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Sarıgül Yıldırım F, Üser Ü, Didem Sarı N, Kurtaran B, Önlen Y, Şenateş E, Gündüz A, Zerdali E, Karsen H, Batırel A, Karaali R, Güner R, Yamazhan T, Köse Ş, Erben N, İnce N, Köksal İ, Çuvalcı Öztoprak N, Yörük G, Kömür S, Bal T, Kaya S, Bozkurt İ, Günal Ö, Esen Yıldız İ, İnan D, Barut Ş, Namıduru M, Tosun S, Türker K, Şener A, Hızel K, Baykam N, Duygu F, Bodur H, Can G, Gül HC, Sağmak Tartar A, Çelebi G, Sünnetçioğlu M, Karabay O, Kumbasar Karaosmanoğlu H, Sırmatel F, Tabak F. In a Real-Life Setting, Direct-Acting Antivirals to People Who Inject Drugs with Chronic Hepatitis C in Turkey. Turk J Gastroenterol 2022; 33:971-978. [PMID: 36415900 PMCID: PMC9797763 DOI: 10.5152/tjg.2022.21834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND People who inject drugs (PWID) should be treated in order to eliminate hepatitis C virus in the world. The aim of this study was to compare direct-acting antivirals treatment of hepatitis C virus for PWID and non-PWID in a real-life setting. METHODS We performed a prospective, non-randomized, observational multicenter cohort study in 37 centers. All patients treated with direct-acting antivirals between April 1, 2017, and February 28, 2019, were included. In total, 2713 patients were included in the study among which 250 were PWID and 2463 were non-PWID. Besides patient characteristics, treatment response, follow-up, and side effects of treatment were also analyzed. RESULTS Genotype 1a and 3 were more prevalent in PWID-infected patients (20.4% vs 9.9% and 46.8% vs 5.3%). The number of naïve patients was higher in PWID (90.7% vs 60.0%), while the number of patients with cirrhosis was higher in non-PWID (14.1% vs 3.7%). The loss of follow-up was higher in PWID (29.6% vs 13.6%). There was no difference in the sustained virologic response at 12 weeks after treatment (98.3% vs 98.4%), but the end of treatment response was lower in PWID (96.2% vs 99.0%). In addition, the rate of treatment completion was lower in PWID (74% vs 94.4%). CONCLUSION Direct-acting antivirals were safe and effective in PWID. Primary measures should be taken to prevent the loss of follow-up and poor adherence in PWID patients in order to achieve World Health Organization's objective of eliminating viral hepatitis.
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Affiliation(s)
- Figen Sarıgül Yıldırım
- Department of Infectious Diseases and Clinical Microbiology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ülkü Üser
- Department of Infectious Diseases and Clinical Microbiology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Nagehan Didem Sarı
- Department of Infectious Diseases, İstanbul Education Research Hospital, İstanbul, Turkey
| | - Behice Kurtaran
- Department of Infectious Diseases and Clinical Microbiology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Yusuf Önlen
- Department of Infectious Diseases and Clinical Microbiology, Mustafa Kemal University Faculty of Medicine, Hatay, Turkey
| | - Ebubekir Şenateş
- Department of Gastroenterology, Medeniyet University Göztepe Training and Research Hospital, İstanbul, Turkey
| | - Alper Gündüz
- Department of Infectious Diseases, İstanbul Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Esra Zerdali
- Department of Infectious Diseases, Haseki Education Research Hospital, İstanbul, Turkey
| | - Hasan Karsen
- Department of Infectious Diseases and Clinical Microbiology, Harran University Faculty of Medicine, Şanlıurfa, Turkey
| | - Ayşe Batırel
- Department of Infectious Diseases, İstanbul Doctor Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Rıdvan Karaali
- Department of Infectious Diseases and Clinical Microbiology, Namık Kemal University Faculty of Medicine, Tekirdağ, Turkey
| | - Rahmet Güner
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara, Turkey
| | - Tansu Yamazhan
- Department of Infectious Diseases and Clinical Microbiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Şükran Köse
- Department of Infectious Diseases, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Nurettin Erben
- Department of Infectious Diseases and Clinical Microbiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Nevin İnce
- Department of Infectious Diseases and Clinical Microbiology, Düzce University Medical School, Düzce, Turkey
| | - İftihar Köksal
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Teknik University Faculty of Medicine, Trabzon, Turkey
| | - Nefise Çuvalcı Öztoprak
- Department of Infectious Diseases and Clinical Microbiology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Gülşen Yörük
- Department of Infectious Diseases, İstanbul Education Research Hospital, İstanbul, Turkey
| | - Süheyla Kömür
- Department of Infectious Diseases and Clinical Microbiology, Mustafa Kemal University Faculty of Medicine, Hatay, Turkey
| | - Tayibe Bal
- Department of Gastroenterology, Medeniyet University Göztepe Training and Research Hospital, İstanbul, Turkey
| | - Sibel Kaya
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - İlkay Bozkurt
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Özgür Günal
- Department of Infectious Diseases, Samsun Education Research Hospital, Samsun, Turkey
| | - İlknur Esen Yıldız
- Department of Infectious Diseases and Clinical Microbiology, Recep Tayyip Erdoğan University Training and Research Hospital, Rize, Turkey
| | - Dilara İnan
- Department of Infectious Diseases and Clinical Microbiology, Akdeniz University Medical School, Antalya, Turkey
| | - Şener Barut
- Department of Infectious Diseases and Clinical Microbiology, Gaziosmanpaşa University Medical Faculty, Tokat, Turkey
| | - Mustafa Namıduru
- Department of Infectious Diseases and Clinical Microbiology, Gaziantep University Medical Faculty, Gaziantep, Turkey
| | - Selma Tosun
- Department of Infectious Diseases and Clinical Microbiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Kamuran Türker
- Department of Infectious Diseases, İstanbul Bağcılar Training and Research Hospital, İstanbul, Turkey
| | - Alper Şener
- Department of Infectious Diseases and Clinical Microbiology, Çanakkale 18 Mart University Faculty of Medicine, Çanakkale, Turkey
| | - Kenan Hızel
- Department of Infectious Diseases and Clinical Microbiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Nurcan Baykam
- Department of Infectious Diseases and Clinical Microbiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Fazilet Duygu
- Department of Infectious Diseases, Ankara Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Hürrem Bodur
- Department of Infectious Diseases, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Güray Can
- Department of Gastroenterology, Bolu İzzet Baysal University Medical Faculty, Bolu, Turkey
| | - Hanefi Cem Gül
- Department of Infectious Diseases, Health Science University Gülhane Faculty of Medicine, Ankara, Turkey
| | - Ayşe Sağmak Tartar
- Department of Infectious Diseases and Clinical Microbiology, Fırat University School of Medicine, Elazığ, Turkey
| | - Güven Çelebi
- Department of Infectious Diseases and Clinical Microbiology, Zonguldak Bülent Ecevit University Training and Research Hospital, Zonguldak, Turkey
| | - Mahmut Sünnetçioğlu
- Department of Infectious Diseases and Clinical Microbiology, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| | - Oğuz Karabay
- Department of Infectious Diseases and Clinical Microbiology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Hayat Kumbasar Karaosmanoğlu
- Department of Infectious Diseases, İstanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Fatma Sırmatel
- Department of Infectious Diseases and Clinical Microbiology, Bolu İzzet Baysal University Medical Faculty, Bolu, Turkey
| | - Fehmi Tabak
- Department of Infectious Diseases and Clinical Microbiology, Gaziosmanpaşa University Medical Faculty, Tokat, Turkey
