Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online... more Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online under ''Instructions for Authors''.) They should be no more than 3 double-spaced pages excluding an Abstract and sub-headings with a maximum of four (4) references. If figures are included, they should be limited to two (2). The cost of printing color figures is the responsibility of the author.
Due to their shared transmission route, hepatitis B virus (HBV) or hepatitis C virus (HCV) co-inf... more Due to their shared transmission route, hepatitis B virus (HBV) or hepatitis C virus (HCV) co-infections can be observed in human immunodeficiency virus (HIV)-infected cases and are associated with more severe clinical courses. The detection of HBV DNA despite HBV surface antigen (HBsAg) seronegativity is defined as occult HBV infections. According to the current seroepidemiological data, Turkey is classified as an intermediate HBV, low HIV endemic region. Occult HBV infections have previously been reported from Turkey but has not been investigated previously in HIV infected cohorts. The aim of this study was to identify occult HBV infections in HIV-infected persons. Twenty-eight HIV-positive cases followed-up at Hacettepe University Hospital, Infectious Diseases Unit were included in the study after informed consent. For the detection of HBsAg, anti-HBs and anti-HCV, commercial ELISA tests (Architect System, Abbott Diagnostics, USA) were employed. Absolute CD4+ and CD8+ T-cell coun...
ABSTRACT Background Health Transformation Programme implementation by the Turkish Ministry of Hea... more ABSTRACT Background Health Transformation Programme implementation by the Turkish Ministry of Health resulted in significant health system changes in Turkey.1 Recognizing the importance of information technology and health technology assessment, Turkey invested in stronger systems and data collection. MEDULA, a nationwide integrated system between health insurance and healthcare providers, was built to collect e-invoice information electronically in 2007. Rheumatoid arthritis (RA) costs in Turkey were analyzed for the first time using real-world data. Objectives Estimate and identify medical cost determinants associated with RA in Turkey using nationwide real-world data. Methods Data was obtained from MEDULA (2009-2011). Adult RA patients (ages 18-99) were identified (01JUN2010-31DEC2010), and were required to have two RA diagnoses ≥60 days apart, and were grouped as prevalent and incident cases. The first RA claim date was designated as the index date. Healthcare costs were examined following the index date. Descriptive and multivariate analyses are provided. Pharmacy, outpatient and inpatient claims were compiled. Generalized linear models were used to calculate expected annual costs after controlling for age, gender, region, comorbid conditions and medication. Results A total of 2,613 patients met all inclusion criteria (693 incident; 1,920 prevalent patients). Prevalent patients were older, less likely to reside in the Marmara region, had higher comorbidity index scores and were more likely to be prescribed non-steroidal anti-inflammatory drugs, biologics and disease-modifying anti-rheumatic drugs relative to incident patients. Average annual costs were €2,000 (incident) and €2,386 (prevalent), due to pharmacy costs (73%, incident; 60%, prevalent). For both groups, inpatient and outpatient costs were mostly due to physician costs. Costs did not significantly differ in terms of age or region, prior comorbid conditions and medication use significantly affected cost estimation. Conclusions RA annual costs were found to be lower in Turkey relative to estimates in Europe, yet a significant portion was due to pharmacy costs. Comparative effectiveness analyses may be useful to decrease RA pharmacy costs. References Akdag R. Progress Report 2008 Health Transformation Programme: Ministry of Health, Ankara; 2008. Disclosure of Interest None Declared
ObjectiveWe aimed to determine the risk factors of methicillin‐resistant Staphylococcus aureus (M... more ObjectiveWe aimed to determine the risk factors of methicillin‐resistant Staphylococcus aureus (MRSA) colonization, and the impact of colonization on MRSA infection to evaluate the necessity of MRSA survey program in intensive care units (ICUs) in Turkey.MethodsThe patients hospitalized in medical and neurosurgical ICUs longer than 24 hr were included into the study. To determine anterior nares MRSA colonization, swabs were taken from each patient in the first 48 hr, and followed by once a week till discharge from ICUs.ResultsDuring the one‐year follow‐up period, the number of the hospitalized patients who spent more than 24 hr in ICUs was 195 of 372 and 85 of 619 in medical and neurosurgical ICUs, respectively. Totally, 23 out of 280 patients (14 from medical ICU, 9 from neurosurgical ICU) were colonized with MRSA, and 11 out of 23 colonized patients were accepted as ICU‐acquired infection. The duration of ICU hospitalization in patients with ICU‐acquired MRSA colonization was foun...
