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Öğe Awareness of Hepatitis B virus reactivation among physicians administering immunosuppressive treatment and related clinical practices(AVES, 2019) Korkmaz, Pınar; Demirtürk, Neşe; Aydın, Gule; Çeken, Sabahat; Aygen, Bilgehan; Toka, Onur; Gündoğdu, Kıymet; Çelikbaş, Aysel Kocagül; İnan, Dilara; Kuruüzüm, Ziya; Kutsoylu, Oya Özlem Eren; Batırel, Ayşe; Sırmatel, Fatma; Ersöz, Gülden; Hakyemez, İsmail Necati; Aşçı, Zerrin; Yeşilbağ, Zuhal; Sönmezer, Meliha Çağla; Tülek, Necla; Örmen, Bahar; Karadağ, Fatma Yılmaz; Yörük, Gülşen; Türker, Nesrin; Özkaya, Hacer Deniz; Kalkan, İrem Akdemir; Süer, Hüseyin Kaya; Tekin, Süda; Saltoğlu, Neşe; Şener, Alper; Yenilmez, Ercan; Çetinkaya, Rıza Aytaç; Özel, Selcan Arslan; Ayaz, Celal; Karagöz, Ergenekon; Aydın, Mehtap; Acar, Ali; Arslan, Eyüp; Ceylan, Mehmet Reşat; Demir, Nazlım Aktuğ; Çaylak, Selmin Dirgen; Günal, Özgür; Solay, Aslı Haykır; Öztürk, Sinan; Ural, Onur; Sümer, Şua; Kadanalı, Ayten; Altıparmak, Vuslat Ecem Güneş; Akhan, Sıla; Sayan, Murat; Köse, ŞükranObjective: This study aimed to evaluate the awareness and knowledge levels of all physicians administering immunosuppressive treatment concerning hepatitis B virus (HBV) reactivation, and draw attention to the importance of the subject through evaluation. Methods: The study was carried out by infectious diseases and clinical microbiology specialists in 37 health centers, and it was performed in Turkey between January and March 2017. All specialists providing a written consent and working in the departments of Medical Oncology, Hematology, Dermatology and Venereology, Physical Medicine and Rehabilitation, and Rheumatology of each study center were included in the study. Results: A total of 430 physicians participated in the study. Their mean age was 39.87 +/- 7.42 years, and 47.9% of them were males. During their career, 39.3% of these physicians had encountered patients developing HBV reactivation while receiving immunosuppressive treatment. The rate of encountering patients who died due to HBV reactivation was 6.5%. 97% of physicians who participated, considered the risk of HBV reactivation to be important. 70.2% of physicians stated that guidelines related to HBV reactivation and antiviral treatment for these patients were discussed in the congresses they participated, regarding their specialties. The rate of performing hepatitis screening among physicians whose patients developed HBV reactivation was statistically significantly higher than those physicians who had no patients with HBV reactivation (p<0.05). Physicians who used the guidelines related to HBV reactivation in their specialties performed screening for the HBV infection much more often than physicians who did not use the guidelines (p=0.002). Conclusions: According to the results obtained in our study, the rates of conducting screening and awareness of HBV reactivation among physicians administering immunosuppressive treatment were higher compared with similar studies; however, their awareness that HBV DNA and anti-HBc should be utilized much more frequently among the serological tests they use for screening of HBV infection, should be increased.Öğe Bir üniversite hastanesi öğrencileri, araştırma görevlileri ve öğretim üyelerinin el hijyeni hakkındaki bilgi düzeyleri(2018) Demir, Nazlım Aktuğ; Sümer, Şua; Demir, Lütfi Saltuk; Ural, OnurAmaç: Bu çalışmanın amacı bir üniversite hastanesi öğrencilerinin,araştırma görevlilerinin ve öğretim üyelerinin el hijyenihakkında farkındalığı ve bilgi düzeyinin değerlendirilmesidir.Yöntemler: Bu çalışma bir üniversite hastanesinde okuyan 892öğrenci, fakültemizde çalışan 243 araştırma görevlisi ve 131öğretim üyesi olmak üzere toplam 1266 kişi üzerinde yapıldı.Literatür taraması sonrasında hazırlanan anketler katılımcılarayüz yüze uygulandı.Bulgular: Çalışmaya katılan 1266 kişinin 657 (%51.9)’si erkek,609 (%48.1)’u kadındı. Çalışmaya katılan öğrencilerin %91’inin,araştırma görevlilerinin %73.2’sinin son 5 yıl içerisinde el hijyenieğitimi aldığı saptandı. Araştırma görevlilerinin %23.1’inin,öğrencilerin %38.7’sinin son bir yıl içerisinde eğitim aldığı tespitedildi. Öğretim üyelerinin hiçbirinin son 5 yıl içerisinde el hijyenieğitimi almadığı saptandı. Çalışmamızda son bir yıl içerisindeeğitim alanlarda bilgi düzeyi en yüksek bulundu (p0.001).Öğrencilerin bilgi düzeyi, araştırma görevlisi ve öğretim üyelerindenyüksek olarak tespit edildi (p0.01). Çalışmaya katılanların%54.2’si el hijyenine uyum oranını orta, %23.1’i iyi, %32.7’sikötü olarak değerlendirdi. Katılımcılar tarafından en çok doğrubilinen bilgi “her hastada eldiven değiştirilmelidir”iken en çokyanlış bilinen bilgi “eldiven giymek el hijyeni yerine geçer” olaraksaptandı. Katılımcılar arasında el hijyenine uyumsuzluğunen önemli nedeni iş yoğunluğu olarak belirtildi.Sonuçlar: Hastanemizde el hijyenine uyumun artırılmasına yönelikolarak yapılan çalışmaların sürekliliğinin sağlanmasının ne kadarönemli olduğu ve ayrıca eğitimlerin hastanede çalışan tüm personele(özellikle de doktorlara) ulaştırılmasının gerekliliği gözlendi.