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Öğe Are bone morphogenetic protein-7 (BMP-7) serum levels correlated with development of hepatic fibrosis?(J INFECTION DEVELOPING COUNTRIES, 2014) Demir, Nazlim Aktug; Kolgelier, Servet; Inkaya, Ahmet Cagkan; Sumer, Sua; Demir, Lutfi Saltuk; Pehlivan, Fatma Seher; Arslan, MahmureIntroduction: Bone morphogenetic protein-7 (BMP-7) is a key protein in organogenesis and liver development. The protein has been studied in the context of liver fibrosis and regeneration. The aim of the present study was to explore any possible association between fibrosis levels (as revealed by liver biopsy) and serum BMP-7 levels. Methodology: A total of 189 patients with chronic hepatitis B and 51 healthy controls were enrolled in the study. Results: The study group contained 120 (63.5%) males and 69 (36.5%) females, and the control group contained 25 males (49.0%) and 26 females (51%). In general, serum BMP-7 values of patients were higher than those of controls (p = 0.001). Serum BMP-7 values of patients with liver fibrosis of stages 1, 2, 3, or 4 were higher than control values (all p values = 0.01), but the serum BMP-7 levels of patients with stage 5 fibrosis were similar to that of controls. Associations between fibrosis stage and the serum levels of BMP-7, ALT, HBVDNA, platelets, and albumin were all statistically significant (p = 0.001). The AUROC for the BMP-7 level in advanced stage fibrosis was found to be 0.23. The data were analyzed using the binary logistic regression analysis (backward stepwise method) and BMP-7, HBVDNA, and platelet levels were found to be risk factors associated with fibrosis (p values 0.031, 0.040, and 0.001, respectively). Conclusions: BMP-7 may play anti-inflammatory and anti-fibrogenic roles in the pathogenesis of chronic hepatitis B infection.Öğe Are Really Family Physicians Aware of Hepatitis B?(DRUNPP-SARAJEVO, 2016) Demir, Lutfi Saltuk; Demir, Nazlim Aktug; Inkaya, Ahmet Cagkan; Guler, Selma; Horasan, Elif Sahin; Kolgelier, Servet; Celik, UmitIntroduction: This study aimed to determine the level of knowledge of family physicians regarding hepatitis B infection, transmission ways, risk groups, clinical course, and protection methods. Methods: This study is held on 236 family physicians at Adiyaman, Mersin, Adana and Kahramanmaras. A questionnaire was held before the awareness raising seminars organized by provincial Health Directorates. Data was analyzed by SPSS 16.0 and descriptive statistics and chi-square test were used. Results: In general, 54.7% of the doctors enrolled in this study gave correct answers. Twenty three percent of physicians were not aware of HBsAg in diagnosis of hepatitis B virus (HBV), 14.8% did not know anti-HBs as indicating immunity against HBV. Though 94.4% of the family physicians administered routine hepatitis B vaccination, 62.3% of them were not informed about the lowest level of anti-HBs titer (10 IU/ml) providing immunity against HBV. Conclusion: This study showed that the level of knowledge of family physicians in HBV infections is inadequate and the family physicians should be trained about contagious diseases.Öğe The Clinical Significance of Serum Apoptotic Cytokeratin 18 Neoepitope M30 (CK-18 M30) and Matrix Metalloproteinase 2 (MMP-2) Levels in Chronic Hepatitis B Patients with Cirrhosis(KOWSAR PUBL, 2013) Sumer, Sua; Demir, Nazlim Aktug; Kolgelier, Servet; Inkaya, Ahmet Cagkan; Arpaci, Abdullah; Demir, Lutfi Saltuk; Ural, OnurBackground: Serum apoptotic cytokeratine 18 neoepitope M30 (CK-18 M30) and matrix metalloproteinase 2 (MMP-2) have been popular markers for detecting liver fibrosis in recent years. CK-18 is a major intermediate filament protein in liver cells and one of the most prominent substrates of caspases during hepatocyte apoptosis. MMP-2 plays an important role in tissue remodeling and repairing processes during physiological and pathological states. Objectives: The objective of this study was to investigate the significance of CK-18 M30 and MMP-2 levels for clinical use in patients with chronic hepatitis B (CHB), as well as their sensitivity in determining cirrhotic patients. Patients and Methods: This study included 189 CHB patients and 51 healthy controls. A modified Knodell scoring system was used to determine the fibrosis level in chronic hepatitis B patients. CK-18 M30 levels were determined with an M30-Apoptosense ELISA assay. MMP-2 levels were determined with the ELISA assay. Results: The study group consisted of 132 (69.8%) males and 57 (30.2%) females, and the control group consisted of 25 males (49.0%) and 26 females (51%). Patients' CK-18 M30 levels were higher than values of the control group (308 [1-762] vs. 168 [67-287], P=0.001). Serum MMP-2 levels were found to be statistically higher in the patient group with respect to the controls (3.0 [1.1-6.8] vs. 2.0 [1.2-3.4], P=0.001). The highest serum CK-18 M30 and MMP-2 levels were measured in patients with cirrhosis. Serum apoptotic CK-18 M30 levels positively correlated with advanced age, fibrosis stage, serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels (P=0.001, 0.033, 0.001, and 0.001, respectively). Serum MMP-2 levels positively correlated with fibrosis stage, serum ALT, and AST levels (P=0.001, 0.001, and 0.001, respectively). Conclusions: Our study indicated that CK-18 M30 and MMP-2 levels were higher in CHB patients compared to healthy controls and they were in association with significant hepatic fibrosis, especially cirrhosis.Öğe Comparison of the Level of Depression and Anxiety in Inactive Hepatitis B Carriers and Chronic Hepatitis B Patients(TURKIYE SINIR VE RUH SAGLIGI DERNEGI, 2013) Demir, Nazlım Aktuğ; Çelik, Mustafa; Kolgelier, Servet; Sümer, Sua; Aksöz, Selçuk; Demir, Lütfi Saltuk; Çağkan, AhmetObjective: The aim of this study was to evaluate the relative contribution of chronic illness and the physical effects such illness on the mental status of chronic hepatitis B patients by comparing them to inactive hepatitis B carriers, based on Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS) scores. Materials and Methods: The study included 444 participants: 249 HBsAg-positive inactive carriers (IC group) and 195 chronic hepatitis B patients (CH group) that were undergoing follow-up at Adiyaman University Research and Education Hospital, Department of Infectious Diseases Department. HBV carrier status and chronic hepatitis B were diagnosed based on European Association for the Study of Liver (EASL) guidelines. The HDRS and HARS were administered to all the participants via psychiatric interview. Results: The overall mean HDRS score was 6.2 +/- 8 and the overall mean HARS score was 6.0 +/- 7.1. Mean HDRS score in the IC group was 7.5 +/- 5.8, versus 8.8 +/- 6.6 in the CH group; the difference was significant (P = 0.037). Mean HARS score were similar in both groups (P > 0.05). There wasn't a difference in anxiety or depression scores based on participants'gender or age (P > 0.05). Additionally, there wasn't a correlation between duration of illness, and family history of hepatitis or cirrhosis, or anxiety or depression scores (P > 0.05). Anxiety scores were higher among the participants with comorbidity, in both CHB and IC groups (P = 0.005 and P = 0.001, respectively). Depression scores were higher among the IC group participants with comorbidity (P = 0.003). that can occur during the treatment and follow-up of chronic hepatitis patients. The presence of comorbidity in chronic hepatitis patients increases the risk of psychiatric complications. Conclusion: Psychiatric comorbidity, particularly anxiety and depression, are important problemsÖğe Evaluation of the Relation Between Hepatic Fibrosis and Basic Laboratory Parameters in Patients With Chronic Hepatitis B Fibrosis and Basic Laboratory Parameters(KOWSAR PUBL, 2014) Demir, Nazlim Aktug; Kolgelier, Servet; Ozcimen, Serap; Gungor, Gokhan; Sumer, Sua; Demir, Lutfi Saltuk; Inkaya, Ahmet CagkanBackground: The hepatitis B virus is an important healthcare problem. According to current clinical practice, a liver biopsy is required for the diagnosis and treatment of chronic liver disease. However, a liver biopsy is an invasive, inconvenient procedure, which requires an expert pathologist opinion. Therefore requirement of biochemical tests, which are considered to indicate hepatic fibrosis and may be repeated easily, increases gradually today. Objectives: This study evaluated the correlation between hepatic fibrosis and routine laboratory values in patients with chronic hepatitis B. Patients and Methods: The files of 456 patients with CHB (chronic hepatitis B) who were referred to the infectious diseases and clinical microbiology clinic between January 2009 and March 2012 were screened retrospectively. Liver biopsy samples were examined according to Ishak scoring. Laboratory parameters and histopathology reports were recorded, and correlations between the fibrosis grade and laboratory parameters were analyzed. Results: There were 320 male and 136 female patients, with a mean age 36.7 +/- 12.1 years. According to liver biopsy results, a low fibrosis score (stage 0-2) was detected in 281 patients (61.6%), and a high fibrosis score ( stage 3-5) was detected in 175 patients (38.4%). Patients with a high fibrosis score had significantly higher ALT (alanine amino transferase), AST (aspartate aminotransferase), and HBV-DNA values and a significantly lower platelet