OBJECTIVE. To evaluate the influence of functional status on the outcome in older patients with b... more OBJECTIVE. To evaluate the influence of functional status on the outcome in older patients with bacteremia. DESIGN: Prospective study of all episodes of bacteremia that occurred in adults during a 27-month period (January 1991 to March 1993). SETTING: A 280-bed community hospital. PARTICIPANTS: During the study period, bacteremia was diagnosed in 242 consecutive patients (incidence of 11.2 bacteremic episodes per 1000 hospital admissions). One hundred twenty-seven of these patients were 65 years of age or older, and 115 were less than age 65. MEASUREMENTS: On identification of a positive blood culture, data on demographics, clinical findings, and a series of factors frequently cited as predisposing to infection were collected. The patient's functional status was assessed using the Barthel index (a score of <60 identifies moderately and highly dependent patients). RESULTS: The overall mortality rate was 14.9% (36 of 242). In the univariate analysis, mortality was associated significantly with age greater than 65 years, nosocomial infection, absence of fever, shock, leukocytosis or leukopenia, inappropriate therapy, more than one underlying disease, immunocompromised state, and limited functional status. Multiple logistic regression analysis revealed that shock (OR = 27.6, 95% CI 5.7-133), a Barthel score less than 60 (OR = 11.7, 95% CI 3.2-43), nosocomial infection (OR = 6.7, 95% CI 1.8-25.5), absence of fever (OR = 5.2,95% CI 1.05-26), and immunocompromised state (OR = 15.6, 95% CI 2.4-101.5) were significantly associated with death attributable to bacteremia. CONCLUSION: The main prognostic factors in a patient with bacteremia were the presence of shock, impaired functional status, immunodeficiency state, acquisition of infection in the hospital, and absence of fever on admission. Age alone did not influence outcome.
Background/Aims: Hepatocellular carcinoma (HCC) is the sixth most common malignancy worldwide and... more Background/Aims: Hepatocellular carcinoma (HCC) is the sixth most common malignancy worldwide and therapeutic options are scarce. As they might represent future targets for cancer therapy, the expression of apoptosis-related genes in HCC is of particular interest. In this pilot study, we further examined apoptosis-related genes in human HCC and also focused on vitamin D signaling as this might be a regulator of HCC cell apoptosis. Methods: We employed tumor tissue and serum samples from 62 HCC patients as well as 62 healthy controls for these studies. Tissue and serum specimens were analyzed by quantitative RT-PCR, immunohistochemistry and ELISA. Results: In HCC patients the apoptosis marker M30 was found to be elevated and several pro-apoptotic (TRAIL, FasL and FasR) as well as anti-apoptotic genes (Mcl-1 and Bcl-2) were simultaneously upregulated in tumor tissue and especially tumor-surrounding tissue as compared to healthy control livers. Moreover, vitamin D serum levels were dec...