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Önlen Y, Bal T, Çabalak M, Çuvalcı Öztoprak N, Didem Sarı N, Kurtaran B, Şenateş E, Gündüz A, Zerdali E, Karsen H, Batırel A, Karaali R, Güner R, Yamazhan T, Köse Ş, Erben N, İnce N, Köksal İ, Sarıgül Yıldırım F, Yörük G, Kömür S, Kaya S, Esen Ş, Günal Ö, Esen Yıldız İ, İnan D, Barut Ş, Namıduru M, Tosun S, Türker K, Şener A, Hızel K, Baykam N, Duygu F, Akıncı E, Can G, User Ü, Cem Gül H, Akbulut A, Çelebi G, Sünnetçioğlu M, Karabay O, Kumbasar Karaosmanoğlu H, Sırmatel F, Tabak F. Efficacy and Safety of Direct-Acting Antivirals in Elderly Patients with Chronic Hepatitis C: A Nationwide Real-Life, Observational, Multicenter Study from Turkey. Turk J Gastroenterol 2022; 33:862-873. [PMID: 35946896 PMCID: PMC9623221 DOI: 10.5152/tjg.2022.21271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 01/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The number and proportion of elderly patients living with chronic hepatitis C are expected to increase in the coming years. We aimed to compare the real-world efficacy and safety of direct-acting antiviral treatment in elderly and younger Turkish adults infected with chronic hepatitis C. METHODS In this multicenter prospective study, 2629 eligible chronic hepatitis C patients treated with direct-acting antivirals between April 2017 and December 2019 from 37 Turkish referral centers were divided into 2 age groups: elderly (≥65 years) and younger adults (<65 years) and their safety was compared between 2 groups in evaluable population. Then, by matching the 2 age groups for demographics and pretreatment risk factors for a non-sustained virological response, a total of 1516 patients (758 in each group) and 1244 patients (622 in each group) from the modified evaluable population and per-protocol population were included in the efficacy analysis and the efficacy was compared between age groups. RESULTS The sustained virological response in the chronic hepatitis C patients was not affected by the age and the presence of cirrhosis both in the modified evaluable population and per-protocol population (P = .879, P = .508 for modified evaluable population and P = .058, P = .788 for per-protocol population, respectively). The results of the per-protocol analysis revealed that male gender, patients who had a prior history of hepatocellular carcinoma, patients infected with non-genotype 1 hepatitis C virus, and patients treated with sofosbuvir+ribavirin had a significantly lower sustained virological response 12 rates (P < .001, P = .047, P = .013, and P = .025, respectively). CONCLUSION Direct-acting antivirals can be safely used to treat Turkish elderly chronic hepatitis C patients with similar favorable efficacy and safety as that in younger adults.
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Affiliation(s)
- Yusuf Önlen
- Mustafa Kemal University Faculty of Medicine, Antakya, Turkey
| | - Tayibe Bal
- Mustafa Kemal University Faculty of Medicine, Antakya, Turkey
| | - Mehmet Çabalak
- Mustafa Kemal University Faculty of Medicine, Antakya, Turkey
| | | | | | | | - Ebubekir Şenateş
- Department of Gastroenterology, Medeniyet University Faculty of Medicine, İstanbul, Turkey
| | - Alper Gündüz
- Department of Infectious Diseases, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Esra Zerdali
- Department of Infectious Diseases, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Hasan Karsen
- Department of Infectious Diseases and Clinical Microbiology, Harran University Faculty of Medicine, Urfa, Turkey
| | - Ayşe Batırel
- Department of Infectious Diseases, Kartal Training and Research Hospital, İstanbul, Turkey
| | - Rıdvan Karaali
- Department of Infectious Diseases and Clinical Microbiology, Tekirdağ Namık Kemal University Faculty of Medicine, Tekirdağ, Turkey
| | - Rahmet Güner
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Tansu Yamazhan
- Department of Infectious Diseases and Clinical Microbiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Şükran Köse
- Department of Infectious Diseases, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Nurettin Erben
- Department of Infectious Diseases and Clinical Microbiology, Eskişehir Osman Gazi University, Eskişehir, Turkey
| | - Nevin İnce
- Department of Infectious Diseases and Clinical Microbiology, Düzce University Faculty of Medicine, Düzce, Turkey
| | - İftihar Köksal
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Figen Sarıgül Yıldırım
- Department of Infectious Diseases, Antalya Training and Research Hospital, Antalya, Turkey
| | - Gülşen Yörük
- Department of Infectious Diseases, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Süheyla Kömür
- Department of Infectious Diseases and Clinical Microbiology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Sibel Kaya
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Şaban Esen
- Department of Infectious Diseases and Clinical Microbiology, Samsun 19 Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Özgür Günal
- Department of Infectious Diseases, Samsun Training and Research Hospital, Samsun, Turkey
| | - İlknur Esen Yıldız
- Department of Infectious Diseases and Clinical Microbiology, RTE University Faculty of Medicine, Rize, Turkey
| | - Dilara İnan
- Department of Infectious Diseases and Clinical Microbiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Şener Barut
- Department of Infectious Diseases and Clinical Microbiology, Gaziosmanpaşa University Faculty of Medicine, Tokat, Turkey
| | - Mustafa Namıduru
- Department of Infectious Diseases and Clinical Microbiology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Selma Tosun
- Department of Infectious Diseases, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Kamuran Türker
- Department of Infectious Diseases, Bağcılar Training and Research Hospital, İstanbul, Turkey
| | - Alper Şener
- Department of Infectious Diseases and Clinical Microbiology, Çanakkale 18 Mart University Faculty of Medicine, Çanakkale, Turkey
| | - Kenan Hızel
- Department of Infectious Diseases and Clinical Microbiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Nurcan Baykam
- Department of Infectious Diseases and Clinical Microbiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Fazilet Duygu
- Department of Infectious Diseases, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Esragül Akıncı
- Department of Infectious Diseases, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Güray Can
- Department of Gastroenterology, Bolu İzzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Ülkü User
- Department of Infectious Diseases and Clinical Microbiology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Hanefi Cem Gül
- Department of Infectious Diseases, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Ayhan Akbulut
- Department of Infectious Diseases and Clinical Microbiology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Güven Çelebi
- Department of Infectious Diseases and Clinical Microbiology, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Mahmut Sünnetçioğlu
- Department of Infectious Diseases and Clinical Microbiology, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| | - Oğuz Karabay
- Department of Infectious Diseases and Clinical Microbiology, Sakarya University Faculty of Medicine, Hatay, Turkey
| | | | - Fatma Sırmatel
- Department of Infectious Diseases and Clinical Microbiology, Bolu İzzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Fehmi Tabak
- İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty of Medicine, İstanbul, Turkey
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Akarca US, Baykam N, Güner R, Günşar F, İdilman R, Kaymakoğlu S, Köksal İ, Tabak F, Yamazhan T. Eliminating Viral Hepatitis in Turkey: Achievements and Challenges. Egypt J Immunol 2022. [DOI: 10.4274/vhd.galenos.2022.2022-9-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Zarakolu P, Eser ÖK, Otlu B, Gürpınar Ö, Özakın C, Akalın H, Köksal İ, Ünal S. In-vitro activity of fosfomycin against Escherichia coli and Klebsiella pneumoniae bloodstream isolates and frequency of OXA-48, NDM, KPC, VIM, IMP types of carbapenemases in the carbapenem-resistant groups. J Chemother 2022; 34:235-240. [PMID: 34495816 DOI: 10.1080/1120009x.2021.1963618] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The aim of this study was to determine the in-vitro activity of fosfomycin against Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) isolates and the frequency of OXA-48, NDM, KPC, VIM, IMP types of carbapenemases in the carbapenem-resistant (CR) groups. A total of 346 isolates (126 E. coli and 220 K. pneumoniae) from nosocomial bloodstream infections were included. Carbapenem and fosfomycin susceptibility were tested by Etest (bioMerieux, France) and agar dilution methods, respectively and evaluated in accordance with EUCAST criteria. The presence of OXA-48, NDM, KPC, VIM, IMP types of carbapenemases were conducted by using PCR method. Of the total 346 isolates, 185 (41 E. coli, 144 K. pneumoniae) were CR. Fosfomycin susceptibility of E. coli was higher than 95% and was not statistically significant between the CR and carbapenem-susceptible (CS) groups. Fosfomycin susceptibility of CS and CR K. pneumoniae was 90.7% and 69.4%, respectively, and statistically significantly lower in CR group. Of the total 185 CR isolates, 163 (32 E. coli, 131 K. pneumoniae) were producing carbapenemases. OXA-48 was the prominent carbapenemase type produced by E. coli (96.8%) and K. pneumoniae (70.9%). The frequency of NDM and KPC types produced by K. pneumoniae was 20.6% and 15.2%, respectively. Fosfomycin has substantial in-vitro activity against nosocomial CS and CR E. coli and CS K. pneumoniae bloodstream isolates. However, due to the risk of emerging resistance with fosfomycin monotherapy, combination therapy should be considered to obtain the possible additive or synergistic activity. Emerging fosfomycin resistance of CR K. pneumoniae isolates is alarming and OXA-48 is still the prominent carbapenemase type in Turkey.
