in mid-northern Anatolia in Turkey: A four-year analysis

@# The hepatitis C virus (HCV) is a blood-borne pathogen that causes acute or chronic infection of the liver, sometimes leading to serious liver damage and fatality. The objective of this study was to evaluate HCV prevalence in patients attending the Regional Training and Research Hospital for Medical Examination and Surgery in Samsun Province of Turkey between 2014 and 2017. Blood specimens taken from 152 596 patients were screened for HCV infection by using the anti-HCV assay. Seropositive samples were subjected to polymerase chain reaction (PCR) testing in order to determine whether the HCV infection was active. Genotyping was then performed. Overall, HCV seropositivity and active HCV infection were 2.76% and 2.05%, respectively. Foreign nationals accounted for 5.61% of the seropositive samples and 1.37% of active HCV infective samples. We further report that 2017 was the year with the highest seroprevalence which was 3.64%. HCV genotype 1 was the most common genotype detected in residents of Samsun Province at 89.86%, followed by Genotype 3 at 4.54%. This study provides important information on the levels of HCV infection in the Samsun region of Turkey. The data indicate that there was a rising trend of HCV infection between 2014 and 2017.

Saliva/serum ghrelin, obestatin and homocysteine levels in patients with ischaemic heart disease.

BACKGROUND: We aimed to compare ghrelin, obestatin, homocysteine (Hcy), vitamin B12 and folate levels in the serum and saliva of ischaemic heart disease patients. METHODS: Serum and saliva were collected from 33 ischaemic heart disease (IHD) patients and 28 age- and body mass index-matched healthy individuals. Levels of acylated and desacylated ghrelin, obestatin and Hcy were determined using the ELISA method. RESULTS: Acylated ghrelin, desacylated ghrelin and obestatin levels in the saliva were found to be higher than those in the serum of the control group, while acylated and desacylated ghrelin levels in the saliva were significantly lower than those in the serum. Obestatin levels were higher in IHD patients (p = 0.001). Saliva and serum vitamin B12 and folate levels in IHD patients were significantly lower than in the control group (p = 0.001). CONCLUSIONS: It was determined that serum ghrelin levels increased in ischaemic heart disease patients, while serum levels of obestatin decreased.

The use of complementary and alternative medicine in patients with common variable immunodeficiency.

OBJECTIVES: Complementary and alternative medicine (CAM) usage is a reality in patients with chronic diseases, but there are no data on CAM usage in immunodeficiency diseases necessitating intravenous immunoglobulin (IVIG) therapy.The aim of this study was to investigate the rate of CAM usage in patients with common variable immunodeficiency (CVID). METHODS: Forty-three patients (29 boys and 14 girls) with CVID and receiving IVIG every 3 weeks were included. Data were collected through a questionnaire completed by the parents. Those using treatments other than their medical therapies that were defined as CAM by the National Center for Complementary and Alternative Medicine were classified as CAM users. RESULTS: The mean (SD) age at diagnosis was 7.56 (9.44) years (range, 6 months to 44 years) and the mean IVIG treatment duration was 6.02 (3.84) years (range, 1 to 20 years). Thirty-six (83.7%) of the 43 patients analyzed had used at least 1 CAM approach. The most common modalities were herbal medicines (65.1%), dietary supplements (62.8%), vitamins (46.5%), and religion (34.9%). Only 11% of those interviewed had informed their doctor that they were using CAM. The most common reason for CAM usage was the desire to improve body resistance. Eighteen parents (50%) claimed that their children had benefited from CAM. CONCLUSION: Our findings reveal that there is a remarkably high tendency to use CAM in patients with CVID. Although no side effects were reported by the families, potential drug interactions should be considered.

Autoimmunity and hepatitis A vaccine in children.

BACKGROUND: Universal vaccination remains the most effective way of preventing the spread of many infectious diseases. Although most adverse effects attributed to vaccines are mild, rare reactions such as autoimmunity do occur. OBJECTIVES: We aimed to evaluate the possible role played by hepatitis A vaccine (HAV) in inducing the synthesis of autoantibodies. The study included 40 healthy children vaccinated with 2 doses of HAV at a 6-month interval. The children were investigated for autoantibodies including anti-nuclear antibodies (ANAs), anti-smooth muscle antibodies, anti-nDNA, anti-microsomal antibodies, anti-cardiolipin (aCL) immunoglobulin (Ig) M/IgG, anti-ds DNA, ANA profile, and anti-neutrophil cytoplasmic antibody profile. RESULTS: One month after the first dose, ANAs at a titer of 1:100 and aCL IgG at 23.7 IgM phospholipid units were detected in 4 children and 1 child, respectively. Of the ANA-positive children, 1 also had ASMA positivity, and another had perinuclear and cytoplasmic ANCA positivity. After the second dose, 3 of the children had aCL IgM. In addition, 2 distinct children had positive anti-thyroid microsomal antibodies and ANA after the second dose. The presence of these autoantibodies following vaccination was statistically significant (P = .002). At month 12 of the study, only 2 children continued to be ANA-positive at the same titer as after the first vaccine dose. CONCLUSIONS: Although HAV can induce the production of autoantibodies, none of the children developed autoimmune disorders. Long-term follow up is necessary to check whether autoimmune disorders develop in children who still have ANA. Genetic, immunological, environmental, and hormonal factors are also important in the development of vaccine-induced autoimmunity.