Öğe Brusellozlu 86 olgunun, klinik belirtileri, laboratuvar sonuçlarının, tedavisi ve komplikasyonlarının değerlendirilmesi(2006) Ural, Onur; Sümer, Şua; Ural, Gaye1998-2005 yılları arasında Selçuk Üniversitesi Meram Tıp Fakültesi ve Konya Numune Hastanesi infeksiyon Hastalıkları Klinikleri'nde izlenen 86 brusellozlu olgunun öyküleri, bulaşma yolları, semptomları, fizik muayene bulguları, laboratuvar değerleri, tedavi rejimleri ve relaps oranları geriye dönük olarak değerlendirildi. Çalışmaya alınan olguların 51'inde (%59.2) bulaşma yolu saptandı. En sık görülen semptomlar sırasıyla; halsizlik, ateş, artralji, terleme ve myalji idi. Fizik muayenede en sık rastlanan bulgular sırasıyla; ateş, hepatomegali, osteo-artiküler tutulum ve splenomegali idi. Olguların tamamında STA titresi 1/160 idi. Kan kültür pozitifliği 12 hastada (%13.9), beyin-omurilik sıvısı (BOS) kültür pozitifliği iki hastada (%2.3) gösterildi. Kan ve BOS'ta üretilen etkenler Brucella melitensis biyotip 1 idi. Hastaların tedavi süreleri uygulanan rejimlere göre değişmekle birlikte, ortalama 6 hafta-12 ay arasında idi. Seksen altı hastanın altısında (%6.9) relaps izlendi.Öğe A Case of Neurosyphilis Presenting With Uveitis(AVES, 2019) Demir, Nazlım Aktuğ; Sümer, Şua; Çimen, Gizem; Öztürk, Banu; Ural, OnurSyphilis is a multisystemic chronic infection caused by Treponema pallidum. As with other sexually transmitted infections, syphilis's tendency to spread in the community is considered to be an indicator of the spread tendency of human immunodeficiency virus (HIV) infection. With the increase in the prevalence of HIV infection, there is a significant increase in syphilis cases. Neurosyphilis is a clinical form of the disease that can be observed at any stage leading to central nervous system involvement. Eye involvement in neurosyphilis often appears in the tertiary period and it might be the first and only finding of neurosyphilis. The most common ocular presentation is uveitis, and it may mimic many ocular pathologies. In this report, a case diagnosed with neurosyphilis while investigating the etiology of uveitis is presented.Öğe A Case of Prosthetic Infection with Candida Growth in the Knee Joınt(Selçuk Üniversitesi, 2023 Nisan) Çifci, Şeyma; Demir, Nazlım Aktuğ; Sümer, Şua; Ural, Onur; Çölkesen, Fatma; Dağı, Hatice TürkIntroduction: Fungal prosthetic joint infections constitute a small part of all prosthetic infection cases, and Candida species are the causative agent in most cases. Most fungal prosthetic joint infections occur after revision arthroplasty. Case: A 77-year-old male patient underwent a total knee prosthesis operation for the right knee due to Gon arthrosis. About five months later, he was hospitalized and treated due to a bacterial prosthetic joint infection. Eight days after discharge, he reapplied with complaints of swelling, pain, temperature increase, and redness in the right knee. He was hospitalized again due to a prosthetic joint infection. Antifungal treatment was started for the patient due to the growth of Candida albicans in the knee joint. A total of 2.5 months of antifungal treatment was given. The recovered patient continues to be followed up in the outpatient clinic. Discussion: In this case report, we wanted to emphasize that in the presence of risk factors in prosthetic joint infection, we should not forget that the factor may also be fungus. During the operation, a culture should be taken, and antifungal treatment should be given for effective and long-term fungal-related prosthetic joint infections.Öğe Comparision of the Side Effects Due To Interferon Alpha 2A Plus Ribavirin and Pegylated Interferon Alpha 2A Plus Ribavirin Combinations For Chronic Hepatitis C Infection(Aves Yayıncılık, İbrahim Kara, 2010) Ural, Onur; Demir, Nazlım Aktuğ; Sümer, Şua; Ural, Gaye; Balcı, MehmetObjectives: Comparision of the side effects due to interferon alpha 2a plus ribavirin and pegylated interferon alpha 2a plus ribavirin combinations for chronic hepatitis C infection. Patients and Methods: In this study, 36 patients, who received interferon alpha 2a, 3 million U, subcutaneously thrice weekly plus oral ribavirin 1000-1200 mg daily were compared with 49 patients, who received pegylated interferon alpha 2a 180 mu gr, subcutaneously once weekly plus oral ribavirin 1000-1200 mg daily with respect to side effects. Results: Lack of appetite, headache and fatigue were more frequent in pegylated interferon alpha group, and these differences between groups were statistically significant (p<0.05). Conclusion: In our study the treatment is discontinued in two patients who received interferon plus ribavirin (anemia in one, both anemia and thrombocytopenia in the other) and three patients, who were treated with pegylated interferon plus ribavirin (anemia in one, both anemia and thrombocytopenia in one and psychiatric problems in the other).