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Yayın An analysis on the roles of angiogenesis-related factors including serum vitamin D, soluble endoglin (sEng), soluble fms-like tyrosine kinase 1 (sFlt1), and vascular endothelial growth factor (VEGF) in the diagnosis and severity of late-onset preeclampsia(TAYLOR & FRANCIS LTD, 2017) Cim, Numan; Kurdoglu, Mertihan; Ege, Serhat; Yoruk, Ibrahim; Yaman, Gorkem; Yildizhan, RecepAim: The aim of this study was to evaluate the roles of proangiogenic factors including serum vitamin D and vascular endothelial growth factor (VEGF) and anti-angiogenic factors including soluble endoglin (sEng) and soluble fms-like tyrosine kinase 1 (sFlt1) in the diagnosis and severity of late-onset preeclampsia. Materials and methods: The study was conducted at Yuzuncu Yil University Research and Education Hospital Department of Gynecology and Obstetrics. The study included a patient group of 40 women with late-onset preeclampsia who were pregnant at >= 32 weeks of gestation according to the last menstrual period (LMP) or ultrasonographic fetal biometric measurement and a control group of 40 healthy pregnant women who presented to our clinic for routine pregnancy examination and were at the same age and gestational period with those in the patient group. The two groups were compared in terms of maternal age, gravida, parity, week of gestation, systolic/diastolic blood pressure, total protein in spot urine sample, 24-h urine protein, white blood cell (WBC), hemoglobin (Hgb), platelet count, urea, creatinine, liver function tests (AST, ALT, LDH), vitamin D-3, 25(OH) vitamin D-3, 1,25(OH) vitamin D-3, sEng, sFlt1, and VEGF levels, mode of delivery, the infant APGAR score at 1 and 5 min after delivery, and infant weight at delivery. Results: The groups were similar in terms of age, gravida, parity, week of gestation, serum vitamin D-3, 25(OH) vitamin D-3, 1,25(OH)(2) vitamin D-3 and VEGF levels, and infant weight at delivery (p > 0.05). Systolic/diastolic blood pressure, total protein in spot urine sample, 24-h urine protein, WBC, Hgb, serum urea, creatine, AST, ALT, and LDH were significantly higher in the preeclamptic group compared to the healthy group (p < 0.05). However, thrombocyte level and the APGAR score at 1 and 5 min after delivery were significantly lower in the preeclamptic group compared to the healthy group (p < 0.05). No significant correlation was found between serum sEng, sFlt1, VEGF, vitamin D-3, 25(OH) vitamin D-3, and 1,25(OH)(2) vitamin D-3 levels. The sEng level was higher in the women with severe preeclampsia compared to the women with mild preeclampsia (p < 0.05) and no significant difference was observed in serum sFlt1, VEGF, vitamin D-3, 25(OH) vitamin D-3, and 1,25(OH)(2) vitamin D-3 levels between the subgroups of preeclampsia (p > 0.05). Conclusion: Both sEng and sFlt1 levels are remarkably high in patients with late-onset preeclampsia; however, only sEng may be a useful tool in the determination of the severity of preeclampsia.Yayın Are physicians aware of current HIV / AIDS diagnostic practices? A study from a tertiary centre in Turkey(J INFECTION DEVELOPING COUNTRIES, 2018) Alasehir, Elcin Akduman; Yesilbag, Zuhal; Karadeniz, Asli; Yaman, GorkemIntroduction: Early diagnosis of HIV infection is essential for the reduction of morbidity/mortality rates, health expenditures and the prevention of infection spread. In this study we aimed to test the knowledge of physicians regarding HIV risk groups, AIDS indicator diseases and their current practices about screening. Methodology: A questionnaire was used to collect data from physicians working in a multidisciplinary 170-bed tertiary university hospital in Istanbul, Turkey. The questionnaire measured physician knowledge of the above-mentioned points. Results: Ninety-six physicians replied to the questionnaire. "Preoperative screening" was found to be the most common (65.6%) indication for HIV testing. A large portion of physicians (72.9%) felt comfortable with an HIV test and 71.9% of the physicians