Effect of amino acid substitutions in the human IFN-γR2 on IFN-γ responsiveness.

Patients with interferon-γ receptor (IFN-γR) null mutations have severe infections with poorly pathogenic Mycobacteria. The IFN-γR complex involves two IFN-γR1 and two IFN-γR2 chains, in which several amino acid substitutions, some linked to disease and some apparently naturally occurring, have been described. We developed a model system to study functional effects of genetic variations in IFN-γR2. We retrovirally transduced wild-type IFN-γR2 and IFN-γR2 carrying presently known amino acid substitutions in various human cell lines, and next determined the IFN-γR2 expression pattern as well as IFN-γ responsiveness. We determined that the T58R, Q64R, E147K and K182E variants of IFN-γR2 are fully functional, although the Q64R variant may be expressed higher on the cell membrane. The R114C, T168N and G227R variants were identified in patients that had disseminated infections with non-tuberculous Mycobacteria. Of these genetic variants, T168N was confirmed to be completely non-functional, whereas the novel variant G227R, and the previously reported R114C, were partial functional. The impaired IFN-γ responsiveness of R114C and G227R is mainly due to reduced receptor function, although expression on the cell membrane is reduced as well. We conclude that the T58R, Q64R, E147K and K182E variants are polymorphisms, whereas the R114C, T168N and G227R constitute mutations associated with disease.

Gamma/delta T cells in patients with acute brucellosis.

We aimed to investigate the population of gamma/delta T (gamma/delta T) cells in patients with acute brucellosis. When the bacteria penetrate to the host, the innate immune response aims to prevent the attack by non-activated professional phagocytes. At that moment, macrophages trigger the other cells of the immune system. The cells that can respond immediately are natural killer and gamma/delta T cells. The study included 40 cases of acute brucellosis and 20 healthy volunteers. In this study, it was aimed to compare gamma/delta and alpha/beta (alpha/beta) receptors of the T cells at pre- and post treatment period of patients diagnosed as brucellosis, especially to evaluate the levels of gamma/delta T cells at monitoring of the disease, using flow cytometry. As a result, it was observed that gamma/delta T cells significantly increased in peripheral blood in patients with brucellosis compared with the healthy individuals (13.23 +/- 4.7 and 5.25 +/- 1.4, respectively (p = 0.0001)). gamma/delta T cells were significantly decreased after the brucellosis treatment (p < 0.01). The results of the present study indicate that considerable counts of gamma/delta T cells are involved in acute brucellosis cases. Our findings suggest that gamma/delta TCR bearing cell counts may be used as a supplementary marker for monitoring brucellosis.

Hematopoietic stem cell transplantation in a CD3 gamma-deficient infant with inflammatory bowel disease.

Partial or total CD3 chain expression defects including CD3 gamma, epsilon, delta, and zeta chain are among the autosomally inherited SCID presenting with T-B+NK+ phenotype with lymphopenia. The clinical findings are generally severe in all except for CD3 gamma deficiency. Here we present a 10-month-old CD3 gamma deficient boy with IBD. The patient had suffered from intractable diarrhea, recurrent pulmonary infections and oral moniliasis since two months of age. Following the first allogeneic HSCT from his HLA-identical (6/6) sister after a reduced intensity regimen, a second transplantation was performed five months later. On day +19 after second transplantation, the CD3 TCR alpha/beta chain expression increased to 66% with development of full donor chimerism (98.6%). A significant improvement in diarrhea, perianal lesions, and rectal fistula was observed suggesting an improvement in inflammatory bowel disease. The patient died at home on day +50 with a sudden respiratory failure secondary to an undetermined infection. The case was interesting being the first reported case with SCID and inflammatory bowel disease who responded very well to HSCT by full recovery of intractable diarrhea, failure to thrive, laboratory findings, and improvement of fistula formation.

Immunoglobulin enhancer HS1,2 polymorphism: a new powerful anthropogenetic marker.