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Affiliation(s)
- Pınar Zarakolu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Özgen Köseoğlu Eser
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Barış Otlu
- Department of Medical Microbiology, Faculty of Medicine, Inönü University, Malatya, Turkey
| | - Öznur Gürpınar
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Cüneyt Özakın
- Department of Medical Microbiology, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Halis Akalın
- Department of Medical Microbiology, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - İftihar Köksal
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Serhat Ünal
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Aydın NN, Köksal İ. An Evaluation of Chronic Hepatitis C Patients’ Responses to Direct-Acting Antivirals According to Transient Elastography and Serum Biomarkers. Egypt J Immunol 2022. [DOI: 10.4274/vhd.galenos.2022.2021-8-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Şenol E, Çilli A, Günen H, Şener A, Dumlu R, Ödemiş A, Topçu AF, Yıldız Y, Güner R, Özhasenekler A, Mutlu B, Köktürk N, Sevimli N, Baykam N, Yapar D, Ekin S, Polatlı M, Gök ŞE, Kılınç O, Sayıner A, Karaşahin Ö, Çuhadaroğlu Ç, Sesin Kocagöz A, Togan T, Arpağ H, Katı H, Köksal İ, Aksoy F, Hasanoğlu C. The Role of Pneumococcal Pneumonia among Community-Acquired Pneumonia in Adult Turkish Population: TurkCAP Study. Turk Thorac J 2022; 22:339-345. [PMID: 35110252 DOI: 10.5152/turkthoracj.2021.20223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the rate of pneumococcal pneumonia (PP) among patients with community-acquired pneumonia (CAP) in Turkey and to investigate and compare features of PP and non-PP CAP patients. MATERIAL AND METHODS This multicenter, non-interventional, prospective, observational study included adult CAP patients (age ≥ 18 years). Diagnosis of PP was based on the presence of at least 1 positive laboratory test result for Streptococcus pneumoniae (blood culture or sputum culture or urinary antigen test [UAT]) in patients with radiographic findings of pneumonia. RESULTS Four hundred sixty-five patients were diagnosed with CAP, of whom 59 (12.7%) had PP. The most common comorbidity was chronic obstructive pulmonary disease (30.1%). The mean age, smoking history, presence of chronic neurological disease, and CURB-65 score were significantly higher in PP patients, when compared to non-PP patients. In PP patients, 84.8% were diagnosed based ony on the UAT. The overall rate of PP patients among CAP was calculated as 22.8% considering the UAT sensitivity ratio of 63% (95% confidence interval: 45-81). The rate of intensive care treatment was higher in PP patients (P = .007). While no PP patients were vaccinated for pneumococcus, 3.8% of the non-PP patients were vaccinated (P = .235). Antibiotic use in the preceding 48 hours was higher in the non-PP group than in the PP group (31.8% vs. 11.1%, P = .002). The CURB-65 score and the rate of patients requiring inpatient treatment according to this score were higher in the PP group. CONCLUSION The facts that PP patients were older and required intensive care treatment more frequently as compared to non-PP patients underline the burden of PP.
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Affiliation(s)
- Esin Şenol
- Department of Infectious Diseases, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Aykut Çilli
- Department of Pulmonary Diseases, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Hakan Günen
- Department of Pulmonary Diseases, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Alper Şener
- Department of Infectious Diseases and Clinical Microbiology, 18 Mart University, Faculty of Medicine, Çanakkale, Turkey
| | - Rıdvan Dumlu
- Department of Infectious Diseases and Clinical Microbiology, 18 Mart University, Faculty of Medicine, Çanakkale, Turkey
| | - Ayşe Ödemiş
- Department of Pulmonary Diseases, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Ayşe Füsun Topçu
- Department of Pulmonary Diseases, Dicle University, Faculty of Medicine, Diyarbakır, Turkey
| | - Yeşim Yıldız
- Department of Infectious Diseases and Clinical Microbiology, Mardin State Hospital, Mardin, Turkey
| | - Rahmet Güner
- Department of Infectious Diseases and Clinical Microbiology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Ayhan Özhasenekler
- Department of Emergency Medicine, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Birsen Mutlu
- Department of Infectious Diseases, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Nurdan Köktürk
- Department of Pulmonary Diseases, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Nurgül Sevimli
- Department of Pulmonary Diseases, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Nurcan Baykam
- Department of Infectious Diseases and Clinical Microbiology, Hitit University, Faculty of Medicine, Çorum, Turkey
| | - Derya Yapar
- Department of Infectious Diseases and Clinical Microbiology, Hitit University, Faculty of Medicine, Çorum, Turkey
| | - Selami Ekin
- Department of Pulmonary Diseases, Yüzüncü Yıl University, Faculty of Medicine, Van, Turkey
| | - Mehmet Polatlı
- Department of Pulmonary Diseases, Adnan Menderes University, Faculty of Medicine, Aydın, Turkey
| | - Şebnem Eren Gök
- Department of Infectious Diseases and Clinical Microbiology, Bozok University, Faculty of Medicine, Yozgat, Turkey
| | - Oğuz Kılınç
- Department of Pulmonary Diseases, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey
| | - Abdullah Sayıner
- Department of Pulmonary Diseases, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Ömer Karaşahin
- Department of Infectious Diseases and Clinical Microbiology, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Çağlar Çuhadaroğlu
- Department of Pulmonary Diseases and Sleep Disorder, Acıbadem Health Group Maslak Hospital, Istanbul, Turkey
| | - Ayşe Sesin Kocagöz
- Department of Infectious Diseases and Clinical Microbiology, Acıbadem Health Group Maslak Hospital, Istanbul, Turkey
| | - Turhan Togan
- Department of Infectious Diseases and Clinical Microbiology, Başkent University Konya Hospital, Konya, Turkey
| | - Hüseyin Arpağ
- Department of Pulmonary Diseases, Sutcu Imam University, Faculty of Medicine, Kahramanmaraş, Turkey
| | - Hakan Katı
- Department of Infectious Diseases, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - İftihar Köksal
- Department of Infectious Diseases, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
| | - Firdevs Aksoy
- Department of Infectious Diseases, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
| | - Canan Hasanoğlu
- Department of Pulmonary Diseases, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
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Tabak F, Şirin G, Demir M, Aladağ M, Sümer Ş, Kurtaran B, Tosun S, Yamazhan T, Bozkurt İ, Gürbüz Y, Batırel A, Şenateş E, Kandemir FÖ, Topal F, Doğanay HL, Sezgin O, Mıstık R, Köse Ş, Yılmaz Y, İnan D, Köksal İ, Parlak E, Akdoğan M, Güner R. Demographic Characteristics and Transmission Risk Factors of Patients with Hepatitis C Virus in Turkey: The EPI-C, A Multicenter and Cross-sectional Trial. Egypt J Immunol 2021. [DOI: 10.4274/vhd.galenos.2021.2021-1-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Gündoğdu Y, Deniz OC, Saka D, Şişman G, Erdamar S, Köksal İ. Sunitinib induced colitis manifesting as invasive diarrhea in a patient with renal cell carcinoma. J Oncol Pharm Pract 2021; 28:516-518. [PMID: 34791942 DOI: 10.1177/10781552211061183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Sunitinib is a tyrosine kinase inhibitor that binds to vascular endothelial factor receptor currently used for the treatment of renal cell carcinoma, as well as for several other conditions such as gastrointestinal stromal tumors and pancreatic neuroendocrine tumors. We present a patient with invasive diarrhea who was treated with sunitinib for metastatic renal cell carcinoma. CASE REPORT Drug induced colitis was confirmed with colonoscopy from histopathological specimens. Clinical recovery of diarrhea was achieved with oral budesonide. Remarkably, the pathologic findings were observed in both the macroscopically normal mucosa and the mucosa with aphthous ulcers in the colon. MANAGEMENT & OUTCOME The patient was treated for sunitinib associated diarrhea, after exclusion of the other reasons. Metronidazole and piperacillin/tazobactam treatment were prescribed. DISCUSSION Diarrhea is a frequent symptom in patients treated with tyrosine kinase inhibitors, however the described pathologic findings have rarely been reported. Our aim is to emphasize the importance of close follow-up in patients treated with tyrosine kinase inhibitors, and to raise awareness on the management of sunitinib induced colitis.
