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Yilmaz G, Sezer S, Bastug A, Singh V, Gopalan R, Aydos O, Ozturk BY, Gokcinar D, Kamen A, Gramz J, Bodur H, Akbiyik F. Concordance and generalization of an AI algorithm with real-world clinical data in the pre-omicron and omicron era. Heliyon 2024; 10:e25410. [PMID: 38356547 PMCID: PMC10864957 DOI: 10.1016/j.heliyon.2024.e25410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/16/2024] Open
Abstract
All viruses, including SARS-CoV-2, the virus responsible for COVID-19, continue to evolve, which can lead to new variants. The objective of this study is to assess the agreement between real-world clinical data and an algorithm that utilizes laboratory markers and age to predict the progression of disease severity in COVID-19 patients during the pre-Omicron and Omicron variant periods. The study evaluated the performance of a deep learning (DL) algorithm in predicting disease severity scores for COVID-19 patients using data from the USA, Spain, and Turkey (Ankara City Hospital (ACH) data set). The algorithm was developed and validated using pre-Omicron era data and was tested on both pre-Omicron and Omicron-era data. The predictions were compared to the actual clinical outcomes using a multidisciplinary approach. The concordance index values for all datasets ranged from 0.71 to 0.81. In the ACH cohort, a negative predictive value (NPV) of 0.78 or higher was observed for severe patients in both the pre-Omicron and Omicron eras, which is consistent with the algorithm's performance in the development cohort.
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Affiliation(s)
- Gulsen Yilmaz
- Department of Medical Biochemistry, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Department of Medical Biochemistry, Ministry of Health, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Sevilay Sezer
- Department of Medical Biochemistry, Ministry of Health, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Aliye Bastug
- Department of Infectious Disease and Clinical Microbiology, Health Science University of Turkey, Gulhane Medical School, Ankara City Hospital, Ankara, Turkey
| | - Vivek Singh
- Siemens Healthineers, Digital Technology and Innovation, Princeton, NJ, USA
| | - Raj Gopalan
- Siemens Healthineers, Diagnostics, Tarrytown, NY, USA
| | - Omer Aydos
- Department of Infectious Disease and Clinical Microbiology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Busra Yuce Ozturk
- Department of Infectious Disease and Clinical Microbiology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Derya Gokcinar
- Department of Anesthesiology and Reanimation, Health Science University Turkey, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Ali Kamen
- Siemens Healthineers, Digital Technology and Innovation, Princeton, NJ, USA
| | - Jamie Gramz
- Siemens Healthineers, Diagnostics, Tarrytown, NY, USA
| | - Hurrem Bodur
- Department of Infectious Disease and Clinical Microbiology, Health Science University of Turkey, Gulhane Medical School, Ankara City Hospital, Ankara, Turkey
| | - Filiz Akbiyik
- Ankara Bilkent City Hospital Laboratory, Medical Director, Siemens Healthineers, Ankara, Turkey
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Kazancioglu S, Bastug A, Ozbay BO, Tezcan H, Buyuktarakci C, Akbay A, Bodur H. The usefulness of hematological parameters and cerebrospinal fluid indexes in the differential diagnosis of acute bacterial from viral meningitis. Diagn Microbiol Infect Dis 2023; 107:116005. [PMID: 37392600 DOI: 10.1016/j.diagmicrobio.2023.116005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/19/2023] [Accepted: 06/07/2023] [Indexed: 07/03/2023]
Abstract
Central nervous system (CNS) infection is a medical emergency with an important cause of mortality worldwide. The 79 patients with confirmed acute CNS infection (48 bacterial and 31 viral meningitis) were evaluated. Bacterial meningitis score, cerebrospinal fluid (CSF)/serum glucose ratio, and CSF/serum albumin ratio had the highest area under the curves (0.873, 0.843, 0.810, respectively) for discriminating bacterial meningitis. Neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte ratio (PLR) and CSF lactate dehydrogenase have a good ability for the differential diagnosis of bacterial meningitis. CSF/serum glucose ratio, NLR (with a cut-off value> 8.87), large unstained cell, total protein, albumin, and procalcitonin levels were found to be predictors for mortality. NLR can be used as a biomarker to differentiate bacterial meningitis from viral meningitis and to predict the prognosis of CNS infection. CSF/serum albumin ratio and CSF lactate dehydrogenase can be used to predict bacterial meningitis as well as CSF/serum glucose ratio.
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Affiliation(s)
- Sumeyye Kazancioglu
- Ministry of Health Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
| | - Aliye Bastug
- Health Science University Turkey, Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Bahadir Orkun Ozbay
- Ministry of Health Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Hatice Tezcan
- Ministry of Health Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Cansu Buyuktarakci
- Ministry of Health Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Aysenur Akbay
- Ministry of Health Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Hurrem Bodur
- Health Science University Turkey, Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
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Ozbay BO, Aypak A, Bastug A, Aydos Ö, Mumcuoglu İ, Büyükberber SG, Karcıoğlu AM, Bodur H. An investigation of clinical characteristics and antimicrobial agent susceptibility patterns in clinical Comamonas testosteroni isolates: An increasingly prevalent nosocomial pathogen. Infect Dis Now 2023; 53:104622. [PMID: 36245130 DOI: 10.1016/j.idnow.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Comamonas testosteroni is a gram-negative bacillus, known before 1987 as Pseudomonas testosteroni. Although considered as a rare pathogen, its frequency has been increasing. Data regarding its antibiotic susceptibility are insufficient. To date, forty-four cases have been reported in the literature. In this study, we identified the C. testosteroni infections observed in our hospital and evaluated their antimicrobial agent susceptibility patterns compared with cases reported in the literature. METHODS For the purposes of the present study, patients admitted to hospital between November 2019 and December 2020 were screened. Those with clinical and laboratory signs of infection with positive C. testosteroni growth in culture were enrolled. Clinical isolates obtained from the samples processed in accordance with standard microbiological examination procedures in our laboratory were defined by MALDI-TOF mass spectrometry with 99.9% probability as C. testosteroni. RESULTS C testosteroni infection was detected between November 2019 and December 2020 in eight patients in our hospital. Six of them had a bloodstream infection (BSI), one had pneumonia, and one had urinary tract infection due to C. testosteroni. Coexistence of COVID-19 was detected in four patients. Six out of the eight cases with BSI had hospital-acquired infection and all of the infections were healthcare-associated. When antimicrobial agent susceptibility results reported in the literature were evaluated in combination with the current results, ceftazidime and meropenem were found to be the most susceptible agents (96.1% and 80%, respectively). CONCLUSIONS The frequency of nosocomial C. testosteroni infections and resistance to antimicrobial agents are gradually increasing. While resistance to carbapenems is on the upswing, third-generation cephalosporins are still seen as suitable treatment options.
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Affiliation(s)
- Bahadır Orkun Ozbay
- Ministry of Health, Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
| | - Adalet Aypak
- Ministry of Health, Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Aliye Bastug
- Health Science University Turkey, Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Ömer Aydos
- Ministry of Health, Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - İpek Mumcuoglu
- Ministry of Health, Ankara City Hospital, Department of Medical Microbiology, Ankara, Turkey
| | | | - Ayşe Müge Karcıoğlu
- Ministry of Health, Ankara City Hospital, Department of Critical Care Medicine, Turkey
| | - Hurrem Bodur
- Health Science University Turkey, Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
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Ozdemir B, Akinci E, But A, Kazancioglu S, Yastı AÇ, Yüksek YN, Sözen İ, Bodur H. Blood Stream Infections (BSI) in Severe Burn Patients: Epidemiology, Microbiology, Laboratory Features and Risk Factors for Mortality. mjima 2022. [DOI: 10.4274/mjima.galenos.2022.2022.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Kazancioglu S, Bastug A, Ozdemir B, Akinci E, Bodur H. Prognostic Value of Hemogram-Derived Ratios in Patients with Crimean-Congo Hemorrhagic Fever. Vector Borne Zoonotic Dis 2022; 22:465-471. [PMID: 36036730 DOI: 10.1089/vbz.2022.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Crimean-Congo hemorrhagic fever (CCHF) is an emerging infectious disease that has epidemic and pandemic potential and causes mortality. Predicting the outcome of the disease is important to guide the management of patients and prevent mortality. Materials and Methods: This study aimed to investigate hemogram parameters and hemogram-derived ratios for predicting mortality in 207 patients with CCHF (survivors = 177, nonsurvivors = 30). Results: Compared with the survivor group, the nonsurvivor group had higher neutrophils, neutrophil-to-lymphocyte ratio (NLR), derived NLR (d-NLR), and aspartate aminotransferase (AST), AST-to-lymphocyte ratio index (ALRI) on admission and third day of hospitalization. Higher white blood cells (WBCs), lower platelet-to-lymphocyte ratio on admission, and lower lymphocytes, and monocytes on the third day were found in the nonsurvivor group. Evaluating the change of admission and the third day of laboratory values, a downward trend in neutrophils, NLR, d-NLR, ALRI, and an upward trend in WBCs were found statistically significant in the survivor group. These dynamic changes were not found in the nonsurvivor group. AST (third day) and ALRI (third day) had the highest area under the curve (AUC) in the receiver operating characteristic analysis (0.939 and 0.934, respectively; p-value is <0.0001 for all). The NLR on the third day than on admission had a higher AUC, the optimal cutoff value was 1.44, which resulted in a sensitivity of 93.33 and a specificity of 40.34 (AUC: 0.790, p < 0.0001). The d-NLR on the third day had a higher AUC (with a sensitivity of 81.48 and a specificity of 67.43) than on admission (0.781 and 0.669, respectively). Conclusion: CCHF is a common vector-borne disease and mortality rates are high. This study revealed that NLR, d-NLR, and ALRI can be used as biomarkers to predict mortality. Patients who survived had better improvement in hemogram parameters and ratios. Therefore, patients who do not show this improvement should be followed more closely.
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Affiliation(s)
- Sumeyye Kazancioglu
- Department of Infectious Diseases and Clinical Microbiology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Aliye Bastug
- Department of Infectious Diseases and Clinical Microbiology, Health Science University Turkey, Ankara City Hospital, Ankara, Turkey
| | - Burcu Ozdemir
- Department of Infectious Diseases and Clinical Microbiology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Esragul Akinci
- Department of Infectious Diseases and Clinical Microbiology, Health Science University Turkey, Ankara City Hospital, Ankara, Turkey
| | - Hurrem Bodur
- Department of Infectious Diseases and Clinical Microbiology, Health Science University Turkey, Ankara City Hospital, Ankara, Turkey
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Özbay BO, Bastuğ A, Köksal Cevher Ş, Yenigün EC, Mumcuoğlu İ, Bodur H. Eggerthia catenaformis-related peritonitis in a patient with peritoneal dialysis. Anaerobe 2022; 75:102558. [DOI: 10.1016/j.anaerobe.2022.102558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 04/02/2022] [Accepted: 04/06/2022] [Indexed: 11/01/2022]
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Kazancioglu S, Bastug A, Kayaaslan B, Mutlu NM, Calci E, Turhan T, Mumcuoglu I, Akinci E, Bodur H. Diagnostic value of β-D-glucan alone or combined with Candida score, colonization index and C-reactive protein for candidemia. J Infect Dev Ctries 2022; 16:362-368. [PMID: 35298433 DOI: 10.3855/jidc.15711] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 01/13/2022] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Candidemia causes high mortality and is occuring at increasing rate in intensive care units (ICUs). (1,3)- β-D-glucan (BDG) testing is recommended in neutropenic patients. However the usefulness of BDG in ICUs is unclear. METHODOLOGY This study was conducted to compare the diagnostic value of Candida score (CS), colonization index (CI), serum BDG detection, and routine laboratory parameters in ICU patients. Characteristics and laboratory data of 83 patients (15 patients with candidemia and 68 patients without candidemia) were evaluated. RESULTS Median serum BDG was significantly higher in the candidemia group (129 pg/mL vs. 36 pg/mL, p < 0.001). BDG assay with standard cut-off value ≥ of 80 pg/mL had 93.33% sensitivity and 64.18% specificity (Areas under the ROC curve (AUC): 0.788). This study concluded that the optimal cut-off value for BDG assay was 112 pg/mL with sensitivity of 86.67% and specificity of 82.09% (AUC: 0.844). C-reactive protein (CRP) with optimal cut-off value ≥ 85 mg/L and BDG ≥ 80 pg/mL had the highest AUC (0.862, 95% CI: 0.768 - 0.928) with sensitivity 93.33% and specificity 79.1%. CONCLUSIONS Predicting candidemia is essential in critically ill patients who are at high risk and have high mortality rates. The results of this study suggest that BDG testing is useful for predicting candidemia in ICU. However, BDG combined with CRP may be a stronger predictor for candidemia.
