Relationship of Serum Kallistatin Level With Arterial Stiffness and Metabolic Parameters in Obesity-Related Chronic Kidney Disease.

OBJECTIVES: We investigated the relationship between serum kallistatin and kidney disease and proteinuria in nondiabetic obesity-related chronic kidney disease and observed the effects on arterial stiffness. MATERIALS AND METHODS: We included 40 patients with nondiabetic obesity-related chronic kidney disease followed in our nephrology clinic and a control group of 40 participants without chronic kidney disease matched by age, sex, and mean body mass index (measured as weight in kilograms divided by height in meters squared). Pulse-wave velocity and augmentation index were measured oscillometrically by pulse-wave analysis (Mobil-O-Graph) by the same operator. Serum kallistatin levels were measured by sandwich enzyme-linked immunosorbent assay. RESULTS: Mean age of patients was 51 ± 7.5 years (range, 29-62 years), and 40% were female. Mean body mass index was 35 ± 3.1. Four patients (10%) had morbid obesity; 21 (52.5%) had hypertension. Glomerular filtration rate (42 ± 18 vs 83 ± 15 mL/min/1.73 m², respectively; P < .001) were significantly lower. However proteinuria (671 ± 1031 vs 80 ± 30 mg/d, respectively; P < .001) were significantly higher in patients than in controls. Also, serum kallistatin and arterial stiffness were significantly higher in patients (P < .05).''The Pulse Wave Velocity was higher in patients with hypertension (P = .01); GFR was lower (P < .01); serum uric acid level was higher (P < .001); and neutrophil-to-lymphocyte ratio (P < .05), C-reactive protein level (P < .05), and serum kallistatin level were higher (P < .05). CONCLUSIONS: Serum kallistatin levels increase in patients with obesity-related kidney disease. Especially hypertension and hyperuricemia are associated with an increase in serum kallistatin.

Evaluation of 99mTechnetium-Vancomycin Imaging Potential in Experimental Rat Model for the Diagnosis of Infective Endocarditis.

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. CONCLUSION: 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.

Rapid virologic response in chronic hepatitis C genotype 1: Evaluation of pretreatment factors in patients.

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.

Role of quantitative hepatitis B surface antigen levels in predicting liver biopsy time in treatment-naive chronic hepatitis B patients.

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.

Long-Term Effects of Tenofovir on Liver Histopathology in Patients with Chronic Viral Hepatitis B Infection.

OBJECTIVE: The aim of this study to evaluate histopathological improvement and virological, serological and biochemical response rates in patients with chronic hepatitis B (CHB) who were treated with tenofovir disoproxil fumarate (TDF). MATERIAL AND METHOD: A total of 91 nucleosid(t)e-naive CHB patients who received TDF were evaluated. Virological, serological and biochemical test results were assessed at baseline and every 12 weeks. Liver biopsy specimens were assessed according to the modified Ishak scoring. RESULTS: The study was conducted on 52 patients. The mean age was 40±10 years and 40.4% were female. The mean follow-up period was 33±11 months. HBsAg seroclearance occurred in none of the patients. The serum level of HBV-DNA became undetectable in 94.2% of the patients. Mean histological activity index at baseline and on-treatment were 8.2±2.3 and 6.2±2.0 and the mean fibrosis scores were 2.65±1.3 and 2.33±1.1, respectively. CONCLUSION: We determined that TDF therapy provided remarkably good HBV DNA suppression and biochemical response rates, but low seroconversion. Improvement of liver necroinflammation was detected, but no significant change observed in fibrosis.

Response to direct-acting antiviral agents in chronic hepatitis C patients with end-stage renal disease: a clinical experience

SUMMARY OBJECTIVE The recent development of direct-acting antiviral agents (DAAs) has dramatically changed the treatment of chronic hepatitis C, and interferon-based regimes have become a poor treatment choice in clinical practice. Today DAAs offer shorter, well-tolerated, highly effective curative therapies. This study aimed to evaluate the effectiveness and safety of DAAs in patients with end-stage renal disease and HCV genotype 1 infection in real clinical practice. METHODS Thirty-six patients who attended our clinic, were diagnosed with chronic hepatitis C (CHC), undergoing hemodialysis, and fulfilled the criteria of age >18 years, genotype 1 infection, with a detectable HCV RNA level were considered for the study. Patients with GT1a infection received OBV/PTV/r plus DSV plus RBV for 12 weeks; GT1b infected patients received this regimen without RBV for 12 weeks. RESULTS The study was conducted on 33 patients. The mean age was 52.30 ±13.77 years, and 70 % of them were male. By the fourth week of treatment, HCV RNA levels decreased below 15 IU/ml in all patients. Sustained virologic response (SVR) 12 rate was 100%. Nine patients had side effects during treatment. Of the patients with side effects, 89.9% were in group 1a and 11.1% in group 1b. CONCLUSION In this study, treatment with OBV/PTV/r and DSV with or without RBV resulted in high rates of sustained virologic response in HCV GT1-infected patients with end-stage renal disease (ESRD). SVR was achieved in all patients with few side effects.

