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Öğe Antibiotic consumption in Turkish hospitals; a multi-centre point prevalence study(Taylor & Francis Ltd, 2017) Guclu, Ertugrul; Ogutlu, Aziz; Karabay, Oguz; Demirdal, Tuna; Erayman, Ibrahim; Hosoglu, Salih; Turhan, VedatThis multi-centre study aimed to determine the antibiotic consumption in Turkish hospitals by point prevalence. Antibiotic consumption of 14 centres was determined using the DDD method. Among hospitalized patients, 44.8% were using antibiotics and the total antibiotic consumption was 674.5 DDD/1000 patient-days (DPD). 189.6 (28%) DPD of the antibiotic consumption was restricted while 484.9 (72%) DPD was unrestricted. Carbapenems (24%) and beta lactam/beta lactamase inhibitors (ampicillin-sulbactam or amoxicillin-clavulanate; 22%) were the most commonly used restricted and unrestricted antibiotics. Antibiotics were most commonly used in intensive care units (1307.7 DPD). Almost half of the hospitalized patients in our hospitals were using at least one antibiotic. Moreover, among these antibiotics, the most commonly used ones were carbapenems, quinolones and cephalosporins, which are known to cause collateral damage. We think that antibiotic resistance, which is seen at considerably high rates in our hospitals, is associated with this level of consumption.Öğe Antiviral Treatment Results and Side Effects During Treatment in Chronic Hepatitis B Patients(Doc Design Informatics Co Ltd, 2021) Bulut, Rukiyye; Kurt, Esma Kepenek; Kandemir, Bahar; Erayman, Ibrahim; Bitirgen, MehmetObjective: Hepatitis B virus is an important health problem leading to chronic hepatitis, cirrhosis, and hepatocellular carcinoma. This study aimed to compare the efficacy and side effects of antiviral drugs used in chronic hepatitis B (CHB). Methods: Five hundred seventy-two patients who were followed and treated with CHB in our clinic were evaluated retrospectively. Results: Fifty-six point five of 572 patients were male, 43.5% were female, and the mean age of the patients was 43.4 +/- 12.4. Of the patients, 153 (26.8%) used tenofovir disoproxil fumarate (TDF), 134 (23.4%) telbivudine (LdT), 114 (20%) entecavir (ETC), 92 (16%) lamivudine (LAM), 26 (4.5%) adefovir (ADV), 27 (4.7%) pegylated interpheron alpha (PEG-IFN-alpha), and 26 (4.6%) used PEG-IFN-alpha + nucleoside analogue (NA). No significant difference was detected between the treatment groups in terms of age, sex ratio, fibrosis, histological activity index (HAI) score, baseline platelet, international normalized ratio (INR), alpha-fetoprotein (AFP) values (p>0.05). Seventy (12.3%) of 568 patients were HBeAg (+), 498 (87.7%) were HBeAg (-). At the end of the first year, the virological response rates were 92.5% in LdT, 82.6% in LAM, 72.8% in ETV, 60.7% in TDF, 26.9% in ADV, 22.2% in PEG-IFN-alpha, 65.3% in PEG-IFN-alpha+NA groups. Twenty-three point eight of the patients had treatment changes, and 76.3% of these patients preferred TDF as a new treatment. Virological breakthrough was observed at 43.5% in LAM, 13.4% in LdT, 7% in ETV and 0.6% in TDF groups. At the end of 3, 4, and 5 years without treatment change, all patients who continued TDF, ETV, LdT, ADV, and LAM treatment were HBV DNA negative. HBsAg clearance developed in 13 (2.3%) patients. At least one side effect was observed in 169 (29.5%) of all patients, and the group with the most frequent side effects was PEG-IFN-alpha+NA (92.3%) and PEG-IFN-alpha (77.8%). Amylase increase in LAM (%3.2), CPK increase in LdT (%27.6), CPK increase in TDF (%3.2) groups were the most common side effects. Conclusions: The drug with the lowest virological response rate and the most common side effect is PEG-IFN-alpha, so its use should be limited to selected patient groups. Treatments with the lowest incidence of side effects and development of resistance were found to be with TDF and ETV. Considering the high virological response rates, TDF and ETV should be preferred in the treatment of CHB. When all treatments are evaluated, HBsAg loss and cure rates are inadequate.