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Affiliation(s)
- Sumeyye Kazancioglu
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey.
| | - Aliye Bastug
- Department of Infectious Diseases and Clinical Microbiology, Health Science University Turkey, Ankara City Hospital, Ankara, Turkey
| | - Bircan Kayaaslan
- Department of Infectious Diseases and Clinical Microbiology, Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | | | - Esin Calci
- Department of Clinical Biochemistry, Uşak Public Health laboratory, Uşak, Turkey
| | - Turan Turhan
- Department of Clinical Biochemistry, Ankara City Hospital, Ankara, Turkey
| | - Ipek Mumcuoglu
- Department of Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Esragul Akinci
- Department of Infectious Diseases and Clinical Microbiology, Health Science University Turkey, Ankara City Hospital, Ankara, Turkey
| | - Hurrem Bodur
- Department of Infectious Diseases and Clinical Microbiology, Health Science University Turkey, Ankara City Hospital, Ankara, Turkey
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Bastug A, Bektas H, Buyuktarakci C, Bodur H. Para-infectious Guillain Barre Syndrome in a Patient Diagnosed with COVID-19. Ankara Med J 2022. [DOI: 10.5505/amj.2022.61482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Guner R, Hasanoglu I, Kayaaslan B, Aypak A, Akinci E, Bodur H, Eser F, Kaya Kalem A, Kucuksahin O, Ates I, Bastug A, Tezer Tekce Y, Bilgic Z, Gursoy FM, Akca HN, Izdes S, Erdem D, Asfuroglu E, Hezer H, Kilic H, Civak M, Aydogan S, Buzgan T. Response to the letter to the editor. J Infect Public Health 2022; 15:65-67. [PMID: 34915424 PMCID: PMC8664607 DOI: 10.1016/j.jiph.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Rahmet Guner
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Imran Hasanoglu
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Bircan Kayaaslan
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Adalet Aypak
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey.
| | - Esragul Akinci
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
| | - Hurrem Bodur
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
| | - Fatma Eser
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Ayse Kaya Kalem
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Orhan Kucuksahin
- Department of Rheumatology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Ihsan Ates
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey.
| | - Aliye Bastug
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
| | - Yasemin Tezer Tekce
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
| | - Zeynep Bilgic
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
| | - Fahriye Melis Gursoy
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
| | - Hatice Nisa Akca
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
| | - Seval Izdes
- Department of Anaesthesiology and Reanimation Ankara, Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Deniz Erdem
- Department of Anaesthesiology and Reanimation Ankara, Ankara City Hospital, Ankara, Turkey.
| | - Emra Asfuroglu
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey.
| | - Habibe Hezer
- Department of Pulmonary Diseases, Ankara City Hospital, Ankara, Turkey.
| | - Hatice Kilic
- Department of Pulmonary Diseases, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Musa Civak
- Department of Internal Medicine Ankara City Hospital, Ankara, Turkey.
| | - Sibel Aydogan
- Department of Virology, Ankara City Hospital, Ankara, Turkey.
| | - Turan Buzgan
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
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Bastug A, Bodur H, Aydos O, Filazi N, Oksuz E, Ozkul A. The changing dynamics of neutralizing antibody response within ten months of SARS-CoV-2 infections. J Med Virol 2021; 94:1983-1989. [PMID: 34967013 PMCID: PMC9015236 DOI: 10.1002/jmv.27544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/15/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022]
Abstract
There are limited data on how long neutralizing antibody (NAb) response elicited via primary SARS‐CoV‐2 infection will last. Eighty‐four serum samples were obtained from a prospective cohort of 42 laboratory‐confirmed COVID‐19 inpatients at the time of discharge from the hospital and in the late convalescent phase. A virus neutralization assay was performed to determine the presence and titers of NAbs with authentic SARS‐CoV‐2. Long‐term dynamics of NAbs and factors that may have an impact on humoral immunity were investigated. Mild and moderate/severe patients were compared. The mean sampling time was 11.12 ± 5.02 days (4–28) for the discharge test and 268.12 ± 11.65 days (247–296) for the follow‐up test. NAb response was present in 83.3% of the patients about 10 months after infection. The detectable long‐term NAb rate was significantly higher in mild patients when compared to moderate/severe patients (95.7% vs. 68.4%, p = 0.025). In the follow‐up, NAb‐positive and ‐negative patients were compared to determine the predictors of the presence of long‐term humoral immunity. The only significant factor was disease severity. Patients with mild infections have more chance to have NAbs for a longer time. Age, gender, and comorbidity did not affect long‐term NAb response. NAb titers decreased significantly over time, with an average rank of 24.0 versus 19.1 (p = 0.002). Multivariate generalized estimating equation analysis revealed that no parameter has an impact on the change of NAb titers over time. The majority of the late convalescent patients still had detectable low levels of neutralizing antibodies. The protective effect of these titers of NAbs from re‐infections needs further studies. The majority of the recovered patients (83%) had detectable NAbs up to nearly 10 months after onset. This study reveals a significant decrease in terms of NAb titers over time. Milder infections were found as the only predictor of long‐term detectable NAb response. Age, gender, and severe disease had no significant effect on changing titers of long‐term NAbs.
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Affiliation(s)
- Aliye Bastug
- Health Science University Turkey, Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Turkey
| | - Hurrem Bodur
- Health Science University Turkey, Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Turkey
| | - Omer Aydos
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Turkey
| | - Nazlican Filazi
- Ankara University, Faculty of Veterinary Medicine, Department of Virology, Turkey
| | - Ergun Oksuz
- Department of Family Medicine, Baskent University, Ankara, Turkey
| | - Aykut Ozkul
- Ankara University, Faculty of Veterinary Medicine, Department of Virology, Turkey.,Ankara University, Biotechnology Institute, Turkey
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Guner R, Kayaaslan B, Hasanoglu I, Aypak A, Bodur H, Ates I, Akinci E, Erdem D, Eser F, Izdes S, Kalem AK, Bastug A, Karalezli A, Surel AA, Ayhan M, Karaahmetoglu S, Turan IO, Arguder E, Ozdemir B, Mutlu MN, Bilir YA, Sarıcaoglu EM, Gokcinar D, Gunay S, Dinc B, Gemcioglu E, Bilmez R, Aydos O, Asilturk D, Inan O, Buzgan T. Development and validation of nomogram to predict severe illness requiring intensive care follow up in hospitalized COVID-19 cases. BMC Infect Dis 2021; 21:1004. [PMID: 34563117 PMCID: PMC8467006 DOI: 10.1186/s12879-021-06656-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/03/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Early identification of severe COVID-19 patients who will need intensive care unit (ICU) follow-up and providing rapid, aggressive supportive care may reduce mortality and provide optimal use of medical resources. We aimed to develop and validate a nomogram to predict severe COVID-19 cases that would need ICU follow-up based on available and accessible patient values. METHODS Patients hospitalized with laboratory-confirmed COVID-19 between March 15, 2020, and June 15, 2020, were enrolled in this retrospective study with 35 variables obtained upon admission considered. Univariate and multivariable logistic regression models were constructed to select potential predictive parameters using 1000 bootstrap samples. Afterward, a nomogram was developed with 5 variables selected from multivariable analysis. The nomogram model was evaluated by Area Under the Curve (AUC) and bias-corrected Harrell's C-index with 95% confidence interval, Hosmer-Lemeshow Goodness-of-fit test, and calibration curve analysis. RESULTS Out of a total of 1022 patients, 686 cases without missing data were used to construct the nomogram. Of the 686, 104 needed ICU follow-up. The final model includes oxygen saturation, CRP, PCT, LDH, troponin as independent factors for the prediction of need for ICU admission. The model has good predictive power with an AUC of 0.93 (0.902-0.950) and a bias-corrected Harrell's C-index of 0.91 (0.899-0.947). Hosmer-Lemeshow test p-value was 0.826 and the model is well-calibrated (p = 0.1703). CONCLUSION We developed a simple, accessible, easy-to-use nomogram with good distinctive power for severe illness requiring ICU follow-up. Clinicians can easily predict the course of COVID-19 and decide the procedure and facility of further follow-up by using clinical and laboratory values of patients available upon admission.
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Affiliation(s)
- Rahmet Guner
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Bilkent Street no:1, Ankara, 06800, Turkey
| | - Bircan Kayaaslan
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Bilkent Street no:1, Ankara, 06800, Turkey.
| | - Imran Hasanoglu
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Bilkent Street no:1, Ankara, 06800, Turkey
| | - Adalet Aypak
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Hurrem Bodur
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Ihsan Ates
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey
| | - Esragul Akinci
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Deniz Erdem
- Department of Anesthesiology and Reanimation, Ankara City Hospital, Ankara, Turkey
| | - Fatma Eser
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Bilkent Street no:1, Ankara, 06800, Turkey
| | - Seval Izdes
- Department of Anesthesiology and Reanimation and Intensive Care Unıt, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Ayse Kaya Kalem
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Bilkent Street no:1, Ankara, 06800, Turkey
| | - Aliye Bastug
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Aysegul Karalezli
- Department of Pulmonary Diseases, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Aziz Ahmet Surel
- Department of General Surgery, Ankara City Hospital, Ankara, Turkey
| | - Muge Ayhan
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | | | - Isıl Ozkocak Turan
- Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Emine Arguder
- Department of Anesthesiology and Reanimation and Intensive Care Unıt, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Burcu Ozdemir
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Mehmet Nevzat Mutlu
- Department of Anesthesiology and Reanimation, Ankara City Hospital, Ankara, Turkey
| | - Yesim Aybar Bilir
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Elif Mukime Sarıcaoglu
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Derya Gokcinar
- Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Sibel Gunay
- Department of Pulmonary Diseases, Ankara City Hospital, Ankara, Turkey
| | - Bedia Dinc
- Department of Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Emin Gemcioglu
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey
| | - Ruveyda Bilmez
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Omer Aydos
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Dilek Asilturk
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Osman Inan
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey
| | - Turan Buzgan
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Bilkent Street no:1, Ankara, 06800, Turkey
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12
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Sertcelik A, Baran I, Akinci E, Kazancioglu S, Bodur H. Evaluation of In Vitro Synergistic Activities of Some Antibiotic Combinations Containing Colistin, Meropenem, Vancomycin, and Minocycline against OXA-48 Carbapenemase-producing Klebsiella pneumoniae. mjima 2021. [DOI: 10.4274/mjima.galenos.2021.2021.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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13
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Bastug A, Oksuz E, Kazancioglu S, Malhan S, Ozbay BO, Bodur H. Efficacy and cost-effectivity analysis of outpatient parenteral antimicrobial therapy unit in infectious disease clinical practices: Turkey perspective. Int J Clin Pract 2021; 75:e14147. [PMID: 33709495 DOI: 10.1111/ijcp.14147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/21/2020] [Accepted: 03/07/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Outpatient parenteral antimicrobial treatment (OPAT) has become a common treatment modality in developed countries. OPAT units are not widespread in Turkey, and their cost-effectivity analysis has not been studied, yet. AIMS To analyze the clinical efficacy and cost-effectiveness of the OPAT unit, based on a 1000-bed teaching hospital. METHODS The records of patients, who were treated between October 2013 and December 2017, in an OPAT unit of a tertiary hospital in Ankara, were obtained retrospectively. The cost that would arise if the patients were hospitalized for the same treatment period with the same diagnosis was calculated and compared with the actual treatment cost of the patients in the OPAT unit. RESULTS A total of 594 patients who received antimicrobial treatment at the OPAT unit were enrolled. The mean age of the patients was 55.39 ± 16.37 years and 313 (52.7%) were males. Based on the end-of-treatment goals, 98.5% of the patients reached the treatment goal. An indirect cost analysis revealed that the OPAT unit was 487.625 94 TL/129.008 78 $ less costly than inpatient parenteral antibiotic treatment. In other words, OPAT cost was 75% of the equivalent inpatient costs. It was also determined that a total of 7078 bed days and 11.9 bed days per person were saved. CONCLUSIONS OPAT units should be expanded increasingly in Turkey. The evaluation together with the health care system conditions in Turkey revealed that the OPAT program is safe, effective, and cost-efficient.