RESUMO O recente desenvolvimento de agentes antivirais de ação direta (DAAs) mudou drasticamente o tratamento da hepatite C crônica, e os regimes livres de interferon tornaram-se pobres escolhas para tratamento na prática clínica. Hoje os DAAs oferecem terapias curativas mais curtas, bem toleradas e altamente eficazes. O objetivo deste estudo foi avaliar a eficácia e segurança dos DAAs em pacientes com doença renal em estágio terminal e infecção pelo genótipo 1 do HCV na prática clínica real. MÉTODOS Trinta e seis pacientes, que se inscreveram em nossa clínica com diagnóstico de hepatite C crônica (CHC), inclusive no programa de hemodiálise, e preencheram os critérios de idade >18 anos, foram considerados para infecção pelo genótipo 1 com nível detectável de RNA do HCV. Os pacientes com infecção por GT1a receberam OBV/PTV/r mais DSV mais RBV por 12 semanas. Os pacientes infectados com GT1b receberam este regime sem RBV por 12 semanas. RESULTADOS O estudo foi realizado em 33 pacientes. A idade média foi de 52,30±13,77 anos e 70% deles eram do sexo masculino. Na semana 4 do tratamento, os níveis de ARN do VHC diminuíram para menos de 15 UI/ml em todos os pacientes. A taxa de resposta virológica sustentada (RVS) 12 foi de 100%. Nove pacientes apresentaram efeitos colaterais durante o tratamento. Dos pacientes com efeitos colaterais, 89,9% estavam no grupo 1a e 11,1% no grupo 1b. CONCLUSÃO Neste estudo, o tratamento com OBV/PTV/r e DSV com ou sem RBV resultou em altas taxas de resposta virológica sustentada em pacientes infectados pelo VGC GT1 com doença renal em estágio final (ESRD). A RVS foi alcançada em todos os pacientes com poucos efeitos colaterais.

Response to direct-acting antiviral agents in chronic hepatitis C patients with end-stage renal disease: a clinical experience.

OBJECTIVE: The recent development of direct-acting antiviral agents (DAAs) has dramatically changed the treatment of chronic hepatitis C, and interferon-based regimes have become a poor treatment choice in clinical practice. Today DAAs offer shorter, well-tolerated, highly effective curative therapies. This study aimed to evaluate the effectiveness and safety of DAAs in patients with end-stage renal disease and HCV genotype 1 infection in real clinical practice. METHODS: Thirty-six patients who attended our clinic, were diagnosed with chronic hepatitis C (CHC), undergoing hemodialysis, and fulfilled the criteria of age >18 years, genotype 1 infection, with a detectable HCV RNA level were considered for the study. Patients with GT1a infection received OBV/PTV/r plus DSV plus RBV for 12 weeks; GT1b infected patients received this regimen without RBV for 12 weeks. RESULTS: The study was conducted on 33 patients. The mean age was 52.30 ±13.77 years, and 70 % of them were male. By the fourth week of treatment, HCV RNA levels decreased below 15 IU/ml in all patients. Sustained virologic response (SVR) 12 rate was 100%. Nine patients had side effects during treatment. Of the patients with side effects, 89.9% were in group 1a and 11.1% in group 1b. CONCLUSION: In this study, treatment with OBV/PTV/r and DSV with or without RBV resulted in high rates of sustained virologic response in HCV GT1-infected patients with end-stage renal disease (ESRD). SVR was achieved in all patients with few side effects.

Hepatitis A, B, C and HIV seroprevalence among Syrian refugee children admitted to outpatient clinics.

Viral hepatitis is the most common cause of serious health problems such as liver cirrhosis and hepatocellular carcinoma (HCC). Leading to immunodeficiency disorders through different mechanisms, Human Immunodeficiency Virus (HIV) causes the development of severe secondary infections. Hepatitis A (HAV) is thought to spread by the faecal-oral route, while Hepatitis B (HBV), Hepatitis C (HCV) and HIV are mostly transmitted vertically during childhood. In our study, we aimed to determine the seroprevalence of HAV, HBV, HCV and HIV among Syrian refugee children who were admitted to outpatient clinics. We conducted a retrospective review of data concerning 171 Syrian children aged between 0-18 years admitted between April 2014 and December 2015 to the outpatient infectious disease clinic of ?zmir Tepecik Training and Research Hospital and the social welfare outpatient clinic for Syrian refugees for reasons other than jaundice. Serum samples from patients were studied for HAV antibody IgG (anti-HAV IgG), HBV surface antigen (HBsAg), antibodies against HBV surface antigen (anti-HBs), antibodies against HBV core antigen (anti-HBc total), HCV antibody (anti-HCV) (anti-HIV) with the ELISA (Enzyme-Linked Immunosorbent Assay) method. In this study 51% of patients were female, with a mean age of 6.52 years among all patients. Six of the 140 patients (4.2%) scanned for HBV among the patients enrolled in the study were HBsAg and anti-HBc total positive and anti-HBs negative. Three patients (2.1%) were HBsAg negative, and anti-HBc total and anti-HBs positive, which indicated they had previously recovered from an HBV infection. HBsAg, anti-HBs, anti-HBc total data for 140 patients (81.9%), anti-HCV data for 109 patients (63.8%), anti-HIV data for 88 patients (51.5%) and HAV IgG data for 86 patients (50.3%) were obtained. Due to migration from regions in Syria where there is no regular follow-up of HBV vaccination in children, HBsAg seroprevalence of refugee children is thought to be higher than in other children in Turkey and anti-HBs positivity is thought to be lower. We expected to see a higher seroprevalence of anti-HCV and anti-HIV in Syria due to the lack of health facilities such as non-regular anti-HCV and anti-HIV screening before blood transfusions and during pregnancy in all regions of Syria. Yet in this study, the anti-HCV, anti-HIV seroprevalence of Syrian refugee children was similar to that in Turkey. According to the results, if the children of asylum seekers are admitted to the national HAV and HBV vaccination schedule, hepatitis infections and their complications may be prevented.