The human HS1,2 enhancer of the immunoglobulin (Ig) heavy chain 3' enhancer complex plays a central role in the regulation of Ig maturation and production. Four common alleles HS1,2-A*1, *2, *3, *4 are directly implicated with the transcription level and at least one of them, HS1, 2-A*2, seems to be related to immune disorders, such as coeliac disease, herpetiform dermatitis and Berger syndrome. Given their clinical significance it is of interest to know the distribution of HS1,2-A variants in populations from different continents, as well as to determine whether the polymorphism is associated to specific evolutionary factors. In this paper we report the distribution of the HS1,2-A polymorphism in 1098 individuals from various African, Asian and European populations. HS1,2-A*3 and HS1,2-A*4 alleles are at their highest frequencies among Africans, and HS1,2-A*2 is significantly lower in Africans in comparison with both Europeans and, to a lesser extent, Asians. Analysis of molecular variance of the allele frequencies indicates that the HS1,2-A polymorphism can be considered as a reliable anthropogenetic marker.

Cardiac thrombus in Omenn syndrome.

Omenn syndrome is characterized by a generalized erythematous skin rash, lymph node enlargement, hepatosplenomegaly, Increased serum IgE levels, eosinophilia, and evidence of severe combined immune deficiency. Patients develop fungal, bacterial, and viral infections. We present the case of a 3-month-old girl with Omenn syndrome who developed right ventricular thrombosis. Echocardiographic study revealed a round structure that filled the apex and corpus of the the right ventricle. We investigated this patient for hypercoagulation and made a diagnosis of ventricular thrombosis, which is an uncommon finding in Omenn syndrome.

Investigation of hearing loss in patients with acute brucellosis by standard and high-frequency audiometry.

This study aimed to determine the effect of acute brucellosis on the auditory system. Forty-two patients with acute brucellosis were evaluated clinically, and with serological and audiological tests, before and after treatment. Hearing threshold averages were calculated at 11 different frequencies (250-8000 Hz) of the auditory airway, and statistical analysis was performed. The average hearing thresholds were > 20 dB, with standard audiometry at 6000-8000 Hz, and < 20 dB at all other frequencies. After treatment, the average auditory threshold decreased to < 20 dB at 6000-8000 Hz (p < 0.0001). Pure-tone hearing thresholds were improved at all frequencies after treatment, with statistically significant differences at all frequencies except 12,000, 14,000 and 16 000 Hz (p < 0.05). There was no permanent hearing loss caused by acute brucellosis, and hearing thresholds were restored after treatment. It was concluded that acute brucellosis affects the auditory system, especially at high frequencies, and that patients with all forms of brucellosis should be evaluated for hearing loss.

Cutaneous anthrax in adults: a review of 25 cases in the eastern Anatolian region of Turkey.

BACKGROUND: The clinical features, therapy and outcome of anthrax cases from the Elazig province (the eastern Anatolian region) of Turkey seen in our clinic over an 8-year period were reviewed. PATIENTS AND METHODS: The records of 25 anthrax cases observed in our clinic during the period January 1994 to April 2002 were examined. RESULTS: All cases were cutaneous; 18 (72%) patients exhibited malignant pustules and seven (28%) malignant edema. Three of the patients with a malignant pustule developed anthrax sepsis when admitted to our clinic. All cases were treated with penicillin. One patient who had penicillin allergy was treated with ciprofloxacin. In addition, patients with malignant edema were also treated with systemic corticosteroids (methylprednisolone or dexamethasone). Two patients died due to anthrax sepsis; one case with anthrax sepsis recovered. The mortality rate was 8%. DISCUSSION: Anthrax is still a reality in Turkey. Cutaneous anthrax should be considered in any patient with a painless ulcer with vesicles, edema and a history of exposure to animals or animal products. In our series, penicillin and ciprofloxacin were effective in treatment of anthrax. Our anthrax sepsis case demonstrates that anthrax sepsis is not always fatal if antibiotic treatment is given early after diagnosis.

Levels of plasma malondialdehyde and erythrocyte antioxidant enzyme activities in patients with chronic hepatitis B.

BACKGROUND/AIMS: Hepatitis B virus infection, extensively seen throughout the world, can become highly chronic. Pathogenesis of chronic hepatitis is not yet known fully. It is shown that oxidative stress may play a role in pathogenesis and may regulate collagen synthesis and thus may contribute to the process of liver damage. This study is aimed at investigating the existence of oxidative stress in chronic hepatitis B cases and its relation with alanine aminotransferase and aspartate aminotransferase which are the serum indicators of liver damage; along with interaction of erythrocyte antioxidation enzyme activities in the same cases. METHODOLOGY: Eighty patients with chronic hepatitis B under follow-up, and 40 healthy volunteers were included in this study. In the control and patients groups, together with serological markers for viral etiology, alanine aminotransferase and aspartate aminotransferase levels; plasma malondialdehyde level; erythrocyte superoxide dismutase, glutathione peroxidase and catalase activities were analyzed. RESULTS: Malondialdehyde levels of chronic hepatitis B cases were statistically high compared to control group (p < 0.05). There was correlation between serum malondialdehyde levels and serum alanine aminotransferase, aspartate aminotransferase levels in the patient group (r = 0.324, p < 0.01, r = 0.273, p < 0.05). Average superoxide dismutase and catalase activities were found to be significantly low compared to control group (p < 0.001); average glutathione peroxidase activity were significantly high when considered statistically (p < 0.001). No correlation between serum alanine aminotransferase and aspartate aminotransferase levels and glutathione peroxidase, catalase and superoxide dismutase activities was found in the patients group (p > 0.05). CONCLUSIONS: In the study we showed that there is correlation between serum malondialdehyde level and alanine aminotransferase and aspartate aminotransferase levels of chronic hepatitis B patients. According to the results of our study, it might be thought that serum malondialdehyde level might be a marker of hepatocellular damage in chronic hepatitis B cases. We suggest that antioxidant treatment for chronic hepatitis B patients should be examined in future studies.