This study aimed to estimate and identify determinants of direct medical costs associated with rh... more This study aimed to estimate and identify determinants of direct medical costs associated with rheumatoid arthritis (RA) in Turkey using nationwide realworld data. Using the Turkish National Health Insurance Database (2009-2011), RA patients (ages 18-99) were identified using International Classification of Disease Tenth Revision Clinical Modification (ICD-10-CM) codes. Patients were required to have two RA diagnoses at least 60 days apart and were grouped as prevalent and incident cases. The date of the first RA claim was identified for each patient and designated as the index date. Total healthcare costs were examined over the 12-month period following the index date. Descriptive and multivariate analyses are provided. Generalized linear models were used to calculate expected annual costs for incident and prevalent RA patients after controlling for age, gender, region, comorbid conditions and medication. A total of 2,613 patients met all inclusion criteria (693 incident; 1,920 prevalent patients). Prevalent patients were older, less likely to reside in the Marmara region, had higher comorbidity index scores and were more likely to use non-steroidal anti-inflammatory drugs, biologics and disease-modifying anti-rheumatic drugs relative to incident patients. Average direct annual costs were €2,000 [(€1,750, €2,247) 95 % CI] for incident cases and €2,385 [(€2,224, €2,545) 95 % CI] for prevalent cases, most due to pharmacy costs (73 % for incident cases, 60 % for prevalent cases). For incident and prevalent cases, a significant portion of inpatient and outpatient costs were due to physician costs (31 % for incident cases, 40 % for prevalent cases). Although the costs were not significantly different in terms of age or region, prior comorbid conditions and medication use significantly affected the cost estimation. RA total annual costs were found to be lower in Turkey, relative to estimates in Europe. The significant portion of the annual costs was due to pharmaceutical expenditures. Comparative effectiveness analysis may be useful to decrease RA-related pharmacy costs.
Eosinophilic colitis (EC) is a rare manifestation of eosinophilic gastrointestinal disorder. Even... more Eosinophilic colitis (EC) is a rare manifestation of eosinophilic gastrointestinal disorder. Even though the cut-off value of eosinophils per HPF for the diagnosis of EC is not clear, histopathological examination is still a cornerstone. Corticosteroids are the main drugs for EC treatment today. Here, we aim to report a woman with EC who showed clinical remission with budesonide and was maintained with adalimumab alone.
Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online... more Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online under ''Instructions for Authors''.) They should be no more than 3 double-spaced pages excluding an Abstract and sub-headings with a maximum of four (4) references. If figures are included, they should be limited to two (2). The cost of printing color figures is the responsibility of the author.
Due to their shared transmission route, hepatitis B virus (HBV) or hepatitis C virus (HCV) co-inf... more Due to their shared transmission route, hepatitis B virus (HBV) or hepatitis C virus (HCV) co-infections can be observed in human immunodeficiency virus (HIV)-infected cases and are associated with more severe clinical courses. The detection of HBV DNA despite HBV surface antigen (HBsAg) seronegativity is defined as occult HBV infections. According to the current seroepidemiological data, Turkey is classified as an intermediate HBV, low HIV endemic region. Occult HBV infections have previously been reported from Turkey but has not been investigated previously in HIV infected cohorts. The aim of this study was to identify occult HBV infections in HIV-infected persons. Twenty-eight HIV-positive cases followed-up at Hacettepe University Hospital, Infectious Diseases Unit were included in the study after informed consent. For the detection of HBsAg, anti-HBs and anti-HCV, commercial ELISA tests (Architect System, Abbott Diagnostics, USA) were employed. Absolute CD4+ and CD8+ T-cell coun...
