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    Antimicrobial Resistance and Molecular Patterns in Community-acquired Complicated Intra-abdominal Infections: A Multicentric Study
    (2020) Oğuz, Vildan Avkan-; Baykam, Nurcan; Korten, Volkan; Abdullayeva, Madina; Yapar, Derya; Mülazımoğlu, Lütfiye; Gülay, Zeynep
    Objective: We aimed to analyze antimicrobial susceptibilities by a molecular evaluation of extended-spectrum beta-lactamase (ESBL) positive of the isolates from communityacquired complicated intra-abdominal infections (CA- IAIs) in Turkey. Method: Clinical samples were obtained during operation. Antimicrobial susceptibilities, inducible beta-lactamase and ESBL status, were determined using Clinical and Laboratory Standards Institute criteria and interpretive standards. ESBL positive and cefoxitin-resistant isolates were evaluated bla genes for CTX-M, TEM, SHV, PER-1 and plasmidic AmpC families with polymerase chain reaction (PCR). We confirmed the results by directly sequencing the bla genes (Macrogen Inc, Korea) with Mega 5.02 and BLAST programs. Results: We isolated 116 pathogens from 81 patients. Clinicians diagnosed 34 (42.1%) patients as acute appendicitis, 15 (18.5%) as cholecystitis, 14 (17.3%) as intra-abdominal abscess, 12 (14.8%) as tumor resection and six (7.3%) acute diverticulitis. Escherichia coli (E. coli) was the most common gram-negative (76%), Enterococcus spp. was the most common gram-positive (13.6%). ESBL production was 12, 3 % in all gram-negative strains; 11, 1% (9/62) in E. coli and 1, 2% (1/9) Klebsiella pneumoniae (K. pneumonia). Quinolone resistance was 22.2% and ceftriaxone resistance was 14.5% in E. coli. We detected CTX-M genes in five of nine ESBL positive isolates. CTX-M-1 group (CTX-M-1, CTX-M-3, and CTX-M-15) was in four and CTX-M-9 group (CTX-M-14) in one ESBL positive E. coli. One isolate had also AmpC, CMY-2 enzyme (1, 6 %). Conclusion: In our study, ESBL positive gram-negative pathogens were >10%. Quinolone resistance was >% 20, so that quinolones should not be the first choice for the treatment of serious IAI's in our country. Cefoxitin resistance was still low in E. coli isolates from CA-IAIs. Regular surveillance data can guide empirical antibiotic therapy in community-acquired intra-abdominal infections. It should emphasize the importance of sampling for culture to surgeons for guiding empirical therapy in the future.
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    Bacterial and protozoal pathogens found in ticks collected from humans in Corum province of Turkey
    (Public Library of Science, 2018) Karasartova, Djursun; Güreser, Ayşe Semra; Gökçe, Tuncay; Çelebi, Bekir; Yapar, Derya; Keskin, Adem; Çelik, Selim; Ece, Yasemin; Erenler, Ali Kemal; Usluca, Selma; Mumcuoğlu, Kosta Yani; Taylan Özkan, Hikmet Ayşegül
    Background: Tick-borne diseases are increasing all over the word, including Turkey. The aim of this study was to determine the bacterial and protozoan vector-borne pathogens in ticks infesting humans in the Corum province of Turkey. Methodology/Principal findings: From March to November 2014 a total of 322 ticks were collected from patients who attended the local hospitals with tick bites. Ticks were screened by real time-PCR and PCR, and obtained amplicons were sequenced. The dedected tick was belonging to the genus Hyalomma, Haemaphysalis, Rhipicephalus, Dermacentor and Ixodes. A total of 17 microorganism species were identified in ticks. The most prevalent Rickettsia spp. were: R. aeschlimannii (19.5%), R. slovaca (4.5%), R. raoultii (2.2%), R. hoogstraalii (1.9%), R. sibirica subsp. mongolitimonae (1.2%), R. monacensis (0.31%), and Rickettsia spp. (1.2%). In addition, the following pathogens were identified: Borrelia afzelii (0.31%), Anaplasma spp. (0.31%), Ehrlichia spp. (0.93%), Babesia microti (0.93%), Babesia ovis (0.31%), Babesia occultans (3.4%), Theileria spp. (1.6%), Hepatozoon felis (0.31%), Hepatozoon canis (0.31%), and Hemolivia mauritanica (2.1%). All samples were negative for Francisella tularensis, Coxiella burnetii, Bartonella spp., Toxoplasma gondii and Leishmania spp. Conclusions/Significance: Ticks in Corum carry a large variety of human and zoonotic pathogens that were detected not only in known vectors, but showed a wider vector diversity. There is an increase in the prevalence of ticks infected with the spotted fever group and lymphangitis-associated rickettsiosis, while Ehrlichia spp. and Anaplasma spp. were reported for the first time from this region. B. microti was detected for the first time in Hyalomma marginatum infesting humans. The detection of B. occultans, B. ovis, Hepatozoon spp., Theileria spp. and Hemolivia mauritanica indicate the importance of these ticks as vectors of pathogens of veterinary importance, therefore patients with a tick infestation should be followed for a variety of pathogens with medical importance. © 2018 Karasartova et al.