Öğe Diagnostic clues for spondylitis in acute brucellosis(SAUDI MED J, 2014) Demir, Nazlım Aktuğ; Kölgelier, Servet; Özçimen, Serap; Sümer, Şua; Demir, Lütfi Saltuk; İnkaya, Ahmet ÇağkanObjectives: To determine the diagnostic factors for brucellar spondylitis. Methods: This retrospective study included 227 consecutive brucellosis patients admitted to the Infectious Diseases and Clinical Microbiology clinics of Adiyaman State Hospital and Adiyaman 82nd Year State Hospital, Adiyaman, Turkey between January 2010 and December 2012. Acute brucellosis was diagnosed by standard tube agglutination test, and/or growth of Brucella spp. in appropriately prepared culture media (Bactec). Brucellar spondylitis was diagnosed and followed-up with contrast-enhanced magnetic resonance imaging. Results: Among the 227 brucellosis patients included, 88 (38.8%) were male, and 139 (61.2%) were female. Brucellar spondylitis was detected in 54 patients (23.7%). Brucellar spondylitis patients had higher mean age, higher fever, and higher blood culture positivity rate when compared with brucellosis patients (p=0.001, p=0.001, and p=0.001). Logistical regression analysis determined that male gender (OR: 3.006), older age (OR: 1.025), erythrocyte sedimentation rate (ESR) (OR: 1.067), high fever at the time of admission (OR: 2.550), and positive blood cultures for Brucella spp. (OR: 4.003) values were independently associated with brucellar spondylitis. However, high C-reactive protein (CRP) levels (OR: 0.971) were not found as a risk factor for brucellar spondylitis. Conclusions: The results of this study shows that the risk of developing brucellar spondylitis is high in patients with acute brucellosis, who are at advanced age, who have high fever, that have Brucella spp. growth in their blood culture that has a high ESR value, and who are male.Öğe Distribution and evaluation of Vancomycin resistant Enterococci seen in Selcuk University Medical Faculty Hospital between 2012 and 2015(BILIMSEL TIP YAYINEVI, 2017) Torun, Ayşe; Sümer, Şua; Ural, Onur; Demir, Nazlım AktuğIntroduction: Prevailing at increasing rates as a cause of hospital infections in recent years, vancomycin resistant enterococcus (VRE) infections pose a serious problem in our country and across the world. This study aims at providing an overview of the VRE problem in our hospital. Materials and Methods: The data of 112 patients monitored in the clinics and intensive care units of Selcuk University Medical School Hospital between 1 January 2012 and 31 December 2015 and who had growth of VRE in their various cultures were reviewed retrospectively by going through patient files. Results: Looking at the distribution of VRE cases by years, it was seen that there were 13 cases in 2013 (11.6%), 23 cases in 2014 (20.5%) and 76 cases in 2015 (67.9%). Of these cases, 71 (63.4%) were colonized, 15 (13.4%) infected and 26 (23.2%) were both colonized and infected. The rate of infected cases was observed to be more in 2013, which was statistically significant (p< 0.001). From the 112 cases involving VRE, 36 (32.1%) were monitored in the clinics and 76 (67.9%) in the intensive care units. Thirty (83.3%) of the patients hospitalized in clinics were followed in the internal medicine clinics and 6 (16.7%) in surgical departments. The rate of colonization in patients treated in the intensive care units was higher than in those treated in clinics, which was statistically significant (p= 0.015). There was one or more underlying diseases in 109 (97.3%) of the 112 patients found to have VRE, a history of antibiotic use in 102 of them (91.1%), presence of urinary catheter in 102 (91.1%), and a history of hospitalization in 86 (76.7%). Therefore, history of hospitalization, history of underlying disease, history of antibiotic use, and presence of a urinary catheter were considered statistically significant risk factors for VRE infections (p values 0.01, 0.02, 0.01 and 0.01, respectively). E. faecium was found in 137 of the 141 isolates with VRE. Their susceptibility to antibiotics was 95.5% for linezolid and 99.2% for tigecycline. Their resistance to ampicillin and ciprofloxacin were 100%, to teicoplanin 95.7%, to trimethoprim sulfamethoxazole 89.2%, to high levels of gentamicin 87.5% and of tetracycline 80.4%. Conclusion: As a result of our study, risk factors for VRE infections were identified, which had become a growing problem in years in our hospital. It is to our belief that it would be useful, as a precaution, to take routine stool cultures from patients found to carry these risk factors.Öğe Diz ekleminde gelişen tüberküloz septik artrit olgusu(2018) Ural, Onur; Sümer, Şua; Demir, Nazlım Aktuğ; Çiftci, ŞeymaSeptik artrit, eklemlerdeki sinovyal zar ve sinovyal sıvının bakteriyel, viral ya da fungal etkenlerle oluşan iltihabıdır. Tüm yaş ve riskgruplarında görülen en sık etken Staphylococcus aureus’tur. Kronik septik artrit söz konusu ise Mycobacterium türleri etken olabilir.Osteoartiküler tüberküloz, birçok kemik eklem patolojisini taklit edebilir. Tedavi edilmeyen olgularda destrüktif osteoartiküler sonuçlaraneden olabileceği için hızlı tanı ve tedavi önemlidir. Bu yazıda tekrarlayan septik artrit atakları ile başvuran ve tüberküloz artrit tanısıalan bir olgu sunulmuştur.