ABSTRACT Background Health Transformation Programme implementation by the Turkish Ministry of Hea... more ABSTRACT Background Health Transformation Programme implementation by the Turkish Ministry of Health resulted in significant health system changes in Turkey.1 Recognizing the importance of information technology and health technology assessment, Turkey invested in stronger systems and data collection. MEDULA, a nationwide integrated system between health insurance and healthcare providers, was built to collect e-invoice information electronically in 2007. Rheumatoid arthritis (RA) costs in Turkey were analyzed for the first time using real-world data. Objectives Estimate and identify medical cost determinants associated with RA in Turkey using nationwide real-world data. Methods Data was obtained from MEDULA (2009-2011). Adult RA patients (ages 18-99) were identified (01JUN2010-31DEC2010), and were required to have two RA diagnoses ≥60 days apart, and were grouped as prevalent and incident cases. The first RA claim date was designated as the index date. Healthcare costs were examined following the index date. Descriptive and multivariate analyses are provided. Pharmacy, outpatient and inpatient claims were compiled. Generalized linear models were used to calculate expected annual costs after controlling for age, gender, region, comorbid conditions and medication. Results A total of 2,613 patients met all inclusion criteria (693 incident; 1,920 prevalent patients). Prevalent patients were older, less likely to reside in the Marmara region, had higher comorbidity index scores and were more likely to be prescribed non-steroidal anti-inflammatory drugs, biologics and disease-modifying anti-rheumatic drugs relative to incident patients. Average annual costs were €2,000 (incident) and €2,386 (prevalent), due to pharmacy costs (73%, incident; 60%, prevalent). For both groups, inpatient and outpatient costs were mostly due to physician costs. Costs did not significantly differ in terms of age or region, prior comorbid conditions and medication use significantly affected cost estimation. Conclusions RA annual costs were found to be lower in Turkey relative to estimates in Europe, yet a significant portion was due to pharmacy costs. Comparative effectiveness analyses may be useful to decrease RA pharmacy costs. References Akdag R. Progress Report 2008 Health Transformation Programme: Ministry of Health, Ankara; 2008. Disclosure of Interest None Declared
ObjectiveWe aimed to determine the risk factors of methicillin‐resistant Staphylococcus aureus (M... more ObjectiveWe aimed to determine the risk factors of methicillin‐resistant Staphylococcus aureus (MRSA) colonization, and the impact of colonization on MRSA infection to evaluate the necessity of MRSA survey program in intensive care units (ICUs) in Turkey.MethodsThe patients hospitalized in medical and neurosurgical ICUs longer than 24 hr were included into the study. To determine anterior nares MRSA colonization, swabs were taken from each patient in the first 48 hr, and followed by once a week till discharge from ICUs.ResultsDuring the one‐year follow‐up period, the number of the hospitalized patients who spent more than 24 hr in ICUs was 195 of 372 and 85 of 619 in medical and neurosurgical ICUs, respectively. Totally, 23 out of 280 patients (14 from medical ICU, 9 from neurosurgical ICU) were colonized with MRSA, and 11 out of 23 colonized patients were accepted as ICU‐acquired infection. The duration of ICU hospitalization in patients with ICU‐acquired MRSA colonization was foun...
OBJECTIVE. To evaluate the influence of functional status on the outcome in older patients with b... more OBJECTIVE. To evaluate the influence of functional status on the outcome in older patients with bacteremia. DESIGN: Prospective study of all episodes of bacteremia that occurred in adults during a 27-month period (January 1991 to March 1993). SETTING: A 280-bed community hospital. PARTICIPANTS: During the study period, bacteremia was diagnosed in 242 consecutive patients (incidence of 11.2 bacteremic episodes per 1000 hospital admissions). One hundred twenty-seven of these patients were 65 years of age or older, and 115 were less than age 65. MEASUREMENTS: On identification of a positive blood culture, data on demographics, clinical findings, and a series of factors frequently cited as predisposing to infection were collected. The patient's functional status was assessed using the Barthel index (a score of <60 identifies moderately and highly dependent patients). RESULTS: The overall mortality rate was 14.9% (36 of 242). In the univariate analysis, mortality was associated significantly with age greater than 65 years, nosocomial infection, absence of fever, shock, leukocytosis or leukopenia, inappropriate therapy, more than one underlying disease, immunocompromised state, and limited functional status. Multiple logistic regression analysis revealed that shock (OR = 27.6, 95% CI 5.7-133), a Barthel score less than 60 (OR = 11.7, 95% CI 3.2-43), nosocomial infection (OR = 6.7, 95% CI 1.8-25.5), absence of fever (OR = 5.2,95% CI 1.05-26), and immunocompromised state (OR = 15.6, 95% CI 2.4-101.5) were significantly associated with death attributable to bacteremia. CONCLUSION: The main prognostic factors in a patient with bacteremia were the presence of shock, impaired functional status, immunodeficiency state, acquisition of infection in the hospital, and absence of fever on admission. Age alone did not influence outcome.