Öğe Comparison of Clinical and Laboratory Findings and Computed Tomography Findings of SARS-CoV-2 Infected Patients Followed-up in a Tertiary University Hospital(Galenos Publ House, 2021) Kurt, Esma Kepenek; Kandemir, Bahar; Erayman, Ibrahim; Vatansev, Hulya; Zamani, Adil; Yosunkaya, Sebnem; Demirbas, SonerIntroduction: The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection is a pandemic, a major global health concern. In this study, it was aimed to compare the clinical, laboratory and computed tomography (CT) findings of patients with SARS-CoV-2 infection followed up in our hospital. Materials and Methods: In this study, reverse transcriptase-polymerase chain reaction (RT-PCR) positive patients hospitalized between 01.03.2020-31.05.2020 were retrospectively analyzed. Computed tomography images of the patients were grouped as typical, indeterminate, atypical, and no pneumonia based on the Radiological Society of North America. After recording patient information on SPSS, clinical and laboratory findings of the patients were analyzed by comparing them to CT findings. Results: Among 237 RT-PCR positive patients, 104 (43.9%) were female and 133 (56.1%) were male. The mean age of the patients was 50.46 +/- 17.26 (18-92) years and the mean symptom onset time of the patients was 3.75 +/- 2.72 (median: 3) days. Eighty-seven of the patients (36.7%) had contact stories. Twenty-three (9.7%) patients were healthcare professionals. Of the patients, 49.8% had a comorbid disease. The most common referral complaint was cough with 66.7%. The most common treatment that patients received was hydroxychloroquine (96.2%). Anemia was detected in 61 (25.7%) patients, leukopenia in 104 (43.9%), lymphopenia in 25 (10.5%) and thrombocytopenia in 14 (5.9%). High rates were detected for C-reactive protein (CRP) in 221 (84%) patients, ferritin in 190 (80.2%) patients, D-dimer in 144 (60.8%) patients, fibrinogen in 147 (62%) patients and sedimentation (SED) in 172 (72.6%) patients. Headache was detected higher in patients with typical pneumonia findings in thorax CT (p=0.006). A statistically significant difference wasn't detected between other symptoms and CT findings. Leukocyte and neutrophil counts, SED, CRP, ferritin, D-dimer, fibrinogen, aspartate aminotransferase, and lactate dehydrogenase (p=0.001) levels were observed to be higher in patients with typical pneumonia findings on thorax CT. Conclusion: Some laboratory parameters, especially acute phase reactants, were found to be higher in patients with typical pneumonia on thorax CT compared to patients without pneumonia. In this viral infection, patients should be evaluated together with clinical, laboratory and CT findings.Öğe COVID-19 Seroprevalance in a University Hospital Health Workers(Bilimsel Tip Yayinevi, 2021) Arslan, Gokce Kader; Ozdemir, Mehmet; Kaya, Havva; Feyzioglu, Bahadir; Kepenek Kurt, Esma; Erayman, IbrahimIntroduction: Healthcare workers are at the forefront in the Pandemic war against COVID-19 (Coronavirus Disease 2019) caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2). In this struggle, they have become high-risk by keeping in close con- tact with patients during their diagnosis, treatment, and follow-up with long working hours. The aim of this study was to contribute to epidemiological data of our country by examining the antibody status of our hospital healthcare workers. Materials and Methods: Anti-SARS-CoV-2 IgG/IgM, COVID-19 ELISA kits were studied from sera samples of healthcare workers in Necmettin Erbakan University Meram Medical Faculty Hospital between June 1 and November 30, 2020. Nasopharyngeal swab sam- ples of these persons were also tested with the Real Time Polymerase Chain Reaction (RT-PCR) method. Results: SARS-CoV-2 seroprevalence of 741 healthcare workers included in our study was found to be 17%. Seropositivity was detected in 6.4% (33/515) of the healthcare workers with negative SARS-CoV-2 PCR test and in 3.9% (5/130) of the healthcare workers who did not have PCR test. Among the healthcare workers, the highest seroprevalence was observed in nurses (39.6%) followed by doctors (%23). Conclusion: It was evaluated that SARS-CoV-2 seroprevalence in healthcare workers is higher than in the population. This study shows that occupational exposure is a risk factor. 3.9% seropositivity was found in healthcare workers who never had a test. Considering that these workers have an asymptomatic or subclinical infection, there is a possible risk for nosocomial transmission. Therefore, healthcare professionals should use personal protective equipment and apply hygiene rules correctly and effectively in infectious diseases, especially during pandemic periods, while working in the hospital.Öğe Crimean-Congo Haemorrhagic Fever and the Role of the Migrating Birds(Aves, 2019) Kepenek-Kurt, Esma; Kandemir, Bahar; Erayman, Ibrahim; Bulut, Rukiyye; Bitirgen, MehmetObjective: We aimed to analyse patients with Crimean-Congo haemorrhagic fever (CCHF) followed in our clinic. Methods: Clinical features, laboratory findings and treatments of 12 patients with CCHF followed between 2009 and 2018 were analysed retrospectively. Results: Mean age of the patients was 37.6 +/- 13.7 (ranges 17-59); 5 (42%) were female and 7 (58%) were male. All had a history of visit to the rural areas. Fever in 10 (83%) and fatigue in 6 (50%) patients were the most common symptoms. 