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Öğe Are bone morphogenetic protein-7 (BMP-7) serum levels correlated with development of hepatic fibrosis?(J Infection Developing Countries, 2014) Demir, Nazlim Aktug; Kolgelier, Servet; Inkaya, Ahmet Cagkan; Sumer, Sua; Demir, Lutfi Saltuk; Pehlivan, Fatma Seher; Arslan, MahmureIntroduction: Bone morphogenetic protein-7 (BMP-7) is a key protein in organogenesis and liver development. The protein has been studied in the context of liver fibrosis and regeneration. The aim of the present study was to explore any possible association between fibrosis levels (as revealed by liver biopsy) and serum BMP-7 levels. Methodology: A total of 189 patients with chronic hepatitis B and 51 healthy controls were enrolled in the study. Results: The study group contained 120 (63.5%) males and 69 (36.5%) females, and the control group contained 25 males (49.0%) and 26 females (51%). In general, serum BMP-7 values of patients were higher than those of controls (p = 0.001). Serum BMP-7 values of patients with liver fibrosis of stages 1, 2, 3, or 4 were higher than control values (all p values = 0.01), but the serum BMP-7 levels of patients with stage 5 fibrosis were similar to that of controls. Associations between fibrosis stage and the serum levels of BMP-7, ALT, HBVDNA, platelets, and albumin were all statistically significant (p = 0.001). The AUROC for the BMP-7 level in advanced stage fibrosis was found to be 0.23. The data were analyzed using the binary logistic regression analysis (backward stepwise method) and BMP-7, HBVDNA, and platelet levels were found to be risk factors associated with fibrosis (p values 0.031, 0.040, and 0.001, respectively). Conclusions: BMP-7 may play anti-inflammatory and anti-fibrogenic roles in the pathogenesis of chronic hepatitis B infection.Öğe Are Really Family Physicians Aware of Hepatitis B?(Drunpp-Sarajevo, 2016) Demir, Lutfi Saltuk; Demir, Nazlim Aktug; Inkaya, Ahmet Cagkan; Guler, Selma; Horasan, Elif Sahin; Kolgelier, Servet; Celik, UmitIntroduction: This study aimed to determine the level of knowledge of family physicians regarding hepatitis B infection, transmission ways, risk groups, clinical course, and protection methods. Methods: This study is held on 236 family physicians at Adiyaman, Mersin, Adana and Kahramanmaras. A questionnaire was held before the awareness raising seminars organized by provincial Health Directorates. Data was analyzed by SPSS 16.0 and descriptive statistics and chi-square test were used. Results: In general, 54.7% of the doctors enrolled in this study gave correct answers. Twenty three percent of physicians were not aware of HBsAg in diagnosis of hepatitis B virus (HBV), 14.8% did not know anti-HBs as indicating immunity against HBV. Though 94.4% of the family physicians administered routine hepatitis B vaccination, 62.3% of them were not informed about the lowest level of anti-HBs titer (10 IU/ml) providing immunity against HBV. Conclusion: This study showed that the level of knowledge of family physicians in HBV infections is inadequate and the family physicians should be trained about contagious diseases.Öğe Diagnostic clues for spondylitis in acute brucellosis(Saudi Med J, 2014) Aktug-Demir, Nazlim; Kolgelier, Servet; Ozcimen, Serap; Sumer, Sua; Demir, Lutfi S.; Inkaya, Ahmet C.Objectives: To determine the diagnostic factors for brucellar spondylitis. Methods: This retrospective study included 227 consecutive brucellosis patients admitted to the Infectious Diseases and Clinical Microbiology clinics of Adiyaman State Hospital and Adiyaman 82nd Year State Hospital, Adiyaman, Turkey between January 2010 and December 2012. Acute brucellosis was diagnosed by standard tube agglutination test, and/or growth of Brucella spp. in appropriately prepared culture media (Bactec). Brucellar spondylitis was diagnosed and followed-up with contrast-enhanced magnetic resonance imaging. Results: Among the 227 brucellosis patients included, 88 (38.8%) were male, and 139 (61.2%) were female. Brucellar spondylitis was detected in 54 patients (23.7%). Brucellar spondylitis patients had higher mean age, higher fever, and higher blood culture positivity rate when compared with brucellosis patients (p=0.001, p=0.001, and p=0.001). Logistical regression analysis determined that