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- ArticleAçık Erişim2023Tularemia in the Differential Diagnosis of Lymphadenitis: A Retrospective Analysis of 16 Cases
Binay, Umut D.; Barkay, Orcun; Karakeçili, Faruk
Introduction: Tularemia is a zoonotic disease caused by Francisella tularensis, a gram-negative, facultative, intracellular coccobacillus. It can occur in different clinical forms, and the most common form in our country (Turkey) is the oropharyngeal form. Unfortunately, the diagnosis of lymphadenitis caused by tularemia is delayed unless it is suspected, especially in sporadic cases. Our aim is to remind clinicians to have tularemia among differentials of lymphadenitis. Methods: In this study, the clinical and laboratory findings of 16 tularemia patients between 2011 and 2021 were evaluated retrospectively. Results: The mean age of the 16 patients included in the study was 39 years, and 62.5% were female. The patients were diagnosed with tularemia on the average 31st day of their complaints. The rate of use of betalactam group antibiotics before diagnosis was 74%. About 81.25% of the patients were engaged in animal husbandry/farming, and living in rural areas (93.75%) and farming (81.25%) were the most common possible risk factors. The patients were admitted to the hospital with the most common complaints of enlarged lymph nodes (100%), fatigue (62.5%) and loss of appetite (56.25%). All patients had lymphadenopathy, and the most common location of lymphadenopathy was the cervical region (81.25%). Moxifloxacin (56.25%) was used most frequently in the treatment of tularemia, and surgical drainage was performed for 31% of the patients. Conclusion: The diagnosis of tularemia is often delayed unless clinical suspicion is high. Delayed diagnosis may lead to unnecessary frequent use of antibiotics, especially beta-lactam group antibiotics. As the diagnosis is delayed, since lymph node suppuration is common, surgical intervention may be required. This situation can cause extra burden for both patients and the health system. It may be beneficial to organize trainings to increase awareness among physicians and society in order to make the diagnosis early.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Possible Sexually Transmitted Crimean-Congo Hemorrhagic Fever Case Report
Sümer, Betuel; Barkay, Orcun; Binay, Umut Devrim; Karakeçili, Faruk
Objective: Crimean-Congo hemorrhagic fever (CCHF) is one of the common zoonotic diseases in our country, and clinical course can result in mortality. CCHF virus is transmitted by ticks or contact with infected humans or animals' blood and body fluids. We present a case who didn't have a tick contact history and was not engaged in animal husbandry but had a history of sexual contact with a primary case who had a recent CCHF diagnosis. We report this case to emphasize that sexual contact should be kept in mind as a possible risk factor for CCHF transmission.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Diagnosis of Latent Tuberculosis Infection in Hemodialysis Patients: TST versus T-SPOT.TB
Binay, Umut Devrim; Kara, Ali Veysel; Karakeçili, Faruk; Barkay, Orçun
Hemodialysis (HD) patients should be screened for latent tuberculosis (TB) infection. We aimed to determine the frequency of latent TB infection in HD patients and to compare the effectiveness of the tests used. The files of 56 HD patients followed between 1 January 2021 and 1 October 2022 were retrospectively analyzed. Demographic data, the presence of the Bacillus Calmette-Guerin (BCG) vaccine, whether or not the patients had previously received treatment for TB before, the status of encountering a patient with active TB of patients over 18 years of age, without active tuberculosis and who had a T-SPOT.TB test or a Tuberculin Skin Test (TST) were obtained from the patient files. The presence of previous TB in a posterior–anterior (PA) chest X-ray was obtained by evaluating PA chest X-rays taken routinely. Of the patients, 60.7% (n = 34) were male and their mean age was 60.18 ± 14.85 years. The mean duration of dialysis was 6.43 ± 6.03 years, and 76.8% (n = 43) had 2 BCG scars. The T-SPOT.TB test was positive in 32.1% (n = 18). Only 20 patients (35.7%) had a TST and all had negative results. While the mean age of those with positive T-SPOT.TB results was higher (p = 0.003), the time taken to enter HD was shorter (p = 0.029). T-SPOT.TB test positivity was higher in the group that had encountered active TB patients (p = 0.033). However, no significant difference was found between T-SPOT.TB results according to BCG vaccine, albumin, urea and lymphocyte levels. Although T-SPOT.TB test positivity was higher in patients with a previous TB finding in a PA chest X-ray, there was no statistically significant difference (p = 0.093). The applicability of the TST in the diagnosis of latent TB infection in HD patients is difficult and it is likely to give false-negative results. The T-SPOT.TB test is not affected by the BCG vaccine and immunosuppression. Therefore, using the T-SPOT.TB test would be a more appropriate and practical approach in the diagnosis of latent TB in HD patients.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Assessment of the optic nerve, macular, and retinal vascular effects of COVID-19