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Affiliation(s)
- Aliye Bastug
- Department of Infectious Disease and Clinical Microbiology, Ankara Numune Education and Research Center, University of Health Science, Ankara, Turkey
| | - Ergun Oksuz
- Department of Family Medicine, Baskent University, Ankara, Turkey
| | - Sumeyye Kazancioglu
- Department of Infectious Disease and Clinical Microbiology, Ankara Numune Education and Research Center, Ankara, Turkey
| | - Simten Malhan
- Department of Health Care Management, Baskent University, Ankara, Turkey
| | - Bahadır Orkun Ozbay
- Department of Infectious Disease and Clinical Microbiology, Ankara Numune Education and Research Center, Ankara, Turkey
| | - Hurrem Bodur
- Department of Infectious Disease and Clinical Microbiology, Ankara Numune Education and Research Center, University of Health Science, Ankara, Turkey
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14
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Kazancioglu S, Yilmaz FM, Bastug A, Ozbay BO, Aydos O, Yücel Ç, Bodur H, Yilmaz G. Assessment of Galectin-1, Galectin-3, and PGE2 Levels in Patients with COVID-19. Jpn J Infect Dis 2021; 74:530-536. [PMID: 33790073 DOI: 10.7883/yoken.jjid.2021.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
It is important to determine the inflammatory biomarkers in the severity of Coronavirus Disease 2019 (COVID-19) with the emergence of the pandemic. Galectins and prostaglandins play important roles in the regulation of immune and inflammatory responses. Therefore, this study aimed to investigate Galectin-1 (Gal-1), Galectin-3 (Gal-3), and prostaglandin E2 (PGE2) levels in patients with COVID-19. Gal-1, Gal-3, and PGE2 serum concentrations were measured using enzyme-linked immunosorbent analysis (ELISA) on 84 COVID-19 patients (severe=29 and nonsevere=55) and 56 healthy controls. In this study, the increased levels of Gal-1 (median, 9.86, 6.35, 3.67 ng/ml), Gal-3 (median, 415.31, 326.33, 243.13 pg/ml)and PGE2 (median, 193.17, 192.58, 124.62 pg/ml) levels were found in patients with COVID-19 than healthy controls (p<0.001 for all). In the severe group, Gal-3 levels were higher while there were no differences in Gal-1 and PGE2 levels (p=0.011, p=0.263, p=0.921, respectively). There was a positive correlation between serum Gal-1 and Gal-3 levels (ρ=0.871, p<0.001). Gal-3, C-reactive protein, lymphocyte count, and age were found as independent predictors of the disease severity (p=0.002, p=0.001, p=0.007, and p=0.003, respectively). With the emergence of effective drug needs in the COVID-19 pandemic, differentiation of severe disease is important. Gal-3 could be a potential prognostic biomarker of COVID-19.
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Affiliation(s)
- Sumeyye Kazancioglu
- Department of Infectious Diseases and Clinical Microbiology, Ministry of Health Ankara City Hospital, Turkey
| | - Fatma Meric Yilmaz
- Medical Biochemistry Laboratory, Ministry of Health Ankara City Hospital, Turkey.,Department of Medical Biochemistry, Ankara Yıldırım Beyazıt University, Faculty of Medicine, Turkey
| | - Aliye Bastug
- Department of Infectious Diseases and Clinical Microbiology, Health Science University Turkey, Ankara City Hospital, Turkey
| | - Bahadir Orkun Ozbay
- Department of Infectious Diseases and Clinical Microbiology, Ministry of Health Ankara City Hospital, Turkey
| | - Omer Aydos
- Department of Infectious Diseases and Clinical Microbiology, Ministry of Health Ankara City Hospital, Turkey
| | - Çiğdem Yücel
- Department of Medical Biochemistry, Health Science University Turkey, Gülhane Training and Research Hospital, Turkey
| | - Hurrem Bodur
- Department of Infectious Diseases and Clinical Microbiology, Health Science University Turkey, Ankara City Hospital, Turkey
| | - Gulsen Yilmaz
- Medical Biochemistry Laboratory, Ministry of Health Ankara City Hospital, Turkey.,Department of Medical Biochemistry, Ankara Yıldırım Beyazıt University, Faculty of Medicine, Turkey
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15
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Bastug A, Aslaner H, Aybar Bilir Y, Kemirtlek N, Gursoy FM, Bastug S, Bodur H. Multiple system inflammatory syndrome associated with SARS-CoV-2 infection in an adult and an adolescent. Rheumatol Int 2021; 41:993-1008. [PMID: 33742229 PMCID: PMC7978449 DOI: 10.1007/s00296-021-04843-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/10/2021] [Indexed: 11/24/2022]
Abstract
Multisystem inflammatory syndrome in adults (MIS-A) is a new syndrome related with COVID-19. A case-based review was performed to present real-life experiences in terms of main findings and treatment options. We described two cases with the diagnosis of MIS and searched the literature to review all reported ≥ 18-year-old cases. The PubMed, Scopus, and Web of Science databases were searched. All relevant articles from January 2020 to February 2021 were reviewed. An adolescent and an adult patient (18 and 40 years-old, respectively) with the diagnosis of MIS were presented. Both had the consistent clinical findings with the case definition criteria. Although steroid, intravenous immunoglobulin (IVIG) and supportive care treatments have been suggested in the literature, there exists no treatment guideline for MIS-A. The clinical and laboratory findings of the patients progressively improved with the implementation of the IVIG and the pulse steroid treatments. A total of 51 cases (≥ 18 years-old) with MIS were analyzed. Mean age was 29.4 ± 10 years. Fever (80.4%), gastrointestinal (72.5%), and respiratory symptoms (54.9%) were the predominant symptoms. Cardiovascular abnormalities were the most frequent reported findings (82.4%, 42/51). The dermatological and conjunctival findings were reported in 39.2% and 35.3% of the patients, respectively. The increased level of inflammatory biomarkers was remarkable. Most of the patients were treated successfully with steroid and IVIG. Clinicians managing adult patients should keep in mind the development risk of MIS related with SARS-CoV-2 infection to perform necessary interventions properly without delay. IVIG and pulse steroid treatments are the effective options on clinical improvement.
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Affiliation(s)
- Aliye Bastug
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences Turkey, Ankara City Hospital, 1604. Street, No: 9, 06800, Çankaya/Ankara, Turkey.
| | - Halide Aslaner
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, 06800, Ankara, Turkey
| | - Yesim Aybar Bilir
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, 06800, Ankara, Turkey
| | - Nizamettin Kemirtlek
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, 06800, Ankara, Turkey
| | - Fahriye Melis Gursoy
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, 06800, Ankara, Turkey
| | - Serdal Bastug
- Department of Cardiology, Yildirim Beyazit University, Ankara City Hospital, 06800, Ankara, Turkey
| | - Hurrem Bodur
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences Turkey, Ankara City Hospital, 1604. Street, No: 9, 06800, Çankaya/Ankara, Turkey
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16
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Guner R, Hasanoglu I, Kayaaslan B, Aypak A, Akinci E, Bodur H, Eser F, Kaya Kalem A, Kucuksahin O, Ates I, Bastug A, Tezer Tekce Y, Bilgic Z, Gursoy FM, Akca HN, Izdes S, Erdem D, Asfuroglu E, Hezer H, Kilic H, Cıvak M, Aydogan S, Buzgan T. Comparing ICU admission rates of mild/moderate COVID-19 patients treated with hydroxychloroquine, favipiravir, and hydroxychloroquine plus favipiravir. J Infect Public Health 2021; 14:365-370. [PMID: 33647553 PMCID: PMC7771901 DOI: 10.1016/j.jiph.2020.12.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In this study, we aimed to compare the intensive care unit (ICU) admission rate of hospitalized mild/moderate COVID-19 patients treated with hydroxychloroquine (HCQ), favipiravir, and HCQ plus favipiravir. METHODS Single center retrospective designed observational study conducted in Ankara City Hospital. Patients who were hospitalized between March 15, 2020 and June 1, 2020 in COVID-19 inpatient clinics with laboratory confirmed diagnosis of COVID-19 were included in the study. An inverse probability of treatment weighting (IPTW) for multiple treatment groups approach was used to balance the differences in several variables on admission. RESULTS Among 2441 patients hospitalized with diagnosis of COVID-19 during the study period, 824 were eligible for the analysis. Median age of patients was 42 (18-93 years). Among all, 347 (43.2%) of the patients had mild disease, 470 (56.8%) had pneumonia. Propensity scores ranged from 0.1841 to 0.9381 in the HCQ group, from 0.03643 to 0.29885 in the favipiravir group, and from 0.03542 to 0.56184 in the HCQ plus favipiravir group. After IPTW for multiple treatment groups was applied, all the covariates in the planned propensity score had weighted standardized effect sizes below 10% which were ranged from 0.005 to 0.092. Multivariate analysis of treatment effect (adjusted effect of treatment) was indicated that there is no statistically significant difference between HCQ, favipiravir, and HCQ plus favipiravir treatment. After using combination of SMOTE and Bootstrap resampling approach, we found no statistically significant difference between HCQ and HCQ plus favipiravir groups in terms of ICU admission. However, compared with the HCQ group, ICU admission rate was statistically significantly higher in the favipiravir group. We obtained the similar results after the sensitivity analysis. CONCLUSIONS HCQ with or without favipiravir treatment is associated with reduced risk of ICU admission compared to favipiravir alone in mild to moderate COVID-19 adult patients.
