1
|
İzci F, Ture Z, Dinc G, Yay AH, Eren EE, Bolat D, Gönen ZB, Ünüvar GK, Yıldız O, Aygen B. The efficacy of mesenchymal stem cell treatment and colistin-fosfomycin combination on colistin-resistant Acinetobacter baumannii sepsis model. Eur J Clin Microbiol Infect Dis 2023; 42:1365-1372. [PMID: 37814067 DOI: 10.1007/s10096-023-04674-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 09/27/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION This study examines the role of mesenchymal stem cells (MSCs) in an experimental sepsis model developed with colistin-resistant Acinetobacter baumannii (CRAB). MATERIALS AND METHODS BALB-c mice were divided into treatment groups (MSC, MSC + colistin (C)-fosfomycin (F), and C-F and control groups (positive and negative)). CRAB was administered to mice through intraperitoneal injection. Three hours later, C, F, and MSC were given intraperitoneally to the treatment groups. Colistin administration was repeated every 12 h, F administration was done every 4 h, and the second dose of MSC was administered after 48 h. Mice were sacrificed at 24 and 72 h. The bacterial load was determined as colony-forming units per gram (cfu/g). Histopathological examination was conducted on the left lung, liver, and both kidneys. IL-6 and C-reactive protein (CRP) levels in mouse sera were determined by enzyme-linked immunosorbent assay. RESULTS Among the treatment groups, the C-F group had the lowest colony count in the lung (1.24 ± 1.66 cfu/g) and liver (1.03 ± 1.08 cfu/g). The highest bacterial clearance was observed at 72 h compared to 24 h in the MSC-treated groups (p = 0.008). The MSC + C-F group showed the lowest histopathological score in the liver and kidney (p = 0.009). In the negative control group, the IL-6 level at the 24th hour was the lowest (p < 0.001). Among the treatment groups, the CRP level was the lowest in the MSC + C-F group at 24 and 72 h. CONCLUSION In a CRAB sepsis model, adding MSCs to a colistin-fosfomycin treatment may be beneficial in terms of reducing bacterial loads and preventing histopathological damage.
Collapse
Affiliation(s)
- Feyza İzci
- Department of Infectious Diseases, Çankırı State Hospital, Çankırı, Turkey
| | - Zeynep Ture
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
| | - Gokcen Dinc
- Department of Medical Microbiology, Faculty of Medicine, and Department of Stem Cell GMP Unit of Genome and Stem Cell Centre, Erciyes University, Kayseri, Turkey
| | - Arzu Hanım Yay
- Department of Histology and Embryology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Esma Eryılmaz Eren
- Department of Infectious Diseases and Clinical Microbiology, Kayseri City Education and Research Hospital, Kayseri, Turkey
| | - Demet Bolat
- Department of Histology and Embryology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Zeynep Burcin Gönen
- Oral and Maxillofacial Surgery, Genome and Stem Cell Center, Erciyes University, Kayseri, Turkey
| | - Gamze Kalın Ünüvar
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Orhan Yıldız
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Bilgehan Aygen
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| |
Collapse
|
2
|
Türe Z, Yıldız O, Yaman O, Kalın Ünüvar G, Aygen B. [Domestic Malaria Cases in Kayseri Province]. MIKROBIYOL BUL 2023; 57:307-316. [PMID: 37067215 DOI: 10.5578/mb.20239922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Malaria continues to be a global public health problem considering the number of cases and death rate worldwide. There were no domestic cases reported from our country in the World Health Organization 2021 malaria report. All the 200-250 annual cases reported from our country have a history of travel to the endemic region. In this report, three malaria cases caused by Plasmodium falciparum and Plasmodium vivax in Kayseri province without a history of travel to the endemic region were presented. The first case was an 18-year-old male patient with no known chronic disease. He admitted to the hospital with the complaint of high fever reaching 40°C, which continued for two days, increased with chills and decreased with sweating. Physical examination revealed hepatosplenomegaly and laboratory results revealed thrombocytopenia. Species identification was made by real-time polymerase chain reaction (Rt-PCR) method in the patient with ring-shaped trophozoites in the peripheral smear. Artemether-lumefantrine and primaquine treatments were given to the patient with mixed parasitemia of P.falciparum and P.vivax. One and two days after the admission, the second and third cases also admitted with similar complaints. Mixed parasitemia was observed in all three patients who did not have a history of traveling abroad. After the antiparasitic treatment, the patients improved clinically and laboratory, and no recurrent parasitemia was observed. With the occurrence of these cases, efforts to combat vectors were initiated throughout the province. In conclusion, the presence of anopheles mosquitoes and imported cases still poses a risk for domestic malaria cases. In patients who do not have a history of traveling abroad, malaria should be considered in the clinical preliminary diagnosis and species identification should be made by methods such as Rt-PCR in order to give appropriate treatments.
Collapse
Affiliation(s)
- Zeynep Türe
- Erciyes University Faculty of Medicine, Department of Clinical Microbiology and Infectious Diseases, Kayseri, Türkiye
| | - Orhan Yıldız
- Erciyes University Faculty of Medicine, Department of Clinical Microbiology and Infectious Diseases, Kayseri, Türkiye
| | - Ozan Yaman
- Erciyes University Faculty of Medicine, Department of Medical Parasitology, Kayseri, Türkiye
| | - Gamze Kalın Ünüvar
- Erciyes University Faculty of Medicine, Department of Clinical Microbiology and Infectious Diseases, Kayseri, Türkiye
| | - Bilgehan Aygen
- Erciyes University Faculty of Medicine, Department of Clinical Microbiology and Infectious Diseases, Kayseri, Türkiye
| |
Collapse
|
3
|
Gökahmetoğlu S, Polat C, Atalay MA, Sezgin GC, Ergör G, Aygen B, Gürsoy Ş, Hakan Abacıoğlu Y, Abacioglu YH. Healthcare-Related HCV Genotype 4d Infections in Kayseri, Turkey. Turk J Gastroenterol 2022; 33:964-970. [PMID: 36098364 PMCID: PMC9797710 DOI: 10.5152/tjg.2022.21822] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The frequency of genotype 4 hepatitis C virus infection is significantly higher in a city compared to other provinces in Turkey. In this study, we aimed to investigate the epidemiology and risk factors of hepatitis C virus genotype 4 infection in Kayseri province of Turkey. METHODS A case-control study was conducted with 61 hepatitis C virus genotype 4-infected patients and 71 controls. A questionnaire was administered to the patients and controls, asking for information about the risk factors of hepatitis C virus transmission. Core/ E1 and NS5B regions of hepatitis C virus genome were amplified and sequenced by Sanger method. Phylogenetic analysis and molecular clock analysis were performed. The risk was determined by calculating the odds ratio and 95% CI. Logistic regression analysis was performed to determine the effect of risk factors by controlling for confounding variables. RESULTS Kayseri isolates were closely related to type 4d sequences but formed a separate cluster. According to the molecular clock analysis, hepatitis C virus genotype 4d entered Kayseri province probably between 1941 and 1988. Blood transfusion and surgical intervention were found to be significant risk factors for the infection. CONCLUSION Epidemiological data showed that hepatitis C virus genotype 4d infections are significantly associated with unsafe medical procedures.
Collapse
Affiliation(s)
- Selma Gökahmetoğlu
- Department of Medical Microbiology, Erciyes University Faculty of Medicine, Kayseri, Turkey,Corresponding author: Selma Gökahmetoğlu, e-mail:
| | - Ceylan Polat
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Altay Atalay
- Department of Medical Microbiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Gülten Can Sezgin
- Department of Gastroenterology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Gül Ergör
- Department of Public Health, Dokuz Eylül University Faculty of Medicine, İzmir, Izmir, Turkey
| | - Bilgehan Aygen
- Department of Infectious Diseases, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Şebnem Gürsoy
- Department of Gastroenterology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Yusuf Hakan Abacıoğlu
- Department of Medical Microbiology, İzmir University of Economics Faculty of Medicine, İzmir, Turkey
| | | | | | | | | | | | | | | | | |
Collapse
|
4
|
İzci F, Türe Z, Kalın Ünüvar G, Baran Ketencioğlu B, Zararsız G, Aygen B, Yıldız O. Current Threat in COVID-19; Asymptomatic Carriers. cjms 2022. [DOI: 10.4274/cjms.2021.3556] [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]
|
5
|
Demirtürk N, Aygen B, Çelik İ, Mıstık R, Akhan S, Barut Ş, Ural O, Batırel A, Şimşek F, Ersöz G, İnan D, Kınıklı S, Türker N, Bilgin H, Gürbüz Y, Tülek N, Tarakçı H, Yıldız O, Türkoğlu E, Kamalak Güzel D, Şimşek S, Tuna N, Aktuğ Demir N, Çağatay A, Çetinkaya RA, Karakeçili F, Hakyemez İN, Tuncer Ertem G, Örmen B, Korkmaz P, Yıldız U, Kuruüzüm Z, Şener A, Arslan Özel S, Öztürk S, Suer K, Çelen MK, Konya P, Asan A, Saltoğlu N, Doğan N. Real-World Data from Turkey: Is Sofosbuvir/Ledipasvir With or Without Ribavirin Treatment for Chronic Hepatitis C Really Effective? Turk J Gastroenterol 2021; 32:155-163. [PMID: 33960939 DOI: 10.5152/tjg.2020.19569] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND In this study, we aimed to investigate the efficacy and safety of sofosbuvir-based therapies in the treatment of chronic hepatitis C in real-world clinical practice. METHODS Data from patients with chronic hepatitis C treated with SOF/LDV ± RBV or SOF/RBV in 31 centers across Turkey between April 1, 2017, and August 31, 2018, were recorded in a nationwide database among infectious disease specialists. Demographics, clinical, and virological outcomes were analyzed. RESULTS A total of 552 patients were included in the study. The mean age of the patients was 51.28 ± 14.2, and 293 (55.8%) were female. The majority had HCV genotype 1b infection (65%), 75.04% of the patients underwent treatment, and non-cirrhosis was present at baseline in 381 patients (72.6%). SOF/LDV ± RBV treatment was given to 477 patients and 48 patients received SOF/RBV according to HCV genotype. The total SVR12 rate was 99% in all patients. Five patients experienced disease relapse during the study and all of them were genotype 2. In patients infected with HCV GT2, SVR12 was 77.3%. SVR was 100% in all patients infected with other HCV genotypes. All treatments were well tolerated by patients without causing severe adverse events. Side effects and side effects-associated treatment discontinuation rates were 28.2% and 0.4%, respectively. Weakness (13.7%) was the common side effect. CONCLUSION The present real-world data of 525 patients with HCV genotypes 1, 1a, 1b, 3, 4, and 5 who underwent SOF/LDV ± RBV treatment in Turkey demonstrated a high efficacy and safety profile. HCV GT2 patients should be treated with more efficacious treatment.