11 (92%) patients were from Konya and its surroundings, and 1 (8%) from Gumushane, endemic for CCHE Tick exposure was detected in 10 (83%) cases. Diagnosis was made by CCHF virus (CCHFV) RNA positivity by polymerase chain reaction (PCR) in 10 patients, while anti-CCHFV IgM antibodies by enzyme-linked immunosorbent assay were positive in two PCR-negative patients. Four patients received blood and blood products for bleeding and five patients received oral ribavirin. Eleven patients were cured and one died. There was not any nosocomial transmission in our hospital. Conclusions: In prevention of CCHE personal protection and prevention from the tick bites should be ensured. Training about transmission routes and prevention methods of CCHF should be provided to health care personnel and persons especially living in rural areas. Because Beysehir Lake which lies in the Beysehir province of Konya, is on the migration routes of migratory birds, it should be considered that inhabitants living in the region are at risk for CCHE CCHF should be considered in the differential diagnosis of patients with fever, fatigue, thrombocytopenia and elevated liver enzymes.Öğe Evaluation of nosocomial infections and related risk factors in a neurosurgery intensive care unit(E-Century Publishing Corp, 2016) Erayman, Ibrahim; Erdi, Fatih; Kalkan, Erdal; Karatas, Yasar; Kaya, Bulent; Keskin, Fatih; Izci, Emir K.Nosocomial infections (NIs) cause increased morbidity, mortality, and hospital costs, particularly in intensive care units. Neurosurgery intensive care units (NICUs) differ from other intensive care units in several respects. The aim of this study was to examine NIs and related risk factors in our NICU. NICU records and the database of our hospital's infection control team from January 2010 to December 2014 were reviewed retrospectively. Type of NI and associated risk factors were subjected to statistical analysis. Demographic data, risk factors for NI development, presentation, length of NICU stay, and Glasgow Coma Scale (GCS) score were recorded and reviewed. One hundred and eighteen NI episodes were detected in 115 of 820 patients. The mean age of the patient population was 42.4 years (range 16-74 years). Of the infected patients, 55 were female and 60 were male. The mean length of hospital stay of these patients was 38.4 +/- 21.8 days. The most common type of NI was ventilator-associated pneumonia, and the most frequently detected pathogen was Acinetobacter spp. GCS score, prior usage of broad-spectrum antibiotics, reoperation, mechanical ventilation, external lumbar or ventricular drainage, tracheostomy, and duration of NICU stay were significantly higher among infected patients. Univariate analysis identified low GCS score, longer NICU stay, use of mechanical ventilation, prior usage of broad-spectrum antibiotics, and reoperation as risk factors for NI.Öğe Evaluation of Patients Infected with Human Immunodeficiency Virus Followed in Our Clinic(Bilimsel Tip Yayinevi, 2020) Kurt, Esma Kepenek; Kandemir, Bahar; Erayman, Ibrahim; Bulut, Rukiyye; Bitirgen, MehmetIntroduction: The number of people infected with human immunodeficiency virus (HIV) in our country is increasing day by day. In this study, epidemiological, clinical, laboratory features, treatment regimens and side effects of HIV/AIDS cases followed in our clinic were evaluated. Materials and Methods: Fifty-four patients who were followed up with HIV infection in our clinic between 2000-2018 were examined retrospectively. Results: Of the 54 patients, 18 (33.3%) were females and 36 (66.7%) were males. Mean age was 42.0 +/- 15.2 (18-70) years. Mean duration of the disease was median 3 (0.5-28) and the duration of clinical follow-up was 3.3 +/- 2.7 (0.5-10) years. A total of 44 (88%) patients had risky sexual contact, and nine women were infected by her husband. The first complaint of the patients for admission to our clinic was weakness (22.2%) and fever (9.3%). Patients were diagnosed most frequently during routine examinations (48%). Mean CD4 count of the patients at the time of admission was 317.2 +/- 247.7 (7-918) cell/mm(3), and HIV-RNA was median 61000 (0-30000000) copy/mL. The most frequent treatment was tenofovir disoproxil fumarate-emtricitabine and lopinavir/ritonavir (TDF-FTC and LPV/r) in 24.4% of the patients. Treatment was changed in 14 (25.9%) patients. In five patients, noncompliance to treatment and in five patients, side effects were encountered, and treatment was changed. Hyperlipidemia was the most common side effect (52.9%) in patients receiving treatment. Prophylaxis was given to 50% of the patients in terms of opportunistic infections at the beginning of treatment. One patient had gonococcal urethritis and one patient had HPV infection in the cervix. Four patients discontinued treatment and 46 patients continued treatment. One female patient was exitus. Conclusion: The number of HIV/AIDS patients, a chronic disease, is increasing also in our country. Early diagnosis of these patients should be made, and the disease should be controlled by providing access to treatment and suppression of viral load.