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Affiliation(s)
- Rahmet Guner
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Imran Hasanoglu
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Bircan Kayaaslan
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Adalet Aypak
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey.
| | - Esragul Akinci
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
| | - Hurrem Bodur
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
| | - Fatma Eser
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Ayse Kaya Kalem
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Orhan Kucuksahin
- Department of Rheumatology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Ihsan Ates
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey.
| | - Aliye Bastug
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
| | - Yasemin Tezer Tekce
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey.
| | - Zeynep Bilgic
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey.
| | - Fahriye Melis Gursoy
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey.
| | - Hatice Nisa Akca
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey.
| | - Seval Izdes
- Department of Anaesthesiology and Reanimation, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Deniz Erdem
- Department of Anaesthesiology and Reanimation, Ankara City Hospital, Ankara, Turkey.
| | - Emra Asfuroglu
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey.
| | - Habibe Hezer
- Department of Pulmonary Diseases, Ankara City Hospital, Ankara, Turkey.
| | - Hatice Kilic
- Department of Pulmonary Diseases, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Musa Cıvak
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey.
| | - Sibel Aydogan
- Department of Virology, Ankara City Hospital, Ankara, Turkey.
| | - Turan Buzgan
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
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17
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Baysal B, Dogan MB, Gulbay M, Sorkun M, Koksal M, Bastug A, Kazancioglu S, Ozbay BO, Icten S, Arslan F, Cag Y, Bodur H, Vahaboglu H. Predictive performance of CT for adverse outcomes among COVID-19 suspected patients: a two-center retrospective study. Bosn J Basic Med Sci 2021; 21:739-745. [PMID: 33577443 PMCID: PMC8554695 DOI: 10.17305/bjbms.2020.5466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 02/08/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of the study was to compare the performance of various computed tomography (CT) reporting tools, including zonal CT visual score (ZCVS), the number of involved lobes, and Radiological Society of North America (RSNA) categorization in predicting adverse outcomes among patients hospitalized due to the lower respiratory symptoms during the coronavirus disease 2019 (COVID-19) pandemic. A total of 405 patients admitted with severe respiratory symptoms who underwent a chest CT were enrolled. The primary adverse outcome was intensive care unit (ICU) admission of patients. Predictive performances of reporting tools were compared using the area under the receiver operating characteristic curves (AUC ROC). Among the 405 patients, 39 (9.63%) required ICU support during their hospital stay. At least two or more observers reported a typical and indeterminate COVID-19 pneumonia CT pattern according to RSNA categorization in 70% (285/405) of patients. Among these, 63% (179/285) had a positive polymerase chain reaction (PCR test for the SARS-CoV-2 virus. The median number of lobes involved according to CT was higher in patients who required ICU support (median interquartile range [IQR], 5[3; 5] vs. 3[0; 5]). The median ZCVS score was higher among the patients that subsequently required ICU support (median [IQR], 4[0; 12] vs. 13[5.75; 24]). The bootstrap comparisons of AUC ROC showed significant differences between reporting tools, and the ZCVS was found to be superior (AUC ROC, 71-75%). The ZCVS score at the first admission showed a linear and significant association with adverse outcomes among patients with the lower respiratory tract symptoms during the COVID-19 pandemic.
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Affiliation(s)
- Begümhan Baysal
- Department of Radiology, Istanbul Medeniyet University Goztepe Education and Research Hospital, Istanbul, Turkey
| | - Mahmut Bilal Dogan
- Department of Radiology, Istanbul Medeniyet University Goztepe Education and Research Hospital, Istanbul, Turkey
| | - Mutlu Gulbay
- Department of Radiology, University of Health Sciences Ankara City Hospital, Ankara, Turkey
| | - Mine Sorkun
- Department of Radiology, Istanbul Medeniyet University Goztepe Education and Research Hospital, Istanbul, Turkey
| | - Murathan Koksal
- Department of Radiology, University of Health Sciences Ankara City Hospital, Ankara, Turkey
| | - Aliye Bastug
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Ankara City Hospital, Ankara, Turkey
| | - Sumeyye Kazancioglu
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Ankara City Hospital, Ankara, Turkey
| | - Bahadir Orkun Ozbay
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Ankara City Hospital, Ankara, Turkey
| | - Sacit Icten
- Department of Chest Disease, Istanbul Medenıyet Unıversıty Goztepe Education And Research Hospital, Istanbul, Turkey
| | - Ferhat Arslan
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Goztepe Education and Research Hospital, Istanbul, Turkey
| | - Yasemin Cag
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Goztepe Education and Research Hospital, Istanbul, Turkey
| | - Hurrem Bodur
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Ankara City Hospital, Ankara, Turkey
| | - Haluk Vahaboglu
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Goztepe Education and Research Hospital, Istanbul, Turkey
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18
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Ergin Tuncay M, Bastug A, Erdogan S, Kazancıoglu S, Yakisik E, Erdem D, Bodur H, Erel O, Yilmaz FM. Platelet hyperreactivity related with COVID-19 disease severity. Ankara Med J 2021. [DOI: 10.5505/amj.2021.01488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Kazancioglu S, Yilmaz FM, Bastug A, Sakallı A, Ozbay BO, Buyuktarakci C, Bodur H, Yilmaz G. Lymphocyte Subset Alteration and Monocyte CD4 Expression Reduction in Patients with Severe COVID-19. Viral Immunol 2020; 34:342-351. [PMID: 33264073 DOI: 10.1089/vim.2020.0166] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The spectrum of coronavirus disease 2019 (COVID-19) severity, related to cellular immune functions, has not been fully clarified yet. Therefore, this study aimed to investigate the alteration of peripheral blood cells in patients with COVID-19. The flow cytometric characterization of immune cell subset was performed on 69 COVID-19 patients and 21 healthy controls. These data were evaluated based on the disease severity. A total of 69 patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were classified as asymptomatic infection (n = 14), nonsevere (n = 39), and severe (n = 16) groups. Decreased lymphocytes and increased CD14 + 4- monocytes are found in patients with severe COVID-19. Decreased CD4 expression level was observed in the monocytes of patients with severe COVID-19. The total lymphocytes, B and T lymphocytes, CD4+ cells and CD8+ cells, and natural killer (NK) and natural killer T (NKT) cells were found to be decreased in patients with severe COVID-19. The CD4+/CD8+ ratio was not significantly different between patients with COVID-19 and healthy controls. The percentage of activated T cells (CD3+HLA-DR+) and B cells (CD19+CD38+) was lower in patients with severe COVID-19. Age and CD4- monocytes were independent predictors of disease severity. The SARS-CoV-2 infection may affect lymphocyte subsets, resulting in decreased T and B cells, monocytes, and NK and NKT cells. Decreased CD4 expression level by monocytes was significantly correlated with disease severity. Further studies on the host immune response to SARS-CoV-2 infection are necessary to predict the disease severity and protect against the virus.
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Affiliation(s)
- Sumeyye Kazancioglu
- Department of Infectious Diseases and Clinical Microbiology, and Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Fatma Meric Yilmaz
- Medical Biochemistry Laboratory, Ministry of Health Ankara City Hospital, Ankara, Turkey.,Faculty of Medicine, Medical Biochemistry Department, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Aliye Bastug
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Health Science University Turkey, Ankara, Turkey
| | - Arzu Sakallı
- Medical Biochemistry Laboratory, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Bahadır Orkun Ozbay
- Department of Infectious Diseases and Clinical Microbiology, and Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Cansu Buyuktarakci
- Department of Infectious Diseases and Clinical Microbiology, and Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Hurrem Bodur
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Health Science University Turkey, Ankara, Turkey
| | - Gulsen Yilmaz
- Medical Biochemistry Laboratory, Ministry of Health Ankara City Hospital, Ankara, Turkey.,Faculty of Medicine, Medical Biochemistry Department, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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20
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Bastug A, Bodur H, Erdogan S, Gokcinar D, Kazancioglu S, Kosovali BD, Ozbay BO, Gok G, Turan IO, Yilmaz G, Gonen CC, Yilmaz FM. Clinical and laboratory features of COVID-19: Predictors of severe prognosis. Int Immunopharmacol 2020; 88:106950. [PMID: 32919217 PMCID: PMC7480980 DOI: 10.1016/j.intimp.2020.106950] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/19/2020] [Accepted: 08/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) emerged first in December 2019 in Wuhan, China and quickly spread throughout the world. Clinical and laboratory data are of importance to increase the success in the management of COVID-19 patients. METHODS Data were obtained retrospectively from medical records of 191 hospitalized patients diagnosed with COVID-19 from a tertiary single-center hospital between March and April 2020. Prognostic effects of variables on admission among patients who received intensive care unit (ICU) support and those who didn't require ICU care were compared. RESULTS Patients required ICU care (n = 46) were older (median, 71 vs. 43 years), with more underlying comorbidities (76.1% vs. 33.1%). ICU patients had lower lymphocytes, percentage of large unstained cell (%LUC), hemoglobin, total protein, and albumin, but higher leucocytes, neutrophils, neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), platelet-lymphocytes ratio (PLR), urea, creatinine, aspartate amino transferase (AST), lactate dehydrogenase (LDH), and D-dimer when compared with non-critically ill patients (p < 0.001). A logistic regression model was created to include ferritin, %LUC, NLR, and D-dimer. %LUC decrease and D-dimer increase had the highest odds ratios (0.093 vs 5.597, respectively) to predict severe prognosis. D-dimer, CRP, and NLR had the highest AUC in the ROC analysis (0.896, 0.874, 0.861, respectively). CONCLUSIONS The comprehensive analysis of clinical and admission laboratory parameters to identify patients with severe prognosis is important not only for the follow-up of the patients but also to identify the pathophysiology of the disease. %LUC decrease and D-dimer, NLR, and CRP increases seem to be the most powerful laboratory predictors of severe prognosis.
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Affiliation(s)
- Aliye Bastug
- Department of Infectious Diseases and Clinical Microbiology, Health Science University Turkey, Ankara City Hospital, 06800 Ankara, Turkey.
| | - Hurrem Bodur
- Department of Infectious Diseases and Clinical Microbiology, Health Science University Turkey, Ankara City Hospital, 06800 Ankara, Turkey
| | - Serpil Erdogan
- Department of Medical Biochemistry, Faculty of Medicine, Ankara City Hospital, 06800 Ankara, Turkey
| | - Derya Gokcinar
- Department of Anesthesiology and Reanimation, Health Science University Turkey, Ankara City Hospital, 06230 Ankara, Turkey
| | - Sumeyye Kazancioglu
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, 06800 Ankara, Turkey
| | | | - Bahadır Orkun Ozbay
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, 06800 Ankara, Turkey
| | - Gamze Gok
- Department of Medical Biochemistry, Faculty of Medicine, Ankara City Hospital, 06800 Ankara, Turkey
| | - Isil Ozkocak Turan
- Department of Anesthesiology and Reanimation, Health Science University Turkey, Ankara City Hospital, 06230 Ankara, Turkey
| | - Gulsen Yilmaz
- Department of Medical Biochemistry, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara City Hospital, 06800 Ankara, Turkey
| | - Canan Cam Gonen
- Department of Critical Care Medicine, Ankara City Hospital, 06800 Ankara, Turkey
| | - Fatma Meric Yilmaz
- Department of Medical Biochemistry, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara City Hospital, 06800 Ankara, Turkey
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Bastug A, Altas AB, Koc BT, Bayrakdar F, Korukluoglu G, Bodur H, Oguzoglu TC. Molecular characterization of human adenoviruses associated with respiratory infection in Turkey. APMIS 2020; 129:23-31. [PMID: 33015856 DOI: 10.1111/apm.13088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/29/2020] [Indexed: 11/27/2022]
Abstract
Human adenoviruses (HAdVs) are responsible for various clinical diseases. Molecular epidemiological studies of respiratory HAdVs are limited in Turkey. To determine the main genotypes and epidemiological characteristics of HAdVs in patients with respiratory symptoms. HAdV PCR-positive extracts of nasal/nasopharyngeal specimens sent to the Turkish Public Health Institution from various cities of Turkey in 2015-2016 were investigated by seminested PCR. Partial sequence analysis of the hexon gene of HAdVs was performed. SPSSv.24.0 was used. A total of 23/68 (33.82%) HAdV-positive samples were amplified. Mastadenovirus B, C, D, and F were detected and mastadenovirus B (10/23; 43.5%) and C (10/23; 43.5%) were predominant strains. Interestingly, HAdV-F known to have gastrointestinal system tropism was detected in two patients with respiratory symptoms. HAdV-B3 was the most prevalent genotype (9/23; 39.1%). Also, HAdV-B7 is defined as a reemerging pathogen. It is noteworthy that there is a cluster of four HAdV-C strains showing a close paraphyletic relationship with HAdV-2/6 intertypic recombination. To our knowledge, this is the first study showing that HAdV-B7 reemerging pathogen circulating in patients with respiratory infections in our country. It is also necessary to emphasize that HAdV-2/6 recombinant strains were detected in this study for the first time in Turkey.