Collapse
Affiliation(s)
- Neşe Demirtürk
- Department of Infectious Disease and Clinical Microbiology, Afyon Saglik Bilimleri University Medical Faculty, Afyonkarahisar, Turkey
| | - Bilgehan Aygen
- Department of Infectious Disease and Clinical Microbiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - İlhami Çelik
- Department of Infectious Diseases and Clinical Microbiology, Kayseri Education and Research Hospital, Saglik Bilimleri University, Kayseri, Turkey
| | - Reşit Mıstık
- Infectious Disease Clinic, Medicana Hospital, Bursa, Turkey
| | - Sıla Akhan
- Department of Infectious Disease and Clinical Microbiology, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Şener Barut
- Department of Infectious Disease and Clinical Microbiology, Gaziosmanpasa University Medical Faculty, Tokat, Turkey
| | - Onur Ural
- Department of Infectious Disease and Clinical Microbiology, Selcuk University Medical Faculty, Konya, Turkey
| | - Ayşe Batırel
- Department of Infectious Diseases and Clinical Microbiology, Kartal Lütfi Kırdar Education and Research Hospital, Saglik Bilimleri University, İstanbul, Turkey
| | - Funda Şimşek
- Department of Infectious Diseases and Clinical Microbiology, Ok Meydanı Education and Research Hospital, Saglik Bilimleri University, İstanbul, Turkey
| | - Gülden Ersöz
- Department of Infectious Disease and Clinical Microbiology, Mersin University Medical Faculty, Mersin, Turkey
| | - Dilara İnan
- Department of Infectious Disease and Clinical Microbiology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Sami Kınıklı
- Department of Infectious Diseases and Clinical Microbiology, Ankara Education and Research Hospital, Saglik Bilimleri University, Ankara, Turkey
| | - Nesrin Türker
- Department of Infectious Disease and Clinical Microbiology, Atatürk Education and Research Hospital, Katip Çelebi University, İzmir, Turkey
| | - Hüseyin Bilgin
- Department of Infectious Disease and Clinical Microbiology, Marmara University Medical Faculty, İstanbul, Turkey
| | - Yunus Gürbüz
- Department of Infectious Disease and Clinical Microbiology, Dışkapı Education and Research Hospital University Medical Faculty, Saglik Bilimleri University, Antalya, Turkey
| | - Necla Tülek
- Department of Infectious Disease and Clinical Microbiology, Atılım University Medical Faculty, Ankara, Turkey
| | - Hüseyin Tarakçı
- Department of Infectious Diseases and Clinical Microbiology, Eşrefpaşa Education and Research Hospital, Saglik Bilimleri University, İzmir, Turkey
| | - Orhan Yıldız
- Department of Infectious Disease and Clinical Microbiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Emine Türkoğlu
- Department of Infectious Disease and Clinical Microbiology, Afyon Saglik Bilimleri University Medical Faculty, Afyonkarahisar, Turkey
| | - Deniz Kamalak Güzel
- Department of Infectious Diseases and Clinical Microbiology, Kayseri Education and Research Hospital, Saglik Bilimleri University, Kayseri, Turkey
| | - Sümeyra Şimşek
- Department of Infectious Disease and Clinical Microbiology, Uludağ University Medical Faculty, Bursa, Turkey
| | - Nazan Tuna
- Department of Infectious Diseases and Clinical Microbiology, Sakarya Education and Research Hospital, Saglik Bilimleri University, Sakarya, Turkey
| | - Nazlım Aktuğ Demir
- Department of Infectious Disease and Clinical Microbiology, Selcuk University Medical Faculty, Konya, Turkey
| | - Atahan Çağatay
- Department of Infectious Disease and Clinical Microbiology, İstanbul University İstanbul Medical Faculty, İstanbul, Turkey
| | - Rıza Aytaç Çetinkaya
- Department of Infectious Diseases and Clinical Microbiology, Sultan Abdülhamid Han Education and Research Hospital, Saglik Bilimleri University, İstanbul, Turkey
| | - Faruk Karakeçili
- Department of Infectious Diseases and Clinical Microbiology, Erzincan University of Faculty of Medicine, Erzincan, Turkey
| | - İsmail Necati Hakyemez
- Department of Infectious Diseases and Clinical Microbiology, Bezmiâlem University of Faculty of Medicine, İstanbul, Turkey
| | - Günay Tuncer Ertem
- Department of Infectious Diseases and Clinical Microbiology, Ankara Education and Research Hospital, Saglik Bilimleri University, Ankara, Turkey
| | - Bahar Örmen
- Department of Infectious Disease and Clinical Microbiology, Atatürk Education and Research Hospital, Katip Çelebi University, İzmir, Turkey
| | - Pınar Korkmaz
- Department of Infectious Diseases and Clinical Microbiology, Kütahya Health Sciences University Faculty of Medicine, Kütahya, Turkey
| | - Uluhan Yıldız
- Department of Infectious Disease and Clinical Microbiology, Marmara University Medical Faculty, İstanbul, Turkey
| | - Ziya Kuruüzüm
- Department of Infectious Disease and Clinical Microbiology, Dokuz Eylül University Faculty, İzmir, Turkey
| | - Alper Şener
- Department of Infectious Diseases and Clinical Microbiology, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, Turkey
| | - Selcan Arslan Özel
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli Training and Research Hospital, Saglik Bilimleri University, Kocaeli, Turkey
| | - Sinan Öztürk
- Department of Infectious Diseases and Clinical Microbiology, Ümraniye Education and Research Hospital, Saglik Bilimleri University, Kocaeli, Turkey
| | - Kaya Suer
- Department of Infectious Diseases and Clinical Microbiology, Yakın Doğu University of Faculty of Medicine, Nicosia, Turkey
| | - Mustafa Kemal Çelen
- Department of Infectious Diseases and Clinical Microbiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Petek Konya
- Department of Infectious Disease and Clinical Microbiology, Afyon Saglik Bilimleri University Medical Faculty, Afyonkarahisar, Turkey
| | - Ali Asan
- Department of Infectious Diseases and Clinical Microbiology, Bursa Yüksek İhtisas Training and Research Hospital, Saglik Bilimleri University, Bursa, Turkey
| | - Neşe Saltoğlu
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University of Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Nurhan Doğan
- Department of Biostatistics and Medical Informatics, Afyon Saglik Bilimleri University Medical Faculty, Afyonkarahisar, Turkey
| |
Collapse
|
6
|
Aygen B, Demirtürk N, Yıldız O, Çelen MK, Çelik İ, Barut Ş, Ural O, Batırel A, Mıstık R, Şimşek F, Asan A, Ersöz G, Türker N, Bilgin H, Kınıklı S, Karakeçili F, Zararsız G, Turkish Society Of Clinical Microbiology And Infectious Diseases TSGFVHOT. Real-world efficacy, safety, and clinical outcomes of ombitasvir/paritaprevir/ritonavir ± dasabuvir ± ribavirin combination therapy in patients with hepatitis C virus genotype 1 or 4 infection: The Turkey experience experience. Turk J Gastroenterol 2020; 31:305-317. [PMID: 32412901 DOI: 10.5152/tjg.2020.19197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND/AIMS mbitasvir/paritaprevir/ritonavir (OMV/PTV/r) ± dasabuvir (DSV) ± ribavirin (RBV) combination has demonstrated excellent rates of sustained virologic response (SVR) and a very good safety profile in patients with the chronic hepatitis C virus (HCV) genotype 1 or 4 infections. We aimed to investigate the effectiveness and safety of OMV/PTV/r ± DSV ± RBV combination regimen in a real-world clinical practice. MATERIALS AND METHODS Data from HCV genotype 1 and 4 patients treated with OMV/PTV/r ± DSV ± RBV (n=862) in 34 centers across Turkey between April 1, 2017 and August 31, 2018 were recorded in a large national database. Demographic, clinical, and virologic data were analyzed. RESULTS The mean age of the patients was 55.63, and 430 patients (49.9%) were male. The majority had HCV genotype 1b infection (77.3%), and 66.2% were treatment-naïve. Non-cirrhosis was present at baseline in 789 patients (91.5%). SVR12 rate was 99.1% in all patients. Seven patients had virologic failure. No significant differences were observed in SVR12 according to HCV genotypes. HCV RNA was undetectable at treatment week 4 in 90.9%, at treatment week 8 in 98.5%, and at the end of treatment (EOT) in 98.9%. SVR12 ratio was significantly higher in the non-cirrhotic patients compared to that in the compensated cirrhotic patients. Rates of adverse events (AEs) in the patients was 59.7%. CONCLUSION The present real-life data of Turkey for the OBV/PTV/r ± DSV ± RBV treatment of patients with HCV genotype 1b, 1a, or 4 infection from 862 patients demonstrated high efficacy and a safety profile.
Collapse
Affiliation(s)
- Bilgehan Aygen
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Neşe Demirtürk
- Department of Infectious Diseases and Clinical Microbiology, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
| | - Orhan Yıldız
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Mustafa Kemal Çelen
- Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakır, Turkey
| | - İlhami Çelik
- Department of Infectious Diseases and Clinical Microbiology, Sağlık Bilimleri University Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Şener Barut
- Department of Infectious Diseases and Clinical Microbiology, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
| | - Onur Ural
- Department of Infectious Diseases and Clinical Microbiology, Selçuk University School of Medicine, Konya, Turkey
| | - Ayşe Batırel
- Department of Infectious Diseases and Clinical Microbiology, Sağlık Bilimleri University Kartal Dr. Lütfü Kırdar Training and Research Hospital, İstanbul, Turkey
| | - Reşit Mıstık
- Department of Infectious Diseases and Clinical Microbiology, Uludağ University School of Medicine, Bursa, Turkey
| | - Funda Şimşek
- Department of Infectious Diseases and Clinical Microbiology, Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Ali Asan
- Department of Infectious Diseases and Clinical Microbiology, Sağlık Bilimleri University Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Gülden Ersöz
- Department of Infectious Diseases and Clinical Microbiology, Mersin University School of Medicine, Mersin, Turkey
| | - Nesrin Türker
- Department of Infectious Diseases and Clinical Microbiology, Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Hüseyin Bilgin
- Department of Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, İstanbul, Turkey
| | - Sami Kınıklı
- Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Faruk Karakeçili
- Department of Infectious Diseases and Clinical Microbiology, Erzincan University School of Medicine, Erzincan, Turkey
| | - Gökmen Zararsız
- Department of Biostatistics, Erciyes University School of Medicine, Kayseri, Turkey
| | | |
Collapse
|
7
|
Idilman R, Razavi H, Robbins-Scott S, Akarca US, Örmeci N, Kaymakoglu S, Aygen B, Tozun N, Güner R, Bodur H, Lazarus JV. A micro-elimination approach to addressing hepatitis C in Turkey. BMC Health Serv Res 2020; 20:249. [PMID: 32209103 PMCID: PMC7093960 DOI: 10.1186/s12913-020-5019-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 02/21/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In 2016, WHO passed the Global Health Sector Strategy on Viral Hepatitis (GHSS), calling for its elimination by 2030. Two years later, Turkey approved a strategy to reach the WHO targets. This study reports new national prevalence data, breaks it down by subpopulation, and models scenarios to reach HCV elimination. METHODS Literature was reviewed for estimates of HCV disease burden in Turkey. They were discussed with stakeholders and used as inputs to develop a disease burden model. The infected population was estimated by sequelae for the years 2015-2030. Three scenarios were developed to evaluate the disease burden in Turkey: a Base 2017 scenario, representing the current standard of care in Turkey; an increased treatment scenario, representing the impact of improved access to DAAs; and a WHO targets scenario, which meet the WHO GHSS viral hepatitis targets of a 65% reduction in mortality and 90% diagnosis rate of the infected population by 2030. RESULTS At the beginning of 2017, 271,000 viremic infections were estimated. Of these, 58,400 were diagnosed and 10,200 treated. Modelling results showed that, with the current treatment paradigm in Turkey, by 2030 the total number of viremic HCV infections would decline by 35%, while liver-related deaths, hepatocellular carcinoma (HCC), and decompensated cirrhosis would decrease by 10-25%. In the increased treatment scenario, by 2030 viremic HCV infections would decrease by 50%; liver-related deaths, HCC and decompensated cirrhosis would decrease by 45-70%. In the WHO targets scenario, HCV infections would decrease by 80%; sequelae would decrease by 80-85%. Data on disease burden in micro-elimination target subpopulations are largely unavailable. CONCLUSIONS To meet the WHO Global Health Sector Strategy targets for the elimination of HCV, Turkey needs to increase treatment. Better data are needed as well as countrywide access to DAAs.