Ugurlu, Adem; Agcayazi, Sümeyye Burcu; Icel, Erel; Budakoglu, Ozlem; Unver, Edhem; Barkay, Orçun; Karakeçili, Faruk; Bayrakceken, Kemal
Objective: To evaluate the effects of SARS-CoV-2 infection on the optic nerve, macula, and retinal vascular structures. Methods: This study included 129 participants recovering from COVID-19 and 130 healthy control subjects aged 18 to 55 years. The study was designed as observational and cross-sectional and was conducted between June 2020 and February 2021. The average thicknesses of the retinal nerve fibre layer (RNFL), ganglion cell complex (GCC), and macula also were measured using a spectral domain optical coherence tomography analysis. The vessel densities of the superficial and deep capillary plexuses of the macula, foveal avascular zone, and radial peripapillary capillary plexus of the optic disc were quantified by optical coherence tomography angiography. Results: In all quadrants, the RNFL and GCC were thinner in patients with neurologic symptoms of COVID-19 (p < 0.05). None of the measurements of the Early Treatment Diabetic Retinopathy Study regions significantly differed between patients with and without COVID-19 symptoms (p > 0.05). The foveal avascular zone area, perimeter, circularity index, and vessel densities (%) of the global and inner and outer circles of superficial capillary plexuses and deep capillary plexus and global and superior and inferior halves of the radial peripapillary capillary plexus measurements were found to significantly differ between the symptomatic COVID-19 group and the asymptomatic COVID-19 and control groups (p < 0.05). Conclusion: RNFL and GCC thickness evaluation with optical coherence tomography and vessel density evaluation with optical coherence tomography angiography can be considered remarkable diagnostic methods for retinal neurovascular abnormalities and a biomarker for microvascular abnormalities after infection with SARS-CoV-2.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2022COVİD 19 Pandemisinde Solunum Yolu Viral Etkenleri
Karakeçili, Faruk; Durmuş, Uğur; Gülhan, Barış; Binay, Umut Devrim; Barkay, Orçun; Gül, Özlem
Giriş: Pandemi süresince solunum yolu semptomları ile başvuran hasta sayısının artması ile mevsimsel solunum yolu hastalıklarının ve Coronavirus 2019 (COVID 19) un ayırıcı tanısı önem kazanmış olup, ayrımda klinik ve laboratuar verilerinin yetersiz olması nedeni ile multiplex PCR ( polimeraz zincir reaksiyonu) tekniklerine gerek duyulmaktadır. Biz de SARS CoV - 2 ye eşlik eden diğer solunum yolu viral etkenlerinin sıklığını tespit etmek, baskın olan viral etkenleri saptamak ve koenfeksiyon oranını belirlemek için bu çalışmayı planladık. Materyal metod: Hastanemizde 01.01.2021-01.04.2021 tarihleri arasındaCOVID 19 polikliniğine solunum yolu enfeksiyonu semptomları ile başvuran 18-65 yaş arası hastalar çalışmaya alındı. Hastalardan eş zamanlı iki adet nazofarengeal s ürüntü örneği alındı. SARS CoV-2 ve diğer solunum yolu viral etkenlerini açısından tetkik edildi. Hastaların demografik verileri, klinik yakınmaları, laboratuar değerleri kaydedildi. Sonuç: Toplamda 80 hasta çalışmaya alındı. Hastaların 14 (%17.5 )’ünde SARS CoV-2 PCR pozitifliği saptanmış olup 4 hastada rinovirus, 1 hastada rinovirus/enterovirus ve SARS COV 2 PCR pozitifliği saptandı. Koenfeksiyon 1 (% 1,25 ) hastada görüldü. Tartışma: Çalışmamızda SARS CoV-2 dışındaki viral etkenlerinin sıklığının pandemi öncesi dönemde görülme sıklığına göre daha az oranda saptanmış olmasının, COVID 19 enfeksiyonundan korunmak için alınan maske, mesafe ve el hijyeni önlemleri ile ilişkili olduğu düşünülmüştür. Solunum yolu enfeksiyonu semptomları ile başvuran ve SARS CoV-2 PCR testi negatif sonuçlanmış olup görüntüleme bulguları
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2022The Importance of Differential Diagnosis During Pandemic: A Case Report with Coexistence of COVID-19, Brucellosis and Crimean-Congo Hemorrhagic Fever; [Pandemi Döneminde Ayırıcı Tanının Önemi: COVID-19, Bruselloz ve Kırım-Kongo Kanamalı Ateşi Birlikteliği Olan Bir Olgu Sunumu]
Gül, Özlem; Binay, Umut Devrim; Barkay, Orçun; Karakeçili, Faruk