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Affiliation(s)
- Aliye Bastug
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Ayse Basak Altas
- National Virology Reference Laboratory, General Directorate of Public Health, Ankara, Turkey
| | - Bahattin Taylan Koc
- Department of Virology, Faculty of Veterinary Medicine, Adnan Menderes University, Aydın, Turkey
| | - Fatma Bayrakdar
- National Virology Reference Laboratory, General Directorate of Public Health, Ankara, Turkey
| | - Gülay Korukluoglu
- National Virology Reference Laboratory, General Directorate of Public Health, Ankara, Turkey
| | - Hurrem Bodur
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Tuba Cigdem Oguzoglu
- Department of Virology, Faculty of Veterinary Medicine, Ankara University, Ankara, Turkey
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Abstract
Background: Limited data are available on the perinatal and postnatal transmission of novel coronavirus disease 2019 (COVID-19). The Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) recommended breastfeeding with necessary precautions to mothers with COVID-19. Case Presentation: A 20-year-old pregnant woman with no symptoms of COVID-19 presented to the hospital for delivery at 39 weeks of gestation. She was tested for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by reverse transcriptase polymerase chain reaction (RT-PCR) because her father had been diagnosed with COVID-19. A nasopharyngeal swab RT-PCR test was positive for SARS-CoV-2. Therefore, the baby and the mother were cared for separately after delivery. Breast milk obtained after first lactation was tested by real-time RT-PCR and was positive for SARS-CoV-2. Conclusions: In this article, we aimed to report the presence of SARS-CoV-2 in breast milk. Although further studies are needed, this situation may have an impact on breastfeeding recommendations.
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Affiliation(s)
- Aliye Bastug
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences Turkey, Ankara City Hospital, Ankara, Turkey
| | - Alireza Hanifehnezhad
- Department of Virology, Faculty of Veterinary Medicine, Ankara University, Ankara, Turkey
| | - Cüneyt Tayman
- Department of Pediatrics and Neonatology, University of Health Sciences Turkey, Ankara City Hospital, Ankara, Turkey
| | - Aykut Ozkul
- Department of Virology, Faculty of Veterinary Medicine, Ankara University, Ankara, Turkey.,Department of Biotechnology, Biotechnology Institute, Ankara University, Ankara, Turkey
| | - Orkun Ozbay
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Sumeyye Kazancioglu
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Hurrem Bodur
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences Turkey, Ankara City Hospital, Ankara, Turkey
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Abstract
Measurements are one of the most important means of evaluating the quality of antibiotic consumption. This study has evaluated the antibiotic consumption using one-day point prevalence study data collected from different hospitals in Turkey. This research was planned as a multicenter point surveillance study which aimed demonstrating the use of antibiotics among inpatients in Turkey. On the day of surveillance, demographic data from 21,920 inpatients, names of antibiotics used by the inpatients, number of antibiotics approved by infectious disease specialist (IDS), and the length of antibiotic use were recorded. These results showed that 30.3% of patients were using antibiotics and 57.7% of those were IDS-approved. The rate of IDS-approved antibiotic consumption was higher for internal medicine wards and in intensive care units, whereas non-IDS-approved antibiotics were used among inpatients of surgical wards.
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Affiliation(s)
- Oguz Karabay
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sakarya University Education and Research Hospital, Sakarya, Turkey
| | - Nevin Ince
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Düzce University School of Medicine, Düzce, Turkey
| | - Adalet Aypak
- Clinic of infectious Diseases and Clinical Microbiology, Ankara Numune Teaching and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Ertugrul Guclu
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sakarya University Education and Research Hospital, Sakarya, Turkey
| | - Hurrem Bodur
- Clinic of infectious Diseases and Clinical Microbiology, Ankara Numune Teaching and Research Hospital, Health Sciences University, Ankara, Turkey
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Idilman R, Razavi H, Robbins-Scott S, Akarca US, Örmeci N, Kaymakoglu S, Aygen B, Tozun N, Güner R, Bodur H, Lazarus JV. A micro-elimination approach to addressing hepatitis C in Turkey. BMC Health Serv Res 2020; 20:249. [PMID: 32209103 PMCID: PMC7093960 DOI: 10.1186/s12913-020-5019-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 02/21/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In 2016, WHO passed the Global Health Sector Strategy on Viral Hepatitis (GHSS), calling for its elimination by 2030. Two years later, Turkey approved a strategy to reach the WHO targets. This study reports new national prevalence data, breaks it down by subpopulation, and models scenarios to reach HCV elimination. METHODS Literature was reviewed for estimates of HCV disease burden in Turkey. They were discussed with stakeholders and used as inputs to develop a disease burden model. The infected population was estimated by sequelae for the years 2015-2030. Three scenarios were developed to evaluate the disease burden in Turkey: a Base 2017 scenario, representing the current standard of care in Turkey; an increased treatment scenario, representing the impact of improved access to DAAs; and a WHO targets scenario, which meet the WHO GHSS viral hepatitis targets of a 65% reduction in mortality and 90% diagnosis rate of the infected population by 2030. RESULTS At the beginning of 2017, 271,000 viremic infections were estimated. Of these, 58,400 were diagnosed and 10,200 treated. Modelling results showed that, with the current treatment paradigm in Turkey, by 2030 the total number of viremic HCV infections would decline by 35%, while liver-related deaths, hepatocellular carcinoma (HCC), and decompensated cirrhosis would decrease by 10-25%. In the increased treatment scenario, by 2030 viremic HCV infections would decrease by 50%; liver-related deaths, HCC and decompensated cirrhosis would decrease by 45-70%. In the WHO targets scenario, HCV infections would decrease by 80%; sequelae would decrease by 80-85%. Data on disease burden in micro-elimination target subpopulations are largely unavailable. CONCLUSIONS To meet the WHO Global Health Sector Strategy targets for the elimination of HCV, Turkey needs to increase treatment. Better data are needed as well as countrywide access to DAAs.
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Affiliation(s)
- Ramazan Idilman
- Department of Gastroenterology, Ankara University Medical Faculty, Ankara, Turkey
| | - Homie Razavi
- Center for Disease Analysis, Lafayette, CO 80026 USA
| | | | - Ulus Salih Akarca
- Department of Gastroenterology, Ege University Medical Faculty, Izmir, Turkey
| | - Necati Örmeci
- Department of Gastroenterology, Ankara University Medical Faculty, Ankara, Turkey
| | - Sabahattin Kaymakoglu
- Department of Gastroenterology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Bilgehan Aygen
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Nurdan Tozun
- Department of Internal Medicine and Gastroenterology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Rahmet Güner
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yildirim Beyazit University, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Hurrem Bodur
- Department of Infectious Diseases, Ankara Numune Training and Research Hospital, University of Healthcare Sciences, Ankara, Turkey
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Calle del Rossellón 132, 4th Floor, ES-08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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Sertcelik A, Baran I, Akinci E, Mumcuoglu I, Bodur H. Synergistic Activities of Colistin Combinations with Meropenem, Sulbactam, Minocycline, Disodium Fosfomycin, or Vancomycin Against Different Clones of Carbapenem-Resistant Acinetobacter baumannii Strains. Microb Drug Resist 2019; 26:429-433. [PMID: 31657659 DOI: 10.1089/mdr.2019.0088] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims: Colistin became the primary treatment option for Acinetobacters that had developed a high rate of resistance to carbapenems which were the first-line therapy in the past, and now Acinetobacters become resistant to nearly all antibiotics. Because of the resistance potential to colistin and the concerns about toxicity, especially for high doses, colistin combination therapies are preferred nowadays. In this study, we aimed to investigate whether combinations of colistin with meropenem, sulbactam, fosfomycin, vancomycin, and minocycline are synergic or not and to determine minocycline susceptibility rate, which is not in use in our country. Results: For the studied 23 Acinetobacter strains, the highest synergy was between colistin and vancomycin, which was shown in 4 (17.4%) strains. The synergy of colistin with meropenem and fosfomycin was detected for 1 (4.3%) strain, the synergy of colistin with minocycline was detected for 2 (8.6%) strains, and no synergy was detected for colistin-sulbactam combination. All the strains were susceptible to minocycline. Conclusion: None of the antibiotic combinations was antagonistic. They had synergistic and additive interactions. Thus, these combinations can be used in clinical practices. The remarkable synergistic interaction of colistin-vancomycin combination and high susceptibility to minocycline highlight the need for more researches on these subjects.
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Affiliation(s)
- Ahmet Sertcelik
- Department of Infectious Diseases and Clinical Microbiology and Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Irmak Baran
- Department of Medical Microbiology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Esragul Akinci
- Department of Infectious Diseases and Clinical Microbiology and Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ipek Mumcuoglu
- Department of Medical Microbiology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Hurrem Bodur
- Department of Infectious Diseases and Clinical Microbiology and Ankara Numune Training and Research Hospital, Ankara, Turkey
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Özen Y, Baştuğ A, Öngürü P, Akıncı E, Yetkin M, Pepe FÜ, Bodur H. Evaluation of geriatric infections in past six years. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.3939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ozdemir B, Yetkin MA, Bastug A, But A, Aslaner H, Akinci E, Bodur H. Evaluation of epidemiological, clinical, and laboratory features and mortality of 144 HIV/AIDS cases in Turkey. HIV Clin Trials 2018; 19:69-74. [PMID: 29566585 DOI: 10.1080/15284336.2018.1453990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background The number of HIV/AIDS cases in Turkey is increasing rapidly, as is the number of cases worldwide. The aim of this study is to evaluate the characteristics of the clinical and laboratory findings and epidemiological features of HIV/AIDS patients to obtain useful data on the epidemic type and transmission routes associated with Turkey and to identify risk factors for mortality. Methods The patient records of 144 HIV-infected patients who were admitted to our clinic between 2000 and 2015 were analyzed retrospectively. Results Most of the cases (55%) were diagnosed due to the detection of anti-HIV-positive individuals without clinical symptoms. The mean CD4 + lymphocyte count on first admission was 108 cells/μL for those admitted before 2009 and 265 cells/μL for those admitted after 2009 (p = 0.003). When the pre- and post-2009 groups were compared for the status of the disease, 55.6 and 44.4% of patients were in the AIDS stage, respectively (p = 0.04). The most noted opportunistic infection was mycobacterial, and throughout the follow-up, 31.2% of the cases were fatal. Conclusions Early diagnosis of HIV infection can have a direct impact on prognosis and survival. Therefore, screening laboratory investigations should be extended, particularly in high-risk groups.
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Affiliation(s)
- Burcu Ozdemir
- a Department Of Infectious Diseases and Clinical Microbiology , Ankara Numune Training and Research Hospital , Ankara , Turkey
| | - Meltem A Yetkin
- b Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology , Giresun University , Giresun , Turkey
| | - Aliye Bastug
- a Department Of Infectious Diseases and Clinical Microbiology , Ankara Numune Training and Research Hospital , Ankara , Turkey
| | - Ayşe But
- a Department Of Infectious Diseases and Clinical Microbiology , Ankara Numune Training and Research Hospital , Ankara , Turkey
| | - Halide Aslaner
- a Department Of Infectious Diseases and Clinical Microbiology , Ankara Numune Training and Research Hospital , Ankara , Turkey
| | - Esragul Akinci
- a Department Of Infectious Diseases and Clinical Microbiology , Ankara Numune Training and Research Hospital , Ankara , Turkey
| | - Hurrem Bodur
- a Department Of Infectious Diseases and Clinical Microbiology , Ankara Numune Training and Research Hospital , Ankara , Turkey
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28
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Bastug A, Kayaaslan B, But A, Aslaner H, Sertcelik A, Akinci E, Onguru P, Yetkin MA, Bodur H. A case of Crimean-Congo hemorrhagic fever complicated with acute pancreatitis. Vector Borne Zoonotic Dis 2017; 14:827-9. [PMID: 25409276 DOI: 10.1089/vbz.2014.1623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease characterized by nonspecific symptoms like fever, myalgia, severe headache, nausea, vomiting, diarrhea, and abdominal pain. It can result in various complications during the course of the disease due to the diffuse endothelial injury involved in the pathogenesis of CCHF. OBJECTIVES Here we present a patient with CCHF complicated by acute pancreatitis, including pleural and intra-abdominal effusions. CASE REPORT A 70-year-old patient was referred to our hospital from an endemic area with the suspicion of CCHF. The physical examination of the patient revealed high fever (38°C), somnolence, and petechial eruption. The diagnosis of case was confirmed with positive reverse transcriptase polymerase chain reaction (RT-PCR). The viral load of the patient was 4×10(9) copies/mL. On the fifth day of admission, upper abdominal pain, scleral ichter, and abdominal distention developed. The patient had abdominal tenderness with guarding. The laboratory tests revealed an amylase level of 1740 U/L (28-100), lipase level of 583 U/L (13-60), and total bilirubin level of 3.75 mg/dL (<0.3). The diagnosis of acute pancreatitis was confirmed with radiological findings. CONCLUSIONS Until now, atypical presentations of CCHF have been reported in some case reports, but not acute pancreatitis. To the best of our knowledge, this is the first case of acute pancreatitis in the literature seen in the course of CCHF.