Collapse
Affiliation(s)
- Ramazan Idilman
- Department of Gastroenterology, Ankara University Medical Faculty, Ankara, Turkey
| | - Homie Razavi
- Center for Disease Analysis, Lafayette, CO 80026 USA
| | | | - Ulus Salih Akarca
- Department of Gastroenterology, Ege University Medical Faculty, Izmir, Turkey
| | - Necati Örmeci
- Department of Gastroenterology, Ankara University Medical Faculty, Ankara, Turkey
| | - Sabahattin Kaymakoglu
- Department of Gastroenterology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Bilgehan Aygen
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Nurdan Tozun
- Department of Internal Medicine and Gastroenterology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Rahmet Güner
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yildirim Beyazit University, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Hurrem Bodur
- Department of Infectious Diseases, Ankara Numune Training and Research Hospital, University of Healthcare Sciences, Ankara, Turkey
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Calle del Rossellón 132, 4th Floor, ES-08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Korkmaz P, Demirturk N, Batırel A, Cem Yardimci A, Cagir U, Atakan Nemli S, Korkmaz F, Zeynep Akcam F, Sener Barut H, Bayrak B, Karakecili F, Tarakci H, Yulugkural Z, Yuksel E, Aktug Demir N, Ural O, Sumer S, Harman R, Kadanali A, Ozturk S, Cetin Akhan S, Eren Tulek N, Keten D, Sener A, Aygen B, Kocagul Celikbas A, Yilmaz Karadag F, Aydin G, Arslan E, Sacligil C, Akengin Ocal G, Tanoglu A, Ulcay A, Karagoz E, Saltoglu N, Sırmatel F, Akdeniz H, Aynıoglu A, Arslan Ozel S, Dirgen Caylak S, Celik I, Alpay Y, Bestepe Dursun Z, Bekcibasi M, Tuncer Ertem G, Tigli A, Sargin Altunok E, Avsar K, Suer K, Sayan M. Noninvasive Models to Predict Liver Fibrosis in Patients with Chronic Hepatitis B: A Study from Turkey. Hepat Mon 2017; In Press. [DOI: 10.5812/hepatmon.60266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
|
10
|
Aygen B, Demirturk N, Turker N, Asan A, Eraksoy H, Gurbuz Y, Inan D, Keten D, Koculu S, Oncu S, Ozkaya D, Saltoglu N, Sayan M, Suer K, Sener A, Tekin S, Tuna N, Yazici S. Management of Chronic Hepatitis C Virus Infection: A Consensus Report of the Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases-2017 Update. Klimik Dergisi 2017. [DOI: 10.5152/kd.2017.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
11
|
Sargin Altunok E, Sayan M, Akhan S, Aygen B, Yildiz O, Tekin Koruk S, Mistik R, Demirturk N, Ural O, Kose Ş, Aynioglu A, Korkmaz F, Ersoz G, Tuna N, Ayaz C, Karakecili F, Keten D, Inan D, Yazici S, Koculu S, Yildirmak T. Protease Inhibitors Drug Resistance Mutations in Turkish Patients with Chronic Hepatitis C. Int J Infect Dis 2016; 50:1-5. [PMID: 27401586 DOI: 10.1016/j.ijid.2016.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 06/01/2016] [Revised: 06/30/2016] [Accepted: 07/03/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Drug resistance development is an expected problem during treatment with protease inhibitors (PIs), this is largely due to the fact that Pls are low-genetic barrier drugs. Resistance-associated variants (RAVs) however may also occur naturally, and prior to treatment with Pls, the clinical impact of this basal resistance remains unknown. In Turkey, there is yet to be an investigation into the hepatitis C (HCV) drug associated resistance to oral antivirals. MATERIALS AND METHODS 178 antiviral-naïve patients infected with HCV genotype 1 were selected from 27 clinical centers of various geographical regions in Turkey and included in the current study. The basal NS3 Pls resistance mutations of these patients were analyzed. RESULTS In 33 (18.5%) of the patients included in the study, at least one mutation pattern that can cause drug resistance was identified. The most frequently detected mutation pattern was T54S while R109K was the second most frequently detected. Following a more general examination of the patients studied, telaprevir (TVR) resistance in 27 patients (15.2%), boceprevir (BOC) resistance in 26 (14.6%) patients, simeprevir (SMV) resistance in 11 (6.2%) patients and faldaprevir resistance in 13 (7.3%) patients were detected. Our investigation also revealed that rebound developed in the presence of a Q80K mutation and amongst two V55A mutations following treatment with TVR, while no response to treatment was detected in a patient with a R55K mutation. CONCLUSION We are of the opinion that drug resistance analyses can be beneficial and necessary in revealing which variants are responsible for pre-treatment natural resistance and which mutations are responsible for the viral breakthrough that may develop during the treatment.
Collapse
Affiliation(s)
- Elif Sargin Altunok
- Infectious Diseases and Clinical Microbiology, Bitlis Public Hospital, Bitlis 13000, Turkey
| | - Murat Sayan
- Clinical Laboratory, Kocaeli University Faculty of Medicine, Kocaeli 41380, Turkey; Near East University, Research Center of Experimental Health Sciences, Nicosia, Northern Cyprus
| | - Sila Akhan
- Infectious Diseases And Clinical Microbiology, Kocaeli University Faculty of Medicine, Kocaeli 41380, Turkey
| | - Bilgehan Aygen
- Infectious Diseases And Clinical Microbiology, Erciyes University Faculty of Medicine, Kayseri 38030, Turkey
| | - Orhan Yildiz
- Infectious Diseases And Clinical Microbiology, Erciyes University Faculty of Medicine, Kayseri 38030, Turkey
| | - Suda Tekin Koruk
- Infectious Diseases and Clinical Microbiology, Koc University Faculty of Medicine, İstanbul 34010, Turkey
| | - Resit Mistik
- Infectious Diseases and Clinical Microbiology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Nese Demirturk
- Infectious Diseases and Clinical Microbiology, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey
| | - Onur Ural
- Infectious Diseases and Clinical Microbiology, Selçuk University Faculty of Medicine, Konya, Turkey
| | - Şükran Kose
- Infectious Diseases and Clinical Microbiology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Aynur Aynioglu
- Infectious Diseases and Clinical Microbiology, Zonguldak Ataturk Public Hospital, Zonguldak, Turkey
| | - Fatime Korkmaz
- Infectious Diseases and Clinical Microbiology, Konya Training and Research Hospital, Konya, Turkey
| | - Gülden Ersoz
- Infectious Diseases And Clinical Microbiology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Nazan Tuna
- Infectious Diseases and Clinical Microbiology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Celal Ayaz
- Infectious Diseases and Clinical Microbiology, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Faruk Karakecili
- Infectious Diseases and Clinical Microbiology, Erzincan University Faculty of Medicine, Erzincan, Turkey
| | - Derya Keten
- Infectious Diseases and Clinical Microbiology, Necip Fazil City Hospital, Kahramanmaraş, Turkey
| | - Dilara Inan
- Infectious Diseases and Clinical Microbiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Saadet Yazici
- Infectious Diseases and Clinical Microbiology, Göztepe Training and Research Hospital, İstanbul, Turkey
| | - Safiye Koculu
- Infectious Diseases and Clinical Microbiology, Giresun Public Hospital, Giresun, Turkey
| | - Taner Yildirmak
- Infectious Diseases and Clinical Microbiology, Okmeydanı Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
12
|
Gürbüz Y, Tülek NE, Tütüncü EE, Koruk ST, Aygen B, Demirtürk N, Kınıklı S, Kaya A, Yıldırmak T, Süer K, Korkmaz F, Ural O, Akhan S, Günal Ö, Tuna N, Köse Ş, Gönen İ, Örmen B, Türker N, Saltoğlu N, Batırel A, Tuncer G, Bulut C, Sırmatel F, Ulçay A, Karagöz E, Tosun D, Şener A, Aynıoğlu A, Altunok ES. Evaluation of Dual Therapy in Real Life Setting in Treatment-Naïve Turkish Patients with HCV Infection: A Multicenter, Retrospective Study. Balkan Med J 2016; 33:18-26. [PMID: 26966614 DOI: 10.5152/balkanmedj.2015.15859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 06/16/2015] [Accepted: 09/30/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Before the introduction of direct-acting antivirals in the treatment of chronic hepatitis C patients, the combination of peginterferon alpha and ribavirin was the standard therapy. Observational studies that investigated sustained virological response (SVR) rates by these drugs yielded different outcomes. AIMS The goal of the study was to demonstrate real life data concerning SVR rate achieved by peginterferon alpha plus ribavirin in patients who were treatment-naïve. STUDY DESIGN A multicenter, retrospective observational study. METHODS The study was conducted retrospectively on 1214 treatment naïve-patients, being treated with peginterferon alpha-2a or 2b plus ribavirin in respect of the current guidelines between 2005 and 2013. The patients' data were collected from 22 centers via a standard form, which has been prepared for this study. The data included demographic and clinical characteristics (gender, age, body weight, initial Hepatitis C virus RNA (HCV RNA) level, disease staging) as well as course of treatment (duration of treatment, outcomes, discontinuations and adverse events). Renal insufficiency, decompensated liver disease, history of transplantation, immunosuppressive therapy or autoimmune liver disease were exclusion criteria for the study. Treatment efficacy was assessed according to the patient's demographic characteristics, baseline viral load, genotype, and fibrosis scores. RESULTS The mean age of the patients was 50.74 (±0.64) years. Most of them were infected with genotype 1 (91.8%). SVR was achieved in 761 (62.7%) patients. SVR rate was 59.1% in genotype 1, 89.4% in genotype 2, 93.8% in genotype 3, and 33.3% in genotype 4 patients. Patients with lower viral load yielded higher SVR (65.8% vs. 58.4%, p=0.09). SVR rates according to histologic severity were found to be 69.3%, 66.3%, 59.9%, 47.3%, and 45.5% in patients with fibrosis stage 0, 1, 2, 3 and 4, respectively. The predictors of SVR were male gender, genotype 2/3, age less than 45 years, low fibrosis stage, low baseline viral load and presence of early virological response. SVR rates to each peginterferon were found to be similar in genotype 1/4 although SVR rates were found to be higher for peginterferon alpha-2b in patients with genotype 2/3. The number of patients who failed to complete treatment due to adverse effects was 33 (2.7%). The number of patients failed to complete treatment due to adverse effects was 33 (2.7%). CONCLUSION Our findings showed that the rate of SVR to dual therapy was higher in treatment-naïve Turkish patients than that reported in randomized controlled trials. Also peginterferon alpha-2a and alpha-2b were found to be similar in terms of SVR in genotype 1 patients.