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    Clinical, radiological and prognostic features of influenza cases in the influenza epidemic during years 2016-2017
    (Ankara Üniversitesi, 2018) Erçen Diken, Özlem; Arslan, Sertaç; Akdoğan, Özlem; Yapar, Derya; Ünal, Özgür; Demir, Emre; Baykam, Nurcan
    Introduction: Influenza subtypes vary by clinical, radiological, and prognostic courses and may go along with viral pneumonia. We aimed to identify clinical, radiological, and prognostic aspects of influenza epidemic during years 2016-2017. Materials and Methods: Influenza cases reported to the Public Health Directorate in our city was assessed retrospectively. Clinical, radiological, and prognostic parameters were compared based on influenza subtypes. Results: We analyzed samples from 197 cases with suspected influenza. Mean age of the subjects was 51.17 ± 26.74. We found influenza A/H1N1, influenza A/H3N2, and influenza B in 59 (30.0%), 29 (14.7%), and 3 (1.5%) cases, respectively. Comorbidity was present in 48 (24.4%) cases. Most common radiological finding was interstitial pattern. Seventy-one and 79 per cent of H1N1 and H3N2 cases were influenza pneumonia, respectively. The prevalence of overall mortality was 5.5% with a predominance in H1N1 over H3N2. Influenza vaccination had been performed in 6.8% and 3.4% of H1N1 and H3N2 cases, respectively. We detected no mortality in any vaccinated patient. We identified 6 pregnant women, 2 of which ended up with preterm birth, and another one with abortion. Conclusion: Often manifested as lower respiratory tract infection, influenza may cause epidemics with increased mortality rate. Influenza should be suspected when interstitial pattern was seen on radiological images. H1N1 cases course worse. Since the prognosis is better in vaccinated patients, seasonal influenza vaccination among the community needs to be elevated. In addition, protective measures like vaccination should be taken in pregnancy to avoid preterm delivery or abortion. © 2018, Ankara University. All rights reserved.
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    Comparison of procalcitonin and c-reactive protein in differential diagnosis of sepsis and severe sepsis in emergency department
    (Dicle Üniversitesi Tıp Fakültesi, 2017) Erenler, Ali Kemal; Yapar, Derya; Terzi, Özlem
    Objective: Sepsis and severe sepsis (sepsis accompanied by acute organ dysfunction) are leading causes of death worldwide. In this study, our aim was to investigate utility of biomarkers commonly used in diagnosis of sepsis in discriminating these two entities. Methods: Two-hundred and three patients involved were divided into 2 subgroups as sepsis and severe sepsis according to Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012. Then groups were compared according to clinical and laboratory (including C-reactive protein (CRP) and procalcitonin (PCT) levels) characteristics. Results: Of 203 patients included into the study, 124 (61.1%) were male and 79 (38.9%) were female. The most common reason for sepsis was urinary tract infection (n=64, 31.5%), followed by catheter infection (n=16, 7.9%) and pneumonia (n=14, 6.9%). Escherichia coli was the most common agent in both blood and urinary cultures. Majority of the patients were treated with ceftriaxone (n=33, 16.3%), followed by meronem/dapson (n=25, 12.3%). In both groups, CRP and PCT levels were high, even higher in severe sepsis group. However, any statistical significance could not be determined between groups. Mortality rate in sepsis patients was 6.4%. Conclusion: Plasma levels of both markers elevate in sepsis and severe sepsis. It was determined that CRP and PCT is higher in severe sepsis than in sepsis. However, the difference is not statistically significant. Plasma levels of CRP and PCT are not useful in differential diagnosis of sepsis and severe sepsis
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    Çorum ilinde hemşirelik öğrencilerinin kist hidatik hakkındaki bilgi düzeyleri ve tutumları
    (Refik Saydam National Public Health Agency (RSNPHA), 2019) Yılmazel, Gülay; Yapar, Derya; Taylan Özkan, Hikmet Ayşegül
