Alveolar echinococcosis (AE) is a chronic disease caused by ingestion of the eggs of the parasitic cestode Echinococcosis multilocularis (EM). In severe cases, liver transplantation (LT) may represent the only possibility of survival and cure. Patients undergoing LT associated with hepatic AE at our institution between April 2011 and October 2014 were investigated retrospectively. The clinical findings of the 27 patients who participated in the study were noted. Kaplan-Meier and chi-square tests were used to investigate the effect of these characteristics on survival and mortality. Living donor LT was performed on 20 patients (74.1%), and deceased donor LT was performed on 7 patients (25.9%). Hilar invasion was the most common indication (14 patients, 51.9%) for transplantation. The patient follow-up was 16.1 6 11.4 months, and the overall survival rate was 77.8%. Primary nonfunction developed only in 2 patients in the posttransplantation period. Six patients died during monitoring, the most common cause of death being sepsis (3 patients). The relationship between the mortality rate of the patients and the invasion of the bile duct and/or portal vein by alveolar lesions was found to be statistically significant (P 5 0.024 and P 5 0.043, respectively). According to PNM staging, when the AE disease exceeds the resectability limits, the only alternative for the treatment of the disease is LT. However, different from LT due to cirrhosis, it is extremely difficult to perform a transplantation for AE disease because of the invasive characteristics of it. In order to decrease the difficulty of the operation and the postoperative mortality, the intracystic abscess and cholangitis which occur because of AE must be treated via medical and percutaneous methods before transplantation.
Objective:
The aim of this study was to analyze the temporal trends of HIV epidemiology in Turkey from 2011 to
2016.
Method:
Thirty-four teams from 28 centers at 17 different cities participated in this retrospective study.
Participating centers were asked to complete a structured form containing questions about
epidemiologic, demographic and clinical characteristics of patients presented with new HIV diagnosis
between 2011 and 2016. Demographic data from all centers (complete or partial) were included in the
analyses. For the cascade of care analysis, 15 centers that provided full data from 2011 to 2016 were
included. Overall and annual distributions of the data were calculated as percentages and Chi square test
was used to determine temporal changes.
Results:
A total of 2,953 patients between 2011 and 2016 were included. Overall male to female ratio was 5:1
with a significant increase in the number of male cases from 2011 to 2016 (p<0.001). The highest
prevalence was among those aged 25-34 years followed by the 35-44 age bracket. Most common reason
for HIV testing was illness (35%). While the frequency of sex among men who have sex with men
increased from 16% to 30.6% (p<0.001) over the study period, heterosexual intercourse (53%) was
found to be the most common transmission route. Overall, 29% of the cases presented with a CD4 count
of >500 cells/mm3
while 46.7% presented with CD4 T cell count of <350 cells/mm3
. Among newly
diagnosed cases, 79% were retained in care, and all such cases initiated ART with 73% achieving viral
suppression after six months of antiretroviral therapy.
Conclusion:
The epidemiologic profile of HIV infected individuals is changing rapidly in Turkey with an increasing
trend in the number of newly diagnosed people disclosing themselves as MSM. New diagnoses were
mostly at young age. Late diagnosis was found to be challenging issue. Despite unavailability of data
for the first 90, Turkey is close to the last two steps of 90-90-90 targets.
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