count compared with those with a low fibrosis score (P=0.001, 0.001, 0.025, and 0.001, respectively). A positive correlation was detected between the fibrosis score and age, BMI, HAI, ALT, and AST values, and a negative correlation was detected between the fibrosis score and albumin and platelet counts. In the regression analysis performed to evaluate the factors associated with high-stage fibrosis, fibrosis was determined to be associated with thrombosis, ALT, and gender. The results of the regression analysis demonstrated that the risk of fibrosis was 4.6 fold higher in men. Conclusions: According to the results obtained in our study, advanced age, higher BMI, AST, ALT, and HBV-DNA levels, and low albumin and platelet levels are correlated with advanced fibrosis in patients with CHB.Öğe THE IMPORTANCE OF SOLUBLE UROKINASE PLASMINOGEN ACTIVATOR RECEPTOR IN PATIENTS WITH ACUTE BRUCELLOSIS(NOBEL ILAC, 2015) Demir, Nazlim Aktug; Dagi, Hatice Turk; Findik, Duygu; Sumer, Sua; Ural, Onur; Kolgelier, ServetObjective: Brucellosis is a common zoonotic infectious disease especially in Mediterranean countries. Inflammatory markers are elevated during the course of acute brucellosis. C-reactive protein (CRP) is the most commonly used biochemical marker in clinical practice. Soluble urokinase type plasminogen activator receptor (suPAR) is an interesting biomarker which has drawn attention recently. Purpose o f this study is to examine correlation between suPAR and CRP levels as markers o f infectious disease in patients diagnosed with acute brucellosis. Material and Method: This study included 125 acute brucellosis patients and 50 healthy controls. Pretreatment blood samples were taken from the patients. suPAR levels were measured using ELISA and CRP levels were measured with nephelometry. Results: There was a positive correlation between suPAR levels and CRP, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (p=0.045, 0.039, 0.040; respectively). When we compared patient and control groups, CRP and suPAR levels were significantly higher than controls (p=0.001, 0.001; respectively). Growth in blood culture was detected in 14 (11.2%) patients. Tlrere was not a significant difference between patients who have or did not have growth in blood cultures (p=0.117). In the ROC curve analysis performed for suPAR, area under the curve (AUC) was 93.6% (p=0.001). Sensitivity and specificity were calculated as 84.8% and 86.0%, respectively, when suPAR's cut-off value was taken as 3.85 ng/mL according to the ROC curve. Conclusion: Results of this study suggest that suPAR, like CRP, is a promising biomarker in acute brucellosis.Öğe Is serum high-mobility group box 1 (HMGB-1) level correlated with liver fibrosis in chronic hepatitis B?(LIPPINCOTT WILLIAMS & WILKINS, 2017) Inkaya, Ahmet Cagkan; Demir, Nazlim Aktug; Kolgelier, Servet; Sumer, Sua; Demir, Lutfi Saltuk; Ural, Onur; Pehlivan, Fatma SeherBackground: High-mobility group box 1 (HMGB1), identified as an alarmin molecule, was shown to have a role in virus-triggered liver injury. We aimed to evaluate the association between serum levels of HMGB1 and liver fibrosis. Method: This cross-sectional case-control study included 189 chronic hepatitis B (CHB) patients and 51 healthy controls. All patients underwent liver biopsy and modified Knodell scoring system used to determine the fibrosis level in CHB patients. Serum HMGB1 levels were determined with enzyme-linked immunosorbent assay (ELISA). Results: Mean serum HMGB1 levels of patients (58.1 +/- 54.7) were found to be higher than those of the control group (7.1 +/- 4.3) (P=. 001). HMGB1 levels of patients with advanced-stage fibrosis (stage 4 and 5) were detected to be higher than those of patients with early-stage fibrosis (stage 1-3). However, this difference was not statistically significant (P>. 05). Albumin levels of fibrosis 3 and 4 patients were lower than fibrosis 1 and 2 patients. ALT, HBV DNA, and AFP levels of fibrosis 5 patients were significantly higher than fibrosis 1 and 2 patients, and their platelet and albumin levels are lower than fibrosis 1 and 2 patients (P<. 001). In a logistic regression model, fibrosis levels were correlated with ALT values and inversely correlated with albumin levels. Conclusion: In this study, we demonstrated that serum HMGB1 levels increase in the early course of liver injury and this increase is not correlated with severity of the liver damage.