We aimed to describe clinical, laboratory, diagnostic and therapeutic features of spinal tuberculosis (ST), also known as Pott disease. A total of 314 patients with ST from 35 centres in Turkey, Egypt, Albania and Greece were included. Median duration from initial symptoms to the time of diagnosis was 78 days. The most common complications presented before diagnosis were abscesses (69%), neurologic deficits (40%), spinal instability (21%) and spinal deformity (16%). Lumbar (56%), thoracic (49%) and thoracolumbar (13%) vertebrae were the most commonly involved sites of infection. Although 51% of the patients had multiple levels of vertebral involvement, 8% had noncontiguous involvement of multiple vertebral bodies. The causative agent was identified in 41% of cases. Histopathologic examination was performed in 200 patients (64%), and 74% were consistent with tuberculosis. Medical treatment alone was implemented in 103 patients (33%), while 211 patients (67%) underwent diagnostic and/or therapeutic surgical intervention. Ten percent of the patients required more than one surgical intervention. Mortality occurred in 7 patients (2%), and 77 (25%) developed sequelae. The distribution of the posttreatment sequelae were as follows: 11% kyphosis, 6% Gibbus deformity, 5% scoliosis, 5% paraparesis, 5% paraplegia and 4% loss of sensation. Older age, presence of neurologic deficit and spinal deformity were predictors of unfavourable outcome. ST results in significant morbidity as a result of its insidious course and delayed diagnosis because of diagnostic and therapeutic challenges. ST should be considered in the differential diagnosis of patients with vertebral osteomyelitis, especially in tuberculosis-endemic regions. Early establishment of definitive aetiologic diagnosis and appropriate treatment are of paramount importance to prevent development of sequelae.
BackgroundThe aim of this study was to assess health-related quality of life (HRQOL) among chronic hepatitis B (CHB) patients in Turkey and to study related factors.MethodsThis multicenter study was carried out between January 01 and April 15, 2015 in Turkey in 57 centers. Adults were enrolled and studied in three groups. Group 1: Inactive HBsAg carriers, Group 2: CHB patients receiving antiviral therapy, Group 3: CHB patients who were neither receiving antiviral therapy nor were inactive HBsAg carriers. Study data was collected by face-to-face interviews using a standardized questionnaire, Short Form-36 (SF-36) and Hepatitis B Quality of Life (HBQOL). Values equivalent to p < 0.05 in analyses were accepted as statistically significant.ResultsFour thousand two hundred fifty-seven patients with CHB were included in the study. Two thousand five hundred fifty-nine (60.1 %) of the patients were males. Groups 1, 2 and 3, consisted of 1529 (35.9 %), 1721 (40.4 %) and 1007 (23.7 %) patients, respectively. The highest value of HRQOL was found in inactive HBsAg carriers. We found that total HBQOL score increased when antiviral treatment was used. However, HRQOL of CHB patients varied according to their socio-demographic properties. Regarding total HBQOL score, a higher significant level of HRQOL was determined in inactive HBV patients when matched controls with the associated factors were provided.ConclusionsThe HRQOL score of CHB patients was higher than expected and it can be worsen when the disease becomes active. Use of an antiviral therapy can contribute to increasing HRQOL of patients.
ÖZET Sıtma, ateş, anemi ve splenomegali ile seyreden, akut dönemde tedavi edilmediği taktirde kronikleşme eğilimi gösteren paraziter bir infeksiyondur. Falsiparum sıtması, kıtalar arası seyahat imkanlarının artışına paralel olarak ülkemizde import vakalar olarak görülebilen ve erken tedaviye başlanmaması halinde ciddi morbidite ve mortalite ile sonuçlanan bir durumdur. Uganda'da altı aylık ikametinden sonra ülkemize dönüş yapan ve sıtma profilaksisine uyum göstermediği anlaşılan bir olguya falsiparum sıtması tanısı konulmuştur. Başlangıçta kanda yüksek düzey parazitemisi artemisin ve lümefantrin kombinasyonu ile kaybolan ancak tedavi bitiminden yaklaşık 18 gün sonra tekrar parazitemi ve ateş atakları ile başvuran bu import vakada kinin ve tetrasiklin tedavisiyle kür sağlanmış olup uygun artemisin kombinasyon tedavisine rağmen rekürrens durumu dikkati çekmiştir. Ülkemizde falciparum sıtmasına bağlı vakalar olmamasına rağmen bu hastalık yurtdışına seyahat öyküsü olan ve ateş ile müracaat eden hastalarda enfeksiyon acilleri arasında düşünülmesi gereken bir durumdur. Dünya Sağlık Örgütü'nün (DSÖ) de önerdiği şekilde tanısı konulduktan sonra başlangıç tedavisi olarak hızlı parazitemi klirensi ve semptomların dramatik kaybomasını sağlayan artemisinli kombinasyonlara hemen başvurulmalıdır. Artemisin bazlı preparatlardan artemether-lümefantrin kombinasyonu ülkemizde de sık tercih edilen rejimdir. Ancak özellikle kanda yüksek parazit yükü olan olgularda uygun artemeter kombinasyonu uygulamasından sonraki takiplerde rekürrens (reinfeksiyon veya rekrudesens) olasılığı açısından hastaların yakından takibi önemlidir. (Turkiye Parazitol Derg 2014; 38: 61- ABSTRACT Malaria is a parasitic infection characterized by anemia, splenomegaly and periodic fever. This infection has a tendency to cause serious complications. Falciparum malaria could occur in our country as an imported case due to increasing intercontinental travel opportunities. The World Health Organisation (WHO) recommends arthemether combination treatment as a first line choice. Here we report a Turkish case admitted to the hospital with high fever, sweating and fatigue. He had been in Uganda for 6 months without prophylaxis. Plasmodium falciparum with an intense parasitic load was diagnosed. We started arthemether-lumefantrine combination therapy immediately. 18 days after his discharge he was readmitted with the same complaints and parasitemia was detected once again. This time, we treated him with the quinine-tetracycline combination regime for 7 days. Within 48 hours the patient was afebrile and the blood smear was negative. Falciparum malaria must be considered in infection emergencies for febrile patients especially with any travel history. For an initial therapy, arthemetherlumefantrine combination is a successful choice of treatment. Even with adequate treatment of arthemether-lumefantrine combination, the problems of recurrence (recrudescence or reinfection) could occur due to treatment failure. For the possibility of recurrence, close monitoring of patients...
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