Collapse
Affiliation(s)
- Yunus Gürbüz
- Department of Infectious Diseases and Clinical Microbiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Necla Eren Tülek
- Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Emin Ediz Tütüncü
- Department of Infectious Diseases and Clinical Microbiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Süda Tekin Koruk
- Department of Infectious Diseases and Clinical Microbiology, Harran University Faculty of Medicine, Şanlıurfa, Turkey
| | - Bilgehan Aygen
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Neşe Demirtürk
- Department of Infectious Diseases and Clinical Microbiology, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey
| | - Sami Kınıklı
- Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Ali Kaya
- Department of Infectious Diseases and Clinical Microbiology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Taner Yıldırmak
- Department of Infectious Diseases and Clinical Microbiology, Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Kaya Süer
- Department of Infectious Diseases and Clinical Microbiology, Near East University Faculty of Medicine, Nicosia, North Cyprus
| | - Fatime Korkmaz
- Department of Infectious Diseases and Clinical Microbiology, Konya Training and Research Hospital, Konya, Turkey
| | - Onur Ural
- Department of Infectious Diseases and Clinical Microbiology, Selçuk University Faculty of Medicine, Konya, Turkey
| | - Sıla Akhan
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Özgür Günal
- Department of Infectious Diseases and Clinical Microbiology, Gaziosmanpaşa University Faculty of Medicine, Tokat, Turkey
| | - Nazan Tuna
- Department of Infectious Diseases and Clinical Microbiology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Şükran Köse
- Department of Infectious Diseases and Clinical Microbiology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - İbak Gönen
- Department of Infectious Diseases and Clinical Microbiology, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Bahar Örmen
- Department of Infectious Diseases and Clinical Microbiology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Nesrin Türker
- Department of Infectious Diseases and Clinical Microbiology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Neşe Saltoğlu
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Ayşe Batırel
- Department of Infectious Diseases and Clinical Microbiology, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey
| | - Günay Tuncer
- Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Cemal Bulut
- Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Fatma Sırmatel
- Department of Infectious Diseases and Clinical Microbiology, Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Asım Ulçay
- Department of Infectious Diseases and Clinical Microbiology, GATA Haydarpaşa Training and Research Hospital, İstanbul, Turkey
| | - Ergenekon Karagöz
- Department of Infectious Diseases and Clinical Microbiology, GATA Haydarpaşa Training and Research Hospital, İstanbul, Turkey
| | - Derviş Tosun
- Department of Infectious Diseases and Clinical Microbiology, Ulus State Hospital, Ankara, Turkey
| | - Alper Şener
- Department of Infectious Diseases and Clinical Microbiology, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, Turkey
| | - Aynur Aynıoğlu
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Elif Sargın Altunok
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| |
Collapse
|
13
|
Tekin Koruk S, Batirel A, Kose S, Cetin Akhan S, Aygen B, Tulek N, Hatipoglu Ç, Bulut C, Yıldız O, Sacligil C, Sirmatel F, Altunok E. Evaluation of hepatitis B virus transmission and antiviral therapy among hepatitis B surface antigen-positive pregnant women. J Obstet Gynaecol Res 2015; 41:1870-6. [PMID: 26369498 DOI: 10.1111/jog.12821] [Citation(s) in RCA: 9] [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] [Received: 02/11/2015] [Accepted: 06/25/2015] [Indexed: 12/21/2022]
Abstract
AIM The aim of the present study was to assess the potential risk of hepatitis B virus (HBV) vertical transmission among Turkish parturient women and to evaluate the efficacy and safety of antiviral agents. MATERIAL AND METHODS Data were collected retrospectively from 114 HBV-infected pregnant women and their infants in eight health institutions in Turkey. RESULTS The baseline characteristics of the women were: mean age, 28.3 ± 5.2 years; alanine aminotransferase, 57.4 ± 139.0 U/L; aspartate aminotransferase, 56.6 ± 150.0 U/L; and HBV DNA, 8.3 × 10(7) ± 2.6 × 10(8) copies/mL. Family history of HBV infection was detected in 53.5% (n = 61). In total, 60 (52.6%) pregnant women received tenofovir (60.0%), lamivudine (33.3%) or telbivudine (6.7%) therapy at the median gestational age of 22.2 ± 8.5 (1-36) weeks. All infants were vaccinated and hepatitis B immune globulin was administered, with 81 of them (71.1%) available for follow-up. After completion of HBV vaccination course, 71 (87.7%) infants had protective anti-HBs levels, three (3.7%) were hepatitis B surface antigen-positive, and seven (8.6%) were hepatitis B surface antigen-negative with nonprotective anti-HBs levels. Five of the infants had low gestational birthweight but no other birth defects were observed. CONCLUSION According to our results, viral load may not be the only effecting factor for transmission of HBV to children of infected mothers. Pregnant women with high viral load should be followed-up closely during pregnancy. They should begin to take tenofovir or telbivudine, which are category B drugs for pregnancy, at the beginning of the third trimester at the latest. We need new treatment strategies; and close follow-up of mothers and children is another important issue.
Collapse
Affiliation(s)
- Suda Tekin Koruk
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Ayse Batirel
- Department of Infectious Diseases and Clinical Microbiology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Sukran Kose
- Department of Infectious Diseases and Clinical Microbiology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Sila Cetin Akhan
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Bilgehan Aygen
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Necla Tulek
- Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Çigdem Hatipoglu
- Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Cemal Bulut
- Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Orhan Yıldız
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Cahide Sacligil
- Department of Infectious Diseases and Clinical Microbiology, Kartal Yavuz Selim Training and Research Hospital, Istanbul, Turkey
| | - Fatma Sirmatel
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Elif Altunok
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| |
Collapse
|
14
|
Aygen B, Yıldız O, Akhan S, Çelen MK, Ural O, Koruk ST, Köse Ş, Korkmaz F, Kuruüzüm Z, Tuna N, Taheri S, Sayan M, Demir NA, Sümer Ş, Altınok ES. Retreatment of Chronic Hepatitis C Infection with Telaprevir: Preliminary Results in Turkey. Balkan Med J 2015; 32:266-72. [PMID: 26185714 DOI: 10.5152/balkanmedj.2015.15366] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 05/16/2014] [Accepted: 01/11/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The use of pegylated interferon alpha and ribavirin (PegIFN/RBV) for the retreatment of chronic hepatitis C virus (HCV) infection without a sustained virological response (SVR) prior to PegIFN/RBV treatment has resulted in low success rates. AIMS To investigate the efficacy and safety of telaprevir (TVR) in combination with PegIFN/RBV in patients infected with HCV genotypes 1 and 4 who were previously treated with PegIFN/RBV and failed to achieve SVR. STUDY DESIGN Multi-center, retrospective, cross-sectional study. METHODS The study included 111 patients: 80 prior relapsers, 25 prior null responders, and six prior partial responders to PegIFN/RBV treatment. The patients were given TVR/PegIFN/RBV for 12 weeks, followed by a 12-week PegIFN/RBV treatment; virological response results were assessed at weeks 4, 12, and 24. Treatment was discontinued in patients with HCV RNA >1000 IU/mL at week 4 or with negative RNA results at week 4 but >1000 IU/mL at week 12. Rapid virological response (RVR), early virological response (EVR), extended rapid virological response (eRVR), and virological response at 24th week of treatment were evaluated. The side effects of combination therapy and the rates of treatment discontinuation were investigated. RESULTS The mean age of the patients was 56.02±9.96 years and 45.9% were male. Ninety-one percent of the patients were infected with viral genotype 1, 69.6% with the interleukin (IL) 28B genotype CT and 20.2% were cirrhotic. The RVR rate was 86.3% in prior relapsers, 56% in prior null responders, and 50% in prior partial responders (p=0.002). EVR rates in those groups were 91.3%, 56%, and 83.3%, respectively (p<0.001). eRVR rates were 83.8% in prior relapsers, 48% in prior null responders, and 50% in prior partial responders (<0.001). The virological response at the 24th week of treatment was found to be the highest in prior relapsers (88.8%); it was 56% in prior null responders and 66.7% in prior partial responders (p<0.001). Common side effects were fatigue, headache, anorexia, malaise, anemia, pruritus, dry skin, rash, dyspepsia, nausea, pyrexia, stomachache, and anorectal discomfort. All treatments were discontinued due to side effects in 9.9% of patients. CONCLUSION High virological response rates were obtained with TVR/PegIFN/RBV treatment. Although side effects were frequently observed, the discontinuation rate of combination therapy was low.
Collapse
Affiliation(s)
- Bilgehan Aygen
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Orhan Yıldız
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Sıla Akhan
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Mustafa Kemal Çelen
- Department of Infectious Diseases and Clinical Microbiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Onur Ural
- Department of Infectious Diseases and Clinical Microbiology, Selçuk University Faculty of Medicine, Konya, Turkey
| | - Süda Tekin Koruk
- Department of Infectious Diseases and Clinical Microbiology, Harran University Faculty of Medicine, Şanlıurfa, Turkey
| | - Şükran Köse
- Department of Infectious Diseases and Clinical Microbiology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Fatime Korkmaz
- Department of Infectious Diseases and Clinical Microbiology, Konya Training and Research Hospital, Konya, Turkey
| | - Ziya Kuruüzüm
- Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylül University Faculty of Medicine, İzmir Turkey
| | - Nazan Tuna
- Department of Infectious Diseases and Clinical Microbiology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Serpil Taheri
- Department of Medical Biology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Murat Sayan
- Clinical Laboratory, PCR Unit, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Nazlım Aktuğ Demir
- Department of Infectious Diseases and Clinical Microbiology, Selçuk University Faculty of Medicine, Konya, Turkey
| | - Şua Sümer
- Department of Infectious Diseases and Clinical Microbiology, Selçuk University Faculty of Medicine, Konya, Turkey
| | - Elif Sargın Altınok
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| |
Collapse
|
15
|
Taheri S, Aygen B, Korkmaz K, Yıldız O, Zararsız G, Canatan H. Characterization of the Interleukin-28B Gene rs12979860 C/T Polymorphism in Turkish Chronic Hepatitis C Patients and Healthy Individuals. Balkan Med J 2015; 32:147-55. [PMID: 26167338 DOI: 10.5152/balkanmedj.2015.15156] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 05/24/2014] [Accepted: 12/10/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Host genetic factors can affect the progress of hepatitis-C virus (HCV) infection. Interleukin-28B (IL28B) single nucleotide polymorphisms may play an important role in the clearance of HCV spontaneously or with treatment. AIMS The aim of our study was to evaluate the rate of IL28B genotypes in patients with Chronic Hepatitis-C (CHC) and healthy control subjects and to examine the characteristics of patients in each IL28B subgroup. STUDY DESIGN Case-control study. METHODS IL28B polymorphisms were genotyped by Polymerase Chain Reaction and Restriction Fragment Length Polymorphism (PCR-RFLP) in all subjects. RESULTS The mean age was 52.3±10.9 years (33% female) in the CHC patients and 52.5±11.5 years (39.1% female) in the healthy controls. The percentage of patients with a high baseline viral load (≥400,000 IU/mL) was higher in the CT group (69.8%) compared to the C/C (44.4%) and T/T (50%) groups (p=0.021). There was no significant difference in liver fibrosis and liver necroinflammation distribution among the CC, CT and TT genotypes with mild, moderate and severe groups (p=0.058 and p=0.791, respectively). Mean age, gender ratio, body mass index, viral load at baseline, rate of HCV genotypes, baseline ALT levels were not significantly different among the three IL28B subgroups (p>0.05). A significant increase was observed in the frequencies of IL28B rs12979860 TT genotypes in the CHC patients (20.6%) compared to the healthy control group (8.7%) (p=0.033). CONCLUSION In the patients with chronic HCV-genotype 1b and 4 infections, the IL28B rs12979860 (C>T) gene polymorphism frequency of the TT genotype and T allele was higher than in healthy control subjects. This result indicates that the TT genotype may be more effective in the progression of HCV infection than other genotypes.