    Amaç: Kistik ekinokokkoz dünyada olduğu gibi ülkemizde de yaygın görülen, sağlık ve ekonomik açıdan yük getiren önemli bir halk sağlığı sorunudur. Bu çalışmanın amacı hemşirelik öğrencilerinin kistik ekinokokkoz hakkındaki bilgi düzeylerini ve tutumlarını belirlemektir. Yöntem: Kesitsel tipteki bu araştırma, Şubat-Mayıs 2016 tarihleri arasında Çorum ilinde yapıldı. Hitit Üniversitesi Sağlık Yüksekokulu’nun hemşirelik bölümünde öğrenim gören gönüllü ve ulaşılabilen 364 öğrenci örneklem kapsamına alındı. Araştırmanın verileri, üç aşamalı bir anket formu ile toplandı. Anket formunun ilk aşaması tüm öğrencilere yönelik olup bu aşamada öğrencilerin sosyodemografik özellikleri yer aldı. Anket formunun ikinci aşaması ise kistik ekinokokkoz hastalığını bildiğini belirten öğrencilere yönelik olup öğrencilerin kistik ekinokokkoz ile ilgili bilgi düzeylerinin değerlendirilmesi amacıyla hazırlandı. Öğrencilerin kistik ekinokokkoz ile ilgili tutumlarının incelenmesinde belirleyici olan “köpeğiniz var mı?” sorusu oldu. Araştırmanın verileri SPSS 17.0 paket programında değerlendirildi. Kategorik değişkenlerin analizinde Ki-kare testi kullanıldı. Bağımlı ve bağımsız değişkenler arasındaki ilişki lojistik regresyon analizi ile belirlendi. P<0.05 değeri istatistiksel açıdan anlamlı kabul edildi. Bulgular: Araştırmada öğrencilerin %75,5’i 18-21 yaş aralığında olup yaş ortalamaları 20,33±1,84 yıldır. Öğrencilerin %63,7’si kız ve %36,3’ü erkektir. Birinci sınıfta öğrenim görenlerin oranı %37,9; dördüncü sınıfta öğrenim görenlerin oranı %19,8’dir. “Kistik ekinokokkoz hastalığını biliyor musunuz” sorusuna “evet” yanıtını verenlerin oranı %28,3’dür. Kistik ekinokokkoz hastalığını bildiğini belirten öğrencilerden %72,8’i hastalığın karaciğeri etkilediğini; %97,1’i hastalığın gastrointestinal belirtilerinin olduğunu; %82,5’i hastalığın su ve besinlerle insanları enfekte ettiğini belirtmiştir. Öğrencilerin %72,9’u ekinokoklar için esas konak olarak köpeği göstermiştir. Araştırma grubunda köpeği olan öğrencilerin oranı %13,2 olup bu öğrenciler arasında köpeğinin yaşam alanlarında (evlerinde) bulunduğunu belirtenlerin oranı %27,1’dir. Hastalığın bilinmesi sınıflar arasında farklıdır, annesi çalışanlarda, annesi ev hanımı olanlara göre anlamlı ölçüde yüksek bulunmuştur(p<0.05). Lojistik regresyon modeli sonuçlarına göre öğrencilerin kistik ekinokokkoz hastalığını bilmemesi birinci sınıf öğrencilerinde 4,2 kat;üçüncü sınıf öğrencilerinde 3,1 kat; annesi ev hanımı olanlarda 4,9 kat daha yüksekti (p<0.001). Sonuç: Çalışmamızda öğrencilerin yaklaşık üçte birinin kistik ekinokokkoz hastalığını bildiği belirlenmiştir. Kistik ekinokokkozise yönelik öğrencilerin bilgi düzeylerinin düşük, hastalığın erken tanısına yönelik tutumlarının olumlu, hastalığın önlenmesi ve kontrol altına alınması açısından yaptıkları uygulamaların yetersiz olduğu belirlenmiştir. Çalışmamızdan elde edilen sonuçlar ışığında müfredat programları dışında da hemşire adaylarına belirli aralıklarla hastalıkla ilgili sürekli ve güçlendirilmiş davranış değiştirici sağlık eğitimlerinin verilmesi önerilebilir.
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    Hitit Index to distinguish patients with and without Crimean-Congo hemorrhagic fever
    (Elsevier Gmbh, 2019) Kayadibi, Hüseyin; Yapar, Derya; Akdoğan, Özlem; Ulusu, Nuray N.; Baykam, Nurcan
    Crimean-Congo hemorrhagic fever (CCHF) is fatal. Therefore, it is very important to use an inexpensive, easily accessible, quick and accurate screening index based on clinical signs and laboratory parameters to identify patients suspected of having CCHF. Laboratory test results on the day of hospitalization for 268 inpatients suspected of having CCHF were used to calculate the laboratory section of the Hitit Index, while 65 of these were also monitored daily during their hospital stay to develop the clinical section of the Hitit Index. Two-hundred CCHF-negative outpatients were also evaluated. One-hundred and forty-nine inpatients were CCHF-positive and 119 inpatients were CCHF-negative. The Hitit Index is 5.6 - (5.3*lymphocyte) - (0.02*fibrinogen) - (12*direct bilirubin) + (0.04*AST) + (0.32*hematocrit) - (0.5*neutrophil) - (0.07*CKD-EPI) - (0.001*CK) +/- conjunctival hyperemia (+1.5 in conjunctival hyperemia presence and -1.5 in conjunctival hyperemia absence). In 65 inpatients monitored daily, Hitit Index results for CCHF-positive and negative inpatients were 6.10(1.90-12.30) and -5.35(-8.83- -1.95), while CCHF-negative outpatients were -10.99(-15.64- -6.95) (P < 0.001), respectively. On hospitalization day, just one inpatient was false-negative in 27 CCHF-positive inpatients, while four were false-positive among 38 CCHF-negative inpatients using the Hitit Index. After 24 h, just one inpatient was diagnosed falsely among 27 CCHF-positive and 38 CCHF-negative inpatients, and there was no change after 48 h. Management of patients living in endemic regions suspected of having CCHF could be achieved within minutes using the Hitit Index. Patients with Hitit Index less than zero can be monitored as outpatients, while patients with Hitit Index results above zero must be hospitalized in infectious diseases wards. This study was not registered since it was retrospective.