male gender (OR: 3.006), older age (OR: 1.025), erythrocyte sedimentation rate (ESR) (OR: 1.067), high fever at the time of admission (OR: 2.550), and positive blood cultures for Brucella spp. (OR: 4.003) values were independently associated with brucellar spondylitis. However, high C-reactive protein (CRP) levels (OR: 0.971) were not found as a risk factor for brucellar spondylitis. Conclusions: The results of this study shows that the risk of developing brucellar spondylitis is high in patients with acute brucellosis, who are at advanced age, who have high fever, that have Brucella spp. growth in their blood culture that has a high ESR value, and who are male.Öğe Evaluation of the Relation Between Hepatic Fibrosis and Basic Laboratory Parameters in Patients With Chronic Hepatitis B Fibrosis and Basic Laboratory Parameters(Kowsar Publ, 2014) Demir, Nazlim Aktug; Kolgelier, Servet; Ozcimen, Serap; Gungor, Gokhan; Sumer, Sua; Demir, Lutfi Saltuk; Inkaya, Ahmet CagkanBackground: The hepatitis B virus is an important healthcare problem. According to current clinical practice, a liver biopsy is required for the diagnosis and treatment of chronic liver disease. However, a liver biopsy is an invasive, inconvenient procedure, which requires an expert pathologist opinion. Therefore requirement of biochemical tests, which are considered to indicate hepatic fibrosis and may be repeated easily, increases gradually today. Objectives: This study evaluated the correlation between hepatic fibrosis and routine laboratory values in patients with chronic hepatitis B. Patients and Methods: The files of 456 patients with CHB (chronic hepatitis B) who were referred to the infectious diseases and clinical microbiology clinic between January 2009 and March 2012 were screened retrospectively. Liver biopsy samples were examined according to Ishak scoring. Laboratory parameters and histopathology reports were recorded, and correlations between the fibrosis grade and laboratory parameters were analyzed. Results: There were 320 male and 136 female patients, with a mean age 36.7 +/- 12.1 years. According to liver biopsy results, a low fibrosis score (stage 0-2) was detected in 281 patients (61.6%), and a high fibrosis score ( stage 3-5) was detected in 175 patients (38.4%). Patients with a high fibrosis score had significantly higher ALT (alanine amino transferase), AST (aspartate aminotransferase), and HBV-DNA values and a significantly lower platelet count compared with those with a low fibrosis score (P=0.001, 0.001, 0.025, and 0.001, respectively). A positive correlation was detected between the fibrosis score and age, BMI, HAI, ALT, and AST values, and a negative correlation was detected between the fibrosis score and albumin and platelet counts. In the regression analysis performed to evaluate the factors associated with high-stage fibrosis, fibrosis was determined to be associated with thrombosis, ALT, and gender. The results of the regression analysis demonstrated that the risk of fibrosis was 4.6 fold higher in men. Conclusions: According to the results obtained in our study, advanced age, higher BMI, AST, ALT, and HBV-DNA levels, and low albumin and platelet levels are correlated with advanced fibrosis in patients with CHB.Öğe Impaired Thiol-Disulfide Balance in Acute Brucellosis(Natl Inst Infectious Diseases, 2017) Kolgelier, Servet; Ergin, Merve; Demir, Lutfi Saltuk; Inkaya, Ahmet Cagkan; Demir, Nazlim Aktug; Alisik, Murat; Erel, OzcanThe objective of this study was to examine a novel profile: thiol-disulfide homeostasis in acute brucellosis. The study included 90 patients with acute brucellosis, and 27 healthy controls. Thiol-disulfide profile tests were analyzed by a recently developed method, and ceruloplasmin levels were determined. Native thiol levels were 256.72 +/- 48.20 mu mol/L in the acute brucellosis group and 461.13 +/- 45.37 mu mol/L in the healthy group, and total thiol levels were 298.58 +/- 51.78 mu mol/L in the acute brucellosis group and 504.83 +/- 51.05 mu mol/L in the healthy group (p < 0.001, for both). The disulfide/native thiol ratios and disulfide/total thiol ratios were significantly higher, and native thiol/total thiol ratios were significantly lower in patients with acute brucellosis than in the healthy controls (p < 0.001, for all ratios). There were either positive or negative relationships between ceruloplasmin levels and thiol-disulfide parameters. The thiol-disulfide homeostasis was impaired in acute brucellosis. The strong associations between thiol-disulfide parameters and a positive acute-phase reactant reflected the disruption of the balance between the antioxidant and oxidant systems. Since thiol groups act as anti-inflammatory mediators, the alteration in the thiol-disulfide homeostasis may be involved in brucellosis.