Collapse
Affiliation(s)
- Serpil Taheri
- Department of Medical Biology, Erciyes University Faculty of Medicine, Kayseri, Turkey ; Betül-Ziya Eren Genome and Stem Cell Center, Erciyes University, Kayseri, Turkey
| | - Bilgehan Aygen
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Keziban Korkmaz
- Betül-Ziya Eren Genome and Stem Cell Center, Erciyes University, Kayseri, Turkey
| | - Orhan Yıldız
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Gökmen Zararsız
- Department of Biostatistics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Halit Canatan
- Department of Medical Biology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| |
Collapse
|
16
|
Aygen B, Yildiz O, Akhan S, Gunal O, Taheri S, Zararsiz G, Sayan M, Rustemoglu A, Altinok ES. Impact of Interleukin 28B Genotype on the Virological Responses in Chronic Hepatitis C Treatment. Gastroenterology Res 2014; 7:123-130. [PMID: 27785282 PMCID: PMC5040535 DOI: 10.14740/gr629e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2014] [Indexed: 12/24/2022] Open
Abstract
Background Interleukin (IL) 28B single nucleotide polymorphisms may play a role in the clearance of hepatitis C virus (HCV). We aimed to evaluate the treatment response of chronic HCV infection patients to pegile interferon (pegIFN) and ribavirin treatment with regard to IL28B rs12979860 C/T polymorphism. Methods A total of 186 patients (mean age, 55.6 ± 10 years; 65.1% female) who underwent pegIFN and ribavirin treatment for chronic HCV infection were studied. We analyzed demographics, HCV genotype, baseline alanine aminotransferase (ALT) levels, histopathological data, viral load before treatment and at 4, 12, 24, 48, and 72 weeks from the treatment start, and IL28B genotype. IL28B polymorphism was genotyped using polymerase chain reaction based restriction fragment length polymorphism (PCR-RFLP) in all the subjects. Results One hundred forty-five (86.8%) patients were infected with viral genotype 1b, and 13.2% were infected with viral genotype 4. The rates of C/C, C/T, and T/T genotypes were 22.6%, 52.7%, and 24.7% respectively. The percentage of patients with a viral load over 400,000 IU/mL was higher in the C/T group (P = 0.020). Of the patients, 44.6% provided sustained virological response (SVR) to pegIFN and ribavirin combination treatment. The frequency of T allele was 41% in patients with SVR, whereas 59% patients provided no response (P < 0.001). SVR was obtained in 66.7%, 42.9%, and 28.3% of CC, CT, and TT groups (P = 0.001). The rates of rapid virological response (RVR), early virological response (EVR), end-of-treatment response (ETR), and SVR were higher in the CC group than other groups (P = 0.216, P < 0.001, P = 0.001, P = 0.001, respectively). The relapse and null response (NR) rates were higher in TT group and partial response rate (PR) was higher in CT group. Conclusions IL28B rs12979860 C/T gene polymorphism affects the response to antiviral treatment in the patients with chronic HCV genotypes 1b and 4 infections.
Collapse
Affiliation(s)
- Bilgehan Aygen
- Department of Infectious Diseases and Clinical Microbiology, Medical School of Erciyes University, Kayseri, Turkey
| | - Orhan Yildiz
- Department of Infectious Diseases and Clinical Microbiology, Medical School of Erciyes University, Kayseri, Turkey
| | - Sila Akhan
- Kocaeli University Medical Faculty Infectious Diseases and Clinical Microbiology, Kocaeli, Turkey
| | - Ozgur Gunal
- Department of Infectious Diseases and Clinical Microbiology, Medical School of Gaziosmanpasa University, Tokat, Turkey
| | - Serpil Taheri
- Erciyes University Betul Ziya Eren Genome and Stem Cell Center, Kayseri, Turkey
| | - Gokmen Zararsiz
- Department of Biostatistics, Medical School of Erciyes University, Kayseri, Turkey
| | - Murat Sayan
- Department of Infectious Diseases and Clinical Microbiology, Medical School of Kocaeli University, Kocaeli, Turkey
| | - Aydin Rustemoglu
- Gaziosmanpasa University Medical Faculty, Department of Medical Biology, Tokat, Turkey
| | - Elif Sargin Altinok
- Department of Infectious Diseases and Clinical Microbiology, Medical School of Kocaeli University, Kocaeli, Turkey
| |
Collapse
|
17
|
Sayan M, Akhan S, Aygen B, Koruk ST, Mistik R, Demirtürk N, Ural O. HCV NS3 inhibitors resistance mutations in the telaprevir started Turkish patients with chronic HCV. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.1367] [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: 10/25/2022] Open
|
18
|
Kemal Celen M, Tekin Koruk S, Aygen B, Dal T, Karabay O, Tosun S, Koksal I, Turgut H, Onlen Y, Balik I, Yildirim N, Sinan Dal M, Ayaz C, Tabak F. The characteristics of patients with chronic hepatitis B in Turkey. Med Glas (Zenica) 2014; 11:94-98. [PMID: 24496347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 07/11/2013] [Indexed: 06/03/2023]
Abstract
AIM To evaluate the characteristics of patients with hepatitis B virus (HBV) infection and summarize the treatment modalities. METHODS By September 30, 2011 the data of 7871 HBsAg (+) patients were complied and analysed according to demographic and medical records (age, sex, laboratory tests, treatment with antiviral agents) in thirty centres of Turkey. RESULTS Of the 7871 patients 3078 (39.1%) were females; mean (standard deviation) age was 35 (14) years, 3180 (40.4%) were HBsAg positive (+) after admission to a hospital, 1488 (18.9%) after blood donation and 967 (11.9%) were found during routine screening. The HBV prevalence among relatives of HBsAg (+) patients was 1764 (22.4%), and most frequently infected family members were siblings and mothers, 4961 (63.0%) and 2149 (27.3%), respectively). Anti-HDV was negative in 7407 94.1% of patients. Three-fourths of the patients 6383 (81.1%) were HBeAg negative (-). Mean (SD) ALT was 85.8 (266.4) U/L. Majority of patients, 5588 (71.0%) were chronic hepatitis-B patients under treatment, while 2283 (29.0%) were asymptomatic carriers without treatment and only 165 (2.1%) of patients were cirrhotic and 6612 (84.0%) of those were compensated. One-third of the patients 2983 (37.9%) were under a combined treatment, while others were under monotherapy. Lamivudine, entecavir and adefovir were the most frequently used oral therapies, used for 2583 (32.8%), 11.6% and 787 (10.0%) of patients, respectively), while 2975 (37.8%) of patients were under interferon treatment. CONCLUSION Hepatitis B is still a problem in our country. First task of the physicians and our state should be to prevent the development and spread of the disease with education and vaccination programs, safe blood transfusions, and control of barbers.
Collapse
Affiliation(s)
- Mustafa Kemal Celen
- 1Dicle University, Faculty of Medicine, Department of Infectious Diseases, Diyarbakir, Turkey, 2Harran University, Faculty of Medicine, Department of Infectious Diseases, Sanliurfa, Turkey, 3 Erciyes University, Faculty of Medicine, Department of Infectious Diseases, Kayseri, Turkey, 4Dicle University, Faculty of Medicine, Department of Microbiology, Diyarbakir, Turkey, 5Sakarya University, Faculty of Medicine, Department of Infectious Diseases, Sakarya, Turkey, 6Manisa State Hospital, Department of Infectious Diseases, Manisa, Turkey, 7Karadeniz Technical University, Faculty of Medicine, Department of Infectious Diseases, Trabzon, Turkey, 8Pamukkale University, Faculty of Medicine, Department of Infectious Diseases, Denizli, Turkey, 9Mustafa Kemal University, Faculty of Medicine, Department of Infectious Diseases, Hatay, Turkey, 10Ankara University, Faculty of Medicine, Department of Infectious Diseases, Ankara, Turkey, 11State Hospital, Department of Infectious Diseases, Mardin, Turkey, 12Dicle University, Faculty of Medicine, Department of Internal Medicine, Diyarbakir, Turkey, 13Istanbul University, Faculty of Medicine, Department of Infectious Diseases, Istanbul, Turkey
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Yıldız O, Aygen B, Demirtürk N, Demirdal T, Inan D, Yıldırmak T, Kantürk A, Tütüncü E, Group HBS. Lamivudine resistance mutations in patients infected with hepatitis B virus genotype D. World J Gastroenterol 2011; 17:4987-92. [PMID: 22174548 PMCID: PMC3236585 DOI: 10.3748/wjg.v17.i45.4987] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 07/04/2011] [Accepted: 07/11/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the distribution of viral genotypes for primary or acquired lamivudine resistance.
METHODS: A total of 283 patients with chronic hepatitis B virus (HBV) infection (245 patients with chronic hepatitis B and 38 inactive hepatitis B surface antigen carriers) were included in the study. The HBV genotype was determined by using quantitative real-time polymerase chain reaction and sequence analysis, and tyrosine-methionine-aspartate-aspartate (YMDD) motif mutations were determined using the reverse transcriptase hybridization method.
RESULTS: Lamivudine resistance was determined in a total of 25 (10.7%) chronic hepatitis B patients. Eight subjects (4%) had primary resistance to lamivudine, and 17 (53.1%) had secondary resistance to lamivudine. Genotype D, which was isolated from 267 of the patients with chronic HBV infection, was the dominant genotype in Turkey.
CONCLUSION: Identification of YMDD motif mutations should have a positive impact on the selection of proper antiviral medication for patients, even for those who are nucleoside naïve.
Collapse
|
20
|
Yildiz O, Tanriverdi F, Simsek S, Aygen B, Kelestimur F. The effects of moderate-dose steroid therapy in sepsis: A placebo-controlled, randomized study. J Res Med Sci 2011; 16:1410-21. [PMID: 22973341 PMCID: PMC3430057] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Accepted: 10/09/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Despite the new developments in sepsis treatment, mortality rate is still high. In this study, we aimed to investigate endocrinologic changes and the effects of moderate dosage steroid treatment in patients with sepsis. METHODS Fifty-five patients were included in the study. Basal hormonal evaluation and adrenocorticotropin hormone (ACTH) stimulation test were performed within 24 h in all patients. Both groups received standard treatment for sepsis. However, one group (steroid group) was also given intravenous prednisolone (20 mg/day). All-cause mortality was assessed during the first 28 days. RESULTS Analysis of the findings revealed a 59.3% mortality rate in steroid group compared with a 53.6% mortality rate in placebo group (p = 0.787). Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores, and peak cortisol and ACTH levels were significant factors related to mortality. The incidence of adrenal insufficiency (AI) was 10.9% and relative adrenal insufficiency (RAI) 36.4%. It was also found that steroid treatment did not have any effects on the mortality of patients with AI and RAI (p = 0.075 and p = 0.999, respectively). CONCLUSIONS Moderate-dose steroid therapy has no effect on mortality. Higher basal cortisol and peak cortisol levels were found more reliable mortality indicators compared to RAI. In addition, the study revealed that ACTH level was a significant indicator of mortality.