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Affiliation(s)
- Yasemin Gündoğdu
- Department of Internal Medicine, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Turkey
| | - Orhan Cem Deniz
- Department of Internal Medicine, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Turkey
| | - Didem Saka
- School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Turkey
| | - Gürhan Şişman
- Department of Gastroenterelogy, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Turkey
| | - Sibel Erdamar
- Department of Pathology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Turkey
| | - İftihar Köksal
- Department of Infectious Diseases, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Turkey
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Tanriover MD, Doğanay HL, Akova M, Güner HR, Azap A, Akhan S, Köse Ş, Erdinç FŞ, Akalın EH, Tabak ÖF, Pullukçu H, Batum Ö, Şimşek Yavuz S, Turhan Ö, Yıldırmak MT, Köksal İ, Taşova Y, Korten V, Yılmaz G, Çelen MK, Altın S, Çelik İ, Bayındır Y, Karaoğlan İ, Yılmaz A, Özkul A, Gür H, Unal S. Efficacy and safety of an inactivated whole-virion SARS-CoV-2 vaccine (CoronaVac): interim results of a double-blind, randomised, placebo-controlled, phase 3 trial in Turkey. Lancet 2021; 398:213-222. [PMID: 34246358 PMCID: PMC8266301 DOI: 10.1016/s0140-6736(21)01429-x] [Citation(s) in RCA: 559] [Impact Index Per Article: 186.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND CoronaVac, an inactivated whole-virion SARS-CoV-2 vaccine, has been shown to be well tolerated with a good safety profile in individuals aged 18 years and older in phase 1/2 trials, and provided a good humoral response against SARS-CoV-2. We present the interim efficacy and safety results of a phase 3 clinical trial of CoronaVac in Turkey. METHODS This was a double-blind, randomised, placebo-controlled phase 3 trial. Volunteers aged 18-59 years with no history of COVID-19 and with negative PCR and antibody test results for SARS-CoV-2 were enrolled at 24 centres in Turkey. Exclusion criteria included (but were not limited to) immunosuppressive therapy (including steroids) within the past 6 months, bleeding disorders, asplenia, and receipt of any blood products or immunoglobulins within the past 3 months. The K1 cohort consisted of health-care workers (randomised in a 1:1 ratio), and individuals other than health-care workers were also recruited into the K2 cohort (randomised in a 2:1 ratio) using an interactive web response system. The study vaccine was 3 μg inactivated SARS-CoV-2 virion adsorbed to aluminium hydroxide in a 0·5 mL aqueous suspension. Participants received either vaccine or placebo (consisting of all vaccine components except inactivated virus) intramuscularly on days 0 and 14. The primary efficacy outcome was the prevention of PCR-confirmed symptomatic COVID-19 at least 14 days after the second dose in the per protocol population. Safety analyses were done in the intention-to-treat population. This study is registered with ClinicalTrials.gov (NCT04582344) and is active but no longer recruiting. FINDINGS Among 11 303 volunteers screened between Sept 14, 2020, and Jan 5, 2021, 10 218 were randomly allocated. After exclusion of four participants from the vaccine group because of protocol deviations, the intention-to-treat group consisted of 10 214 participants (6646 [65·1%] in the vaccine group and 3568 [34·9%] in the placebo group) and the per protocol group consisted of 10 029 participants (6559 [65·4%] and 3470 [34·6%]) who received two doses of vaccine or placebo. During a median follow-up period of 43 days (IQR 36-48), nine cases of PCR-confirmed symptomatic COVID-19 were reported in the vaccine group (31·7 cases [14·6-59·3] per 1000 person-years) and 32 cases were reported in the placebo group (192·3 cases [135·7-261·1] per 1000 person-years) 14 days or more after the second dose, yielding a vaccine efficacy of 83·5% (95% CI 65·4-92·1; p<0·0001). The frequencies of any adverse events were 1259 (18·9%) in the vaccine group and 603 (16·9%) in the placebo group (p=0·0108) with no fatalities or grade 4 adverse events. The most common systemic adverse event was fatigue (546 [8·2%] participants in the vaccine group and 248 [7·0%] the placebo group, p=0·0228). Injection-site pain was the most frequent local adverse event (157 [2·4%] in the vaccine group and 40 [1·1%] in the placebo group, p<0·0001). INTERPRETATION CoronaVac has high efficacy against PCR-confirmed symptomatic COVID-19 with a good safety and tolerability profile. FUNDING Turkish Health Institutes Association.
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Affiliation(s)
- Mine Durusu Tanriover
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey; Hacettepe University Vaccine Institute, Ankara, Turkey
| | - Hamdi Levent Doğanay
- Department of Gastroenterology, Turkish Republic Ministry of Health, İstanbul Provincial Health Directorate, University of Health Sciences İstanbul Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Murat Akova
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey; Hacettepe University Vaccine Institute, Ankara, Turkey.