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Affiliation(s)
- Aliye Bastug
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Training and Research Hospital , Ankara, Turkey
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29
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Sivas F, Yurdakul FG, Durak M, Hatipoğlu G, Önal ED, Bodur H. Hypophosphatemic osteomalacia: a case simulating anklylosing spondylitis treated with anti-TNF therapy. Osteoporos Int 2016; 27:3651-3654. [PMID: 27620624 DOI: 10.1007/s00198-016-3758-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/24/2016] [Indexed: 11/26/2022]
Abstract
In this case, a young male patient diagnosed as hypophosphatemic osteomalacia and ankylosing spondylitis (AS) will be assessed by literature. A 32-year-old male patient who had been previously diagnosed as ankylosing spondylitis and hypophosphatemic osteomalacia was admitted to our clinic. In the beginning of the disease, he complained of pain on the first metatarsal bone and low back. Sacroiliac magnetic resonance (MR) images were interpreted as sacroiliitis. He was diagnosed as AS, and referred to many hospitals and received several therapies. He did not benefit from the treatment and his complaints worsened. The human leukocyte antigen (HLA) B-27 test was negative and alkaline phosphatase level was high. Old femur fractures were reported in the whole body bone scintigraphy. In addition, the patient was diagnosed with osteomalacia. While the patient was receiving vitamin D, oral phosphate, anti-tumor necrosis factor therapy was added. Patient's diagnosis was reevaluated. His final diagnosis was hypophosphatemic osteomalacia instead of ankylosing spondylitis.
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Affiliation(s)
- F Sivas
- Department of Physical Medicine and Rehabilitation, Ankara Numune Education and Research Hospital, Ankara, Turkey.
- , 380 Sok. 2/9 Çankaya,06610, Ankara, Turkey.
| | - F G Yurdakul
- Department of Physical Medicine and Rehabilitation, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - M Durak
- Department of Physical Medicine and Rehabilitation, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - G Hatipoğlu
- Department of Radiology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - E D Önal
- Department of Endocrinology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - H Bodur
- Department of Physical Medicine and Rehabilitation, Ankara Numune Education and Research Hospital, Ankara, Turkey
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Ozaras R, Sunbul M, Parlak M, Bodur H, Leblebicioglu H. Treating hepatitis B virus/hepatitis C virus coinfected patients with direct-acting hepatitis C virus antivirals only is not safe. Hepatology 2016; 64:1825-1827. [PMID: 27043022 DOI: 10.1002/hep.28592] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 03/29/2016] [Indexed: 12/07/2022]
Affiliation(s)
- Resat Ozaras
- Department of Infectious Diseases, Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey
| | - Mustafa Sunbul
- Department of Infectious Diseases, Ondokuz Mayis University Medical School, Samsun, Turkey
| | - Mehmet Parlak
- Department of Infectious Diseases, Ataturk University, Medical School, Erzurum, Turkey
| | - Hurrem Bodur
- Ankara Education and Teaching Hospital, Ankara, Turkey
| | - Hakan Leblebicioglu
- Department of Infectious Diseases, Ondokuz Mayis University Medical School, Samsun, Turkey
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Demir ZC, Bastug A, Bodur H, Ergunay K, Ozkul A. MicroRNA expression profiles in patients with acute Crimean Congo hemorrhagic fever reveal possible adjustments to cellular pathways. J Med Virol 2016; 89:417-422. [PMID: 27551771 DOI: 10.1002/jmv.24667] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2016] [Indexed: 12/13/2022]
Abstract
Several viral diseases are associated with altered microRNA (miRNA) expression, which can provide vital information about how cellular pathways respond to infection. However, the miRNA profile of Crimean Congo Hemorrhagic Fever (CCHFV) infections are not known. To address this gap, we performed real-time PCR-based miRNA analysis in individuals with acute Crimean Congo Hemorrhagic Fever (CCHFV) infections, with the goal of identifying pathways that might be associated with this disease. Peripheral blood mononuclear cells were analysed in eight individuals with detectable viral RNA and compared to five healthy subjects. A total of 106 differentially expressed miRNAs were identified, of which 19 miRNAs were either fivefold prominently up- or down-regulation. Several miRNAs associated with cytokine expression, some of which were previously associated with Dengue and Hantavirus infections were revealed. Moreover, possible mechanisms related to secretion of adhesion molecules and viral escape from innate immunity were identified. Pathway enrichment analyses further revealed the putative involvement of TNF-alfa, TGF-beta, MAPK, WNT, and neurotrophin signaling pathways in disease pathogenesis. J. Med. Virol. 89:417-422, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Aliye Bastug
- Infectious Diseases Clinic, Numune Training and Research Hospital, Ankara, Turkey
| | - Hurrem Bodur
- Infectious Diseases Clinic, Numune Training and Research Hospital, Ankara, Turkey
| | - Koray Ergunay
- Faculty of Medicine, Department of Medical Microbiology, Virology Unit, Hacettepe University, Ankara, Turkey
| | - Aykut Ozkul
- Faculty of Veterinary Medicine, Department of Virology, Ankara University, Ankara, Turkey
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Mumcuoglu I, Kanyilmaz D, Yetkin MA, Cetin F, Ozmen BB, Karahan ZC, Baran I, Kayaaslan B, Bodur H, Aksu N. Serratia marcescens bacteremia cases: A pseudo-outbreak experience. Am J Infect Control 2016; 44:852-3. [PMID: 27005589 DOI: 10.1016/j.ajic.2016.01.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 01/12/2016] [Indexed: 11/25/2022]
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Akinci E, Bodur H, Sunbul M, Leblebicioglu H. Prognostic factors, pathophysiology and novel biomarkers in Crimean-Congo hemorrhagic fever. Antiviral Res 2016; 132:233-43. [PMID: 27378224 DOI: 10.1016/j.antiviral.2016.06.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/28/2016] [Indexed: 12/16/2022]
Abstract
Crimean-Congo hemorrhagic fever (CCHF) is a geographically widespread tick-borne zoonosis. The clinical spectrum of the illness varies from mild infection to severe disease and death. In severe cases, hemorrhagic manifestations develop, with fatality rates of 4-20%, depending on the geographic region and quality of the health care. Although vast majority of the CCHF cases were reported from Turkey, mortality rate is lower than the other regions, which is 5% on average. Prediction of the clinical course of the disease enables appropriate management planning by the physician and prompt transportation, if needed, of the patient to a tertiary care hospital for an intensive therapy. Thus, predicting the outcome of the disease may avert potential mortality. There are numerous studies investigating the prognostic factors of CCHF in the literature. Majority of them were reported from Turkey and included investigations on clinical and biochemical parameters, severity scoring systems and some novel biomarkers. Somnolence, bleeding, thrombocytopenia, elevated liver enzymes and prolonged bleeding times are the most frequently reported prognostic factors to predict the clinical course of the disease earlier. High viral load seems to be the strongest predictor to make a clinical decision about the patient outcome. The severity scoring systems based on clinically important mortality-related parameters are especially useful for clinicians working in the field to predict the course of the disease and to decide which patient should be referred to a tertiary care hospital for intensive care. In the light of the pathophysiological characteristics of CCHF, some new biomarkers of prognosis including cytokines, soluble adhesion molecules, genetic polymorphisms and coagulopathy parameters were also investigated. However most of these tests are not available to clinicians and they were obtained mostly for research purposes. In spite of the various studies about prognostic factors, they have several inherent limitations, including large variability in the results and confusing data that are not useful for clinicians in routine practice. In this paper, the results of diverse studies of the prediction of the prognosis in CCHF based on epidemiological, clinical and laboratory findings of the disease were summarized and suggestions for future studies are provided.
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Affiliation(s)
- Esragul Akinci
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Hurrem Bodur
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Mustafa Sunbul
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Samsun, Turkey
| | - Hakan Leblebicioglu
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Samsun, Turkey.
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Guven MA, Koc O, Bodur H, Erkanli S, Bagis T, Usal D. Acardiac twin pregnancy: successful intrauterine ablative treatment with alcohol at 14 weeks of gestation. CLIN EXP OBSTET GYN 2016. [DOI: 10.12891/ceog2139.2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Sivas F, Yurdakul F, Kılıcaslan A, Duran S, Baskan B, Bodur H. AB0188 Effect of Smoking on Joint Damage and Disease Activity in Patients with Rheumatoid Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kazancioğlu S, Akinci E, Baştuğ A, Kayaaslan B, But A, Aslaner H, Eren SS, Yetkin MA, Bodur H. Does the course of laboratory parameters help us to predict the outcome of CCHF? Turk J Med Sci 2016; 46:328-34. [PMID: 27511493 DOI: 10.3906/sag-1408-89] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 06/24/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM This study was performed to identify the characteristics distinguishing fatal and nonfatal cases of patients diagnosed with Crimean-Congo hemorrhagic fever (CCHF). MATERIALS AND METHODS A total of 92 patients with confirmed diagnosis of CCHF in 2009-2013 were included in the study. RESULTS A high level of urea and aPTT on the third day of hospital stay, diarrhea, somnolence, and the interval from the beginning of the symptoms to hospital admission were independently associated with fatality. Each 10-unit increase in aPTT and urea levels increased the fatality rate by 3.379-fold and 1.236-fold, respectively. Delay in hospital admission increased the fatality rate 1.453-fold for each day of delay. When comparing first and third admission-day laboratory values, the increase in leukocyte counts and the decrease in CPK, urea, creatinine, aPTT, PT, INR, and hemoglobin levels were significant in nonfatal cases. CONCLUSION This study showed that the course of these laboratory tests helps us to predict the outcome of the disease. In a few days of hospitalization, persistence or progress of the abnormal laboratory parameters may warn us about poor prognosis.