Collapse
Affiliation(s)
- Orhan Yildiz
- Associate Professor, Department of Infectious Diseases, School of Medicine, Erciyes University, Kayseri, Turkey.,
Corresponding author: Orhan Yildiz E-mail:
| | - Fatih Tanriverdi
- Associate Professor, Division of Endocrinology, Department of Internal Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Serap Simsek
- Consultant, Department of Infectious Diseases, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Bilgehan Aygen
- Professor, Department of Infectious Diseases, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Fahrettin Kelestimur
- Professor, Division of Endocrinology, Department of Internal Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
| |
Collapse
|
21
|
Korten V, Söyletir G, Yalçın AN, Oğünç D, Dokuzoğuz B, Esener H, Ulusoy S, Tünger A, Aygen B, Sümerkan B, Arman D, Dizbay M, Akova M, Hasçelik G, Eraksoy H, Başaran S, Köksal I, Bayramoğlu G, Akalın H, Sınırtaş M. [Comparative evaluation of in vitro activities of carbapenems against gram-negative pathogens: Turkish data of COMPACT study]. MIKROBIYOL BUL 2011; 45:197-209. [PMID: 21644063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The aim of this study was to determine the in vitro activities of doripenem, imipenem, and meropenem against clinical gram-negative isolates. A total of 596 clinical isolates were obtained from intensive care unit (ICU) and non-ICU patients in 10 centers over Turkey between September-December 2008. The origin of the isolates was patients with nosocomial pneumonia (42.4%), bloodstream infections (%40.4), and complicated intraabdominal infections (17.1%). Of the isolates, 51.8% were obtained from ICU patients. The study isolates consisted of Pseudomonas spp. in 49.8%, Enterobacteriaceae in 40.3%, and other gram-negative agents in 9.9%. The minimum inhibitory concentrations (MIC) for doripenem, imipenem and meropenem were determined for all isolates in each center using Etest® strips (AB Biodisk, Solna, Sweden). Of the isolates, 188 (31.5%) were resistant to at least one of the carbapenems. MIC50 of doripenem against Pseudomonas spp. Was 1 mg/L which was similar to that of meropenem and two-fold lower than imipenem. Susceptibility to carbapenems in P.aeruginosa was 64% for doripenem at an MIC level of 2 mg/L, 53.9% and 63% for imipenem and meropenem at an MIC level of 4 mg/L, respectively. Doripenem and meropenem showed similar activity with the MIC90 of 0.12 mg/L whereas imipenem was four-fold less active at 0.5 mg/L. Against other gramnegative pathogens, mostly Acinetobacter spp., MIC50 was 8 mg/L for doripenem and 32 mg/L for other two carbapenems. P.aeruginosa isolates were inhibited 84.2% with doripenem and 72.1% with meropenem at the MIC level of 8 mg/L. Doripenem generally showed similar or slightly better activity than meropenem and better activity than imipenem against pathogens collected in this study. Against Pseudomonas spp., doripenem was the most active of the three carbapenems. Doripenem and meropenem were equally active against Enterobacteriaceae and at least four-fold more active than imipenem. It was concluded that doripenem seemed to be a promising agent in the treatment of nosocomial pneumonia, blood stream infections and intraabdominal infections particularly in patients who were under risk of developing antimicrobial resistance.
Collapse
Affiliation(s)
- Volkan Korten
- Marmara University Faculty of Medicine, İstanbul, Turkey.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Atalay MA, Gokahmetoglu S, Aygen B. Genotypes of hepatitis B virus in Central Anatolia, Kayseri, Turkey. Saudi Med J 2011; 32:360-363. [PMID: 21483993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVE To investigate the distribution of hepatitis B virus (HBV) genotypes among patients with chronic hepatitis B in Kayseri, Turkey. METHODS The study took place in the Department of Microbiology, Erciyes University, Kayseri, and Iontek Laboratory, Istanbul, Turkey, from January 2005 to October 2007. One hundred and ten patients with chronic hepatitis B were included in this study. Hepatitis B virus DNA in sera were investigated by using the real-time polymerase chain reaction. Viral DNA was extracted from 200 uL of serum using the QIAamp DNA minElute kit (Qiagen, Hilden, Germany). Reaction mixture was prepared by Fluorion HBV QNP 2.0 ( Iontek, Istanbul, Turkey). RESULTS Genotype D was detected in 107 of 110 (97.2%) patients, however, genotyping failed in 3 patients (2.7%). No other genotypes were found. CONCLUSION The vast majority of Turkish patients with chronic hepatitis B have genotype D.
Collapse
Affiliation(s)
- Mustafa A Atalay
- Department of Microbiology, Medical Faculty, Erciyes University, Kayseri, Turkey
| | | | | |
Collapse
|
23
|
Nordmann P, Picazo JJ, Mutters R, Korten V, Quintana A, Laeuffer JM, Seak JCH, Flamm RK, Morrissey I, Azadian B, El-Bouri K, Jones G, Masterton B, Morgan M, Oppenheim B, Waghorn D, Smyth E, Abele-Horn M, Jacobs E, Mai U, Mutters R, Pfister W, Schoerner C, Seifert H, Bebear C, Bingen E, Bonnet R, Jehl F, Levy PY, Nordmann P, Delvallez MR, Paniara O, Papaparaskevas J, Piotr H, Kolar M, Zemlickova H, Hanzen J, Kotulova D, Campa M, Fadda G, Fortina G, Gesu G, Manso E, Milano F, Nicoletti G, Pucillo L, Rigoli R, Rossolini G, Sambri V, Sarti M, Akalin H, Sinirtas M, Akova M, Hascelik G, Arman D, Dizbay M, Aygen B, Sumerkan B, Dokuzoguz B, Esener H, Eraksoy H, Basaran S, Koksal I, Bayramoglu G, Korten V, Soyletir G, Ulusoy S, Tunger A, Yalcin AN, Ogunc D, Bou G, Bouza E, Canton R, Coll P, Garcia-Rodriguez JA, Gimeno C, Gobernado M, Bertomeu FG, Gomez-Garces JL, Marco F, Martinez-Martinez L, Pascual A, Perez JL, Picazo J, Prats G, Linares MS, Ghaly F, Cristino M, Diogo J, Ramos H, Balode A, Jurna-Ellam M, Koslov R. Comparative activity of carbapenem testing: the COMPACT study. J Antimicrob Chemother 2011; 66:1070-8. [DOI: 10.1093/jac/dkr056] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
|
24
|
Metan G, Alp E, Yildiz O, Percin D, Aygen B, Sumerkan B. Clinical Experience with Tigecycline in the Treatment of Carbapenem-Resistant AcinetobacterInfections. J Chemother 2010; 22:110-114. [DOI: 10.1179/joc.2010.22.2.110] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
25
|
Demiraslan H, Metan G, Mese EA, Yildiz O, Aygen B, Sumerkan B, Doganay M. Neurobrucellosis: an evaluation of a rare presentation of brucellosis from a tertiary care centre in Central Anatolia, Turkey. Trop Doct 2010; 39:233-5. [PMID: 19762578 DOI: 10.1258/td.2009.080430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Nervous system involvement is a rare manifestation of brucellosis. We describe our experience of the diagnosis, treatment and final outcome of patients with neurobrucellosis at the Erciyes University Gevher Nesibe Hospital, a tertiary referral centre in Central Anatolia, Turkey. Thirty-six adult patients were diagnosed with neurobrucellosis from January 1997 to December 2006. Headache and fever were the most common symptoms. Neck stiffness was present in 25 patients. Brucella spp was isolated from the blood of nine patients and from the cerebrospinal fluid of 11. Doxycycline (by mouth) plus rifampin (by mouth) with ceftriaxone (intravenously) were the most common treatment choices. Three patients died as a result of problems other than neurobrucellosis and relapse occurred in one patient. Neurobrucellosis presents with hetoregenous clinical signs.
Collapse
Affiliation(s)
- Hayati Demiraslan
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
Malnutrition is fairly common in end-stage renal disease (ESRD) patients, persistent lack of appetite being a major symptom. Ghrelin and obestatin are two hormones that are involved in appetite and energy homeostasis. The present study examined ghrelin and obestatin levels in 24 ESRD patients undergoing haemodialysis and 24 age-matched healthy controls. Serum and saliva ghrelin and obestatin levels in the ESRD patients were significantly higher compared with controls, while saliva ghrelin and obestatin levels in all study participants were significantly higher than serum levels. Saliva ghrelin correlated with serum ghrelin and saliva obestatin correlated with serum obestatin in all study participants, although there was no correlation between ghrelin and obestatin levels. In conclusion, the results suggest that the kidneys may have a role in the metabolism and/or clearance of obestatin, as they do for ghrelin. Further studies are needed to determine if elevated levels of these hormones in ESRD patients contribute to the malnutrition that is common in these patients.
Collapse
Affiliation(s)
- B Aygen
- Department of Nephrology, Medical Faculty, Firat University, Elazig, Turkey.
| | | | | | | | | | | | | |
Collapse
|
27
|
Aygen B, Celiker H, Dogukan A, Ilhan N. The effects of trimetazidine on lipid peroxidation in patients with end-stage renal disease. ACTA ACUST UNITED AC 2008; 30:757-60. [DOI: 10.1358/mf.2008.30.10.1316831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
28
|
Abstract
PURPOSE This study focused on the effect of immuno-compromising conditions on the clinical presentation of severe listerial infection. PATIENTS AND METHODS Nine human listeriosis cases seen from 1991-2002 were reviewed. All adult patients, from whose blood, peritoneal fluid or cerebrospinal fluid (CSF) the L. monocytogenes was isolated, were included in this retrospective study. RESULTS Listeriosis presented as primary sepsis with positive blood cultures in 5 cases and meningitis with positive CSF cultures in 4 cases. All of these patients had at least one underlying disease, most commonly, hematologic malignancy, diabetes mellitus, amyloidosis and hepatic cirrhosis; 55.6% had received immunosuppressive or corticosteroid therapy within a week before the onset of listeriosis. The patients were adults with a mean age of 60 years. Fever, night sweats, chills and lethargy were the most common symptoms; high temperature (> 38 degrees C), tachycardia, meningeal signs and poor conditions in general were the most common findings on admission. The mortality rate was 33.3% and was strictly associated with the severity of the underlying disease. Mortality differences were significant between sepsis (20%) and meningitis (50%) patients. CONCLUSION Listeriosis as an uncommon infection in our region and that immuno- suppressive therapy is an important pre-disposing factor of listeriosis. Sepsis and meningitis were more common in this group of patients and had the highest case-fatality rate for food-borne illnesses.
Collapse
Affiliation(s)
- Orhan Yildiz
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, 38039 Kayseri, Turkey.
| | | | | | | | | | | | | |
Collapse
|
29
|
Metan G, Alp E, Aygen B, Sumerkan B. Acinetobacter baumannii meningitis in post-neurosurgical patients: clinical outcome and impact of carbapenem resistance. J Antimicrob Chemother 2007; 60:197-9. [PMID: 17540668 DOI: 10.1093/jac/dkm181] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
30
|
Yildiz O, Alp E, Yucel S, Kiran B, Tucer B, Ok E, Aygen B. R2267 Repeated prevalence surveys of surgical site infections in a Turkish university hospital. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)72106-4] [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: 11/16/2022]
|
31
|
Metan G, Alp E, Aygen B, Sumerkan B. Carbapenem-resistant Acinetobacter baumannii: an emerging threat for patients with post-neurosurgical meningitis. Int J Antimicrob Agents 2007; 29:112-3. [PMID: 17134880 DOI: 10.1016/j.ijantimicag.2006.08.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Revised: 08/17/2006] [Accepted: 08/17/2006] [Indexed: 11/17/2022]
|
32
|
Alp E, Yildiz O, Aygen B, Sumerkan B, Sari I, Koc K, Couble A, Laurent F, Boiron P, Doganay M. Disseminated nocardiosis due to unusual species: two case reports. ACTA ACUST UNITED AC 2006; 38:545-8. [PMID: 16798710 DOI: 10.1080/00365540500532860] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pulmonary nocardiosis is the major clinical manifestation of human nocardiosis and disseminated infection can be seen in immunocompromised patients. N. asteroides is the predominant pathogen associated with disseminated diseases. We report 2 cases of pulmonary nocardiosis admitted with disseminated infection, caused by rare species of Nocardia: Nocardia transvalensis and Nocardia cyriacigeorgica.