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    Hitit Üniversitesi Çorum Eğitim ve Araştırma Hastanesi’nde lenfadenopati ön tanılı olguların toksoplazmoz açısından irdelenmesi
    (Refik Saydam Hıfzıssıhha Merkezi Başkanlığı, 2017) Güreser, Ayşe Semra; Yapar, Derya; Taşçı, Leyla; Boyacıoğlu, Zehra İlkay; Turgal, Ebru; Baykam, Nurcan; Taylan Özkan, Hikmet Ayşegül
    Amaç: Sağlıklı insanlarda genellikle asemptomatik seyreden toksoplazmozun en sık görülen semptomatik formu lokalize lenfadenopati (LAP)'dir. Bu çalışmada LAP ön tanısı ile başvuran hastaların toksoplazmoz açısından irdelenmesi amaçlanmıştır. Yöntem:01.08.2013-31.07.2015 tarihleri arasında Hitit Üniversitesi Çorum Eğitim ve Araştırma Hastanesi Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Kliniği'ne LAP ön tanısı ile başvuran 239 (%57,70 kadın, %42,30 erkek) hastaya ait demografik, serolojik, radyolojik ve patolojik veriler hastane bilgi sisteminden (HBS) elde edilmiştir. Anti-Toxoplasma IgG ve IgM testleri Architect (Abbott Diagnostics) veya Cobas E 601 (Roche Diagnostics) cihazlarıyla kemilüminesan yöntemiyle çalışılmıştır.mikropartikül enzimimmünassay Bulgular: Hiçbirinde immunsupresyon hikayesi olmayan hastalardan 138 kadının 51 (%36,96)'inde, 101 erkeğin 13 (%12,87)'ünde IgG ve/veya IgM antikoru pozitifti. Hem erkeklerde (%3,76) hem de kadınlarda (%10,46) en yüksek antikor pozitiflik oranı 39 yaş altındadır. Hastaların 48 (%20,10)'inde yalnızca anti-Toxoplasma IgG, 12 (%5)'sinde ise IgG ve IgM birlikte ve dört (%1,70)'ünde ise tek başına IgM pozitifliği belirlenmiştir. Anti-Toxoplasma IgM'i pozitif 16 hastadan 7 (%2,93)'si 39 yaş altı kadın olup yalnızca ikisinde çalışılan IgG avidite testi yüksek avidite olarak bulunmuştur. IgM pozitif olan hastaların ultrasonografisine ulaşılan 12'sinde, altısında çoklu tutulum olmak üzere LAP'ların dağılımı şöyledir: yedi bilateral servikal, beş submandibular, üç parotis, 3 oksipital, bir submental, bir retroaurikular. LAP'ların en küçüğü 6x5 mm, en büyüğü ise 24x12 mm ebatlarındadır. Toksoplazmoz IgM pozitif hastalardan üçüne ince iğne aspirasyon biyopsisi yapılmış, birinde reaktif lenfoid hiperplazi, ikisinde kronik nonspesifik lenfadenit tespit edilmiştir. LAP ve IgM pozitif olan altı hastaya tedavi verildiği ve LAP'larında gerileme olduğu belirlenmiştir.Sonuç: Sonuç olarak çalışmamızda belirlediğimiz %6,70'lik IgM pozitifliği klinisyenlerin LAP etiyolojisinde toksoplazmozu akılda tutması gerekliliğini ortaya koymaktadır. Bu amaçla LAP incelemesinde yer alan hekimlere ayırıcı tanı ve toksoplazmozda serolojik tanının yeri konusunda eğitim verilmesi önerilir.