The coronavirus disease-2019 (COVID-19) pandemic, which affects millions of people around the world, has been affecting our country since March 2020. The fact that the symptoms such as fever, myalgia, headache, joint pain which are common in COVID-19 patients are quite similar to the symptoms of diseases such as Crimean-Congo hemorrhagic fever (CCHF) and Brucellosis. This may cause a diagnostic confusion in regions where these diseases are seen as endemic. In this report, a patient hospitalized with a pre-diagnosis of COVID-19 and diagnosed with acute Brucellosis, CCHF and COVID-19 during followup was presented. A 31-year-old female patient living in a rural area admitted to the emergency service with complaints of fever, weakness, headache, and body/joint pain. Physical examination revealed a temperature of 38.3°C, a pulse rate of 102/minute, and a peripheral capillary oxygen saturation of 97% in room air. The system examination was normal. In the laboratory findings, an increase in liver enzymes and acute phase reactants was observed and the platelet count was at the lower limit of the normal range. In terms of COVID-19, no involvement compatible with COVID-19 was detected in the thorax computed tomography (CT) of the patient whose nasopharyngeal and oropharyngeal mixed swab samples were taken.The patient was transferred to our infectious diseases service with a pre-diagnosis of COVID-19 and CCHF. Serum samples were sent to the Public Health Agency Microbiology Reference Laboratory Department (PHA-MRLD) for CCHF diagnostic tests and supportive treatment was started. Brucella Rose Bengal and Coombs’ immuncapture (1/1280 titer) tests were found as positive in the patient, who was examined for brucellosis because of living in a rural area and having a history of consuming fresh dairy products. In the tests performed at PHA-MRLD, CCHF-specific IgM positivity and the presence of viral RNA were detected. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) reverse-transcriptase polymerase chain reaction (RT-PCR) test was negative. For Brucellosis, doxycycline and rifampicin were added to the treatment of the patient whom was given supportive therapy for CCHF. In the followup, the patient’s fever was persisting and loss of taste and smell complaint developed. In this context, COVID-19 test was repeated and resulted as positive. Upon this, hydroxychloroquine sulfate treatment was started due to the recommendation of the current Ministry of Health Scientific Committee Guide. No new infiltration was detected in the chest radiography of the patient. The patient’s fever subsided during follow-up and laboratory findings improved. The treatment of brucellosis was completed to eight weeks at the outpatient clinic. No problems were detected in the follow-up. This report was prepared because of a case with simultaneous brucellosis, CCHF and COVID-19 infections which could not be encountered in the literature review. As a result; in regions such as our country where both brucellosis and CCHF are seen as endemic, it is very important to keep these diseases in mind in the differential diagnosis of COVID-19 infection.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2022Which scoring system is effective in predicting mortality in patients with Crimean Congo hemorrhagic fever? A validation study
Bakir, Mehmet; Öksüz, Caner; Karakeçili, Faruk; Baykam, Nurcan; Barut, Şener; Büyüktuna, Seyit Ali; Özkurt, Zülal; Öz, Murteza; Barkay, Orçun; Akdoğan, Özlem
We aimed to decide which scoring system is the best for the evaluation of the course of Crimean-Congo Hemorrhagic Fever (CCHF) by comparing scoring systems such as qSOFA (quick Sequential Organ Failure Assessment), SOFA (Sequential Organ Failure Assessment), APACHE II (Acute Physiology and Chronic Health Evaluation II) and SGS (Severity Grading System) in centers where patients with CCHF were monitored. The study was conducted with patients diagnosed with CCHF in five different centers where the disease was encountered most commonly. Patients having proven PCR and/or IgM positivity for CCHF were included in the study. The scores of the scoring systems on admission, at the 72nd hour and at the 120th hour were calculated and evaluated. The data of 388 patients were obtained from five centers and evaluated. SGS, SOFA and APACHE II were the best scoring systems in predicting mortality on admission. All scoring systems were significant in predicting mortality at the 72nd and 120th hours. On admission, there was a correlation between the qSOFA, SOFA and APACHE II scores and the SGS scores in the group of survivors. All scoring systems had a positive correlation in the same direction. The correlation coefficients were strong for qSOFA and SOFA, but poor for APACHE II. A one-unit rise in SGS increased the probability of death by 12.818 times. qSOFA did not provide significant results in predicting mortality on admission. SGS, SOFA and APACHE II performed best at admission and at the 72nd and 120th hours.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2021Aşı Öncesi ve Sonrası Dönemde Suçiçeği Olgularının Özellikleri