Öğe Is serum high-mobility group box 1 (HMGB-1) level correlated with liver fibrosis in chronic hepatitis B?(Lippincott Williams & Wilkins, 2017) Inkaya, Ahmet Cagkan; Demir, Nazlim Aktug; Kolgelier, Servet; Sumer, Sua; Demir, Lutfi Saltuk; Ural, Onur; Pehlivan, Fatma SeherBackground: High-mobility group box 1 (HMGB1), identified as an alarmin molecule, was shown to have a role in virus-triggered liver injury. We aimed to evaluate the association between serum levels of HMGB1 and liver fibrosis. Method: This cross-sectional case-control study included 189 chronic hepatitis B (CHB) patients and 51 healthy controls. All patients underwent liver biopsy and modified Knodell scoring system used to determine the fibrosis level in CHB patients. Serum HMGB1 levels were determined with enzyme-linked immunosorbent assay (ELISA). Results: Mean serum HMGB1 levels of patients (58.1 +/- 54.7) were found to be higher than those of the control group (7.1 +/- 4.3) (P=. 001). HMGB1 levels of patients with advanced-stage fibrosis (stage 4 and 5) were detected to be higher than those of patients with early-stage fibrosis (stage 1-3). However, this difference was not statistically significant (P>. 05). Albumin levels of fibrosis 3 and 4 patients were lower than fibrosis 1 and 2 patients. ALT, HBV DNA, and AFP levels of fibrosis 5 patients were significantly higher than fibrosis 1 and 2 patients, and their platelet and albumin levels are lower than fibrosis 1 and 2 patients (P<. 001). In a logistic regression model, fibrosis levels were correlated with ALT values and inversely correlated with albumin levels. Conclusion: In this study, we demonstrated that serum HMGB1 levels increase in the early course of liver injury and this increase is not correlated with severity of the liver damage.Öğe Knowledge Level of Hepatitis B and its Prevalance in Policemen Working in Adiyaman(Modestum Ltd, 2015) Kolgelier, Servet; Demir, Nazlim Aktug; Demir, Lutfi Saltuk; Ozcimen, Serap; Inkaya, Ahmet CagkanAim of this study to investigate the level of knowledge about hepatitis B and prevalence of HBsAg carriage in police and other security staff. Hepatitis B knowledge of police and other staff working for Adiyaman police department were measured using a questionnaire. This questionnaire was prepared after a literature search and was applied to 683 subjects before an education seminar. Fully and regularly filled 437 questionnaires were selected for evaluation. HBsAg and Anti HBs values of subjects were measured. Data were recorded to SPSS 16.0 package program. Chi square test was used for data analyses. Of all the study subjects 406 (92.9%) were males and 31 (7.1%) were females. Three hundred sixty subjects (82.3%) were police staff, 60 (13.7%) were public serveants, 15 (3.4%) were commissaries and 2 (0.05%) were nightmen. Mean age was 34.5 +/- 7. Fifty four subjects gave correct answers to the question about transmission ways of hepatitis B. Three hundred eighty four subjects didn't have enough knowledge about transmission ways of this virus. HBsAg positivity was detected in 34 (7.7%) subjects. Three hundred twenty five (51,4%) subjects had adequate antibody level for immunity. As a result, we detected that knowledge level was inadequate and increased risk for infection in this profession. It was concluded that security staff should be educated regarding risks and screened for bloodborne diseases.