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Affiliation(s)
- Sümeyye Kazancioğlu
- Department of Infectious Diseases and Clinical Microbiology, Niksar State Hospital, Tokat, Turkey
| | - Esragül Akinci
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Aliye Baştuğ
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Bircan Kayaaslan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Ayşe But
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Halide Aslaner
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Selim Sırrı Eren
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Meltem Arzu Yetkin
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Hurrem Bodur
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Research and Training Hospital, Ankara, Turkey
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Bastug A, Kislak S, Mutlu NM, Akcaboy ZN, Koksal A, Sertcelik A, Ünlü RE, Akinci E, Bodur H. Necrotizing fasciitis due to Streptococcus mitis caused by accidental human bite. J Infect Dev Ctries 2016; 10:100-2. [PMID: 26829544 DOI: 10.3855/jidc.7040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 12/29/2015] [Accepted: 10/16/2015] [Indexed: 10/31/2022] Open
Abstract
Human bite wounds are more prone to infection than animal bites, which may cause necrotizing soft tissue infections such as myositis, fasciitis. Both aerobic and anaerobic microorganisms may be responsible, including Streptococcus spp., Staphylococcus aureus, Peptostreptococcus spp. Necrotizing fasciitis is characterized by serious tissue destruction and systemic toxicity with high morbidity and mortality. We report a patient with Streptococcus mitis associated necrotizing fasciitis on the upper extremity resulting from an accidental human bite, which caused nearly fatal infection. Prophylactic antibiotic treatment should be given after a human bite to prevent infection. If the infection signs and symptoms develop, rapid diagnosis, appropriate antibiotic and surgical therapy should be administered immediately. Streptococcus mitis is a viridans streptococcus, usually known as a relatively benign oral streptococcus. To our knowledge, this is the first necrotizing fasciitis case due to Streptococcus mitis after human bite.
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Affiliation(s)
- Aliye Bastug
- Ankara Numune Training and Research Hospital, Ankara, Turkey.
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Leblebicioglu H, Sunbul M, Bodur H, Ozaras R. Discharge criteria for Crimean-Congo haemorrhagic fever in endemic areas. J Infect 2016; 72:500-1. [PMID: 26828701 DOI: 10.1016/j.jinf.2016.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 01/20/2016] [Accepted: 01/24/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Hakan Leblebicioglu
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Samsun, Turkey.
| | - Mustafa Sunbul
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Samsun, Turkey.
| | - Hurrem Bodur
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Research and Training Hospital, Ankara, Turkey.
| | - Resat Ozaras
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey.
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Leblebicioglu H, Sunbul M, Guner R, Bodur H, Bulut C, Duygu F, Elaldi N, Cicek Senturk G, Ozkurt Z, Yilmaz G, Fletcher TE, Beeching NJ. Healthcare-associated Crimean-Congo haemorrhagic fever in Turkey, 2002-2014: a multicentre retrospective cross-sectional study. Clin Microbiol Infect 2016; 22:387.e1-387.e4. [PMID: 26806137 PMCID: PMC5023843 DOI: 10.1016/j.cmi.2015.11.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 11/19/2015] [Accepted: 11/22/2015] [Indexed: 11/19/2022]
Abstract
Healthcare-related transmission of Crimean-Congo haemorrhagic fever (CCHF) is a well-recognized hazard. We report a multicentre retrospective cross-sectional study undertaken in Turkey in 2014 in nine hospitals, regional reference centres for CCHF, covering the years 2002 to 2014 inclusive. Data were systematically extracted from charts of all personnel with a reported health care injury/accident related to CCHF. Blood samples were tested for CCHF IgM/IgG by enzyme-linked immunosorbent assay and/or viral nucleic acid detection by PCR after the injury. Fifty-one healthcare-related exposures were identified. Twenty-five (49%) of 51 resulted in laboratory-confirmed infection, with a 16% (4/25) overall mortality. The main route of exposure was needlestick injury in 32/51 (62.7%). A potential benefit of post-exposure prophylaxis with ribavirin was identified.
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Affiliation(s)
- H Leblebicioglu
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Samsun, Turkey.
| | - M Sunbul
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Samsun, Turkey
| | - R Guner
- Department of Infectious Diseases and Clinical Microbiology, Yildirim Beyazit University Medical School, Ankara, Turkey
| | - H Bodur
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - C Bulut
- Department of Infectious Diseases and Clinical Microbiology, Ankara Research and Training Hospital, Ankara, Turkey
| | - F Duygu
- Department of Infectious Diseases and Clinical Microbiology, Gaziosmanpasa University Medical School, Tokat, Turkey
| | - N Elaldi
- Department of Infectious Diseases and Clinical Microbiology, Cumhuriyet University Medical School, Sivas, Turkey
| | - G Cicek Senturk
- Department of Infectious Diseases and Clinical Microbiology, SB Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Z Ozkurt
- Department of Infectious Diseases and Clinical Microbiology, Ataturk University Medical School, Erzurum, Turkey
| | - G Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University Medical School, Erzurum, Turkey
| | - T E Fletcher
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Samsun, Turkey; Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - N J Beeching
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom; NIHR HPRU in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
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Guven MA, Koc O, Bodur H, Erkanli S, Bagis T, Usal D. Acardiac twin pregnancy: successful intrauterine ablative treatment with alcohol at 14 weeks of gestation. CLIN EXP OBSTET GYN 2016; 43:460-462. [PMID: 27328517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Twin reversed arterial perfusion (TRAP) sequence is a serious condition of monochorionic twin pregnancy, occurring in approximately one in 35,000 cases. First trimester treatment of TRAP sequence is controversial with higher incidence of procedure related complications. Present case demonstrates a TRAP sequence that was managed by intrauterine treatment with one-ml 100% pure alcohol injection into the abdominal part of the umbilical artery and obliteration of the acardiac twin at 14 weeks of gestation. Antenatal follow-up was uneventful and elective cesarean section was performed at 39 weeks' gestation. Postnatal outcome of the pump twin was excellent at 30 months after birth. Early second trimester elective ablation by alcohol injection can be an inexpensive, alternative, and reasonable minimal invasive treatment option to prevent fetal loss of pump twin before mid and late second trimester in perinatology centers where intrafetal cord occlusive methods are not available.
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Kayaaslan B, Bastug A, Aydin E, Akinci E, But A, Aslaner H, Yetkin MA, Bodur H. A long-term survey of brucellosis: Is there any marker to predict the complicated cases? Infect Dis (Lond) 2015; 48:215-21. [PMID: 26568367 DOI: 10.3109/23744235.2015.1107187] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aimed to find markers to predict complicated cases in brucellosis. Patients with and without complications were compared in terms of epidemiological, clinical and laboratory properties. METHODS A total of 700 patients hospitalised at the Department of Infectious Diseases and Clinical Microbiology were evaluated retrospectively. RESULTS Of a total of 700 patients, 383 (54.7%) were male and mean age was 41.5 ± 17.0 years. Of the patients, 517 (73.8%) were classified as acute cases. Complications occurred significantly less frequently in acute infections (p < 0.001). Increased C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) occurred more frequently in patients with complicated cases (p = 0.005 and 0.021, respectively), whereas malaise, myalgia and blood culture positivity occurred significantly less frequently in those cases (p < 0.001, < 0.001 and 0.014, respectively). Fever at examination, loss of malaise and myalgia and blood culture negativity were statistically significant predictive factors for complicated patients in multivariate analysis (p < 0.001, for each). As compared to patients without orchitis, leukocytosis occurred more often in cases with orchitis (p < 0.001); leukopenia occurred more often in neurobrucellosis than in cases without neurobrucellosis (p = 0.008). Of patients who attended control regularly, 422 (98%) were treated successfully. All of the nine patients who did not recover fully were cases with osteoarticular involvement. CONCLUSIONS Fever was the most significant predictive marker of complications. Other classical symptoms of brucellosis like myalgia and malaise were absent in most of the complicated cases. Blood culture was of limited value in the diagnosis of complicated cases most of the time.
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Affiliation(s)
- Bircan Kayaaslan
- a Department of Infectious Diseases and Clinical Microbiology , Yıldırım Beyazıt University, Faculty of Medicine, Ankara Atatürk Education and Research Hospital , Ankara , Turkey
| | - Aliye Bastug
- b Department of Infectious Diseases and Clinical Microbiology , Ankara Numune Education and Research Hospital , Ankara , Turkey
| | - Emsal Aydin
- c Department of Infectious Diseases and Clinical Microbiology , Kafkas University, Faculty of Medicine , Kars , Turkey
| | - Esragul Akinci
- b Department of Infectious Diseases and Clinical Microbiology , Ankara Numune Education and Research Hospital , Ankara , Turkey
| | - Ayse But
- b Department of Infectious Diseases and Clinical Microbiology , Ankara Numune Education and Research Hospital , Ankara , Turkey
| | - Halide Aslaner
- b Department of Infectious Diseases and Clinical Microbiology , Ankara Numune Education and Research Hospital , Ankara , Turkey
| | - Meltem Arzu Yetkin
- b Department of Infectious Diseases and Clinical Microbiology , Ankara Numune Education and Research Hospital , Ankara , Turkey
| | - Hurrem Bodur
- b Department of Infectious Diseases and Clinical Microbiology , Ankara Numune Education and Research Hospital , Ankara , Turkey
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Bastug A, Kayaaslan B, Kazancioglu S, But A, Aslaner H, Akinci E, Yetkin MA, Kanyilmaz D, Eren SS, Bodur H. Emergence of multidrug resistant isolates and mortality predictors in patients with solid tumors or hematological malignancies. J Infect Dev Ctries 2015; 9:1100-7. [DOI: 10.3855/jidc.6805] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/20/2015] [Accepted: 08/21/2015] [Indexed: 10/31/2022] Open
Abstract
Introduction: Infections are an important preventable cause of death in cancer patients. The aim of this study was to clarify the epidemiologic characteristics and resistance patterns of causative isolates and mortality predictors in infections of cancer patients. Methodology: Patients with sterile site infections were evaluated in a retrospective cohort study. Etiological agents, antimicrobial resistance patterns of the isolates, and possible risk factors for mortality were recorded. Survivors and non-survivors on day 30 after each infection onset were compared to identify the predictors of mortality. Results: A total of 205 infection episodes of 132 patients were included in this study. Of them, 75% had hematologic malignancies and 25% had solid tumors. Febrile neutropenia was diagnosed in 61.5%. Bloodstream infections were the most frequent infection (78%). The majority of the pathogens were Enterobacteriaceae (44.3%) and nonfermentative isolates (17.6%). Multidrug-resistant (MDR) infections were responsible for 40% of the episodes. The mortality rate was 23.4%. Inadequate initial antibiotic treatment (OR = 4.04, 95% CI = 1.80–9.05, p = 0.001), prolonged neutropenia (> 7 days) before infection (OR = 3.61, 95% CI = 1.48–8.80, p = 0.005), infection due to Klebsiella species (OR = 3.75, 95% CI = 1.31–10.7, p = 0.013), and Acinetobacter baumannii (OR = 5.00, 95% CI = 1.38–18.2, p = 0.014) were independent predictors of mortality. Conclusions: Gram-negative isolates were found to be the predominant pathogens with higher mortality rates. Local epidemiological data should be taken into account when administering empirical therapy since the inadequacy of initial antibiotherapy is associated with a poor outcome.
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Bani M, Akal N, Bodur H, Odabaş ME, Tüzüner T, Delilbaşı AE, Özdoğan YT. The reasons for extractions of primary teeth in Turkish children. Eur J Paediatr Dent 2015; 16:187-190. [PMID: 26418919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM The aim of this study was to determine the current reasons for primary teeth extractions in Turkish children and their relative importance. STUDY DESIGN retrospective evaluation of patients by analysing dental records of children aged 2-13 years, receiving treatment in different regions in Turkey over a period of five years (2007-2012). Patient's age, gender, any significant medical finding, type of tooth extracted and the reason for the extraction were the parameters evaluated. RESULTS It resulted that 2,508 primary teeth belonging to 1,755 children aged of 2-13 years were extracted. Extraction due to caries (57,4%) was found to be the most common reason. STATISTICS Chi-square tests were performed for statistical analysis. Although no differences in the types of teeth extracted were observed between genders, striking differences were noted in the different age groups. CONCLUSION From this study it can be concluded that caries and subsequent pulpal pathology are the most common reasons for extraction of primary teeth in Turkey. Primary molars were the most common tooth type extracted. Preventive programmes for preschool children should be given importance.