| | - Hatice Rahmet Güner
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Alpay Azap
- Department of Infectious Diseases and Clinical Microbiology, Ankara University School of Medicine, Ankara, Turkey
| | - Sıla Akhan
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Şükran Köse
- Department of Infectious Diseases, Turkish Republic Ministry of Health, İzmir Provincial Health Directorate, İzmir University of Health Sciences Tepecik Training and Research Hospital, İzmir, Turkey
| | - Fatma Şebnem Erdinç
- Department of Infectious Diseases, Turkish Republic Ministry of Health, Ankara Provincial Health Directorate, Ankara Training and Research Hospital, Ankara, Turkey
| | - Emin Halis Akalın
- Department of Infectious Diseases and Clinical Microbiology, Bursa Uludağ University Health Application and Research Centre, Bursa Uludağ University Hospital, Bursa, Turkey
| | - Ömer Fehmi Tabak
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Hüsnü Pullukçu
- Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, İzmir, Turkey
| | - Özgür Batum
- Department of Chest Diseases, Turkish Republic Ministry of Health, İzmir Provincial Health Directorate, University of Health Sciences Dr Suat Seren Chest Diseases and Surgery Training and Research Hospital, İzmir, Turkey
| | - Serap Şimşek Yavuz
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Özge Turhan
- Department of Infectious Diseases and Clinical Microbiology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Mustafa Taner Yıldırmak
- Department of Infectious Diseases and Clinical Microbiology, Turkish Republic Ministry of Health, İstanbul Provincial Health Directorate, Prof Dr Cemil Taşcıoğlu City Hospital, İstanbul, Turkey
| | - İftihar Köksal
- Department of Infectious Diseases and Clinical Microbiology, Acıbadem University Atakent Hospital, İstanbul, Turkey
| | - Yeşim Taşova
- Department of Infectious Diseases and Clinical Microbiology, Çukurova University Balcalı Hospital Health Application and Research Centre, Adana, Turkey
| | - Volkan Korten
- Department of Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, İstanbul, Turkey
| | - Gürdal Yılmaz
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey; Department of Chest Diseases, Turkish Republic Ministry of Health, Ankara Provincial Health Directorate, Ankara Keçiören Sanatorium, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Mustafa Kemal Çelen
- Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Sedat Altın
- Department of Chest Diseases, Turkish Republic Ministry of Health, İstanbul Provincial Health Directorate, University of Health Sciences İstanbul Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - İlhami Çelik
- Department of Infectious Diseases and Clinical Microbiology, Turkish Republic Ministry of Health, Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Yaşar Bayındır
- Department of Infectious Diseases and Clinical Microbiology, İnönü University Turgut Özal Health Centre, Malatya, Turkey
| | - İlkay Karaoğlan
- Department of Infectious Diseases and Clinical Microbiology, Gaziantep University Şahinbey Research and Application Centre, Gaziantep, Turkey
| | - Aydın Yılmaz
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey; Department of Chest Diseases, Turkish Republic Ministry of Health, Ankara Provincial Health Directorate, Ankara Keçiören Sanatorium, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Aykut Özkul
- Department of Virology, Ankara University Faculty of Veterinary Medicine, Ankara, Turkey
| | - Hazal Gür
- Department of Medical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Serhat Unal
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey; Hacettepe University Vaccine Institute, Ankara, Turkey
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Karakullukçu S, Beyhun NE, Kaklıkkaya N, Köksal İ, Topbaş M, Buruk CK, Çan G, Yılmaz M, Hamzaoğlu K, Sayın E, Kolaylı CC. [Seroprevalence of Toxoplasmosis among 20 Years and Older Individuals in Trabzon, Turkey]. MIKROBIYOL BUL 2021; 55:233-247. [PMID: 33882654 DOI: 10.5578/mb.20219909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Materials and Methods Result Conclusions
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Affiliation(s)
| | - Nazım Ercüment Beyhun
- Karadeniz Technical University Faculty of Medicine, Department of Public Health, Trabzon, Turkey
| | - Neşe Kaklıkkaya
- Karadeniz Technical University Faculty of Medicine, Department of Microbiology and Clinical Microbiology, Trabzon, Turkey
| | - İftihar Köksal
- Acibadem Health Group Department of Infectious Disease and Clinical Microbiology, Istanbul, Turkey
| | - Murat Topbaş
- Karadeniz Technical University Faculty of Medicine, Department of Public Health, Trabzon, Turkey
| | - Celal Kurtuluş Buruk
- Karadeniz Technical University Faculty of Medicine, Department of Microbiology and Clinical Microbiology, Trabzon, Turkey
| | - Gamze Çan
- Canakkale Onsekiz Mart University Faculty of Medicine, Department of Public Health, Canakkale, Turkey
| | - Mustafa Yılmaz
- Karadeniz Technical University Faculty of Medicine, Department of Internal Medicine, Trabzon, Turkey
| | | | - Esin Sayın
- Trabzon Provincial Directorate of Health, Trabzon, Turkey
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Aydın M, Aksoy F, Yıldırım Z, Köksal İ. An Evaluation of the Efficacy of High-dose Hepatitis B Vaccine in Patients Using Biological Agents. Egypt J Immunol 2020. [DOI: 10.4274/vhd.galenos.2020.2019.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Yıldırım S, Karakoç HN, Yaşar A, Köksal İ. Determination of levofloxacin, ciprofloxacin, moxifloxacin and gemifloxacin in urine and plasma by HPLC-FLD-DAD using pentafluorophenyl core-shell column: Application to drug monitoring. Biomed Chromatogr 2020; 34:e4925. [PMID: 32557742 DOI: 10.1002/bmc.4925] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/10/2020] [Accepted: 06/16/2020] [Indexed: 11/10/2022]
Abstract
Concentrations of fluoroquinolones, which are used in the treatment of many bacterial infections, should be monitored in biological fluids as they exhibit concentration-dependent bactericidal activity. In this study, a liquid chromatography method for the determination of levofloxacin, ciprofloxacin, moxifloxacin and gemifloxacin in human urine and plasma was developed for the first time. The efficiency of five different columns for the separation of these fluoroquinolones was compared. Experimental parameters that affect the separation, such as percentage of organic solvent, pH, temperature, gradient shape and detector wavelength, were optimized by a step-by-step approach. Using a pentafluorophenyl core-shell column (100 × 4.6 mm, 2.7 μm), the separation of four analytes was accomplished in <7.5 min. The developed method was validated for the determination of analytes in both urine and plasma with respect to sensitivity, specificity, linearity (r ≥ 0.9989), recovery (79.46-102.69%), accuracy, precision and stability (85.79-111.07%). The intra- and inter-day accuracies were within 89.55-111.94% with relative standard deviations of 0.35-8.05%. The feasibility of method was demonstrated by analyzing urine and plasma samples of patients orally receiving levofloxacin, ciprofloxacin or moxifloxacin. The developed method is suitable for therapeutic drug monitoring of these fluoroquinolones and can be applied to pharmacokinetic and toxicological studies.