Inflammatory Biomarkers and Liver Histopathology in Non-Uremic and Uremic Chronic Hepatitis C Patients.

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.

A Case of Cerebral Malaria Managed by Erythrocyte Exchange.

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.

Factors affecting responsiveness to hepatitis B immunization in dialysis patients.

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 <10 IU/mL, an additional 40 µg in four vaccine doses was administered immediately and they were retested for the anti-HBs following the same schedule. The patients were divided into two groups: responders and non-responders. RESULTS: HBsAg and anti-HCV seroprevalence was 3.4% and 10.3%, respectively. After vaccination schedule, 264 (83.5%) patients had antibody response to HBV vaccine and 52 (16.5%) had no response. Hepatitis B vaccine unresponsiveness is more common in the patients with hepatitis C positivity (p = 0.011), BMI >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.

The effect of long-term entecavir therapy on liver histopathology in patients with chronic viral hepatitis B.

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 0.5 mg/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 44 ± 12.9, 26.1% of them were female. The mean duration of follow-up was 44.9 ± 10.8 months. 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% achieved ≥ 2 point improvement in HAI scores and 30.4% achieved ≥ 1 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.

Evaluation of Percutaneous Liver Biopsy Complications in Patients with Chronic Viral Hepatitis.

OBJECTIVE: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Prevalence of latex allergy among healthcare workers in Izmir (Turkey).

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.

Latex-related allergy in hemodialysis patients.

BACKGROUND: Incidence of allergic reactions is increased in hemodialysis (HD) patients. However, the prevalence of latex allergy is not exactly known in HD patients. The aim of this present study is to determine the prevalence of latex allergy in HD patients. METHODS: A total of 205 adult HD patients were included in the study. Questionnaires were completed during patient interviews, and their consents were provided. Latex prick test and latex specific IgE test (HY-TEC, K82) were performed. Mean age of the patients was 52 ± 14 (25-79) years, and 61% was male. Mean dialysis duration was 38 months, and 21% of them were diabetics. Only five patients had allergic complaints in their histories, and none of them had severe anaphylaxis history. Latex prick test was positive in two patients. Latex specific IgE test was positive in five patients. Overall latex sensitivity was defined as 3.4%. CONCLUSION: No increased prevalence in latex allergy was determined in HD patients. Latex allergy incidence may be increased in atopic HD patients. Therefore, the use of latex products should be avoided as much as possible especially in atopic HD patients.

A leptospirosis case presenting with thrombotic thrombocytopenic purpura.

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.

Hepatitis A seroprevalence in children and adolescents aged 1-18 years among a low socioeconomic population in Izmir, Turkey.

The age-specific prevalence of hepatitis A virus (HAV) infection and risk factors were evaluated in a low socioeconomic population in Izmir. Children and adolescents 1-18 years of age admitted to the outpatient clinics for follow-up visits, or healthy children between April-December 2009 were investigated for anti-HAV antibodies by a cross-sectional study. A questionnaire on sociodemographic and hygiene information was obtained from the parents. All unvaccinated children against HAV were grouped according to their age. Seven hundred and twenty-nine children were enrolled in the study. Total HAV IgG seropositivity was 29.5% while age related values were as follows: 1-2 years, 21.4%; 2.1-5 years, 15.1%; 5.1-8 years, 20.1%; 8.1-11 years, 32.6%; 11.1-14 years, 44.3% and 14.1-18 years, 52.4%. The presence of anti-HAV IgG was associated significantly with low family income and lack of education of parents and living in a crowded family. HAV infection was endemic in a population of children living in Izmir. Anti-HAV vaccination should be considered for preschool children because teenagers are at risk of infection in this region.

Evaluation of vaccination results in high-risk patients included in hepatitis B vaccination program.

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.