Öğe Knowledge Level of Hepatitis B and its Prevalance in Policemen Working in Adiyaman(MODESTUM LTD, 2015) Kolgelier, Servet; Demir, Nazlim Aktug; Demir, Lutfi Saltuk; Ozcimen, Serap; Inkaya, Ahmet CagkanAim of this study to investigate the level of knowledge about hepatitis B and prevalence of HBsAg carriage in police and other security staff. Hepatitis B knowledge of police and other staff working for Adiyaman police department were measured using a questionnaire. This questionnaire was prepared after a literature search and was applied to 683 subjects before an education seminar. Fully and regularly filled 437 questionnaires were selected for evaluation. HBsAg and Anti HBs values of subjects were measured. Data were recorded to SPSS 16.0 package program. Chi square test was used for data analyses. Of all the study subjects 406 (92.9%) were males and 31 (7.1%) were females. Three hundred sixty subjects (82.3%) were police staff, 60 (13.7%) were public serveants, 15 (3.4%) were commissaries and 2 (0.05%) were nightmen. Mean age was 34.5 +/- 7. Fifty four subjects gave correct answers to the question about transmission ways of hepatitis B. Three hundred eighty four subjects didn't have enough knowledge about transmission ways of this virus. HBsAg positivity was detected in 34 (7.7%) subjects. Three hundred twenty five (51,4%) subjects had adequate antibody level for immunity. As a result, we detected that knowledge level was inadequate and increased risk for infection in this profession. It was concluded that security staff should be educated regarding risks and screened for bloodborne diseases.Öğe LEVEL OF KNOWLEDGE AND COMPLIANCE TO HAND HYGIENE AMONG HEALTH CARE WORKERS(NOBEL ILAC, 2013) Demir, Nazlim Aktug; Kolgelier, Servet; Kucuk, Ahmet; Ozcimen, Serap; Sonmez, Bilgehan; Demir, Lutfi Saltuk; Inkaya, Ahmet CagkanObjective: This study aims to evaluate the knowledge and attitud of health care workers (HCW) about hand hygiene. Material and Method: This study was conducted on 479 individuals including 106 doctors, 205 nurses, 111 laboratory workers and student, and 57 cleaning staff working at state hospitals in Achyaman. The study was planned by the Infection Control Committee consisting of 6 members. After listing the study participants, 190 subjects were chosen randomly for observation about compliance to hand hygiene. Ten working days after the questionnaire, 190 randomly selected attendants working at clinics, wards, intensive care unit, or laboratories were observed in total 600 hand hygiene indications. Results: There were 205 nurses, 111 laboratory workers and students, 106 doctors, and 57 cleaning staff in the cohort. In general there was no difference in percentage of correct answers, according to professional status or working units, although new graduates (graduated in the last five years) answered questions more correctly. The most known answer was 'gloves must be changed after each patient, and then hand hygiene must be ensured'. The most wrongly answered question was "gloves protect completely". Hand hygiene compliance at 600 hand hygiene indication was found to be 19%. Compliance rate was highest after exposure to body fluids and was lowest after exposure to the surroundings of the patients. 26% of the personnel who washed hands to achieve hand hygiene and 54% of the personnel who used antiseptic solutions utilized the correct method and duration. Conclusion: In this observational study, we demonstrated low knowledge level and noncompliance among HCW with regard to hand hygiene.Öğe Serum Levels of Annexin A2 as a Candidate Biomarker for Hepatic Fibrosis in Patients With Chronic Hepatitis B(KOWSAR PUBL, 2015) Kolgelier, Servet; Demir, Nazlim Aktug; Inkaya, Ahmet Cagkan; Sumer, Sua; Ozcimen, Serap; Demir, Lutfi Saltuk; Pehlivan, Fatma SeherBackground: Hepatologists have studied serologic markers of liver injury for decades. Annexins are a prominent group of such markers and annexin A2 (AnxA2) is one of the best characterized annexins. AnxA2 inhibits HBV polymerase among other functions. Its expression is up-regulated in regenerative hepatocytes. Objectives: To determine if serum AnxA2 level has a role in estimating liver damage in chronic HBV infection and investigate whether AnxA2 levels correlate with hepatic fibrosis. Patients and Methods: This study included 173 patients with chronic hepatitis B (CHB) and 51 healthy controls. Liver fibrosis was graded histologically on liver biopsy samples. Blood samples were taken from patients during biopsy and serum AnxA2 levels were measured with ELISA. Results: In a group of adult patients with CHB, AnxA2 values were far higher than those of the control group (P = 0.001). When we assessed AnxA2 levels based on fibrosis stages, serum AnxA2 levels of patients with early stage fibrosis (stages 1 - 3) were significantly higher than those of patients with advanced stage fibrosis (stages 4 - 5; P = 0.001). Conclusions: AnxA2 is a useful biomarker for early stage fibrosis in patients with CHB.