Karakeçili, Faruk; Barkay, Orçun; Topal, İsmail
GİRİŞ ve AMAÇ: Suçiçeği, duyarlı bireylerde generalize ekzantematöz döküntü ile karakterize, çocukluk döneminde sık görülen bir klinik tablodur.\rYÖNTEM ve GEREÇLER: Ülkemizde suçiçeği aşısının çocukluk çağı rutin aşılama takvimine alındığı 2013 yılından önceki ve sonraki dönemlerde gelişen olguların demografik, klinik-laboratuvar özelliklerinin değerlendirilmesi ve kıyaslanması amaçlanmıştır.\rBULGULAR: : Bu çalışma, Ocak 1994-Nisan 1997 tarihleri arasında Dr. Sami Ulus Çocuk Sağlığı ve Hastalıkları Merkezi’nde tanı alan 502 (1. grup), Ocak 2016-2020 tarihleri arasında Mengücek Gazi Eğitim ve Araştırma Hastanesi’nde tanı alan 170 (2. grup) suçiçeği olgusunun retrospektif incelenmesi ile yapılmıştır.\rTARTIŞMA ve SONUÇ: İki grupta da hastaların çoğunluğu erkeklerden oluşmaktaydı (%57 vs %54.2). Ortalama yaş birinci grupta 4.4 (±3) iken ikinci grupta 6.8 (±3.6) idi. Ana gruplardaki hastalar yaşlarına göre 0-4, 5-10, 11-15 yaş grubu olmak üzere 3’er alt gruba ayrıldı. Buna göre; birinci ve ikinci gruptaki hastaların çoğunluğunu 0-4 yaş grubu hastalar oluşturmaktaydı. Birinci gruptan 47, ikinci gruptan ise 5 hasta hastaneye yatırılarak izlenmişti. Birinci gruptaki en sık komplikasyonlar alt solunum yolu enfeksiyonu ve deri-yumuşak doku enfeksiyonuydu. İkinci gruptaki en sık komplikasyon ise alt solunum yolu enfeksiyonuydu.\rSonuç: Bildirilen ve komplikasyon gelişen olgu sayısında aşılama sonrasında anlamlı oranda azalma saptanması, aşı karşıtlığının giderek arttığı bu dönemde ciddi önem arz etmektedir.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2021The Effect of Increased Hand Hygiene Adaptation to Chest Diseases Intensive Care Unit Culture Results during COVID-19 Pandemic Process
Tosun, Mustafa; Binay, Umut Devrim; Akyüz, Sumeyye; Ölmez, Hasan; Karakeçili, Faruk
Introduction: Intensive care units are units where healthcare associated infections (HAIs) are most common. Hand hygiene plays a critical role in preventing HAIs. We divided the patients hospitalized in Erzincan Binali yildirim University Faculty of Medicine, Chest Diseases Intensive Care Unit (ICU) into two groups as before and after COVID-19 pandemic. In our study, it was aimed to measure the effect of hand hygiene compliance, which increased in healthcare workers with the pandemic on culture results and to emphasize the importance of hand hygiene. Materials and Methods: Patients were examined in two groups in 4-month periods. The period between 15 November, 2019-15 March, 2020 was considered as before COVID-19 and between March 16, 2020 and 15 July, 2020 as after COV1D-19. The number of cultures taken from these patients and the agents isolated were determined, and according to the number of cultures taken, the change in growth rate, resistance rates, length of stay in intensive care unit, intubation days and mortality rates were compared. Results: There were 40 females (46.5%) and 46 males (53.5%) in the Pre-Pandemic (Prep) group, and mean age was 71.5 +/- 14.8 years. In the Post-Pandemic (PostP) group, there were 38 females (38.8%) and 60 males (61.2%) with a mean age of 72.6 +/- 14.8 years. The agent was reproduced in 128 (21%) of a total of 605 cultures taken from 86 patients in the PreP group, and in 31 (10.2%) of a total of 304 cultures from 98 patients in the PostP group. When the two groups were compared in terms of the number of cultures, the number of agent-isolated cultures and the percentage of growth according to the cultures, all parameters in the PreP group were found to be significantly higher than the PostP group (p< 0.001, p= 0.002, p= 0.001, respectively). Conclusion: As a result, for whatever reason, it is thought that the increase in hand hygiene compliance may have resulted in a decrease in active microorganisms in the cultures and indirectly in the decrease in HAls. For this reason, the first step to be taken in order to prevent multi-drug resistant (MDR) infections, especially in intensive care units, is to ensure hand hygiene compliance of healthcare workers.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2021Real-world data from Turkey: Is sofosbuvir/ledipasvir with or without ribavirin treatment for chronic hepatitis C really effective?