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    Monitoring Crimean-Congo haemorrhagic fever virus RNA shedding in body secretions and serological status in hospitalised patients, Turkey, 2015
    (Eur Centre Dis Prevention & Control, 2020) Yagci-Caglayik, Dilek; Kayaaslan, Bircan; Yapar, Derya; Kocagul-Celikbas, Aysel; Ozkaya-Parlakay, Aslinur; Emek, Mestan; Ozkul, Aykut
    Introduction: Crimean-Congo haemorrhagic fever (CCHF) is a tick-borne disease in Africa, Asia, the Balkan peninsula, the south-east of Europe and the Middle East, with mortality rates of 3-30%. Transmission can also occur through contact with infected animals or humans. Aim: This observational, prospective case series aimed to investigate detectable viral genomic RNA in whole-body fluids and antibody dynamics in consecutive daily samples of patients diagnosed with CCHF until discharge from hospital. Methods: We tested 18 patients and 824 swabs and sera with RT-PCR and 125 serum samples serologically. Results: The longest duration until clearance of viral RNA was 18 days from serum collection and 18, 15, 13, 19 and 17 days, respectively, from nasal, oral, genital (urethral or vaginal) and faecal swab, and urine. In seven patients, viral load decreased in serum at the same time as it increased in urine or persisted at the same logarithmic values. Despite clearance in serum, viral RNA was detected in faeces and genital swabs in two and three patients, respectively. Viral clearance from body fluids occurred earlier than from serum in eight patients on ribavirin treatment. The shortest seroconversion time was 3 days after symptom onset for IgM and IgG. Seroconversion of IgG occurred until Day 14 of symptoms. Conclusion: We report persistence of viral RNA in urine, faeces and genital swabs despite serum clearance. This may indicate a need for extending isolation precautions, re-evaluating discharge criteria and transmission risk after discharge, and considering oral swabs as a less invasive diagnostic alternative.
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    Multi-center prospective evaluation of discharge criteria for hospitalized patients with Crimean-Congo Hemorrhagic Fever
    (Elsevier B.V., 2016) Leblebicioglu, Hakan; Sünbül, Mustafa; Barut, Şener; Büyüktuna, Seyit Ali; Özkurt, Zülal; Yapar, Derya; Yılmaz, Gürdal; Güner, Rahmet
    Introduction The information of discharge criteria in patients with Crimean-Congo Hemorrhagic Fever (CCHF) is limited. In this study, we aimed to determine the clinical and laboratory parameters used in discharging the patients by the experienced centers. Materials and methods The study was done in 9 reference centers of CCHF from May 1, 2015 to December 1, 2015 and included laboratory-confirmed patients with CCHF. The study was prospective, observational and non-interventional. Results The study included 260 patients. Mean age was 51.3 ± 16.3 years; 158 (60.8%) were male. Mean hospital stay was 7 ± 2.6 days. The decision of discharging was taken considering clinical and laboratory findings. On discharge, no patients had fever or hemorrhage. The patients were followed-up clinically and a repeat CCHF PCR was not studied. All centers considered the following criteria for discharge: no fever and hemorrhage, improvement in clinical findings and laboratory studies. For all patients except one, platelet count was >50,000/mm3 and had a tendency to increase. Prothrombin time and international normalized ratio (INR) were normal in 258 (99.6%) and 254 (98.1%) patients respectively. Alanine aminotransferase (ALT) was either normal or not higher than 10-fold and had a tendency to decrease in 259 (99.6%) patients. ALT and aspartate aminotransferase (AST) levels were not taken as discharge criteria with priority. During 30 days following the discharge, complication, relapse, or secondary transmission were not reported. Conclusions The discharging practice of the centers based on clinical and laboratory parameters seems safe considering no complications, relapses, or secondary infection thereafter. Current discharge practice of the centers composed of no fever and hemorrhage, improvement in clinical findings, platelet count of either >100,000/mm3 or >50,000/mm3 with a tendency to increase, and normal bleeding tests can be used as the criteria of discharge. © 2016 Elsevier B.V.
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    Nadir Görülen Olgu: Skabiese Bağlı Lökositoklastik Vaskülit
    (2020) Yapar, Derya; Akdoğan, Özlem; Baykam, Nurcan
    Skabies, Sarcoptes scabiei’nin neden olduğu kaşıntılı bir kutanöz parazitozdur. Lökositoklastik vaskülit (LCV) erişkinlerde sık görülen vaskülit olup sıklıkla idiopatiktir ancak enfeksiyon, otoimmün hastalıklar, malinite veya ilaçlara bağlı gelişebilir. Literatürde skabiese bağlı LCV ile ilgili az sayıda olgu bildirilmiştir. Skabiese bağlı olduğunu düşündüğümüz LCV olgumuzu literatür incelemesi eşliğinde tartışmayı istedik. Altmış iki yaşında erkek hasta iki gündür olan öksürük, balgam, ateş ve bacaklarında bir buçuk aydır olan kaşıntılı döküntü şikayetleri ile başvurdu. Pnömoniye yönelik tedavi başlandı. Kaşıntılı makülopapüler ve purpurik döküntüleri olan hastaya skabies tanısı konuldu. Hastanın eşinde de kaşıntılı cilt lezyonlarının olduğunu öğrendik. Topikal permetrin tedavisi başlandı. Vaskülitik lezyonlarından alınan cilt biyopsisinde lökositoklastik vaskülit tespit edildi. Kitlesel malinite, otoimmün hastalıklar, infeksiyöz nedenler ekarte edildi. Topikal tedavi ile vaskülitik lezyonların iyileştiği görüldü. Hastamızda topikal permetrin tedavisi ile vaskülitik lezyonların iyileşmesi, diğer nedenlerin ekarte edilmesi ve eşinde benzer şikayetlerin olması ile skabies ve skabiese sekonder gelişen LCV tanısını düşündük. Özellikle kaşıntılı lezyonlarda skabiese bağlı LCV gibi nadir görülen komplike bir olguda iyi alınan anamnezin tanıyı kolaylaştıracağını düşündük.