Öğe GPER-1 in chronic hepatitis B(Elsevier, 2020) Kandemir, Bahar; Ates, Selma; Kurutas, Ergul Belge; Durduran, Yasemin; Erayman, Ibrahim; Bitirgen, MehmetEstrogen has a significant role in regulating cell proliferation, growth, migration, aging, and many disease states. Estrogen shows its effects through estrogen receptors alpha, beta, and G protein-coupled estrogen receptor 1 (GPER1). The aim of this study is to evaluate serum GPER1 levels and its relationship with fibrosis score in chronic hepatitis B patients. The cases were selected from two university hospitals and consisted of patients who had not previously been treated for hepatitis B, were over 18. Quantitative sandwich enzyme immunoassay technique was used for measuring the serum levels of GPER1. The data evaluated were analyzed by using the statistical tests. Out of the 65 cases; 26 (40%) had hepatitis B, 39 (60%) were controls. Patients underwent liver biopsy. GPER1 levels were significantly high in Hepatitis B group (p < 0.001). Out of the 26 hepatitis B patients; 21(80,8%) had low-stage fibrosis, 5(19,2%) had high-stage fibrosis. When the GPER1 level was >= 017600000 the sensitivity, specificity, positive predictive value, and negative predictive value for the hepatitis B patients were found to be 96%, 87,7%, 96%, and 92,8%, respectively. GPER levels have shown high expression in patients with chronic hepatitis B.Öğe Influence of aluminum salts on COVID-19 infected patients(Tubitak Scientific & Technological Research Council Turkey, 2020) Demir, Ali; Erayman, Ibrahim; Dogan, Oguz; Kekilli, MuratBackground/aim: Based on the antiviral and antibacterial properties of aluminum salts, we aimed to find out the influence of aluminum salts on COVID-19 infected patients. Materials and methods: We performed an observational retrospective cohort study which includes the patients diagnosed as COVID-19 and received aluminum salts in addition to actual treatments during hospitalization as the treatment group (Alum Group). Patients who received standard COVID-19 treatment protocols in the Infectious Diseases Clinics were included as the Control Group. Clinical findings, laboratory parameters, length of stay, survival, radiological follow-up, intensive care and mechanical ventilation needs, the presence of comorbidity, polymerase chain reaction (PCR) tests, symptoms, symptom recovery times, hospital stay times, treatment protocols, and clinical presence of pneumonia were examined in all patients. Advanced chemical composition analyzes of existing aluminum salts were also performed. Results: A total of 109 patients, 54 in the alum group and 55 in the control group, were included in the study. None of the patients in the aluminum group developed side effects due to the intake of aluminum salt. Survival status was significantly different between the two groups as there were 5 loss in the Control Group and none in the Alum Group (P = 0.023). The symptom recovery time was significantly shorter in the Alum Group; 2 (1-3) vs. 1 (1-2) days, P= 0.003. According to the paired samples analyses of the comparison between hospitalization and discharge, CRP levels significantly drops in the Alum Group (from 54.09 to 27, P = 0.001) but not in the Control Group. The drop was significantly same for the lactate dehydrogenase (LDH) and procalcitonin levels with P = 0.001. Conclusion: It has been observed that aluminum salts have beneficial effects in COVID-19 infected cases. Considering the low systemic toxicity of intermittent oral intake of aluminum salts as food supplements and the fact that pandemic control is still not achieved, the use of aluminum salts is promising.