Demirtürk, Neşe; Aygen, Bilgehan; Çelik, İlhami; Mıstık, Reşit; Akhan, Sıla; Barut, Şener; Ural, Onur; Batırel, Ayşe; Şimşek, Funda; Ersöz, Gülden
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.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2021Immune responses in multiple hosts to Nucleocapsid Protein (NP) of Crimean-Congo Hemorrhagic Fever Virus (CCHFV)
Karaaslan, Elif; Çetin, Nesibe Selma; Kalkan-Yazıcı, Merve; Hasanoğlu, Sevde; Karakeçili, Faruk; Özdarendeli, Aykut; Kalkan, Ahmet; Kılıç, Ali Osman; Doymaz, Mehmet Ziya
In 2019, the World Health Organization declared 3 billion to be at risk of developing Crimean Congo Hemorrhagic Fever (CCHF). The causative agent of this deadly infection is CCHFV. The data related to the biology and immunology of CCHFV are rather scarce. Due to its indispensable roles in the viral life cycle, NP becomes a logical target for detailed viral immunology studies. In this study, humoral immunity to NP was investigated in CCHF survivors, as well as in immunized mice and rabbits. Abundant antibody response against NP was demonstrated both during natural infection in humans and following experimental immunizations in mice and rabbits. Also, cellular immune responses to recombinant NP (rNP) was detected in multispecies. This study represents the most comprehensive investigation on NP as an inducer of both humoral and cellular immunity in multiple hosts and proves that rNP is an excellent candidate warranting further immunological studies specifically on vaccine investigations.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2021Is taste and smell impairment irreversible in COVID-19 patients?
Salcan, İsmail; Karakeçili, Faruk; Salcan, Sara; Ünver, Edhem; Akyüz, Sümeyye; Seçkin, Ender; Cingi, Cemal
Objective: It is known that the COVID-19 disease, which has affected the whole world, causes symptoms, such as cough, fever, shortness of breath, muscle pain, fatigue, diarrhea, headache and sore throat, in addition to various clinical findings, such as loss of smell and taste. In this study, we aimed to reveal the loss of sense of taste and smell in COVID-19 patients and to investigate whether these sensory losses are permanent in the healing process of the disease. Method: This prospective study included 94 COVID-19 patients. Smell and taste tests were applied to all patients. Ten days after the first test, a second test was applied to the patients with an impaired sense of smell to compare the results. Results: Of the 94 patients, 55.3% were male, and the mean age was 53 ± 19.6 (21–90) years. There were 67 patients with smell and taste impairment, of whom 34 (50.7%) had smell impairment only, 3 (4.4%) had taste impairment only, and 30 (44.7%) had both smell and taste impairment. It was found that the smell scores of 55 patients with smell and taste impairment in the first evaluation were significantly higher at the second measurement; and their tasting period was significantly shortened compared to the first measurement (p˂0.001). Conclusion: COVID-19 patients may present to medical centers with a broad variety signs and symptoms. This study shows that impairment in the senses of smell and taste is common in this disease and strongly associated with COVID-19 infection. However, smell and taste impairment is mostly temporary and improves during the recovery period.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2020Genotype distribution in Hepatitis C patients admitted to Erzincan Mengücek Gazi Training and Research Hospital
Karakeçili, Faruk; Arslan, Yusuf Kemal; Yılmaz, Aysun; Kara, Murat; Dabanlıoğlu, Bülent