Background/Aims: Hepatocellular carcinoma (HCC) is the sixth most common malignancy worldwide and... more Background/Aims: Hepatocellular carcinoma (HCC) is the sixth most common malignancy worldwide and therapeutic options are scarce. As they might represent future targets for cancer therapy, the expression of apoptosis-related genes in HCC is of particular interest. In this pilot study, we further examined apoptosis-related genes in human HCC and also focused on vitamin D signaling as this might be a regulator of HCC cell apoptosis. Methods: We employed tumor tissue and serum samples from 62 HCC patients as well as 62 healthy controls for these studies. Tissue and serum specimens were analyzed by quantitative RT-PCR, immunohistochemistry and ELISA. Results: In HCC patients the apoptosis marker M30 was found to be elevated and several pro-apoptotic (TRAIL, FasL and FasR) as well as anti-apoptotic genes (Mcl-1 and Bcl-2) were simultaneously upregulated in tumor tissue and especially tumor-surrounding tissue as compared to healthy control livers. Moreover, vitamin D serum levels were dec...
This study aimed to estimate and identify determinants of direct medical costs associated with rh... more This study aimed to estimate and identify determinants of direct medical costs associated with rheumatoid arthritis (RA) in Turkey using nationwide realworld data. Using the Turkish National Health Insurance Database (2009-2011), RA patients (ages 18-99) were identified using International Classification of Disease Tenth Revision Clinical Modification (ICD-10-CM) codes. Patients were required to have two RA diagnoses at least 60 days apart and were grouped as prevalent and incident cases. The date of the first RA claim was identified for each patient and designated as the index date. Total healthcare costs were examined over the 12-month period following the index date. Descriptive and multivariate analyses are provided. Generalized linear models were used to calculate expected annual costs for incident and prevalent RA patients after controlling for age, gender, region, comorbid conditions and medication. A total of 2,613 patients met all inclusion criteria (693 incident; 1,920 prevalent patients). Prevalent patients were older, less likely to reside in the Marmara region, had higher comorbidity index scores and were more likely to use non-steroidal anti-inflammatory drugs, biologics and disease-modifying anti-rheumatic drugs relative to incident patients. Average direct annual costs were €2,000 [(€1,750, €2,247) 95 % CI] for incident cases and €2,385 [(€2,224, €2,545) 95 % CI] for prevalent cases, most due to pharmacy costs (73 % for incident cases, 60 % for prevalent cases). For incident and prevalent cases, a significant portion of inpatient and outpatient costs were due to physician costs (31 % for incident cases, 40 % for prevalent cases). Although the costs were not significantly different in terms of age or region, prior comorbid conditions and medication use significantly affected the cost estimation. RA total annual costs were found to be lower in Turkey, relative to estimates in Europe. The significant portion of the annual costs was due to pharmaceutical expenditures. Comparative effectiveness analysis may be useful to decrease RA-related pharmacy costs.
Eosinophilic colitis (EC) is a rare manifestation of eosinophilic gastrointestinal disorder. Even... more Eosinophilic colitis (EC) is a rare manifestation of eosinophilic gastrointestinal disorder. Even though the cut-off value of eosinophils per HPF for the diagnosis of EC is not clear, histopathological examination is still a cornerstone. Corticosteroids are the main drugs for EC treatment today. Here, we aim to report a woman with EC who showed clinical remission with budesonide and was maintained with adalimumab alone.
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