Öğe Evaluation of 48-week response of treatment-naive chronic hepatitis B patients to 0.5 mg/day entecavir(TUBITAK SCIENTIFIC & TECHNICAL RESEARCH COUNCIL TURKEY, 2014) Kölgelier, Servet; Demir, Nazlım Aktuğ; Özçimen, Serap; Sümer, ŞuaAim: The hepatitis B virus (HBV) is an important healthcare problem. Chronic hepatitis B infection may present with a wide range of manifestations from inactive carrier state to cirrhosis and hepatocellular cancer. Therefore, treatment is very important in chronic hepatitis B. In this study, the treatment results of 199 chronic hepatitis B patients taking entecavir 0.5 mg/day for 48 weeks were evaluated. Materials and methods: This study retrospectively evaluated data of 199 treatment-naive chronic hepatitis B patients who were treated with entecavir. Results: Of the 199 treatment-naive chronic hepatitis B patients, 141 (70.9%) were males and 58 (29.1%) were females, and mean age of the whole group was 37.5 +/- 12.1 years. HBeAg was positive in 91 (45.7%) and antiHBe was positive in 108 (54.3%) patients. Mean HBV DNA value was 666,449,365.5 +/- 2,759,013,996.9 IU/mL, mean ALT value was 112.1 +/- 95.7 U/L, and mean AST value was 95.3 +/- 71.2 U/L. At week 24 of the treatment, HBV DNA levels were below 50 IU/mL in 56% of the HBeAg-positive and 76% of the HBeAg-negative patients. At week 48 of the treatment, HBV DNA levels were below 50 IU/mL in 79% of the HBeAg-positive and 87% of the HBeAg-negative patients. At week 24, ALT had normalized in 72% of the HBeAg-positive and 79% of the HBeAg-negative patients. At week 48, ALT had normalized in 89% of the HBeAg-positive and 88% of the HBeAg-negative patients. AntiHBe seroconversion was seen in 2 of 91 patients (2.2%), but the loss of HBsAg was never observed. Conclusion: The 48-week entecavir treatment at a dose of 0.5 mg/day was shown to be effective both for HBeAg-positive and negative patients.Öğe Evaluation of 48-week response of treatment-naive chronic hepatitis B patients to 0.5 mg/day entecavir(2014) Kölgelier, Servet; Demir, Nazlım Aktuğ; Özçimen, Serap; Sümer, ŞuaAim: The hepatitis B virus (HBV) is an important healthcare problem. Chronic hepatitis B infection may present with a wide range of manifestations from inactive carrier state to cirrhosis and hepatocellular cancer. Therefore, treatment is very important in chronic hepatitis B. In this study, the treatment results of 199 chronic hepatitis B patients taking entecavir 0.5 mg/day for 48 weeks were evaluated. Materials and methods: This study retrospectively evaluated data of 199 treatment-naive chronic hepatitis B patients who were treated with entecavir. Results: Of the 199 treatment-naive chronic hepatitis B patients, 141 (70.9%) were males and 58 (29.1%) were females, and mean age of the whole group was 37.5 ± 12.1 years. HBeAg was positive in 91 (45.7%) and antiHBe was positive in 108 (54.3%) patients. Mean HBV DNA value was 666,449,365.5 ± 2,759,013,996.9 IU/mL, mean ALT value was 112.1 ± 95.7 U/L, and mean AST value was 95.3 ± 71.2 U/L. At week 24 of the treatment, HBV DNA levels were below 50 IU/mL in 56% of the HBeAg-positive and 76% of the HBeAg-negative patients. At week 48 of the treatment, HBV DNA levels were below 50 IU/mL in 79% of the HBeAg-positive and 87% of the HBeAgnegative patients. At week 24, ALT had normalized in 72% of the HBeAg-positive and 79% of the HBeAg-negative patients. At week 48, ALT had normalized in 89% of the HBeAg-positive and 88% of the HBeAg-negative patients. AntiHBe seroconversion was seen in 2 of 91 patients (2.2%), but the loss of HBsAg was never observed. Conclusion: The 48-week entecavir treatment at a dose of 0.5 mg/day was shown to be effective both for HBeAg-positive and negative patients.Öğe Evaluation of Depression, Anxiety Level and Quality of Life in Patients With Chronic Hepatitis B and Inactive Hepatitis B Virus Carriers(AVES, 2017) Yiğit, Özge; Ural, Onur; Demir, Nazlım Aktuğ; Sümer, Şua; Güler, Özkan; Demir, Lütfi SaltukObjective: The objective of this study was to compare the anxiety, depression and quality of life scores of chronic hepatitis B (CHB) patients and inactive hepatitis B virus (HBV) carriers with healthy control subjects and to demonstrate the need for a multidisciplinary approach in the follow-up and treatment of patients with HBV infection. Methods: The study was carried out by comparing 200 subjects including 100 CHB patients and 100 inactive HBV carriers, who were admitted to the Outpatient Clinic of Infectious Diseases and Clinical Microbiology Department, Faculty of Medicine, Selcuk University between August 2013 and August 2014 with 100 healthy control subjects. All subjects were given Hospital Anxiety and Depression (HAD) Scale and Short Form-36 (SF-36) to assess their quality of life. Results: Based on the HAD Scale, anxiety