Öğe Investigating Hepatitis C, D and HIV Prevalance in Cases with Positive Hepatitis B Virus Antigen in a Tertiary Hospital and Examining Anti-HDV Positive Cases(Galenos Publ House, 2021) Kurt, Esma Kepenek; Bulut, Rukiyye; Kandemir, Bahar; Erayman, Ibrahim; Bitirgen, Mehmet; Tasbent, Fatma EsenkayaObjectives: Hepatitis B infection has a faster and more progressive course in the presence of hepatitis C virus (HCV), HDV and human immunodeficiency virus (HIV) infections. The aim of this study was to determine anti-HCV, anti-HDV and anti-HIV prevalance in hepatitis B surface antigen (HBsAg) (+) positive patients and to examine patients with positive anti-HDV. Materials and Methods: Data were obtained through scanning hepatitisB patient follow-up files and the hospital automation system. Descriptive data was expressed in numbers and percentages (%). Results: Mean age of 1829 HBsAg positive patients was 42.65 +/- 14.83 (7-95) and 1099 (60.1%) were male and 730 (39.9%) were female. 30 patients (1.64%) had anti-HCV and 28 patients (1.53%) had anti-HDV while 1 patient (0.055%) had positive anti-HIV. The mean age of the patients with positive anti-HDV was 53.16 +/- 15.46 and 12 of these (42.9%) were female and 16 (57.1%) were male. Fifteen HDV positive patients were given peginterferon and 10 patients had relapse and 4 patients had hepatocellular cancer during the follow-up. A patient died due to the quick progression of the disease after deciding upon transplantation. Conclusion: Patients should also be scanned for hepatitis C, D and HIV in the presence of hepatitis B infection and the patient should be followed up and treated accordingly if coinfection is detected.Öğe Rapid Dissemination of Multidrug Resistant Providencia Stuartii- A University Hospital Based Study(Allied Acad, 2014) Feyzioglu, Bahadir; Gueldemir, Dilek; Karagoz, Alper; Erayman, Ibrahim; Demircili, Mehmet Emin; Baykan, MahmutProvidencia stuartii infections are not common. There are a few reports of declared outbreaks or spreads. In our study, nosocomial dissemination by extended-spectrum beta-lactamase (ESBL) producing Providencia stuartii in a variety of clinics was investigated in a short period. Nine multidrug-resistant Providencia stuartii clinical isolates were collected between October and November in 2011. Nine isolates were obtained from six patients who had been hospitalized in a variety of clinics at a university hospital in Turkey. The clonal relationship among nine isolates was determined by pulsed-field gel electrophoresis. All isolates were ESBL positive and resistant to quinolones, and we determined amikacin resistance to three strains. There were two antibiotypes, and a second PFGE profile was not observed in different types. The outbreak was due to the dissemination of one epidemic multiresistant clone of Providencia stuartii. We considered that it had been a common dissemination from a single source and the first isolate which was collected from the first patient was epidemic clone. The respiratory tract colonization of the first patient was considered to be the possible route of transmission. The resistance to amikacin occurred during treatment with aminoglycoside. It was noteworthy.Öğe The roles of BDNF, S100B, and oxidative stress in interferon-induced depression and the effect of antidepressant treatment in patients with chronic viral hepatitis: A prospective study(Pergamon-Elsevier Science Ltd, 2014) Cicek, Ismet Esra; Cicek, Erdinc; Kayhan, Fatih; Uguz, Faruk; Erayman, Ibrahim; Kurban, Sevil; Yerlikaya, F. HumeyraObjective: The aim of the study was to research the relationship between interferon (IFN) induced depression and sociodemographic characteristics, neurotrophic factors and oxidative stress. Methods: Sixty four cases, 34 with Chronic Hepatitis B (CHB) and 30 with Chronic Hepatitis C (CNC), were included in the study. The patients were assessed with Structured Clinical Interview for DSM-IV (SCID-I), Hamilton Anxiety Rating Scale (HARS) and Hamilton Depression Rating Scale (HDRS) at baseline on the 2nd and 6th weeks of treatment. S100 calcium binding protein B (S100B), brain-derived neurotrophic factor (BDNF), total antioxidant status (TAS) and total oxidative stress (TOS) levels were measured at the same visits. Results: In total, 20 patients were diagnosed with major depression (MD) on the sixth week. A significant relationship was found between depression developed after IFN therapy and baseline HARS scores and the type of IFN-alpha. When the pretreatment levels of HDRS, HARS, S100B, BDNF, TAS, and TOS were compared to those after treatment on the 2nd week, there was a significant increase in HDRS and HARS levels and a significant decrease in the levels of S1 00B and BDNF. No significant change was determined for TAS and TOS levels. Conclusions: Our study suggests that the pathogenesis of IFN induced depression may involve neurotrophic factors. (c) 2014 Elsevier Inc. All rights reserved.