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    Nedeni Bilinmeyen Ateş Nedeni: Supskapular Apse
    (2020) Yapar, Derya; Akdoğan, Özlem; Baykam, Nurcan
    Subskapular apse literatürde az sayıda olgu olması ve erken dönemde tanı konulup acil cerrahi müdahale gerektirmesi nedeniyle nadir ama ciddi klinik bir durumdur. Bu yazıda travma ya da cerrahi girişim olmaksızın metisiline dirençli Staphylococcus aureus septisemisine neden olan, erken dönemde tanısı konulan ve tedavi edilen spontan subskapular apse olgusu sunulmuştur
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    Predicting tularemia with clinical, laboratory and demographical findings in the ED
    (W.B. Saunders, 2016) Yapar, Derya; Erenler, Ali Kemal; Terzi, Özlem; Akdoğan, Özlem; Ece, Yasemin; Baykam, Nurcan
    Introduction We aimed to determine clinical, laboratory and demographical characteristics of tularemia on admission to Emergency Department (ED). Material and Methods Medical data of 317 patients admitted to ED and subsequently hospitalized with suspected tularemia between January 1, 2011, and May 31, 2015, were collected. Patients were divided into 2 groups according to microagglutination test results, as tularemia (+) and tularemia (-). Results Of the 317 patients involved, 49 were found to be tularemia (+) and 268 were tularemia (-). Mean age of the tularemia (+) patients was found to be higher than that of tularemia (-) patients. When compared to tularemia (-) patients, a significant portion of patients in tularemia (+) patients were elderly, living in rural areas and had contact with rodents. When clinical and laboratory findings of the 2 groups were compared, any statistical significance could not be determined. Conclusion Tularemia is a disease of elderly people living in rural areas. Contact with rodents also increases risk of tularemia in suspected patients. © 2015 Elsevier Inc.
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    Quantitative evaluation and progress of olfactory dysfunction in COVID-19
    (Springer, 2021) Uğurlu, Burak Numan; Akdoğan, Özlem; Arı Yılmaz, Yasemin; Yapar, Derya; Aktar Uğurlu, Gülay; Yerlikaya, Hüseyin Serdar; Aslan Felek, Sevim
    Purpose Since many different rates have been reported in the literature and the studies conducted are mostly based on the patient anamnesis, it was aimed to analyze the olfactory dysfunction in Coronavirus Disease 2019 (COVID-19) quantitatively and to reveal its progress by time. Methods Patients who described new-onset olfactory dysfunction, who were treated in the COVID-19 departments of our hospital and whose PCR tests demonstrated SARS-CoV-2 presence were included in the study and they were investigated prospectively. Clinical information of all the patients was taken and the levels of olfactory function were detected using the Brief Smell Identification Test (BSIT). Scores equal to or below 8 are considered as olfactory dysfunction. Patients who were followed up for 3 months were reevaluated with the BSIT test at the end of the third month and the progression of the symptom was investigated. Results The mean BSIT test score of the 42 patients (23 female patients, 19 male patients, mean age: 41.2 +/- 14.6) was 5.2 +/- 2.2. There was severe olfactory dysfunction in 16.7% of the patients (0-2 points), moderate olfactory dysfunction in 31% (3-5 points), and mild olfactory dysfunction in 52.4% (6-8 points). After a follow-up for 3 months, full recovery was observed in 36 patients (85.7%) and the mean test score rose to 9.9 +/- 1.8. Although olfactory dysfunction persisted in 6 patients, an elevation in test scores was noted. Olfactory dysfunction was the first symptom in 17 patients (40%) and the other symptoms occurred after 2 days (1-6) on average. Conclusion We investigated olfactory dysfunction caused by COVID-19 using BSIT, and found a high rate of moderate-mild level symptoms with a high level of recovery in the 3-month follow-up. The finding revealing that olfactory dysfunction was the first symptom in 40% of the patients suggests the importance of inquiry on olfactory functions for the early diagnosis of the disease.