risk among the carriers was higher than the control group (p=0.031). Depression risk in the patient (p=0.031) and carrier groups (p=0.046) were higher than the control group. There was no significant difference between the patient and carrier groups with regard to anxiety risk or depression risk (p>0.05). Females had higher anxiety risk in the patient (p=0.015), carrier (p=0.035) and control (p=0.001) groups. Depression risk was also higher in females in the patient (p=0.037) and carrier (p=0.038) groups. There were no significant relations between marital status, family type, place of living and anxiety and depression risks (p>0.05). Three quality of life parameters including general health, role limitations due to physical health and vitality scores in the inactive HBV carriers and CHB patients were lower than those of the control group (p<0.05). Conclusions: Psychological state of the patients who are chronically infected with HBV should not be neglected during treatment and follow-up. If a psychiatric disturbance is identified, effective treatment will increaseÖğe First case of hepatitis B virus genotype H Infection in Turkey [Türkiye'de Ilk Kez Saptanan Hepatit B Virus Genotip H Enfeksiyonu Olgusu](2013) Ural, Onur; Sayan, Murat; Akhan, Sıla; Sümer, Şua; Şimşek, FundaClinical studies reported from Turkey indicate that hepatitis B virus (HBV) genotype D is more prevalent than other genotypes. Epidemiological and clinical information on genotype H infection is currently limited. Genotype H infection is most likely due to its regional (Central and South America) prevalence throughout the world. The aim of this report is to present the first HBV genotype H infection in a chronic hepatitis B patient in Turkey. Laboratory findings of a 42 years old male patient admitted to our hospital revealed HBsAg (+), anti-HBs (-), HBeAg (-), anti-HBe (+), anti-HBc IgM (-), anti-HBc IgC (+), anti-HAV IgG (+), HBV-DNA: 5.689.776 IU/ml and high liver enzymes (ALT: 223 U/L, AST: 121 U/L). History of the patient indicated no risk factor (intravenous drug use, blood transfusion, suspicious sexual contact) related to HBV transmission. Since liver ultrasonography showed multiple hemangiomas, biopsy was performed and histologic activity index was found as 6/18 and fibrosis as 2/6, according to modified Knodell score system. HBV DNA isolated from the serum sample of the patient was amplified by polymerase chain reaction and polymerase gene segment of HBV was directly sequenced. UPGMA method was used for phylogenetic analysis, and the genotype of the virus was identified accordingly. The nucleotide sequence was compared to those from the international DNA data bank (GenBank). The genotyping of the patient revealed that the isolated HBV was genotype H. Treatment with tenofovir disoproxil fumarate was initiated and the patient responded to the treatment. This finding suggested that other HBV genotypes, except the predominant genotype D may also be in circulation in Turkey. In conclusion, detection of epidemiologic and molecular characteristics of HBV genotype H which is related to chronic hepatitis, seems to be necessary in order to better understand its circulation and progression around the world.Öğe Gözden kaçabilen bir enfeksiyon: Abdominal tüberküloz(2014) Demir, Nazlım Aktuğ; Sümer, Şua; Yiğit, Özge; Ural, OnurMycobacterium tuberculosis, en sık pulmoner tutulumla seyreden ve halen dünyada yaygın olarak görülmeye devam eden bir en- feksiyon hastalığıdır. Ekstrapulmoner tüberküloz tüm tüberküloz vakalarının %15-20'sini oluştururken, abdominal tüberküloz ise ekstapulmoner tüberküloz olgularının yalnızca %3'ünü kapsar. Bu yazıda yüksek ateş, halsizlik, iştahsızlık şikayetleri ile başvuran, dirençli ateşin nedenini bulmaya yönelik yapılan araştırmalar sırasında izole karaciğer ve dalak tutulumu saptanan bir tüberküloz olgusu sunulmuşturÖğe Hepatosteatozun entekavir ve tenofovir tedavilerinde virolojik yanıta etkisi(AVES, 2019) Korkmaz, Pınar; Demirtürk, Neşe; Batırel, Ayşe; Tülek, Necla; Özgüler, Müge; Harman, Rezan; Çınar, Güle; Toka, Onur; Yörük, Gülşen; Hatipoğlu, Çiğdem Ataman; Sarıgül, Figen; Sırmatel, Fatma; İmre, Ayfer; Özatağ, Duru Mıstanoğlu; Karakeçili, Faruk; Ural, Onur; Sümer, Şua; Demir, Nazlım Aktuğ; Kadanalı, Ayten; Çomoğlu, Şenol; Üçer, Sengül; Saltoğlu, Neşe; Günal, Özgür; Özkaya, Hacer Deniz; Yenilmez, Ercan; Çetinkaya, Rıza Aytaç; Yüksel, Esma; Hakyemez, İsmail Necati; Meriç-Koç, Meliha; Tuncer-Ertem, Günay; Dursun, Zehra Beştepe; Çelik, İlhami; Yılmaz, Emel; Evik, Güliz; Kaya, Ali; Süer, KayaObjective: Both chronic hepatitis B (CHB) and hepatosteatosis may lead to necroinflammation in liver. Therefore, the presence of hepatosteatosis might negatively affect the efficacy of antiviral therapy. We aimed to determine the effect of hepatosteatosis on virological response in patients with CHB receiving entecavir (ETV) and tenofovir (TDF) treatment. Methods: The study was designed retrospectively. All patients receiving antiviral therapy due to CHB