had no impeding condition for HIV testing. Physicians were mostly (67.7%) unaware of the current guidelines for HIV testing. Conclusions: Teaching programs are essential to increase knowledge of HIV screening for physicians as this is an essential part of early diagnosis and therefore important for decreasing morbidity and mortality.Yayın A Case of Rib Tuberculosis and Chest Wall Abscess with Multi-Drug Hypersensitivity Reactions(ANKARA MICROBIOLOGY SOC, 2015) Akduman Alasehir, Elcin; Sariman, Nesrin; Yaman, Gorkem; Olgac, Muge; Saygi, AttilaExtrapulmonary tuberculosis is the reactivation of the remaining latent organism which spreads during primary infection by the lymphohematogenous way. It should be considered in the differential diagnosis especially in endemic countries for tuberculosis. Tuberculosis (TB) treatment is based on the principle of the combined use of several drugs. As a result of the combination therapy there can be life threatening side effects which can lead to improper use of medications and may also cause drug resistance. In this report, we present an 85-year-old male patient desensitized due to the development of allergy against multi-drugs with rib tuberculosis and chest wall abscess to whom, culture, drug susceptibility and genotypical tests were applied. In November 2012, the patient applied to a medical center with complaints of swelling and pain under the right rib, underwent rib resection and eventually diagnosed as rib TB by histopathological examination. However, the anti-TB treatment was discontinued due to the hypersensitivity reactions in the skin and in addition to the hepatic and renal dysfunction side effects. The patient had widespread redness, rash and pruritus on the body and the laboratory findings were as follows; ALT: 114 U/L, AST: 152 U/L, ALP: 93 U/L, GGT: 26U/L, blood urea nitrogen (BUN): 26 mg/dL and creatinine: 1.7 mg/dL. After the disapperance of the complaints within 3 days of drug discontinuation, isoniazid treatment was initiated. However, the new treatment was also discontinued when the reactions reoccurred. Afterwards, the patient developed hypersensitivity reactions against the combination of streptomycin and ethambutol. The patient refused any further treatment and was discharged from the hospital. The patient was untreated for the last 5 months and admitted to our clinic with a fistulized swelling and abscess in the right chest wall. Bacteria was not detected in the acid-fast staining of the abscess material, however Mycobacterium tuberculosis was isolated from culture by MGIT (Mycobacteria Growth Incubator Tube; BBL MGIT, BD, USA) system. The spoligotyping revealed that the genotype was Haarlem 1. Major drug susceptibility testing against rifampin, streptomycin, ethambutol, isoniazid, and pyrazinamide yielded sensitivity to those drugs. Minor drug susceptibility testing against paraaminosalicylic acid, ethionamide, kanamycin, capreomycin and ofloxacin was found to be sensitive. A regimen of isoniazid 300 mg/day, ethambutol 1000 mg/day and moxifloxacin 400 mg/day was initiated. Rapid oral desensitization against isoniazid and ethambutol were repeated on two consecutive days. The patient continued antituberculosis therapy for 12 months without adverse reactions. The chest wall fistula was closed. Abscess was drained surgically. Clinical and radiological improvements were achieved. The patient remains clinically disease free and continues his regular follow ups. This case is presented to emphasize about the importance of culture and susceptibility testing in extrapulmonary tuberculosis cases and desensitization in drug hypersensitivity reactions.Yayın Distribution of Hepatitis C Virus genotypes in patients with chronic Hepatitis C infection in Eastern Turkey(ALLIED ACAD, 2015) Ozer, Turkan Toka; Berktas, Mustafa; Yaman, Gorkem; Erkoc, RehaViral hepatitis is one of the most important liver diseases in the world. Duration of hepatitis C virus (HCV) infection and response to standard therapy is strongly related to HCV genotypes. Geographical