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    SEROPREVALENCE OF RICKETTSIOSIS IN PATIENTS WITH CRIMEAN -CONGO HEMORRHAGIC FEVER PRELIMINARY DIAGNOSIS IN THE CASE OF CORUM PROVINCE TURKEY
    (Parlar Scientific Publications (P S P), 2021) Akdoğan, Özlem; Yapar, Derya; Gürel, Büşra; Karasartova, Djursun; Güreser, Ayşe Semra; Savcı, Ünsal; Taylan Özkan, Hikmet Ayşegül
    People engaged in agriculture and animal husbandry living in endemic areas are at high risk of tick-transmitted infectious diseases. Both Crimean-Congo Hemorrhagic Fever (CCHF) and rickettsial diseases can be transmitted as a result of tick bites. We aimed to evaluate the patients preliminarily diagnosed with CCHF at our clinic in terms of CCHF and rickettsia seropositivity, epidemiologic features and to compare ELISA and IFAT for serodiagnosis of rickettsiosis. Between 2014-2017, 265 patients who were followed up with a preliminary CCHF diagnosis at the Infectious Diseases and Clinical Microbiology Department of Hitit University Comm Erol Olcok Training and Research Hospital, were included in this study. Rickettsia was analyzed by ELISA IgG and 1gM (Vircell, Rickettsia conorii ELISA IgG+IgM, Spain), IFA (Vircell, Rickettsia conorii IFA IgG, Granada, Spain) and also by in house-PCR. According to the laboratory results for CCHF and Rickettsia patients were divided into two groups: (i) CCHF positive (+), (ii) Rickettsia seropositive (Rickettsia+; ELISA/IFA IgM and/or IgG positive). Of the 265 patients, 179 (67.55%) were male, and the average age was 49.04 (age range 18-90) years. In our study, CCHF virus positivity was 51.3%, while Rickettsia IgG+IgM positivity was 24.9%. In the diagnosis of rickettsiosis IFA and ELISA showed 99.62% agreement, but no PCR positivity was found. In total, CCHF+(n=136), CCHF-(n=129), Rickettsia+(n=66), cases were evaluated. In total, 123 (90.44%) of the patients who were positive for CCHF and 55 (84.62%) of patients seropositive for Rickettsia had applied to the hospital from rural areas (p>0.05). In both group, most of the cases have tick bite history (77.2% in CCHF+ group and 59.1% in Rickettsia+ group). In the group in which both agents were found to be negative, this rate decreased to 38.2% (p 0.98). Rickettsia was found to be seropositive in 39 (28.7%) of the 136 patients with CCHF positivity. Rickettsia was seropositive in 27 (20.9%) of the 129 patients with CCHF negativity. Except one case with positive Rickettsia IgM, other 65 cases with IgG positive were not considered as acute rickettsiosis. The fact that we live in an area where CCHF and rickettsial diseases are endemic requires us to keep these diseases in mind constantly. Although IFAT is considered as the reference test for serological diagnosis of rickettsiosis, ELISA could be an alternative. Rickettsial disease, a deadly but treatable disease, should be especially considered in patients who apply with a history of acute fever in endemic areas.
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    The role of T reg population in pathogenesis of Crimean Congo hemorrhagic fever
    (Elsevier B.V., 2018) Gazi, Umut; Yapar, Derya; Karasartova, Djursun; Güreser, Ayşe Semra; Akdoğan, Özlem; Ünal, Özgür; Baykam, Nurcan; Taylan Özkan, Hikmet Ayşegül
    Crimean-Congo hemorrhagic fever (CCHF) is a severe human infection caused by CCHF virus (CCHFV). Today, although the literature on CCHF pathogenesis is still limited, it is thought to be associated with immunosuppression in the early phase of infection followed by pro-inflammatory immune response that may lead to fatal outcomes. The aim of this study is to investigate the role of regulatory T-cells (T reg cells) in the pathogenesis of CCHFV. Peripheral blood mononuclear cell samples collected from 14 acute CCHF patients with mild disease course and 13 healthy subjects were included in this study. T reg expression and functional levels were analyzed by flow cytometry. T reg cells were identified as CD4+CD25 + CD127dim cells, and their functional levels were compared by measuring their ability to suppress CD69 and CD154 expression by activated T-cells. The flow cytometry analysis revealed that total T-cell and helper T-cell levels did not vary between the two groups. In contrast, CCHF patients displayed higher T reg cell levels but lower T reg suppressive activities when compared with control subjects. This is the first study on the involvement of T reg cells in CCHF pathogenesis. Our results indicate that even though T reg cell levels are elevated during acute phase of CCHF infection, not all generated T reg cells has immunosuppressive capacity, and therefore may not represent ‘true’ T reg cell population. Future studies on the intrinsic mechanisms responsible for the reduced T reg inhibitory activities are required for further enlightening the CCHF pathogenesis, especially in the acute phase of the disease. © 2018 Elsevier B.V.