in the departments of Infectious Diseases and Clinical Microbiology of 29 different hospitals between January 2012 and June 2017 were searched by examining medical records. Results: A total of 1069 patients were included. Six hundred and fifty of the patients had been receiving TDF and 419 of them had been receiving ETV. The rate of virological response obtained at the 48'h week of TDF was higher in patients with steatosis (p=0.029). Virological response at the 24th week and 48th week of ETV were higher in the patients without steatosis (p=0.001). TDF and ETV therapies were compared in the patients with hepatosteatosis and it was found that the virological response at 48th week was higher in the TDF group. Conclusion: Although steatosis has an effect on virological response in the short-term results of nucleos(t)ide therapy, it does not have any effect on virological response in the long-term results.Öğe İnaktif hepatit b taşıyıcıları ve kronik hepatit b hastalarının depresyon ve anksiyete düzeylerinin karşılaştırılması(2013) Demir, Nazlım Aktuğ; Aksöz, Selçuk; Çelik, Mustafa; Kölgelier, Servet; Sümer, Şua; Demir, Lütfi Saltuk; İnkaya, Ahmet ÇağkanAmaç: Bu çalışmada, HBsAg pozitif inaktif taşıyıcı ve kronik hepatihastalarından oluşan toplam 444 kişinin Hamilton depresyon ve anksiyete puanları karşılaştırılarak, kronik bir hastalığa sahip olmanın getirdiği psikolojik etkilerle hastalığın oluşturduğu fiziksel etkilerin hastaların ruhsal durumu üzerindeki bağıl katkılarının değerlendirilmesi amaçlandı. Yöntem: Bu çalışma, Adıyaman Devlet Hastanesi ve Adıyaman 82Yıl Devlet Hastanesi Enfeksiyon Hastalıkları Polikliniğinde takip edilen HBsAg pozitif 249 inaktif taşıyıcı (T), 195 kronik hepatit hastas(KHB) olmak üzere toplam 444 kişi üzerinde yapıldı. HBV taşıyıcılığve kronik hepatit B, Avrupa Karaciğer Çalışmaları Birliği (European Association for the Study of Liver/ EASL) kılavuzu eşliğinde teşhis edildiPsikiyatrik görüşme ile tüm katılımcılara Hamilton Depresyon ve Hamilton Anksiyete Ölçekleri uygulandı. Bulgular: Katılımcıların Hamilton Depresyon Derecelendirme Ölçeğ(HDDÖ) puan ortalaması 6,28, Hamilton Anksiyete DeğerlendirmÖlçeği (HADÖ) puan ortalaması 6,07,1 idi. HDDÖ puan ortalaması inaktif taşıyıcılarda 7,55,8, hastalarda 8,86,6 idi. Kronik hepatiB hastalarında HDDÖ puan ortalaması, inaktif taşıyıcılardan anlamlolarak yüksekti (p0,037). HADÖ puanı iki grupta benzerdi (p0,05)Hastaların cinsiyetine ve yaşına göre anksiyete ve depresyon puanlaraçısından fark saptanmadı (p0,05). Hastalığın süresi, ailede hepatit vsiroz öyküsü ile anksiyete ya da depresyon puanları arasında ilişki bulunmadı (p0,05). Hem hasta hem taşıyıcılarda ek hastalık olması durumunda anksiyete puanları anlamlı olarak yüksek tespit edildi (p değeri sırasıyla 0,005 ve 0,001). Depresyon puanı ise ek hastalığı olan taşıyıcılarda anlamlı olarak yüksek bulundu (p0,003). Sonuç: Kronik hepatitli hastaların tedavi ve izlemi sırasında anksiyetve depresyon başta olmak üzere psikiyatrik ek tanılar önemli sorunlardır. Kronik hepatit varlığı ve eşlik eden başka hastalık bulunması psikiyatrik komplikasyon riskini artırmaktadır.Öğe Isolated Cervical Spondylodiscitis Due to Brucellosis: A Case Report(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2013) Ural, Onur; Sümer, Şua; Demir, Nazlım Aktuğ; Dikici, Nebahat; Fırat, VildanBrucellosis is a zoonotic disease, which has the potential to affect all organs and systems. It most commonly involves the musculoskeletal system and may result in sacroiliitis, spondylitis, spondylodiscitis, arthritis, osteomyelitis, tenosynovitis or bursitis. Lumbosacral region is the most commonly affected in cases of spinal complications. Involvement of the cervical region is very rare, however, when it does occur, the prognosis is worse than when it affects the lumbar region and more neurological damage. is observed. Brucellosis should always be considered in the differential diagnosis of patients presenting with musculoskeletal complaints in regions where brucellosis is endemic. We report an unusual case of brucellar spondylodiscitis involving the cervical region and discuss this with reference to the recent literature.Öğe Konya Bölgesinde Tularemi(ANKARA MICROBIOLOGY SOC, 2012) Dikici, Nebahat; Ural, Onur; Sümer, Şua; Öztürk, Kayhan; Yiğit, Özgen Albayrak; Katlanır, Eda; Keleş, BaharTularemia is a zoonotic infection caused by Francisella tularensis. In the recent years tularemia has become a reemerging infection in Turkey with epidemics and also sporadic cases. Transmission occurs most often through consumption of contaminated water and food, direct contact with animals and insect/tick bites. In this study, we evaluated clinical features and laboratory findings of 35 tularemia cases diagnosed during two outbreaks that occurred in two different villages during two different periods in Konya (located in Central Anatolia), Turkey and five sporadic cases. In both outbreaks, first (index) cases were admitted to our outpatient clinic with the complaints of