Aim: We aimed to determine the genotype distribution in Hepatitis C patients who Parasitology applied to Erzincan Binali YildirimUniversity, Mengücek Gazi Training and Research Hospital. Hepatitis C virus, the only member of the genus Hepacivirus of Flaviviridaefamily, is responsible for 25%-40% of all liver diseases. Hepatitis C virus causes acute hepatitis C and chronic hepatitis C infections.Chronic hepatitis C infection causes cirrhosis, liver failure, hepatocellular cancerand liver diseases in terminal periods.Material and Methods: A total of 77 patients, 41 male and 36 female, who were admitted to Erzincan Binali Yıldırım University,Mengücek Gazi Training and Research Hospital in the period of January 2013-June 2019, were included in our study. RT-PCR andDNA sequencing for the 5’UTR region of the HCV genome for HCV genotyping was performed using the ABI Prism 3130 × 1 DNASequencer device.Results: Sex of a total of 77 patients included in the study; 41 of them are men (53.2%) and 36 are women (46.8%). Average age of thepatients; It was 59.9 ± 16.6 (minimum 20 and maximum 94). HCV G1b (80.5%) in 62 patients, HCV G1a (7.8%) in 6, HCV G3a (3.9%)in 3, HCV G3 (2.6%) in 2 and HCV G2 (2.6%) was found in 2 patients. HCV G1 (1.3%) was detected in 1, HCV G4 (1.3%) in 1 patient.Conclusion: The dominant genotype in Hepatitis C patients who applied to Mengücek Gazi Training and Research Hospital wasdetermined as “HCV Genotype 1b”.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2020Evaluation of Laboratory, Clinical and Treatment Results in Patients with Uncomplicated Brucellosis
Türken, Melda; Pamukçuoglu, Serap Sevim; Karakeçili, Faruk; Tunca, Berivan; Çelik, Didem; Köse, Sukran
Introduction: Brucellosis is a zoonotic infectious disease endemic in our country and affects all systems. We aimed to evaluate clinical, laboratory findings and treatment outcomes of uncomplicated brucellosis in our study. Materials and Methods: Patients with uncomplicated brucellosis and with no relapse were evaluated from four different cities. Demographic data, clinical, laboratory and radiological findings of follow-up and treatment of 101 patients were recorded in forms. Clinical response (healing, treatment failure, relapse, etc.), treatment side effects, compliance and treatment discontinuation were evaluated at one-year follow-up. Results: The most common risk factors for brucellosis were detected respectively as fresh cheese/dairy product consumption (82.2%), rural area life (71.3%), brucellosis in family and surroundings (42.6%), animal husbandry (27.7%), and brucellosis in animals (24.8%). 80.2% of the patients were evaluated as acute brucellosis. Clinically, fatigue, sweating, loss of appetite, fever, body aches, arthralgia; elevated erythrocyte sedimentation rate, elevated C-reactive protein, elevated liver function tests, anemia and thrombocytopenia were the most frequent findings in laboratory examinations, respectively. In patients with brucellosis, blood culture positivity was 68%, Rose Bengal slide agglutination test was 97.1%, and tube agglutinin test positivity was 96.8%. The most preferred treatment regimen (90%) was doxycycline and rifampicin for 45 days, and treatment response was 89%. In five of the patients, treatment was changed due to doxycycline-linked gastrointestinal side effects. Relapses were seen in 4.9% of all patients. Conclusion: In brucellosis, delay in diagnosis increases the incidence of complications and the tendency to become chronic. For this reason, brucellosis must be considered in patients referred to health institutions with complaints such as fever, sweating and joint pain. Since uncomplicated brucellosis was evaluated in this study, it was seen that the majority of the patients were acute onset and had a high response rate to treatment.
RDL Kalıcı Kaydıİncele - LetterAçık Erişim2020A Significant Increase at the Number of Crimean-Congo Haemorrhagic Fever Cases in COVID-19 Pandemic: What Is Happening?