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Affiliation(s)
- M Bani
- Department of Paediatric Dentistry, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - N Akal
- Department of Paediatric Dentistry, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - H Bodur
- Department of Paediatric Dentistry, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - M E Odabaş
- Department of Paediatric Dentistry, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - T Tüzüner
- Department of Paediatric Dentistry, Faculty of Dentistry, Karadeniz Technical University,Trabzon, Turkey
| | - A E Delilbaşı
- Department of Paediatric Dentistry, Faculty of Dentistry, Yeni Yüzyil University, Istanbul, Turkey
| | - Y T Özdoğan
- Department of Pediatric Dentistry,75. Yil Dental Center, Ankara, Turkey
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Jääskeläinen AJ, Kallio-Kokko H, Ozkul A, Bodur H, Korukruoglu G, Mousavi M, Pranav P, Vaheri A, Mirazimi A, Vapalahti O. Development and evaluation of a real-time RT-qPCR for detection of Crimean-Congo hemorrhagic fever virus representing different genotypes. Vector Borne Zoonotic Dis 2015; 14:870-2. [PMID: 25514124 DOI: 10.1089/vbz.2014.1577] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic disease caused by a nairovirus belonging to family Bunyaviridae. The CCHF virus (CCHFV) can be transmitted to humans by Hyalomma ticks as well as by direct contact with infected body fluids or tissues from viremic livestock or humans. Our aim was to set up a fast RT-qPCR for detection of the different CCHFV genotypes in clinical samples, including an inactivation step to make the sample handling possible in lower biosafety levels (BSL) than BSL-4. This method was evaluated against commercial reference assays and international External Quality Assessment (EQA) samples. The analytical limit of detection for the developed CCHFV-S RT-qPCR was 11 CCHFV genomes per reaction. After exclusion of four dubious samples, we studied 38 CCHFV-positive samples (using reference tests) of which 38 were found positive by CCHFV-S RT-qPCR, suggesting a sensitivity of 100%. CCHFV-S RT q-PCR detected all eight different CCHFV strains representing five different CCHFV genotypes. In conclusion, the CCHFV-S RT-qPCR described in this study was evaluated using various sources of CCHFV samples and shown to be an accurate tool to detect human CCHFV infection caused by different genotypes of the virus.
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Affiliation(s)
- Anne J Jääskeläinen
- 1 HUSLAB, Department of Virology and Immunology, Helsinki University Central Hospital , Helsinki, Finland
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Leblebicioglu H, Sunbul M, Memish ZA, Al-Tawfiq JA, Bodur H, Ozkul A, Gucukoglu A, Chinikar S, Hasan Z. Consensus report: Preventive measures for Crimean-Congo Hemorrhagic Fever during Eid-al-Adha festival. Int J Infect Dis 2015; 38:9-15. [PMID: 26183413 DOI: 10.1016/j.ijid.2015.06.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/29/2015] [Accepted: 06/30/2015] [Indexed: 11/26/2022] Open
Abstract
Crimean-Congo hemorrhagic fever (CCHF) is endemic in Eurasian countries such as, Turkey, Pakistan, Afghanistan and Iran. CCHF virus is spread by the Hyalomma tick, which is found mainly on cattle and sheep. Muslim countries, in which these animals are sacrificed during Eid-Al-Adha, are among the countries where CCHF is endemic, and it has been observed that CCHF is associated with practices surrounding the Eid-ad-Adha festival. The dates for Eid-Al-Adha drift 10 days earlier in each year according to Georgian calendar. In previous years Eid-al-Adha occurred in autumn-winter months however in the next 10-15 years it will be take place in the summer months when CCHF is more prevalent. This may lead to a rise in the number of cases due to increased dissemination of CCHF virus with uncontrolled animal movements in and between countries. This consensus report focuses on the variable practices regarding animal handling in different regions and possible preventative measures to reduce the incidence of CCHF. Environmental hygiene and personal protection are essential parts of prevention. There is a need for international collaborative preparedness and response plans for prevention and management of CCHF during Eid-Al-Adha in countries where the disease is prevalent.
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Affiliation(s)
- Hakan Leblebicioglu
- Department of Infectious Diseases and Clinical Microbiology, Medical School, Ondokuz Mayis University, Samsun, Turkey.
| | - Mustafa Sunbul
- Department of Infectious Diseases and Clinical Microbiology, Medical School, Ondokuz Mayis University, Samsun, Turkey.
| | - Ziad A Memish
- Public Health Directorate, Ministry of Health, Riyadh, Saudi Arabia; College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia.
| | - Jaffar A Al-Tawfiq
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Hurrem Bodur
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Education and Research Hospital, Ankara, Turkey.
| | - Aykut Ozkul
- Department of Virology, Faculty of Veterinary Medicine, Ankara University, Ankara, Turkey.
| | - Ali Gucukoglu
- Department of Food Hygiene & Technology, Faculty of Veterinary Medicine, Ondokuz Mayis University, Samsun, Turkey.
| | - Sadegh Chinikar
- Arboviruses and Viral Haemorrhagic Fevers Laboratory National Reference, Laboratory, Pasteur Institute of Iran, Tehran, Iran.
| | - Zahra Hasan
- Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan.
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Bastug A, Kayaaslan B, Kazancioglu S, Aslaner H, But A, Akinci E, Yetkin MA, Eren S, Bodur H. Crimean-Congo Hemorrhagic Fever: Prognostic Factors and the Association of Leukocyte Counts with Mortality. Jpn J Infect Dis 2015; 69:51-5. [PMID: 26073733 DOI: 10.7883/yoken.jjid.2014.566] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We aimed to determine the relationship between leukocyte counts and the survival of patients with Crimean-Congo hemorrhagic fever (CCHF), a life-threatening illness. This is the first study to do so. A total of 220 patients with CCHF were evaluated retrospectively. The mortality rate was 16.4%. Analysis of the relationship between leukocyte counts and mortality rates provided insight into the pathogenesis of CCHF. Receiving operating curve analysis revealed that leukocyte counts ≥2,950/mm(3) on the day of admission predicted mortality rate with 62.1% sensitivity. The mean hospitalization stay in patients with fatal disease was 4.3 days; therefore, leukocyte counts were compared on the day of admission and day 3 of the hospital stay. Increases in neutrophil levels and decreases in lymphocyte and monocyte levels were identified as significant risk factors for mortality (P = 0.01, 0.037, and 0.001, respectively). The mortality risk was 7-12 fold higher in patients whose levels of leukocytes (2,950 μL), lactate dehydrogenase (967.5 U/L), and alanine aminotransferase (>119.5 U/L) and activated partial thromboplastin time (42.4 s) exceeded the cut-off values; these were identified as independent predictors of mortality. Depletion of monocytes and lymphocytes and accumulation of neutrophils correlated with poor outcome. These results highlight the importance of the mononuclear immune response for the survival of patients with CCHF.
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Affiliation(s)
- Aliye Bastug
- Ankara Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology
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Öncülokur N, Keskin D, Garip Çimen Y, Bodur H, Köse K. FRI0213 Turkish Version of Easiqol Questionnaire in Patients with Ankylosing Spondylitis: A Validation and Reability Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bani M, Bodur H, Kapci EG. Are behaviour risk factors for traumatic dental injuries in childhood different between males and females? Eur J Paediatr Dent 2015; 16:29-32. [PMID: 25793950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM Examination of the risk factors for childhood traumatic dental injuries for male and female patients have been elusive. The present study aimed to examine whether males and females are differentially vulnerable to Traumatic Dental Injuries in relation to emotion regulation, attention deficiency hyperactive disorder symptomatology and behaviour problems. MATERIALS AND METHODS An institutional ethical review board approved the case-control study carried out at the Gazi University, Faculty of Dentistry, Turkey. A total of 80 patients with traumatic dental injuries and 80 patients with other dental problems participated in the study. Patients' parents filled in two scales: Conners' Rating Scales-Revised Attention Deficiency Hyperactive Disorder-Index, Oppositional Behavior, Hyperactivity, Anxious-Shy, Social Problems, Inattentive and Hyperactive-Impulsive subscales; and Emotion Regulation Checklist, with two subscales of Emotional Lability and Emotion Regulation. Multiple logistic regression analyses were performed separately for male and female patients. RESULTS Oppositional behaviour, hyperactivity and social problems were found to be risk factors for male patients. Being anxious/shy was the protective factor for both males and females. Classification accuracy for males and females were calculated to be 79.2% and 85.2% respectively. CONCLUSION Several risk factors for childhood traumatic dental injuries were found to differ for male and female patients.
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Affiliation(s)
- M Bani
- Gazi University, Faculty of Dentistry, Department of Paediatric Dentistry, Ankara, Turkey
| | - H Bodur
- Gazi University, Faculty of Dentistry, Department of Paediatric Dentistry, Ankara, Turkey
| | - E G Kapci
- Ankara University, Faculty of Educational Sciences, Department of Psychological Services in Education, Ankara, Turkey
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Guclu E, Tuna N, Karabay O, Akhan S, Bodur H, Ceylan B, Demirdal T, Demirdag K, Demirturk N, Ekerbicer H, Erol S, Esen S, Evirgen O, Geyik MF, Gunduz A, Karahocagil MK, Kokoglu OF, Ozdemir D, Ozgunes N, Sargın F, Tosun S, Tutuncu E. Predictors of response to pegylated interferon treatment in HBeAg-negative patients with chronic hepatitis B. J Infect Dev Ctries 2014; 8:1601-8. [PMID: 25500658 DOI: 10.3855/jidc.4953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/13/2014] [Accepted: 07/05/2014] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Although pegylated interferons (pegIFNs) alpha-2a and alpha-2b have been used in chronic hepatitis B (CHB) treatment for many years, there are few studies concerning predictors of sustained virologic response (SVR) to pegIFN therapy. In this study, we aimed to investigate the predictors of response to pegIFN treatment in cases with HBeAg-negative CHB infection. METHODOLOGY Seventeen tertiary care hospitals in Turkey were included in this study. Data from consecutively treated HBeAg-negative CHB patients, who received either pegIFN alpha-2a or alpha-2b, were collected retrospectively. SVR is defined as an HBV DNA concentration of less than 2,000 IU/mL six months after the completion of therapy RESULTS SVR was achieved in 40 (25%) of the 160 HBeAg-negative CHB patients. Viral loads in patients with SVR were lower compared to those with no SVR, beginning in the third month of treatment (p < 0.05). The number of cases with a decline of 1 log10 IU/mL in viral load after the first month of treatment and with a serum HBV DNA level under 2,000 IU/mL after the third month of treatment was higher in cases with SVR (p < 0.05). The number of patients who had undetectable HBV DNA levels at week 48 among responders was significantly greater than among post-treatment virological relapsers (p < 0.05). CONCLUSIONS Detection of a 1 log10 decline in serum HBV DNA level at the first month of treatment and a serum HBV DNA level < 2000 IU/mL at the third month of therapy may be predictors of SVR.
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Affiliation(s)
- Ertugrul Guclu
- Faculty of Medicine, Sakarya University, Sakarya, Turkey.
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Abstract
Osteomalacia is a metabolic bone disorder characterized by impaired mineralization of bone matrix. Symptoms of osteomalacia can be confused with other conditions such as spondyloarthropathy, polymyalgia rheumatica, polymyositis, and fibromyalgia. In this case, we report a patient with axial osteomalacia who developed low back pain, morning stiffness, and "grade 3 sacroiliitis" in pelvis X-ray, leading to the misdiagnosis as seronegative spondyloarthropathy. Serum biochemical studies revealed low serum phosphorus, low 25-hydroxy vitamin D3, normal calcium, elevated parathyroid hormone, and alkaline phosphatase levels. Her symptoms were relieved with vitamin D and calcium therapy. The diagnosis of osteomalacia should be considered in case of sacroiliitis and spondylitis.
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Affiliation(s)
- Y Garip
- Department of Physical Medicine and Rehabilitation, Basak Medical Center, Istasyon Mah Ayas Cad no 60 Sincan, Ankara, Turkey,
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