cervical lympadenopathy. After diagnosis of tularemia, an organized team visited the villages to search if more cases existed. For microbiological diagnosis, blood, throat and tonsil swabs and lymph node aspirate specimens were collected from the suspected cases. Diagnostic tests (culture, serology, molecular methods) for tularemia were performed in reference center, Refik Saydam National Public Health Agency. Drinking and potable water samples from those villages were also collected by provincial health authorities. The cases (n= 14) that belonged to the first epidemics were detected in February 2010 and cases (n= 21) of the second epidemics in NovemberDecember 2010; five cases were followed as sporadic. The mean age of the 40 patients (25 females, 15 males) was 37.6 (age range: 5-80 years; five of them were pediatric group) years. The most common complaints of patients were cervical mass (90%), sore throat (63%), chills (60%) and fever (58%). The most frequently detected clinical findings were enlarged lymph nodes (n= 34, 85%), followed by tonsillitis (20%), skin lesions (15%) and conjunctivitis (8%). Most of the patients (82.5%) had been misdignosed as acute tonsillitis, suppurative lymphadenitis, tuberculous lymphadenitis and brucellosis, before their admission to our hospital and treated with beta-lactam antibiotics. Demographic analysis of the cases revealed that 68% of them lived in the rural area, 75% had rodents at home, 46% used natural water supplies, 53% fed animals, 15% had contact with game animals and 5% had contact with ticks. Clinical samples from the patients were found culture negative for F.tularensis. The diagnosis of the cases was based on the presence of specific F.tularensis antibodies between 1/160-1/1280 titers obtained by microagglutination test. Additionally F.tularensis DNA was demonstrated in three lymph node aspirate samples by polymerase chain reaction (PCR). Water samples were found negative both by culture and PCR assays. However, it was detected that there were problems in the chlorination of water supplies in the two villages where epidemics were seen. All the patients were treated with streptomycin (2 x 1 g, intramuscular, 10 days), and surgical intervention was performed for the patients (n= 12) with extremely large lymph nodes and suppuration. Erythema nodosum developed in two patients following the end of treatment. Death or serious complications such as pneumonia or meningitis were not detected. In conclusion, tularemia should be considered in patients presenting with cervical lymphadenopathy, sore throat, fever and unresponsive to previous treatment with beta-lactam antibiotics. For the management of the disease, healthcare personnel and the community should be educated concerning the risk factors and precautions for tularemia.Öğe Konya Bölgesinde tularemi(2012) Dikici, Nebahat; Ural, Onur; Sümer, Şua; Öztürk, Kayhan; Albayrak, Özgen Yiğit; Katlanır, Eda; Keleş, BaharFrancisella tularensisin neden olduğu zoonotik bir enfeksiyon olan tularemi, son yıllarda ülkemizde oluşan salgınlar ve sporadik olgularla yeniden önem kazanmıştır. Etkenin bulaşı en sık, kontamine su ve besinler, enfekte hayvanlarla temas ve böcek/kene ısırığı ile olur. Bu çalışmada, bölgemizde iki ayrı bel- dede iki ayrı dönemde ortaya çıkan salgınlarda tularemi tanısı konulan 35 olgu ile beş sporadik olgu, klinik özellikleri ve laboratuvar bulguları yönünden değerlendirilmiştir. Her iki salgında da ilk (indeks) olgular kliniğimize servikal lenfadenopati şikayetiyle başvurmuştur. Tularemi tanısı konulduktan sonra, başka olguların olup olmadığını araştırmak amacıyla bir ekip oluşturulmuş ve ilçeler ziyaret edilmiştir. Mikrobiyolojik tanıya yönelik olarak, şüpheli olgulardan kan, boğaz ve tonsil sürüntüsü ve lenf nodu as- pirasyon örnekleri alınmış; tanısal testler (kültür, seroloji, moleküler yöntemler) Refik Saydam Hıfzıssıh- ha Merkezinde gerçekleştirilmiştir. Ayrıca, İl Sağlık Müdürlüğü tarafından, adı geçen beldelerin içme ve kullanma sularından örnekler toplanmıştır. Çalışmamızda, Emen beldesindeki ilk epidemiye ait olgular (n 14) Şubat 2010 tarihinde, Yukarıçiğil beldesindeki ikinci epidemiye ait olgular (n 21) Kasım-Aralık 2010 tarihinde tanımlanmış; beş olgu ise sporadik olarak izlenmiştir. Toplam 40 olgunun 25i kadın, 15i erkek olup, yaş ortalaması 37.6 (yaş aralığı: 5-80 yıl; beşi çocuk yaş grubu) yıldır. Başvuru şikayetlerinin en sık; boyunda kitle (%90), boğaz ağrısı (%63), üşüme/titreme (%60) ve ateş (%58) olduğu görülmüştür. En sık saptanan fizik muayene bulgusu ise servikal lenfadenopati (n 34, %85) olmuş; bunu tonsillit (%20), cilt lezyonları (%15) ve konjunktivit (%8) izlemiştir. Hastaların çoğunun (%82.5), klini- ğimize başvuru öncesinde değişik tanılar (akut tonsillit, süpüratif lenfadenit, tüberküloz lenfadenit, bru- selloz) ile beta-laktam antibiyotik tedavisi aldığı öğrenilmiştir. Olguların %68inin kırsal kesimde yaşadı- ğı, %75inin evinde kemirici bulunduğu, %46sının doğal su kaynaklarını kullandığı, %53ünün evde