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Affiliation(s)
- Sercan Yıldırım
- Department of Analytical Chemistry, Faculty of Pharmacy, Karadeniz Technical University, Trabzon, Turkey
| | - Hanife Nur Karakoç
- Department of Infectious Disease, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Ahmet Yaşar
- Department of Analytical Chemistry, Faculty of Pharmacy, Karadeniz Technical University, Trabzon, Turkey
| | - İftihar Köksal
- Department of Infectious Disease, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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13
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Aydın NN, Aksoy F, Yavuz İ, İskender S, Altunçekiç Yıldırım A, Yıldız İE, Köksal İ. Efficacy of Direct-acting Antivirals in Hemodialysis Patients with Chronic Hepatitis C: A Real-life Retrospective Study. Egypt J Immunol 2019. [DOI: 10.4274/vhd.galenos.2019.2019.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Aksoy F, Kaya S, Karakoç HN, Yılmaz G, Atalar S, Köksal İ. The Importance of Antiviral Prophylaxis against Hepatitis B Virus in Patients under Immunosuppressive Therapy. Egypt J Immunol 2019. [DOI: 10.4274/vhd.galenos.2019.2018.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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15
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Aksoy F, Aydın M, Yılmaz G, Güvercin AR, EYÜBOĞLU İ, Sarı A, Bayramoğlu G, Köksal İ. Idiopathic CD4 Lymphocytopenia (HIV Negative AIDS): Case Report and Literature Review. mjima 2019. [DOI: 10.4274/mjima.galenos.2019.2019.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Köksal İ, Yılmaz G, Parlak M, Demirdal T, Kınıklı S, Candan M, Kaya A, Akhan S, Aydoğdu Ö, Turgut H, Gürbüz Y, Dağlı Ö, Gökal AA, Güner R, Kuruüzüm Z, Tarakçı H, Beslen N, Erdoğan S, Özdener F, Study Group TCHC. Diagnostic value of combined serum biomarkers for the evaluation of liver fibrosis in chronic hepatitis C infection: A multicenter, noninterventional, observational study. Turk J Gastroenterol 2019; 29:464-472. [PMID: 30249562 DOI: 10.5152/tjg.2018.16597] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS The hepatitis C virus (HCV) infection is important cause of chronic hepatitis. Liver biopsy is considered the gold standard for assessment of fibrosis but this procedure is an invasive procedure. We aimed to evaluate the diagnostic efficiency of non-invasive serum biomarkers, separately and in combinations, on liver fibrosis in treatment-naive chronic hepatitis C (CHC) patients. MATERIALS AND METHODS Two hundred and sixteen treatment-naive CHC patients were enrolled from 32 locations across Turkey in this open-labelled, non-interventional prospective observational study. FibroTest®, aspartate aminotransferase-to-platelet ratio index(APRI), aspartate aminotransferase and alanine aminotransferase ratio (AAR), fibrosis index based on four factors (FIB-4), Age-platelet(AP) index and Forns index were measured and compared with Metavir scores got from liver biopsies. RESULTS Data from 182 patients with baseline liver biopsy were suitable for analysis. One hundred and twenty patients (65.9%) had F0-F1 fibrosis and 62 patients (34.1%) had F2-F4 fibrosis. APRI 0.732 area under the curve(AUC) indicated advanced fibrosis with 69% sensitivity and 77% specificity. FIB-4 0.732 AUC and FibroTest 0.715 AUC indicated advanced fibrosis with 69% and 78.4% sensitivity, and 75% and 71.4% specificity, respectively. The combined use of tests also led to an increase in AUC and specificity. Combinations of FibroTest with APRI and/or FIB-4, and FIB-4 with APRI were optimal for the evaluation of liver fibrosis. CONCLUSION Fibrotest, FIB-4, APRI, AP index and Forns index exhibit good diagnostic performance for determining liver fibrosis in CHC patients, and the use of at least two tests together will increase their diagnostic value still further.
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Affiliation(s)
- İftihar Köksal
- Department of Infectious Diseases, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Gürdal Yılmaz
- Department of Infectious Diseases, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Mehmet Parlak
- Department of Infectious Diseases, Atatürk University School of Medicine, Erzurum, Turkey
| | - Tuna Demirdal
- Department of Infectious Diseases, İzmir Atatürk Training and Research Hospital, İzmir, Turkey
| | - Sami Kınıklı
- Department of Infectious Diseases, Ankara Training and Research Hospital, Ankara, Turkey
| | - Mehmet Candan
- Department of Infectious Diseaes, 25 Aralık State Hospital, Gaziantep, Turkey
| | - Ali Kaya
- Department of Infectious Diseaes, Mersin University School of Medicine, Mersin, Turkey
| | - Sıla Akhan
- Department of Infectious Diseaes, Kocaeli, University School of Medicine, Kocaeli, Turkey
| | - Özcan Aydoğdu
- Department of Infectious Diseaes, Bafra State Hospital, Samsun, Turkey
| | - Hüseyin Turgut
- Department of Infectious Diseaes, Pamukkale University School of Medicine, Denizli, Turkey
| | - Yunus Gürbüz
- Department of Infectious Diseaes, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Özgür Dağlı
- Department of Infectious Diseaes, Kilis State Hospital, Kilis, Turkey
| | - Ahmet Ali Gökal
- Department of Infectious Diseaes, Giresun A. İlhan Özdemir State Hospital, Giresun, Turkey
| | - Rahmet Güner
- Department of Infectious Diseaes, Yıldırım Beyazıt University Atatürk Training and Research Hospital, Ankara, Turkey
| | - Ziya Kuruüzüm
- Department of Infectious Diseaes, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Hüseyin Tarakçı
- Department of Infectious Diseaes, Eşrefpaşa State Hospital, İzmir, Turkey
| | - Nuri Beslen
- Department of Infectious Diseaes, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Seda Erdoğan
- Department of Clinical Research, Roche Pharmaceuticals, İstanbul, Turkey
| | - Fatih Özdener
- Department of Clinical Research, Roche Pharmaceuticals, İstanbul, Turkey
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Abstract
Pneumococcal disease is responsible for significant morbidity and mortality. All over the world, 1.6 million people die of pneumococcal disease every year; this estimate includes the deaths of 1 million children aged less than 5 years and the deaths of 600.000- 800.000 adults. The burden of pneumococcal disease is high in adults. Increasing age and the presence of comorbidity has a significant affected of the risk of developing the disease. During mass gatherings, such as pilgrimage individuals, is exposed to severe community-acquired pneumococcal infections. Individuals who has Streptococcus pneumoniae in nasopharynx, have the potential to infection and leave exposed to the risk of pneumococcal disease the other Individuals with sneezing, coughing or out of breath, given breath through droplets of these microorganisms. In the present review, the relationship of pneumococcal disease in adults and pilgrimage, vaccination strategies will be considered and then during a visit to Pilgrimate and Umrah pilgrims against the current vaccine recommendations will be summarised.
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Affiliation(s)
- İftihar Köksal
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Esin Şenol
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Aykut Çilli
- Department of Chest Diseases, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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18
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Kaymakoğlu S, Köksal İ, Tabak F, Akarca US, Akbulut A, Akyüz F, Bodur H, Çağatay A, Dinçer D, Esen Ş, Güner R, Gürel S, Köse Ş, Şentürk Ö, Şimşek H, Yamazhan T, Yılmaz Y, Idilman R, Guidelines Study Group VH. Recommendation for treatment of hepatitis C virus infection. Turk J Gastroenterol 2018; 28:94-100. [PMID: 29303106 DOI: 10.5152/tjg.2017.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Sabahattin Kaymakoğlu
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - İftihar Köksal
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Fehmi Tabak
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ulus S Akarca
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ayhan Akbulut
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Filiz Akyüz
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Hürrem Bodur
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Atahan Çağatay
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Dinç Dinçer
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Şaban Esen
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Rahmet Güner
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Selim Gürel
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Şükran Köse
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ömer Şentürk
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Halis Şimşek
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Tansu Yamazhan
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Yusuf Yılmaz
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ramazan Idilman
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
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Aygen B, Demir AM, Gümüş M, Karabay O, Kaymakoğlu S, Köksal AŞ, Köksal İ, Örmeci N, Tabak F. Immunosuppressive therapy and the risk of hepatitis B reactivation: Consensus report. Turk J Gastroenterol 2018; 29:259-269. [PMID: 29755010 PMCID: PMC6284666 DOI: 10.5152/tjg.2018.18263] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 04/07/2018] [Indexed: 12/12/2022]
Abstract
This consensus report includes expert opinions and recommendations regarding the screening, and if necessary, the follow-up, prophylaxis, and treatment of hepatitis B before the treatment in patients who will undergo immunosuppressive therapy due to an emergency risk of hepatitis B reactivation. To increase awareness regarding the risk of hepatitis B reactivation in immunosuppressive patients, academicians from several university health research and training centers across Turkey came together and discussed the importance of the subject, current status, and issues in accordance with the current literature data and presented solutions.