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    Öğe
    Ülseratif Koliti Olan Bir Hastada Sitomegalovirus Koliti
    (Aves, 2020) Akdoğan, Özlem; Yapar, Derya; Düzenli, Tolga; Kaplan, Gülcan; Tunçel Öztürk, Pınar; Özçerezci, Tuğba; Baykam, Nurcan; Kocagül Çelikbaş, Aysel
    Sitomegalovirus (CMV), immünosüprese bireylerde, gastrointestinal sistem de dahil olmak üzere ağır, kalıcı ve yaşamı tehdit eden hastalıklara neden olabilir. Yedi yıldan beri ülseratif kolit tanısıyla Gastroenteroloji Polikliniği’nde takip edilen 71 yaşında kadın hastanın, karın ağrısı ve kanlı ishal şikayetlerinin alevlenmesi nedeniyle yapılan kolonoskopisinde yer yer mukoza ülserasyonları ve psödopolipler gözlendi. Histomorfolojik bulgular CMV kolitiyle uyumluydu. İmmünohistokimyasal boyamada CMV antijen-pozitif hücreler görüldü. Polimeraz zincir reaksiyonu testiyle CMV DNA doku biyopsi örneklerinde 257 000 kopya/ mg, serumda ise 137 kopya/ml olarak saptandı. Bir ay süreyle gansiklovir 2×5 mg/kg İV uygulandıktan sonra serumda ve doku biyopsisi örneklerinde CMV DNA sonuçlarının negatifleştiği saptandı. Klinik tablosu kısmi bir düzelme gösteren hasta, tedavisi üç aya tamamlanmak üzere oral valgansiklovire geçilerek taburcu edildi. Başlanan tedaviye devam etmemesi üzerine, hasta üç ay sonra yineleyen karın ağrısı ve kanlı ishal şikayetleriyle yeniden yatırıldı. Kolon biyopsisi materyalinde CMV DNA 814 kopya/mg bulunması üzerine başlanan metilprednizolon ve gansiklovir tedavisine yanıt alınamayınca, tedavi rejimine infliksimab da eklendi. Bu tedaviyle hastanın doku ve serum CMV DNA negatif oldu ve klinik tablosunda düzelme oldu. Gansiklovir kesilerek hasta IFX tedavisine devam edilmek üzere taburcu edildi. Hastanın altı aylık takibinde yeni bir atak gelişmedi. Bu olgu da göstermektedir ki, ülseratif kolit hastalarında, benzer bulguları olabilen CMV koliti akılda bulundurulması bir fırsatçı infeksiyondur.
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    Öğe
    Yoğun Bakım Ünitelerinde Takip Edilen Yaşlı ve Yaşlı Olmayan Hastalarda Hastane İnfeksiyonu
    (2020) Yapar, Derya; Güner, Rahmet
    Giriş: Bu çalışmada, yoğun bakım ünitesinde 48 saatten uzun takip edilen hastane infeksiyonu gelişen ve gelişmeyen yaşlı (? 65 yaş) ve yaşlı olmayan “erişkin” (< 65 yaş) hastalarda hastane infeksiyonu hızı, risk faktörleri, etkenler ve mortaliteyi etkileyen faktörlerin karşılaştırmalı olarak incelenmesi amaçlanmıştır. Materyal ve Metod: Yoğun bakım ünitesinde 48 saatten uzun yatan 462 hasta ile yürütülen bu çalışmada, 65 yaş ve üzeri “yaşlı” ve 18-64 yaş arası “erişkin” hasta grupları hastane infeksiyonu açısından karşılaştırıldı. Bulgular: Yaşlı ve erişkin grupta sırasıyla %28.5 ve %25.1 oranında olmak üzere, hastane infeksiyonu toplamda 462 hastada tanımlanmış ve iki grup arasında fark bulunmamıştır (p= 0.48). Hospitalizasyon ve aspirasyon öyküsü, diabetes mellitus, kronik obstrüktif akciğer hastalığı, kronik böbrek yetmezliği ve kronik hastalıkların varlığı yaşlı hastalarda, kan transfüzyon öyküsü ise erişkin grubunda risk faktörü olarak saptanmıştır. Çok değişkenli analizde, hastanede kalış süresi ve diabetes mellitus yaşlı hasta grubunda hastane infeksiyonu için risk faktörleri olarak saptanmıştır. Lojistik regresyon analizinde ise ileri yaş, kalış süresinin uzunluğu, mekanik ventilatör mortaliteyi artıran bağımsız risk faktörleri olarak tespit edilmiştir. Sonuç: Giderek yaşlanan dünyada çalışmamızda yaş, hastane infeksiyonu için risk faktörü olarak tespit edilmemiştir. Ancak artan yaşla beraber artan yatış süresi, direnç paterni, mortalite ile karşı karşıya kaldığımız ortadadır. Bu nedenle yoğun bakım ünitelerinde yaşlılar hastane infeksiyonu açısından değerlendirilirken yaşlı olmayan hastalara göre farklı değerlendirme yapılması uygun olacaktır.