hayvan beslediği, %15inin av hayvanları ile teması olduğu ve %5inin çevresinde kene varlığı öyküsü saptanmıştır. Olgulardan alınan boğaz sürüntüsü ve lenf nodu aspirat kültürlerinin hiçbirinde F.tularensis üremesi olmamış; olguların tanısı mikroaglutinasyon testi ile saptanan 1/160-1/1280 titrelerde pozitif özgül F.tularensis antikor varlığıyla konulmuştur. Ayrıca, üç olgudan alınan aspirat örneğinde, polimeraz zincir reaksiyonu (PCR) ile F.tularensis DNAsı gösterilmiştir. Su örneklerinde kültür ve PCR ile F.tularensis pozitifliği saptanmamış; ancak epidemi izlenen her iki bölgede de içme sularının klorlanmasında aksaklıklar (şebeke suyuna, klorlama yapılmayan bir kaynak suyunun bağlanması gibi) olduğu izlenmiştir. Tüm hastalar streptomisin (2 x 1 g, 10 gün, intramusküler) ile tedavi edilmiş; lenf bezi ileri derece- de büyük olan ve süpürasyon gösteren olgulara (n 12) cerrahi girişim uygulanmıştır. İki olguda tedavi sonlandıktan iki hafta sonra eritema nodozum gelişmiş; olguların hiçbirinde pnömoni, menenjit gibi ciddi komplikasyonlar ve ölüm izlenmemiştir. Sonuç olarak, servikal lenfadenopati, boğaz ağrısı ve ateş şikayetleriyle başvuran, özellikle beta-laktam antibiyotik tedavisine yanıt alınamayan hastalarda tulareminin dikkate alınması; risk faktörleri ve önlemler açısından sağlık personeli ve topluma yönelik eğitim- lerin yapılması gerektiği kanısına varılmıştır.Öğe Konya Bölgesinde Tularemi(2012) Dikici, Nebahat; Ural, Onur; Sümer, Şua; Öztürk, Kayhan; Yiğit, Özgen Albayrak; Katlanır, Eda; Keleş, BaharTularemia is a zoonotic infection caused by Francisella tularensis. In the recent years tularemia has become a re-emerging infection in Turkey with epidemics and also sporadic cases. Transmission occurs most often through consumption of contaminated water and food, direct contact with animals and insect/tick bites. In this study, we evaluated clinical features and laboratory findings of 35 tularemia cases diagnosed during two outbreaks that occurred in two different villages during two different periods in Konya (located in Central Anatolia), Turkey and five sporadic cases. In both outbreaks, first (index) cases were admitted to our outpatient clinic with the complaints of cervical lympadenopathy. After diagnosis of tularemia, an organized team visited the villages to search if more cases existed. For microbiological diagnosis, blood, throat and tonsil swabs and lymph node aspirate specimens were collected from the suspected cases. Diagnostic tests (culture, serology, molecular methods) for tularemia were performed in reference center, Refik Saydam National Public Health Agency. Drinking and potable water samples from those villages were also collected by provincial health authorities. The cases (n= 14) that belonged to the first epidemics were detected in February 2010 and cases (n= 21 J of the second epidemics in November-December 2010; five cases were followed as sporadic. The mean age of the 40 patients (25 females, 15 males) was 37.6 (age range: 5-80 years; five of them were pediatric group) years. The most common complaints of patients were cervical mass (90%), sore throat (63%), chills (60%) and fever (58%). The most frequently detected clinical findings were enlarged lymph nodes (n= 34, 85%), followed by tonsillitis (20%), skin lesions (15%) and conjunctivitis (8%). Most of the patients (82.5%) had been misdignosed as acute tonsillitis, suppurative lymphadenitis, tuberculous lymphadenitis and brucellosis, before their admission to our hospital and treated with beta-lactam antibiotics. Demographic analysis of the cases revealed that 68% of them lived in the rural area, 75% had rodents at home, 46% used natural water supplies, 53% fed animals, 15% had contact with game animals and 5% had contact with ticks. Clinical samples from the patients were found culture negative for F.tularensis. The diagnosis of the cases was based on the presence of specific F.tularensis antibodies between 1/160-1/1280 titers obtained by microagglutination test. Additionally F.tularensis DNA was demonstrated in three lymph node aspirate samples by polymerase chain reaction (PCR). Water samples were found negative both by culture and PCR assays. However, it was detected that there were problems in the chlorination of water supplies in the two villages where epidemics were seen. All the patients were treated with streptomycin (2 x 1 g, intramuscular, 10 days), and surgical intervention was performed for the patients (n= 12) with extremely large lymph nodes and suppuration. Erythema nodosum developed in two patients following the end of treatment. Death or serious complications such as pneumonia or meningitis were not detected. In conclusion, tularemia should be considered in patients presenting with cervical lymphadenopathy, sore throat, fever and unresponsive to previous treatment with beta-lactam antibiotics. For the management of the disease, healthcare personnel and the community should be educated concerning the risk factors and precautions for tularemia.