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Affiliation(s)
- Bilgehan Aygen
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Ahmet Muzaffer Demir
- Division of Hematology, Department of Internal Diseases, Trakya University School of Medicine, Edirne, Turkey
| | - Mahmut Gümüş
- Division of Oncology, Department of Internal Diseases, İstanbul Medeniyet University School of Medicine, İstanbul, Turkey
| | - Oğuz Karabay
- Department of Infectious Diseases and Clinical Microbiology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Sabahattin Kaymakoğlu
- Division of Gastroenterology, Department of Internal Diseases, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Aydın Şeref Köksal
- Division of Gastroenterology, Department of Internal Diseases, Sakarya University School of Medicine, Sakarya, Turkey
| | - İftihar Köksal
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Necati Örmeci
- Division of Gastroenterology, Department of Internal Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Fehmi Tabak
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
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21
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Yilmaz H, Kostakoğlu U, Demir S, Aksoy F, Menteşe A, Karahan SC, Köksal İ, Alver A, Yilmaz G. Carbonic anhydrase I-II autoantibodies and oxidative status in long-term follow-up of patients with Crimean-Congo haemorrhagic fever. Arch Physiol Biochem 2018; 124:69-74. [PMID: 28796539 DOI: 10.1080/13813455.2017.1361449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
CONTEXT Crimean-Congo haemorrhagic fever (CCHF) is a life-threatening acute febrile haemorrhagic disease. OBJECTIVE This study was to measure levels of the oxidative stress biomarkers malondialdehyde (MDA), total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) and of CA I-II autoantibodies as biomarkers for autoimmunity and course of disease in patients with CCHF. METHODS Seventy CCHF patients and 39 healthy control volunteers were included in the study. RESULTS Serum MDA and TAS levels were significantly higher (p < .0001) and serum TOS and OSI levels were significantly lower (p < .0001) in both the acute period and at 6th-month follow-up in the CCHF patients compared to the healthy volunteers. CA II levels were significantly higher in the acute period compared to the healthy volunteers (p < .005) and were significantly lower at 6th-month follow-up (p < .05). CONCLUSION Serum MDA and CA II autoantibodies appear to reflect oxidative stress status and disease progression in CCHF and may be used as biomarkers for oxidative stress and disease progression.
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Affiliation(s)
- Hülya Yilmaz
- a Department of Medical Biochemistry , Health Sciences University, Kanuni Training and Research Hospital , Trabzon , Turkey
| | - Uğur Kostakoğlu
- b Department of Infection Diseases and Clinic Microbiology , Recep Tayyip Erdoğan University Medical Faculty , Rize , Turkey
| | - Selim Demir
- c Department of Nutrition and Dietetics, Faculty of Health Sciences , Karadeniz Technical University , Trabzon , Turkey
| | - Firdevs Aksoy
- d Department of Infectious Diseases and Clinical Microbiology, Medical Faculty , Karadeniz Technical University , Trabzon , Turkey
| | - Ahmet Menteşe
- e Department of Medical Biochemistry, Medical Faculty , Karadeniz Technical University , Trabzon , Turkey
| | - Süleyman Caner Karahan
- e Department of Medical Biochemistry, Medical Faculty , Karadeniz Technical University , Trabzon , Turkey
| | - İftihar Köksal
- d Department of Infectious Diseases and Clinical Microbiology, Medical Faculty , Karadeniz Technical University , Trabzon , Turkey
| | - Ahmet Alver
- f Department of Medical Biochemistry , Recep Tayyip Erdogan University Medical Faculty , Rize , Turkey
| | - Gürdal Yilmaz
- d Department of Infectious Diseases and Clinical Microbiology, Medical Faculty , Karadeniz Technical University , Trabzon , Turkey
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İskender S, Yılmaz G, Köksal İ. An examination of healthcare-associated infections in elderly patients. Turk J Med Sci 2017; 47:1693-1698. [PMID: 29306225 DOI: 10.3906/sag-1706-92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim: Healthcare-associated infections (HCAIs) are increasing due to the growing numbers of elderly people requiring long-term care and immunosuppressive therapies. The purpose of this study was to examine HCAIs occurring in elderly inpatients in our hospital.Materials and methods: This study prospectively investigated HCAIs developing in all patients hospitalized over a 1-year period. Diagnosis was based on Centers for Disease Control criteria. The results were subjected to statistical analysis between patients aged over and under 65.Results: A total of 24,692 patients were evaluated and 894 HCAIs were identified. Of these infections, 214 were seen in patients aged 65 or over. The rate of HCAIs in elderly patients was 15.1, compared to 2.9 in the under-65 patient group (P < 0.001). Seventy-nine (36.9%) infections in elderly patients were urinary system infections, 60 (28.0%) were bacteremia, 43 (20.1%) were pneumonia, 29 (13.6%) were surgical site infections, and 3 (1.4%) were other infections. Forty-three of the 187 elderly patients followed with a diagnosis of HCAI died. Seventeen patients had mortality attributable to HCAI. Conclusion: Awareness that HCAIs seen in the elderly have different clinical and microbiological characteristics than those of other patients, and the appropriate precautions being taken, will reduce the problems that may result from these diseases with high mortality and morbidity.
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Abstract
The optimal duration of the treatment of ventilator-associated pneumonia (VAP) is still the subject of debate. While 1 week treatment has been reported as possibly sufficient, patients generally receive antibiotic therapy for 10 to 14 days. The purpose of our study was to investigate whether length of treatment in patients with VAP can be reduced with an individualized therapeutic strategy. The study was performed prospectively with patients diagnosed with VAP in our hospital's intensive care units between 1 January and 31 December 2015. Duration of antibiotic therapy was determined with 5 day clinical evaluation according to previously established criteria. Patients were divided into two groups depending on length of treatment, short (7-10 days) and long treatment (>10 days). Nineteen patients received 7 to 10 day antibiotic therapy, and 30 received >10 day antibiotic therapy. Demographic and clinical characteristics, Glasgow Coma Scale score, CPIS and the PaO2/FiO2 ratio at the time of diagnosis of VAP were statistically similar between the two groups (P>0.05). A second VAP attack occurred post-treatment in three patients receiving short-term treatment and in four receiving long-term treatment (P=0.561). The numbers of antibiotic-free days were 15.6±6.2 in the short-term treatment group and 8.3±7.5 in the long-term group (P<0.0001). One of the patients receiving short-term treatment died within 28 days after treatment, and four of the patients receiving long-term treatment (P=0.348) did so. The most commonly observed micro-organisms in both groups were Acinetobacterbaumannii and Pseudomonasaeruginosa. Short-term treatment can be administered in cases with early clinical and laboratory response started on VAP treatment by considering individual characteristics and monitoring fever, CPIS, the PaO2/FiO2 ratio, C-reactive protein and procalcitonin values.