Öğe Serum Levels of Annexin A2 as a Candidate Biomarker for Hepatic Fibrosis in Patients With Chronic Hepatitis B(Kowsar Publ, 2015) Kolgelier, Servet; Demir, Nazlim Aktug; Inkaya, Ahmet Cagkan; Sumer, Sua; Ozcimen, Serap; Demir, Lutfi Saltuk; Pehlivan, Fatma SeherBackground: Hepatologists have studied serologic markers of liver injury for decades. Annexins are a prominent group of such markers and annexin A2 (AnxA2) is one of the best characterized annexins. AnxA2 inhibits HBV polymerase among other functions. Its expression is up-regulated in regenerative hepatocytes. Objectives: To determine if serum AnxA2 level has a role in estimating liver damage in chronic HBV infection and investigate whether AnxA2 levels correlate with hepatic fibrosis. Patients and Methods: This study included 173 patients with chronic hepatitis B (CHB) and 51 healthy controls. Liver fibrosis was graded histologically on liver biopsy samples. Blood samples were taken from patients during biopsy and serum AnxA2 levels were measured with ELISA. Results: In a group of adult patients with CHB, AnxA2 values were far higher than those of the control group (P = 0.001). When we assessed AnxA2 levels based on fibrosis stages, serum AnxA2 levels of patients with early stage fibrosis (stages 1 - 3) were significantly higher than those of patients with advanced stage fibrosis (stages 4 - 5; P = 0.001). Conclusions: AnxA2 is a useful biomarker for early stage fibrosis in patients with CHB.Öğe Serum Neutrophil Gelatinase-Associated Lipocalin Levels in Acute Brucellosis and Brucellar Spondylodiscitis(Ankara Microbiology Soc, 2022) Sumer, Sua; Aktug Demir, Nazlim; Demir, Lutfi Saltuk; Findik, Duygu; Kolgelier, Servet; Ural, OnurBrucellosis is a zoonotic infectious disease caused by Brucella spp., an intracellular bacterium. The complications of acute Brucellosis may affect all organs and systems. The most common complication of the disease is musculoskeletal system involvement. The neutrophil gelatinase-associated lipocalin (NGAL) is a marker of neutrophil formation and acts as a siderophore-binding protein to prevent bacterial iron uptake and its use as a marker in the diagnosis and follow-up of bacterial infections is being investigated. The aim of this study was to measure the serum levels of NGAL in patients with acute Brucellosis and Brucellar spondylodiscitis, and to determine whether there is a correlation between NGAL levels and the progression and complications of the disease. This prospective case control study was conducted with 240 patients and 120 healthy controls. The diagnosis of acute Brucellosis was established when a person was asked to take an STA test due to clinical symptoms within the past eight weeks, and the test result that exceeded 1/160, or a 4-fold titer increase was found in the STA test after an interval of two weeks, and/or there was Brucella spp. growth in the blood culture. A contrasted lumbar magnetic resonance (MR) scan was performed on patients diagnosed with acute Brucellosis who had lower back pain. Presence of spondylodiscitis was assessed radiologically with contrasted lumbar MR images. NGAL levels were determined with ELISA assay. The median NGAL value was found to be 456.67 ng/L (101.41-5804.41 ng/L) in patients with acute Brucellosis and 113.84 ng/L (58.29-542.34 ng/L) in the control group. The median NGAL value was statistically higher in the patients than the control group (p= 0.001). Brucellar spondylodiscitis was detected in 57 (23.7%) of 240 patients diagnosed with acute Brucellosis. The median NGAL value was 1885.62 ng/L (143.21-5804.41 ng/L) in patients with Brucellar spondylodiscitis, and 356.87 ng/L (101.41-1874.07 ng/L) in those who did not have Brucellar spondylodiscitis. This difference was statistically significant (p= 0.001). Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values were found to be higher in patients who had Brucellar spondylodiscitis. Blood cultures were drawn from 186 (77.5%) of the 240 patients diagnosed with acute Brucellosis. The blood culture positivity rate was 36.02%. Patients whose blood cultures were positive had higher NGAL levels (p= 0.001). The blood culture positivity rate was higher in patients who were diagnosed with Brucellar spondylodiscitis (p= 0.001). A regression analysis showed that female gender and high levels of NGAL, ESR, and alanine aminotransferase (ALT) could be used as predictors of Brucellar spondylodiscitis. The explanatoriness of the model was 82.3%. Although determination of NGAL levels is seen as a useful marker in the diagnosis of acute Brucellosis and predicting the presence of Brucellar spondylodiscitis, more comprehensive studies are required to be used in clinical practice in regions where Brucellosis is endemic.