Collapse
Affiliation(s)
- Emine Alp
- Department of Infectious Diseases, Erciyes University, Faculty of Medicine, Kayseri, Turkey.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Alp E, Koc RK, Durak AC, Yildiz O, Aygen B, Sumerkan B, Doganay M. Doxycycline plus streptomycin versus ciprofloxacin plus rifampicin in spinal brucellosis [ISRCTN31053647]. BMC Infect Dis 2006; 6:72. [PMID: 16606473 PMCID: PMC1458347 DOI: 10.1186/1471-2334-6-72] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Accepted: 04/11/2006] [Indexed: 11/25/2022] Open
Abstract
Background The optimal treatment regimen and duration of the therapy is still controversial in spinal brucellosis. The aim of this study is to compare the efficacy, adverse drug reactions, complications and cost of ciprofloxacin plus rifampicin versus doxycycline plus streptomycin in the treatment of spinal brucellosis. Methods The patients diagnosed as spinal brucellosis between January 2002 to December 2004 were enrolled into the study. Patients were enrolled into the two antimicrobial therapy groups (doxycycline plus streptomycin vs. ciprofloxacin plus rifampicin) consecutively. For the cost analysis of the two regimens, only the cost of antibiotic therapy was analysed for each patient. Results During the study period, 31 patients with spinal brucellosis were enrolled into the two antimicrobial therapy groups. Fifteen patients were included in doxycycline plus streptomycin group and 16 patients were included in ciprofloxacin plus rifampicin group. Forty-two levels of spinal column were involved in 31 patients. The most common affected site was lumbar spine (n = 32, 76%) and involvement level was not different in two groups. Despite the disadvantages (older age, more prevalent operation and abscess formation before the therapy) of the patients in the ciprofloxacin plus rifampicin group, the duration of the therapy (median 12 weeks in both groups) and clinical response were not different from the doxycycline plus streptomycin. The cost of ciprofloxacin plus rifampicin therapy was 1.2 fold higher than the cost of doxycycline plus streptomycin therapy. Conclusion Classical regimen (doxycycline plus streptomycin), with the appropriate duration (at least 12 weeks), is still the first line antibiotics and alternative therapies should be considered when adverse drug reactions were observed.
Collapse
Affiliation(s)
- Emine Alp
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Rahmi Kemal Koc
- Department of Neurosurgery, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ahmet Candan Durak
- Department of Radiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Orhan Yildiz
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Bilgehan Aygen
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Bulent Sumerkan
- Department of Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Mehmet Doganay
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| |
Collapse
|
34
|
Metan G, Alp E, Eşel D, Aygen B, Sümerkan B. [Salmonella enteritidis: an unusual meningitis agent in an adult patient]. MIKROBIYOL BUL 2005; 39:509-12. [PMID: 16544553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Salmonella species may cause wide spectrum of infections changing from enterocolitis to sepsis. However, Salmonella meningitis in adults is a rare but important clinical condition with a high mortality rate. In this report, a 71 years old male patient with Salmonella enteritidis meningitis who was followed-up with the diagnosis of immune thrombocytopenic purpura and had been administered azothioprin and prednisolone, has been presented and similar cases in the literature have been reviewed. The cerebrospinal fluid culture yielded S. enteritidis, and the isolate was intermediate susceptible to ampicillin, susceptible to cefotaxime, trimethoprim-sulphametoxasole, ciprofloxacin and chloramphenicol. Our patient was successfully treated with ceftriaxone (2 x 2 gr i.v.) and discharged with total cure.
Collapse
Affiliation(s)
- Gökhan Metan
- Erciyes Universitesi Tip Fakültesi, infeksiyon Hastaliklan ve Klinik Mikrobiyoloji Anabilim Dali, Kayseri
| | | | | | | | | |
Collapse
|
35
|
Yildiz O, Alp E, Tokgoz B, Tucer B, Aygen B, Sumerkan B, Couble A, Boiron P, Doganay M. Nocardiosis in a teaching hospital in the Central Anatolia region of Turkey: treatment and outcome. Clin Microbiol Infect 2005; 11:495-9. [PMID: 15882201 DOI: 10.1111/j.1469-0691.2005.01145.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Predisposing factors, antimicrobial susceptibility patterns, treatment and outcome were analysed for nine consecutive patients with nocardiosis. Predisposing factors were identified in six (67%) of the nine patients. Clinical syndromes of nocardial infection were pulmonary infection (three patients), cerebral infection (five patients) and disseminated infection (one patient). The predominant (60%) species was Nocardia farcinica rather than the Nocardia asteroides complex. Treatment was started empirically, modified according to the antimicrobial susceptibility pattern, and then continued for 6-12 months. Overall mortality was 33%, with death being caused by the Nocardia infection in two cases.
Collapse
Affiliation(s)
- O Yildiz
- Infectious Diseases, Medical Faculty, Erciyes University, Kayseri, Turkey.
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Yildiz O, Gokce C, Alp E, Durak AC, Aygen B, Kelestimur F, Doganay M. Investigation of the hypothalamo-pituitary-adrenal axis and changes in the size of adrenal glands in acute brucellosis. Endocr J 2005; 52:183-8. [PMID: 15863945 DOI: 10.1507/endocrj.52.183] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aim of the study was to investigate the hypothalamo-pituitary-adrenal (HPA) axis by ACTH stimulation test and the changes in adrenal size in acute brucellosis before and after therapy in a prospective study. Sixteen patients with acute brucellosis and 15 healthy subjects were included in the study during the last two years. Cortisol levels were assessed before, 30 and 60 minutes after ACTH (250 microg i.v.) injection and the size of the adrenals was measured in both groups. Mean basal cortisol levels in the patients before the therapy and after the therapy were 22.1 +/- 6.9 microg/dL and 11.3 +/- 6.0 microg/dL, respectively. The difference was statistically significant (p<0.001). There was also statistically significant difference for basal cortisol levels between the healthy subjects (12.2 +/- 4.6 microg/dL) and the patients before the therapy (p<0.001). Peak cortisol responses to ACTH were higher before the therapy in the patients with acute brucellosis (39.3 +/- 10.7 microg/dL) than in the healthy subjects (30.4 +/- 4.8 microg/dL, p = 0.014). However, there was no significant difference for peak cortisol levels in the patients before and after the therapy (32.7 +/- 8.0 microg/dL). Mean basal cortisol levels and peak cortisol responses to ACTH between the patients after the therapy and the healthy controls were similar. Both the maximum width of the adrenal glands and the width of the adrenal limbs were significantly greater before the therapy compared to healthy subjects and post-treatment period. We concluded that the HPA axis is activated and the adrenal glands are enlarged in acute brucellosis, which is reduced after appropriate therapy.
Collapse
Affiliation(s)
- Orhan Yildiz
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri/Turkey
| | | | | | | | | | | | | |
Collapse
|
37
|
Gunal AI, Karaca I, Aygen B, Yavuzkir M, Dogukan A, Celiker H. Strict fluid volume control and left ventricular hypertrophy in hypertensive patients on chronic haemodialysis: a cross-sectional study. J Int Med Res 2004; 32:70-7. [PMID: 14997710 DOI: 10.1177/147323000403200112] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Left ventricular hypertrophy (LVH) is very common in haemodialysis patients. We measured left ventricular mass in three groups of haemodialysis patients: group A (n = 40) were normotensive and receiving a strict salt-restricted diet; group B (n = 23) were normotensive and receiving anti-hypertensive drugs; and group C (n = 43) were hypertensive despite anti-hypertensive drug treatment. The interdialytic weight gain in group B and group C was significantly higher than in group A; the mean left atrial index and left ventricular end-systolic and end-diastolic diameter indices were all higher in group B than in group A. The interventricular septum and posterior wall were significantly thicker in group B and group C than group A, resulting in a higher left ventricular mass index. Left ventricular systolic and diastolic function parameters were slightly better in group A than in the other groups. These results show that strict fluid volume control decreases blood pressure, reduces dilated cardiac compartments and corrects LVH more effectively than lowering blood pressure without correcting the volume overload.
Collapse
Affiliation(s)
- A I Gunal
- Department of Nephrology, Firat University Medical School, Elazig, Turkey.
| | | | | | | | | | | |
Collapse
|
38
|
Alp E, Güven M, Yıldız O, Aygen B, Voss A, Doganay M. Incidence, risk factors and mortality of nosocomial pneumonia in intensive care units: a prospective study. Ann Clin Microbiol Antimicrob 2004; 3:17. [PMID: 15369593 PMCID: PMC521500 DOI: 10.1186/1476-0711-3-17] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2004] [Accepted: 09/15/2004] [Indexed: 01/15/2023] Open
Abstract
To determine the frequency, risk factors and mortality of nosocomial pneumonia a prospective study was conducted in the intensive care units. In the study period, 2402 patients were included. The nosocomial pneumonia was defined according to the Centers for Disease Control Criteria. Overall, 163 (6.8%) of the patients developed nosocomial pneumonia and 75.5% (n = 123) of all patients with nosocomial pneumonia were ventilator-associated pneumonia. 163 patients who were admitted to the intensive care unit during the same period but had no bacteriologic or histologic evidence of pneumonia were used as a control group. The APACHE II score, coma, hypoalbuminemia, mechanical ventilation, tracheotomy, presence of nasogastric tube were found as independent risk factors. Crude and attributable mortality were 65% and 52.6%, respectively. The mortality rate was five times greater in the cases (OR: 5.2; CI 95%: 3.2–8.3). The mean length of stay in the intensive care unit and hospital in the cases were longer than controls (p < 0.0001). Patients requiring mechanical ventilation have a high frequency of nosocomial pneumonia.
Collapse
Affiliation(s)
- Emine Alp
- Clinical Microbiology and Infectious Disease, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Muhammet Güven
- Intensive Care Unit, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Orhan Yıldız
- Clinical Microbiology and Infectious Disease, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Bilgehan Aygen
- Clinical Microbiology and Infectious Disease, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Andreas Voss
- Medical Microbiology, University Medical Centre St Radboud, Nijmegen, The Netherlands
| | - Mehmet Doganay
- Clinical Microbiology and Infectious Disease, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| |
Collapse
|
39
|
Aygen B, Yörük A, Yýldýz O, Alp E, Kocagöz S, Sümerkan B, Doğanay M. Bloodstream infections caused by Staphylococcus aureus in a university hospital in Turkey: clinical and molecular epidemiology of methicillin-resistant Staphylococcus aureus. Clin Microbiol Infect 2004; 10:309-14. [PMID: 15059119 DOI: 10.1111/j.1198-743x.2004.00855.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In total, 177 patients with bloodstream infections caused by Staphylococcus aureus (BSISA) were investigated prospectively between June 1999 and June 2001. Of these, 19.8% had community-acquired BSISA, while 80.2% had nosocomial BSISA. Surgical intervention, foreign body, mechanical ventilation, total parenteral nutrition, and previous antibiotic treatment were found to be important risk factors for the nosocomial BSISA group. Secondary BSISA formed a greater proportion (62.9%) of community-acquired infections than of nosocomial infections (26.8%; p 0.0001). Catheter-related nosocomial BSISA was observed in 72.1% of patients. The suppurative complication rate was significantly higher among community-acquired infections (22.9%) than among nosocomial infections (6.3%; p 0.008). Of the nosocomial BSISA, 65.5% were methicillin-resistant. Analysis of 80 methicillin-resistant S. aureus isolates by pulsed-field gel electrophoresis identified ten main clones (A-J), but 61 (76.3%) of the 80 isolates belonged to clone A.