Barkay, Orcun; Binay, Umut Devrim; Gül, Ozlem; Karakeçili, Faruk
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2020Real-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
Aygen, Bilgehan; Demirtürk, Neşe; Yıldız, Orhan; Çelen, Mustafa Kemal; Çelik, İlhami; Barut, Şener; Ural, Onur; Batırel, Ayşe; Mıstık, Reşit; Şimşek, Funda
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.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2019Frequency of Rota Virus in Children with Acute Gastroenteritis
Karakeçili, Faruk; Topal, İsmail; Arslan, Yusuf Kemal; Aydin Peker, Necla; Sürücü Kara, İlknur; Çıkman, Aytekin
Objective: Gastroenteritis is a common clinical condition in infancy and childhood. It is reported that 17% of the deaths in children under the age of five in the world are caused by diarrheal diseases. In this age group, the agents in 70% of acute gastroenteritis cases are active viruses. Rotavirus is the most frequent viral factor. In the study it was aimed to determine the frequency of rotavirus in pediatric patients who applied to Erzincan Mengücek Gazi Education and Research Hospital with complaints of diarrhea. Material and Method: Between January 2013 and December 2016, the results of stool samples of 7851 patients screened for rotavirus antigen were evaluated retrospectively. During these periods, the presence of rotavirus antigen was investigated by immunochromatographic method in fresh stool specimens. Results: A total of 4416 (56%) stool samples were obtained from males, and 3435 (44%) were obtained from females. Analysis revealed that 820 (10.44%) of the specimens were rotavirus antigen positive. Rotavirus positivity was most commonly seen in the age group from 2 to 5 years in winter and spring. Conclusion: Rotavirus infections still maintain their importance and cause seasonal epidemics. Rotavirus vaccine might be taken into consideration for the national vaccination program, because of the common frequency in the age group from 2 to 5 years.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2019Microorganisms Causing Ventilator-Associated Pneumonia and Their Antibiotic Susceptibility
Karakeçili, Faruk; Karavaş, Erdal; Ünver, Edhem; Çıkman, Aytekin; Binay, Umut Devrim; Koç, Alparslan
Objectives: The aim of this study was to determine the microorganisms causing ventilator-associated pneumonia(VAP) and investigate their antibiotic susceptibility.Methods: Patients diagnosed with VAP in the adult intensive care units (ICUs) between January 2015 and December2018 were included in the study. VITEK 2 (bioMérieux, Marcy l’Etoile, France) automated microbiology system was usedto identify microorganisms and to determine their antibiotic susceptibility.Results: Average VAP rates was found 26.51 per 1000 ventilator-days. A single microorganism was isolated in 104 ofa total of 105 patients while two microorganisms were isolated in 1 patient. Of the isolated microorganisms, 94.3%(n=100) were Gram-negative bacteria and 5.7% (n=6) were Gram-positive bacteria. When the distribution of all microorganisms is examined in order of frequency, 62.2% were found to be Acinetobacter spp., 17.9% Pseudomonas spp., 6.6%Klebsiella pneumoniae, 4.7% Staphylococcus aureus, 3.7% Serratia marcescens, 2.8% Escherichia coli, 0.9% Enterococcusfaecium, and 0.9% Stenotrophomonas maltophilia. The most effctive antibiotics against Acinetobacter spp. were foundto be colistin (96.9%), tigecycline (95%), amikacin (15%) and gentamicin (5%), whereas those the most effctive againstPseudomonas spp. were found to be colistin (94.1%), ceftazidime (57.8%), gentamicin (55.5%), ciproflxacin (50%), amikacin(50%), and piperacillin/tazobactam (42.1%).Conclusion: Acinetobacter spp. was the most common agent in VAP. The fact that Acinetobacter spp., which is resistantto carbapenems, quinolones, piperacillin-tazobactam and cephalosporins, was the most common agent in VAP, cansignifiantly affct the mortality rate of the infection
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2019Bruselloz Hastalarında Asimetrik Dimetilarjinin (ADMA) Düzeylerinin Araştırılması
Terzioğlu, Merve Aydın; Karakeçili, Faruk; Arslan, Yusuf Kemal; Sezgin, Muhammed; Gülhan, Barış; Çıkman, Aytekin