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Affiliation(s)
- Gürdal Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
| | - Sedat Salyan
- Department of Anesthesiology and Reanimation, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
| | - Firdevs Aksoy
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
| | - İftihar Köksal
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
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Yilmaz H, Yilmaz G, Kostakoğlu U, Yaman H, Örem A, Köksal İ. The prognostic significance of serum troponin T levels in Crimean-Congo hemorrhagic fever patients. J Med Virol 2016; 89:408-412. [PMID: 26693839 DOI: 10.1002/jmv.24454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2015] [Indexed: 11/05/2022]
Abstract
Crimean-Congo Hemorrhagic Fever (CCHF) is a disease transmitted by the Crimean-Congo hemorrhagic fever virus (CCHFV), characterized by severe fever and hemorrhage and with a reported fatality level of 3-30%. Cerebral hemorrhage, gastrointestinal hemorrhage, severe anemia, shock, myocardial infarction, pulmonary edema, and pleural effusion may be seen as causes of death. Cardiac troponin T (cTn-T) is a biochemical marker with high sensitivity and specificity in myocardial injury. The purpose of this study was to determine the prognostic significance of serum troponin T levels in CCHF patients. Patients hospitalized with a diagnosis of CCHF and whose serum cTn-T was investigated were examined retrospectively. Patients were divided into two groups on the basis of presence or absence of hemorrhage. Data were subjected to statistical analysis. One hundred thirty-five CCHF patients and 72 control subjects were included. Hemorrhage was present in 48 (35.6%) patients. Mean serum cTn-T level was 17.3 ± 28.0 ng/L in the patients with hemorrhage, 9.98 ± 5.97 ng/L in the non-hemorrhage patients (P = 0.001) and 6.6P = 2.6 ng/L in the control samples (P < 0.001). At a cTn-T level cut-off point of 9 ng/L, area under the ROC curve was 0.797 (95%CI: 0.730-0.854), sensitivity 83.0%, specificity 87.5%, PPD 95.7%, and NPV 60.3%. At logistic regression analysis, a rise in cTn-T level above 14 ng/L increased the probability of hemorrhage in CCHF patients approximately threefold. An increased troponin T level may be a prognostic risk factor for hemorrhage in CCHF patients. This marker should therefore be borne in mind in determining treatment strategy in these patients. J. Med. Virol. 89:408-412, 2017. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Hülya Yilmaz
- Department of Medical Biochemistry, Karadeniz Technical University, Faculty of Medicine and Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Gürdal Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
| | - Uğur Kostakoğlu
- Department of Infectious Diseases and Clinical Microbiology, Recep Tayyip Erdoğan University, Faculty of Medicine, Rize, Turkey
| | - Hüseyin Yaman
- Department of Medical Biochemistry, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Asım Örem
- Department of Medical Biochemistry, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
| | - İftihar Köksal
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
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Yilmaz G, Yilmaz H, Arslan M, Kostakoğlu U, Menteşe A, Karahan SC, Köksal İ. The prognostic significance of serum TGF-β1 levels in patients with Crimean-Congo hemorrhagic fever. J Med Virol 2016; 89:413-416. [PMID: 27467498 DOI: 10.1002/jmv.24647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 11/08/2022]
Abstract
Crimean-Congo Hemorrhagic Fever (CCHF) may exhibit a mild clinical course or a severe profile like mortal bleeding. The pathogenesis of the illness and reason of bleeding are unclear. However, endothelial injury is a key factor in the pathogenesis of the illness. Transforming growth factor beta (TGF-β) is one of the materials involved in repairing injured endothelium. This is a significant polypeptide released in pretty much all cells and important for the regulation of cellular events, epithelium formation, inflammation, blood coagulation, and collagen synthesis. This study aimed to determine the prognostic significance of serum TGF-β1 levels in CCHF patients. We examined 120 patients hospitalized with CCHF diagnosis and their serum TGF-β1 was investigated, retrospectively. Patients were put into two groups according to the existence of hemorrhage. Forty-four (36.7%) patients had hemorrhage. TGF-β1 levels in patients with bleeding were 5.2 ± 1.8, and 7.1 ± 2.2 for non-bleeding (P < 0.0001). When ROC analysis was performed in patients with CCHF alone in order to identify patients with bleeding, at a TGF-β1 cut-off point of 4.9, AUC was 0.762 (0.675-0.835), sensitivity 59.1%, specificity 85.5%, PPV 70.3%, and NPV 78.3%. We summarize that TGF-β1 level and endothelial dysfunction can be related. A decreased TGF-β1 level is a likely prognostic and diagnostic factor for bleeding in CCHF patients. Therefore, this marker should be considered in the treatment strategy for these patients. J. Med. Virol. 89:413-416, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Gürdal Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
| | - Hülya Yilmaz
- Department of Medical Biochemistry, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Mustafa Arslan
- Department of Infectious Diseases and Clinical Microbiology, Amasya University Sabuncuoglu Serefeddin Training and Research Hospital, Amasya, Turkey
| | - Uğur Kostakoğlu
- Department of Infectious Diseases and Clinical Microbiology, 4Recep Tayyip Erdogan University Medical Faculty, Rize, Turkey
| | - Ahmet Menteşe
- Department of Medical Biochemistry, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
| | - Süleyman Caner Karahan
- Department of Medical Biochemistry, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
| | - İftihar Köksal
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
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26
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Yilmaz H, Yilmaz G, Menteşe A, Kostakoğlu U, Karahan SC, Köksal İ. Prognostic impact of platelet distribution width in patients with Crimean-Congo hemorrhagic fever. J Med Virol 2016; 88:1862-6. [PMID: 27089100 DOI: 10.1002/jmv.24547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2016] [Indexed: 11/12/2022]
Abstract
Platelet distribution width (PDW) is a readily available blood test involving calculations performed by automated blood analyzers. Crimean-Congo hemorrhagic fever (CCHF) may exhibit a severe profile with fatal hemorrhaging or else present with a mild clinical process. The purpose of our study was to investigate the importance of PDW in CCHF patients and its clinical prognostic value. This study was conducted with patients with CCHF. Patients were divided into two groups on the basis of presence or absence of bleeding. Demographic characteristics, clinical findings, PDW, and other laboratory tests were recorded onto forms. A total of 423 patients were included. Hemorrhaging was observed in 27.9% during hospitalization. PDW on the first day of hospitalization was 17.2 ± 0.9% in the hemorrhagic patients and 17.1 ± 0.6% in the cases without hemorrhage (P = 0.290). On the third day of hospitalization, PDW was 17.6 ± 0.8% in the hemorrhagic patients and 17.0 ± 0.7% in the cases without hemorrhage (P < 0.001). At a third-day PDW level cut-off point of 17.1%, AUROC was 0.677, sensitivity 65.5%, specificity 54.6%, PPV 35.5%, and NPV 80.6%. A one-unit raise in third day PDW stepped up the probability of bleeding in patients with CCHF 3.45-fold at logistic regression analysis. This study shows that PDW is a parameter that may be used to determine disease severity. This parameter may be at least as useful as platelet count in helping clinicians identify severe cases. Early identification of cases with a severe course will make it possible to provide early planning of modalities such as intensive care support. J. Med. Virol. 88:1862-1866, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hülya Yilmaz
- Department of Medical Biochemistry, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Gürdal Yilmaz
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University, Trabzon, Turkey
| | - Ahmet Menteşe
- Faculty of Medicine, Department of Medical Biochemistry, Karadeniz Technical University, Trabzon, Turkey
| | - Uğur Kostakoğlu
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Süleyman Caner Karahan
- Faculty of Medicine, Department of Medical Biochemistry, Karadeniz Technical University, Trabzon, Turkey
| | - İftihar Köksal
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University, Trabzon, Turkey
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Kaya S, Aksoy F, Kenç NN, Eroğlu A, Köksal İ. The Importance of Supportive Care with Tranexamic Acid in Crimean-Congo Hemorrhagic Fever. Chemotherapy 2016; 61:148-51. [PMID: 26784703 DOI: 10.1159/000442083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/02/2015] [Indexed: 02/05/2023]
Abstract
This report describes a case of Crimean-Congo hemorrhagic fever with widespread hemorrhages and multiple organ dysfunction syndrome in a 46-year-old patient from an endemic region. Although the patient had numerous poor prognostic factors, he was discharged in a healthy condition after 17 days of hospitalization with close monitoring and supportive care. Tranexamic acid was successfully used together with other supportive treatments.
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Affiliation(s)
- Selçuk Kaya
- Karadeniz Technical University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey.
| | - Gülçin Bayramoğlu
- Karadeniz Technical University, School of Medicine, Department of Medical Microbiology, Trabzon, Turkey
| | - Mehmet Sönmez
- Karadeniz Technical University, School of Medicine, Department of Hematology, Trabzon, Turkey
| | - İftihar Köksal
- Karadeniz Technical University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey
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