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    B cell aplasia and hypogammaglobulinemia associated with levetiracetam
    (K FAISAL SPEC HOSP RES CENTRE, 2018) Özdemir, Hülya; Sümer, Sua; Karabağlı, Hakan; Akdemir, Gökhan; Calışkaner, A. Zafer; Artaç, Hasibe
    Levetiracetam (LEV) is a second-generation antiepileptic drug approved for the treatment of several types of epilepsy. We report a 45-year-old female who developed hypogammaglobulinemia and B cell aplasia during LEV treatment. The Naranjo probability score for an adverse drug reaction was 6. After LEV discontinuation, the number of B cells gradually increased and reached normal levels within two months. This case suggests that monitoring of immunoglobulin levels and lymphocyte subsets analysis is important in patients treated with LEV, especially in cases of prolonged infections.
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    Calcified intracranial hydatid cyst: Case report
    (2011) Köktekir, Ender; Erdem, Yavuz; Gökçek, Cevdet; Karatay, Mete; Yılmaz, Ali; Bayar, Mehmet Akif; Sümer, Sua
    Bu çalışmada; 26 yaşında, çiftlik işleri ile uğraşan, asemptomatik intrakraniyal hidatik kisti olan bir olgu sunulmaktadır. Kafa travması nedeni ile yapılan radyolojik incelemelerde kalsifiye intrakraniyal hidatik kist saptanan hasta cerrahi tedavi ile kitlenin tamamen çıkartılması sonrası nörolojik defisiti olmadan taburcu edildi. İntrakraniyal hidatik kistlerin kalsifikasyonu oldukça nadirdir. Bilgisayarlı beyin tomografisi ve kraniyal magnetik rezonans incelemeleri operasyon öncesi tanı için oldukça önemlidir. Radyolojik incelemeler esnasında membran detaşmanının, kist duvarında kalsifikasyonun ve kist içi membranların varlığı hidatik kist varlığına işaret eder. (Turkiye Parazitol Derg 2011; 35: 220-3)
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    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, Ahmet
    Objective: 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 problems
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    First Case of Hepatitis B Virus Genotype H Infection in Turkey
    (ANKARA MICROBIOLOGY SOC, 2013) Ural, Onur; Sayan, Murat; Akhan, Sıla; Sümer, Sua; Şimşek, Funda
    Clinical 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 IgG (+), 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 polynnerase 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.
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    How should procalcitonin and C-reactive protein levels be interpreted in haemodialysis patients?
    (WILEY, 2018) Demir, Nazlım A.; Sümer, Sua; Çelik, Gülperi; Afşar, Rengin Elsürer; Demir, Lütfi S.; Ural, Onur
    Background: Procalcitonin (PCT) and C-reactive protein (CRP) are used most widely in the diagnosis/treatment of bacterial infections. These are not infection-specific and may also show increases in other inflammation-causing cases. Aim: To establish a new cut-off value for PCT and CRP to eliminate confusion in the diagnosis and treatment of bacterial infections in haemodialysis (HD) patients. Methods: A total of 1110 patients, 802 with undocumented infection and 308 with documented infection, was included in the study. Results: A total of 802 patients with undocumented infection had a mean CRP value of 12.2 +/- 9.6 mg/dL and a mean PCT value of 0.51 +/- 0.96 ng/mL and the 308 patients with documented infection had a mean CRP value of 125.9 +/- 83.3 mg/dL and a mean PCT value of 13.9 +/- 26.9 ng/mL at the time of admittance. In HD patients, the cut-off values for CRP was determined as 19.15 mg/dL and for PCT as 0.685 ng/mL in the presence of infection. The use of these two parameters in combination (CRP = 19.15 mg/dL and PCT = 0.685 ng/mL) was found to have 95% positive predictive value (PPV) and 93% negative predictive value (NPV) for the diagnosis of infectious diseases in HD patients. When CRP = 100 mg/dL and PCT = 5 ng/mL, this was found to have 100% PPV and 94% NPV for the diagnosis of sepsis in HD patients. Conclusion: We specified PCT and CRP cut-off values with high PPV and NPV for revealing the presence of bacterial infection and sepsis in HD patients.
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    Intracranial Giant Tuberculoma Mimicking Brain Tumor: A Case Report
    (TURKISH NEUROSURGICAL SOC, 2015) Sümer, Sua; Köktekir, Ender; Demir, Nazlım Aktuğ; Akdemir, Gökhan
    Tuberculomas are small tumor-like lumps that can be seen, usually in large numbers, in central nervous system involvement of tuberculosis. Giant tuberculomas that are big enough to cause symptoms of compression are also encountered, though rarely. When they are really large, tuberculomas may result in increased intracranial compression, neurologic deficits, or epileptic attacks. Giant tuberculomas may be confused with brain tumors on cranial magnetic resonance imaging. Cranial magnetic resonance imaging and histopathology examinations are used for diagnosis. Although magnetic resonance imaging is useful for diagnosing tuberculoma, histopathology examination is the gold standard for a final diagnosis. This paper presents a case involving a 66-year-old patient who complained of headache, imbalance and dizziness, and underwent an operation in the neurosurgery clinic with a pre-diagnosis of brain tumor, and was then diagnosed with intracranial giant tuberculoma.
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    The Role of Procalcitonin, C-Reactive Protein, Interleukin-6, Interleukin-8 and Endotoxin in the Early Diagnosis and Follow-up of Local Infections
    (NOBEL ILAC, 2012) Sümer, Sua; Erayman, İbrahim; Türk Arıbaş, Emel
    Objective: Infectious diseases are one of the leading cause of mortality and morbitidy in developed as well as in developing countries. Local infections, uriner tract and wound infections are most frequently seen. In this study the role of procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 interleukin-8 (IL-8) ye endotoxin is investigated in the early diagnosis and follow-up of local infections. Material and Method: A total of 67 patients (33/34 patients with urinary tract and wound infections) between May 2006-June 2007 at various departments and intensive care units of Selcuk University Meram Medical School Hospital were evaluated. The control group consisted of 20 healthy individuals. The patients over the age of 18, with no history of antibiotic therapy were included in the urinary tract infection group if they were symptomatic and had a positive urine test. The patients who were monitored with the diagnosis of decubitus / diabetic foot ulcers or surgical zone infection who had positive wound culture tests were included in the wound infection group. The patients with negative culture results were excluded regardless of data indicating infection. Results: In the wound infection group changes of PCT, CRP IL-6, IL-8 and endotoxin levels were from baseline to day 7 respectively 0.12/4.74-0.05/0.94 ng/ml, 11.3/203-4.17/200 mg/dl, 2.70/22.79-1.07/10.25 pg/ml, 0.19/5-0.1/4.8 pg/ml, 0.01/6.25-0.01/0.86 pg/ml (p <= 0.001). In the urinary tract infection group changes of CRP, IL-6, IL-8 and endotoxin levels were detected from baseline to day 7 respectively 3.17/200-2.1/126 mg/dl, 1.26/14.25-0.8/6.85 pg/ml, 0.49/4.6-0.07/3.2 pg/ml, 0.07/9.65-0.01/3.65 pg/ml (p <= 0.001). Changes in PCT level was statistically significant in the wound infection group (p <= 0.001) but was not statistically significant in the urinary tract infection group (p=0.004). Conclusion: PCT, CRP and endotoxin levels are useful tools for clinicians to differantiate local infections from the healthy people. CRP, IL-6, IL-8 and endotoxin levels are useful tools for follow-up urinary tract and wound infections.