Amaç: Asimetrik dimetilarginin (ADMA), nitrik oksit sentazın (NOS) ana endojen inhibitörüdür. NOS, konak savunmasında vevasküler yapının sürdürülmesinde önemli rol oynamaktadır. Yüksek ADMA düzeylerinin endoteldis fonksiyonu ile ilişkili olduğu veçeşitli hastalıklarda rol aldığı gösterilmiştir. Brucellaspp.’nin neden olduğu zoonoz bir hastalık olan bruselloz, vaskülopati olarakkendini gösterebilmektedir. Ancak, bruselloz ile ADMA arasındaki ilişki ile ilgili yeterli veri bulunmamaktadır. Çalışmamızın amacıbruselloz hastalarında ve kontrol grubunda ADMA düzeyinin araştırılmasıdır.Yöntemler: Çalışmamıza 40 akut bruselloz hastası ve 40 sağlıklı gönüllü alındı. Bruselloz hastalarında ve sağlıklı gönüllülerdeserum ADMA düzeyleri İnsan ADMA ELISA kiti ile üretici firma önerileri doğrultusunda araştırıldı. Katılımcıların fiziki muayeneleriyapılarak, cinsiyet, yaş ve ikamet adreslerini içeren demografik karakteristikleri ve laboratuvar test sonuçları kayıt altına alındı.Verilerin değerlendirilmesinde IBM SPSS 20 istatistik paket programı kullanıldı. İstatistiksel anlamlılık düzeyi (p<0.05) ve (p<0.01)olarak kabul edildi.Bulgular: Çalışmaya alınan 40 akut brusellozlu hastanın 18'i (% 45) erkek, 22'si (% 55) kadındı ve yaş ortalaması 49.22 ± 17.33 idi.Kontrol grubundaki 40 sağlıklı gönüllünün 18'i (% 45) erkek, 22'si (% 55) kadındı ve yaş ortalaması 39.02 ± 7.88 idi. Serum ADMAdüzeyleri bruselloz ve kontrol grubunda sırasıyla; 262.6±139.59 ng/ml ve 196.52±85.25 ng/ml olarak saptandı. Brusellozgrubunda, kontrol grubu ile karşılaştırıldığında istatistiksel olarak anlamlı bir farklılık tespit edildi (p=0.013).Sonuç: Çalışmamızda bruselloz grubundaki hastalarda serum ADMA düzeyleri, kontrol grubuna göre anlamlı olarak yüksekbulundu. ADMA düzeylerindeki bu yüksekliğin, brusellozun vaskülitteki rolü konusunda yeni yorumlar yapılmasına olanaksağlanacağı ve yeni tedavi yöntemlerinin gündeme gelebileceği kanaatindeyiz.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2019Comparison of Tuberculin Skin Test (TST) and T-SPOT.TB Tests for Diagnosis of Latent Tuberculosis Infection (LTBI) in HIV-infected Patients; [HIV ile Enfekte Hastalarda Latent Tüberküloz Enfeksiyonunu (LTBE) Belirlemede Tüberkülin Deri Testi (TDT) ve T-SPOT.TB Testlerinin Karşılaştırılması]
Binay, Umut Devrim; Fincanci, Muzaffer; Fersan, Esra; Karakeçili, Faruk
Tuberculosis (TB) is the most common opportunistic infection in human immunodeficiency virus (HIV)-infected patients. Diagnosis and treatment of latent tuberculosis infection (LTBI) is the most important step in preventing the development of active TB. In our country where TB is moderately endemic, HIV-infected patients should be investigated for LTBI. Tuberculin skin test (TST) and interferon-gamma release assays (IGRA) are used in the diagnosis of LTBI but there isn't a standard practice. The aim of this study is to compare the TST and T-SPOT.TB test efficiency in the diagnosis of LTBI in HIV-infected patients. Patients who had no previous active TB infection, who were not treated for LTBI and who had no active tuberculosis infection at the time of admission were included in the study. A total of 100 HIV-infected patients who were admitted to the Infectious Diseases and Clinical Microbiology outpatient clinic between June 2015 and March 2016 were evaluated cross-sectionally. CD4+ T lymphocyte counts in the last one month were detected. All patients underwent chest radiography at the time of admission. Patients who are not considered as active TB infection with clinical and laboratory findings and who had no TST within the last one month were included in the study. TST was performed after the blood samples were taken for T-SPOT.TB test. In our study, 87% of the patients were male and the mean age was 40.2. The mean CD4+ T lymphocyte count was 605 cells/mm3 (26-1313). 16% of the patients had a history of encountring a person with tuberculosis and 81% had BCG vaccination scar. TST positivity and T-SPOT.TB positivity were 22.9% and 22%, respectively. The concordance between the two tests was found to be moderate (Kappa= 0.491). It was determined that BCG vaccination and the presence of a contact with a patient with TB did not affect TST and T-SPOT.TB test positivity (p> 0.05). There was a positive correlation between CD4+ T lymphocyte count and TST measurement values (r= 0.3, p= 0.003). Accordingly, as the number of CD4+ T lymphocytes increased, TST positivity increased (p= 0.007). T-SPOT.TB test was not affected by CD4+ T lymphocyte count (p= 0.289). Our study showed that TST was affected by CD4+ T lymphocyte count and patients' compliance with this test was also low. On the contrary T-SPOT.TB test was not affected by CD4+ T lymphocyte count. There was no statistically significant difference between T-SPOT.TB test positivity and CD4+ T lymphocyte count (p= 0.289). The concordance between the two tests was found to be moderate. It is thought that the main reason for the discordance between the tests is due to false negative or false positive results of TST. In conclusion, T-SPOT.TB was found more reliable in the diagnosis of LTBI in HIV-infected individuals. In the light of these findings, especially in HIV-infected patients with low CD4+ T lymphocyte counts, T-SPOT.TB test can be considered for LTBI diagnosis.
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