distribution of HCV genotypes is also important for epidemiological studies. We aimed to determine the distribution of HCV genotypes and their prevalence in Eastern Turkey. Fifty eight Anti-HCV, LIA, HCV-RNA positive patients (35 male, 23 female) were included in this study. Genotypes were determined by reverse dot-blot hybridization method. Distribution of HCV genotypes in 58 patients were as follows: Genotype 1b in 53.4% (n=31), genotype 1a in 36.2% (n=21), genotype 1, 3, 4, 1a/1b in 1.7 % (n=1) for each. Genotype 1 was identified as the dominant type in 93.2% (n=54). HCV genotype could not be identified in 3.4% (n=2) patients. Genotype 1b was the most common HCV genotype in our region and this result is in accordance with the previous data of Turkey. Although genotype 1b is predominant, detection of genotype 1a in studies show that genotyping is beneficial for cost-effectiveness of chronic HCV infection. Thus, genotyping of HCV patients in our region guide clinicians in terms of monitoring and treatment success.Yayın Evaluation of MALDI-TOF MS for identification of nontuberculous mycobacteria isolated from clinical specimens in mycobacteria growth indicator tube medium(EDIZIONI INT SRL, 2018) Genc, Gonca Erkose; Demir, Melda; Yaman, Gorkem; Kayar, Begum; Koksal, Fatih; Satana, DilekNowadays, there is a rising worldwide incidence of diseases caused by nontuberculous mycobacteria (NTM) species, especially in immunocompromised patients and those with underlying chronic pulmonary diseases. Recently, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) became a method of choice for the identification of NTM species. The aim of this study was to evaluate MALDI-TOF MS for the identification of NTM isolates compared to the PCR-restriction enzyme analysis (PRA)-hsp65 method. In this study; a total of 152 NTM strains isolated from various clinical specimens were retrospectively analysed. MALDI-TOF MS successfully identified 148 (97.4%) of the 152 NTM isolates but failed to identify four (2.6%) of them. Bruker mycobacteria library gave spectral scores higher than 2.0 for 45 (29.6%) of NTM isolates, between 1.6 and 2.0 for 98 (64.5%) of NTM isolates, and lower than 1.6 for nine (5.9%) NTM isolates. The discordant results between MALDI-TOF MS and PRA-hsp65 analysis were confirmed by sequence analysis. In conclusion, MALDI-TOF MS is a technique capable of performing accurate, rapid, cost-effective, and easy identification of NTM isolates.Yayın Evaluation of mycobacterial microscopy and culture results of Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital: A 3-year analysis(TURKISH ASSOC TUBERCULOSIS & THORAX, 2016) Akduman Alasehir, Elcin; Balikci, Ahmet; Partal, Mualla; Catmabacak, Gulay; Yaman, GorkemIntroduction: Effective diagnosis of tuberculosis is of great importance for transmission control and treatment success. The purpose of this study is to evaluate microscopic examination results of Ehrlich-Ziehl Neelsen (EZN) and Auramine-Rhodamine staining methods and automated BACTEC MGIT 960 (TM) system and Lowenstein-Jensen (L-J) culture results of various clinical samples in the light of recent data from the world and Turkey. Materials and Methods: Specimens that were sent from various clinics to Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital Microbiology Laboratory from January 2012 to December 2015 were evaluated retrospectively. Results: From a total of 62456 samples; 60923 (97.5%) were pulmonary and 1533 (2.5%) were non-pulmonary samples, especially pleura. 2853 (4.6%) Acid-resistant bacilli (ARB) positivity was detected and mycobacterial culture positivity was in total 12.2%. 