Genetic diversity of vaginal lactobacilli from women in different countries based on 16S rRNA gene sequences.

AIMS: Lactobacilli are widely distributed in food and the environment, and some colonize the human body as commensal bacteria. The aim of this study was to determine the species of lactobacilli that colonize the vagina and compare them with those found in food and the environment. METHODS AND RESULTS: Thirty-five Lactobacillus strains from women from seven countries were isolated, and sequences from 16S rRNA genes were determined and compared with existing data in GenBank. A phylogenetic tree was achieved using the Neighbour-Joining method based on the analysis of 1465 nucleotides. The results showed that most vaginal isolates were L. crispatus, L. jensenii and L. gasseri. Some were L. vaginalis, L. fermentum, L. mucosae, L. paracasei and L. rhamnosus. Two isolates from a native American woman displayed distinct branches, indicating novel phylotypes. Few vaginal isolates matched food or environmental Lactobacillus species. CONCLUSIONS: Most women worldwide were colonized by three common Lactobacillus species: L. crispatus, L. jensenii and L. gasseri. SIGNIFICANCE AND IMPACT OF THE STUDY: Knowledge of vaginal Lactobacillus species richness and distribution in women worldwide may lead to the design of better probiotic products as bacterial replacement therapy.

Low dose cyclosporin A treatment in generalized pustular psoriasis.

Generalized pustular psoriasis is a rare form of psoriasis, seldom seen in children. Three patients with generalized pustular psoriasis are presented, two of whom were a sister and brother and whose grandfather also had pustular psoriasis. Lesions consisted of pustular, erythematous, scaly, follicular papules located on the trunk, scalp, and extremities. The pustules in some areas coalesced to form lakes. Histologic examination of several biopsy specimens revealed the changes of pustular psoriasis, which were parakeratosis, elongation of the rete ridges, and deep spongioform pustules and Munro abscesses. All patients were treated with cyclosporin A for periods of 2-12 months. The doses ranged from 1 to 2 mg/kg/day. Clearance of psoriatic lesions occurred after 2-4 weeks of therapy.

Comparative study of vaginal Lactobacillus phages isolated from women in the United States and Turkey: prevalence, morphology, host range, and DNA homology.

Lactobacilli play an important role in maintaining vaginal health. However, during bacterial vaginosis lactobacilli decrease for unknown reasons. Our preliminary study showed that phages could infect vaginal lactobacilli. Therefore, the aim of this study was to analyze the distribution, virulence, and types of vaginal Lactobacillus phages isolated from women of two countries: the United States and Turkey. A total of 209 vaginal lactobacilli were isolated from reproductive-aged women in the United States (n = 107) and Turkey (n = 102). By analysis of 16S rRNA gene sequence and by comparison of protein profiles, most lactobacilli were identified as L. crispatus, L. gasseri, and L. jensenii. After mitomycin C induction, 28% of American lactobacilli and 36% of Turkish lactobacilli released phages. A total of 67 phages were isolated and further characterized by their host range, electron microscopy, and DNA homology. All 67 phages were infective against lactobacilli from both collections. The host ranges of most phages were broad, including multiple Lactobacillus species. Even though the phages were all temperate, they were able to cause lytic infection in various strains. The electron micrographs of these phages showed a hexagon-shaped head and a long tail with or without a contractile tail sheath. Based on their morphology, these phages belonged to Bradley's phage groups A and B, and could be further classified into four morphotypes. All four types were found among American phages, but only three were found among Turkish isolates. DNA hybridization with labeled probes of the four types of phages revealed that additional genetic types existed within each morphotype among these phages. The phage genomic sizes ranged between 34 and 55 kb. Many of the lysogenic Lactobacillus strains released phages spontaneously at a high frequency of 10(-3) to 10(-4) PFU/cell. In conclusion, lysogeny in vaginal lactobacilli is widely spread. Some lysogenic lactobacilli spontaneously release phages with a broad host range, which can be lytic against other vaginal lactobacilli regardless of their geographic origin.