Collapse
Affiliation(s)
- B Aygen
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
| | | | | | | | | | | | | |
Collapse
|
40
|
Hoşoğlu S, Geyik MF, Balik I, Aygen B, Erol S, Aygencel SG, Mert A, Saltoğlu N, Dökmetaş I, Felek S, Sünbül M, Irmak H, Aydin K, Ayaz C, Kökoğlu OF, Uçmak H, Satilmiş S, Sümbül M. Tuberculous meningitis in adults in Turkey: epidemiology, diagnosis, clinic and laboratory [corrected]. Eur J Epidemiol 2003; 18:337-43. [PMID: 12803374 DOI: 10.1023/a:1023673532656] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A retrospective study was performed to assess the epidemiology, diagnosis, clinic, and laboratory of the patients with tuberculous meningitis (TBM) in a multicentral study. The medical records of adult cases with TBM treated at 12 university hospitals throughout Turkey, between 1985 and 1998 were reviewed using a standardized protocol. The diagnosis of TMB was established with the clinical and laboratory findings and/or microbiological confirmation in cerebrospinal fluid (CSF). The non-microbiologically confirmed cases were diagnosed with five diagnostic sub-criteria which CSF findings, radiological findings, extra-neural tuberculosis, epidemiological findings and response to antituberculous therapy. A total of 469 patients were included in this study. Majority of the patients were from Southeast Anatolia (164 patients, 35.0%) and (108 patients, 23.0%) from East Anatolia regions. There was a close contact with a tuberculous patient in 88 of 341 patients (25.8%) and with a tuberculous family member in 53 of 288 patients (18.4%). BCG scar was positive in 161 of 392 patients (41.1%). Tuberculin skin test was done in 233 patients and was found to be negative in 75. Totally 115 patients died (24.5%) of whom 23 died in 24 hour after admittance. The diagnosis was confirmed with clinical findings and CSF culture and/or Ziehl-Nelson staining in 88 patients (18.8%). Besides clinical criteria, there were three or more diagnostic sub-criteria in 252 cases (53.7%), two diagnostic sub-criteria in 99 cases (21.1%), and any diagnostic sub-criteria in 30 patients (6.4%). Since TBM is a very critical disease, early diagnosis and treatment may reduce fatal outcome and morbidity.
Collapse
Affiliation(s)
- S Hoşoğlu
- Department of Clinical Microbiology and Infectious Diseases, Dicle University Hospital, Diyarbakir, Turkey.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Aygen B, Doğanay M, Sümerkan B, Yildiz O, Kayabaş Ü. Clinical manifestations, complications and treatment of brucellosis: a retrospective evaluation of 480 patients. Med Mal Infect 2002. [DOI: 10.1016/s0399-077x(02)00403-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
42
|
Esel D, Doganay M, Bozdemir N, Yildiz O, Tezcaner T, Sumerkan B, Aygen B, Selcuklu A. Polymicrobial ventriculitis and evaluation of an outbreak in a surgical intensive care unit due to inadequate sterilization. J Hosp Infect 2002; 50:170-4. [PMID: 11886191 DOI: 10.1053/jhin.2002.1187] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
At the end of 1999, a case of polymicrobial ventriculitis in the Department of Neurosurgery followed by an outbreak of Serratia marcescens mediastinitis in the intensive care unit of cardiovascular surgery occurred. These nosocomial surgical infections were considered to be the result of contamination of surgical sites with inadequately sterilized instruments or theatre linen. An epidemiological survey was focused on the central sterilization unit of the hospital. The microbiological results of this survey proved that the cause of the outbreak was the use of inadequately decontaminated theatre linen. This study indicates that strict infection control measures including the control of sterilization procedures and a well-organized infection control team are necessary to prevent nosocomial surgical infections.
Collapse
Affiliation(s)
- D Esel
- Department of Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Yildiz O, Doganay M, Aygen B, Güven M, Keleştimur F, Tutuû A. Physiological-dose steroid therapy in sepsis [ISRCTN36253388]. Crit Care 2002; 6:251-9. [PMID: 12133187 PMCID: PMC125315 DOI: 10.1186/cc1498] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2001] [Revised: 01/27/2002] [Accepted: 04/02/2002] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION The aim of the study was to assess the prognostic importance of basal cortisol concentrations and cortisol response to corticotropin, and to determine the effects of physiological dose steroid therapy on mortality in patients with sepsis. METHODS Basal cortisol level and corticotropin stimulation test were performed within 24 hours in all patients. One group (20 patients) received standard therapy for sepsis and physiological-dose steroid therapy for 10 days; the other group (20 patients) received only standard therapy for sepsis. Basal cortisol level was measured on the 14th day in patients who recovered. The outcome of sepsis was compared. RESULTS Only Sequential Organ Failure Assessment (SOFA) score was found related to mortality, independent from other factors in multivariate analysis. No significant difference was found between the changes in the percentage of SOFA scores of the steroid therapy group and the standard therapy group in survivors, nor between the groups in basal and peak cortisol levels, cortisol response to corticotropin test and mortality. The mortality rates among patients with occult adrenal insufficiencies were 40% in the steroid therapy group and 55.6% in the standard therapy group. DISCUSSION There was a trend towards a decrease in the mortality rates of the patients with sepsis who received physiological-dose steroid therapy. In the advancing process from sepsis to septic shock, adrenal insufficiency was not frequent as supposed. There was a trend (that did not reach significance) towards a decrease in the mortality rates of the patients with sepsis who received physiological-dose steroid therapy.
Collapse
Affiliation(s)
- Orhan Yildiz
- Department of Infectious Diseases, School of Medicine, Erciyes University, Kayseri, Turkey.
| | | | | | | | | | | |
Collapse
|
44
|
Hosoglu S, Geyik MF, Balik I, Aygen B, Erol S, Aygencel TG, Mert A, Saltoglu N, Dokmetas I, Felek S, Sunbul M, Irmak H, Aydin K, Kokoglu OF, Ucmak H, Altindis M, Loeb M. Predictors of outcome in patients with tuberculous meningitis. Int J Tuberc Lung Dis 2002; 6:64-70. [PMID: 11931403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE To assess predictors of mortality and neurological sequelae in patients with tuberculous meningitis (TBM). METHODS Patients with TBM treated at 12 university hospitals in Turkey between 1985 and 1997 were evaluated using a standardised protocol applied retrospectively. Variables associated with hospital mortality as well as with the presence of neurological sequelae at 6 months were determined using logistic regression models. RESULTS Four hundred and thirty-four patients between the ages of 13 and 83 years (mean 33 years) were evaluated. Sixty-eight per cent of these patients presented with Medical Research Council Stage II or III. One hundred and one patients (23.3%) died and 67 (27%) of evaluable survivors had neurological sequelae. In multi-variable analysis, convulsion (OR 3.3, 95%CI 1.2-9.0, P = 0.02), comatose mental status (OR 6.0, 95%CI 3.6-10.2, P = 0.01), and delayed or interrupted treatment (OR 5.1, 95%CI 2.4-11.2, P = 0.01) were shown to be predictors for mortality. The presence of extra-meningeal tuberculosis (OR 2.1, 95%CI 1.1-4.2, P = 0.035), cranial nerve palsy (OR 2.6, 95%CI 1.4-4.2, P = 0.01), hemiparesia/focal weakness (OR 9.3, 95%CI 3.8-22.6, P = 0.01), hemiplegia/multiple neurological deficit (OR 7.1, 95%CI 2.14-23.38, P = 0.01) and drowsiness (OR 4.2, 95%CI 2.04-8.82, P = 0.01) were independent predictors of neurological sequelae at 6 months following hospital discharge. CONCLUSION The results of this study emphasise the importance of prompt and uninterrupted anti-tuberculosis therapy for tuberculous meningitis. The presence of seizures or coma on admission to hospital are important predictors for mortality, while the presence of focal neurological signs is a predictor for persistent neurological sequelae in survivors.
Collapse
Affiliation(s)
- S Hosoglu
- Department of Clinical Microbiology, Dicle University Hospital, Diyarbakir, Turkey.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
|
46
|
Koçer-Büyükbingöl Z, Aygen B, Ekim M. Serum vitamin E levels in children with nephrotic syndrome. Pathophysiology 1998. [DOI: 10.1016/s0928-4680(98)80347-7] [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: 11/28/2022] Open
|
47
|
Abstract
A case is reported of a 43-year-old man who presented prostatitis and hepatitis due to Brucella melitensis. His symptoms were icterus, weakness, anorexia, fever, and urinary discomfort. Physical examination revealed icterus and hepatosplenomegaly. Lymphomonocytosis, elevated erythrocyte sedimentation rate and abnormal liver functions had been detected in laboratory tests. Brucella melitensis was isolated from prostatic fluid and blood cultures.
Collapse
Affiliation(s)
- B Aygen
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | | | | | | |
Collapse
|
48
|
Affiliation(s)
- M Doğanay
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | | |
Collapse
|
49
|
Abstract
The basal cortisol level and cortisol response to ACTH stimulation test were assessed in patients with sepsis, the results being compared to a control group of 30 healthy persons. The study group included 49 patients with sepsis and 30 healthy subjects as a control group. The mean age in the study group was 42.6 +/- 18.7 years and 41.4 +/- 12.1 years in the control group. Fifteen of the 49 (30.6%) patients had hospital-acquired and 34 (69.4%) patients community-acquired sepsis. Etiological agent was isolated in 35 (71.4%) patients (57.1% gram negative bacteria and 34.3% gram positive bacteria, plus 8.6% polymicrobial). Fourteen of 49 (28.6%) patients died. Mean basal cortisol level was 597.1 +/- 304.6 nmol/l (range 217.8-1667.9) in the study group and 460.2 +/- 180.8 nmol/l (range 253.6-988.9) in the control group. Mean basal cortisol level in the study group was significantly higher than that of the control group (p < 0.05). Mean basal cortisol level was found to be 725.5 +/- 448.9 nmol/l in the patients who died and 545.8 +/- 210.9 nmol/l in the patients who recovered. The difference between the two groups was found to be significant (p < 0.05). ACTH stimulation test was performed in 43 of the patients and 30 healthy subjects. Cortisol response was significantly lower (mean 277.7 +/- 216.9 nmol/l) in the patients than that detected in the control group (mean 519.6 +/- 279.2) (p < 0.001). Mean cortisol response in the patients who died was 227.2 +/- 224.5 nmol/l and 302.1 +/- 212.7 nmol/l in the patients who recovered (p > 0.05). Adrenocortical insufficiency was detected in 16.3% of the patients and 42.9% of these patients died. In conclusion, sepsis is characterized by high basal cortisol level which may show a poor prognosis and a blunted cortisol response to ACTH stimulation. A small percentage of patients with sepsis may develop adrenocortical insufficiency.
Collapse
Affiliation(s)
- B Aygen
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | | | | | | |
Collapse
|
50
|
Aygen B, Sümerkan B, Mirza M, Doganay M, Arman F. Treatment of neurobrucellosis with a combination of ceftriaxone, rifampicin and doxycycline (a study on ten cases). Med Mal Infect 1996. [DOI: 10.1016/s0399-077x(96)80124-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|