7076 (93%) and 535 (7%) mycobacteria other than tuberculosis (MOTT) strains were isolated. In 356 specimens the cultures were negative in despite the positive ARB results. Considering mycobacterial culture as the gold standard; the sensitivity, specificity, positive and negative predictive values of ARB microscopy were 32.8%, 99.4%, 87.5% and 91.4%, respectively. The contamination rates in total were within acceptable limits being 2.7% for L-J and 3.8% for MGIT. Conclusion: Analysis of our data indicated that the sensitivity of microscopy is low and it should be evaluated together with the mycobacterial culture to rule out tuberculosis infection. With the use of fluorescent staining and also L-J and MGIT broth together for routine culture since 2013; ARB false negativity rate was observed to fall to 51.7% from 74.1% compared to the years. The follow-up of data such as the sensitivity of microscopy, culture positivity, false-positivity and false-negativity rates and contamination values is of great importance in terms of assessing compliance with laboratory quality standards and contributing to the surveillance studies.Yayın EVALUATION OF PANDEMIC INFLUENZA A (H1N1) CASES IN VAN REGION(NOBEL ILAC, 2014) Cikman, Aytekin; Berktas, Mustafa; Parlak, Mehmet; Bayram, Yasemin; Yaman, GorkemObjective: Influenza viruses have retained their importance throughout history by creating pandemics since the segmental structure of the RNA undergo frequent genetic changes. The purpose of this study was to investigate the pandemic influenza A (H1N1) cases detected our region. Material and Method: Totally 570 patients were registered with pre-diagnosis of Pandemic Influenza A (H1N1) infection in five different hospitals located in Van region between 15 October 2009 - 15 January 2010. After nasopharyngeal/throat swab samples were taken from patients, they were sent to Refik Saydam Hygiene Center (RSHC) in accordance with the rules of biosafety, and specimens were investigated for Pandemic Influenza A(H1N1) 2009 by using Real-Time PCR method. Results: Pandemic Influenza A (HI NI) was determined by RSHC as positive for 220 patients. 36 of these patients were in intensive care conditions, 85 were hospitalized and 16 passed away. 109 patients, who were diagnosed with Pandemic Influenza A (H1N1), were within range of 6-25 years. All patients in this age range were treated and discharged. The most common symptoms of patients who were hospitalized were defined as cough and fever In these patients, the most common risk factors were as follows; being <5 years, having the cardiovascular disease, using immunosuppressive drugs and having lung disease. Conclusion: Pandemic influenza A (H1N1) infections are more frequent in young adults and patients without risk factor, unlike seasonal flu. When examining its effect on the society, Pandemic Influenza A (H1N1) 2009 constitutes a good opportunity in terms of preparation of inevitable struggling with pandemics in the future.Yayın The seroprevalence of hepatitis A in Istanbul, Turkey(MARMARA UNIV, FAC MEDICINE, 2017) Karadeniz, Asli; Akduman Alasehir, Elcin; Yesilbag, Zuhal; Balikci, Ahmet; Yaman, GorkemObjective: Hepatitis A, a leading cause of enterically transmitted acute viral hepatitis throughout the world, has changed its pattern in developing countries. The objective of this study is to determine the current seroprevalence of hepatitis A virus (HAV) for different age groups in Istanbul, Turkey. Materials and Methods: Serum samples of 3,868 patients, which had been previously taken, were used to determine anti-HAV IgG levels by the microparticle enzyme immunoassay (MPEIA) method (Architect SR i1000 and i2000, Abbott Diagnostics, Germany) between January 2011 and December 2013. Results: The prevalence of total anti-HAV antibodies was 64.8% for all patients. Among the 3,868 serum samples tested, 54% were from male patients and 46 % were from female patients. Seropositivity rates among the age groups were determined and anti-HAV antibody positivity rates were 55% for the 0-16 age group; 47% for the 17-30 age group; 73.5% for the 31-45 age group and the seroprevalence increased significantly from 50% (972/1944) in 0 to 30 years old to 89% in patients older than 46 years. Conclusion: The low seronegativity rates in young adults, show this group to be at high risk of acquiring an HAV infection. The results support the routine vaccination of children and the seronegative young adults against HAV.
