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    A 32-year-old male with an ulser with necrotic crusts on the right arm
    (Marmara Univ, Fac Medicine, 2011) Tekin, Recep; Yesilova, Yavuz; Boşnak, Vuslat; Celen, Mustafa Kemal; Ayaz, Celal
    [Abstract Not Available]
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    Acute hepatitis: a rare complication of Epstein-Barr virus (EBV) infection
    (J Infection Developing Countries, 2010) Ulug, Mehmet; Celen, Mustafa Kemal; Ayaz, Celal; Geyik, Mehmet Faruk; Hosoglu, Salih
    Infectious Mononucleosis (IM), a benign lymphoproliferative disease, is the best known clinical syndrome caused by Epstein-Barr Virus (EBV). It usually resolves over a period of weeks or months without sequelae but may occasionally be complicated by a wide variety of neurologic, hematologic, hepatic, respiratory, and psychological complications. In this report we describe a patient with acute hepatitis following EBV-IM in a previously healthy woman. A 26-year-old woman who presented with fever, generalized weakness, nausea, sore throat, yellowing of skin, and a generalized skin rash was admitted to our clinic. Tonsillar enlargement, pharyngeal erythema, palatal petechiae, lymphadenopathy, and jaundice were noted. Significant atypical lymphocytes (> 10%) were seen on the peripheral blood smear. Liver function tests such as ALT: 303 U/L, AST: 172 U/L, ALP: 193 U/L and total bilirubin: 7.3 mg/dl were elevated. Serological tests for EBV infection were consistent with acute infection (EBV virus capsid antigen was reactive with IgM and IgG antibodies). The Monospot test was also positive. On the seventh day, liver function tests and bilirubin had risen to peak level and platelets were decreased. The patient was managed supportively and her critical condition improved and was finally stabilized. Although the prognosis for IM is very favorable, a variety of acute complications may occur.
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    ANTI-TUBERCULOSIS DRUG RESISTANCE IN SOUTHEAST OF TURKEY
    (Carbone Editore, 2013) Dal, Tuba; Ozcan, Nida; Tekin, Recep; Tekin, Alicem; Celen, Mustafa Kemal; Ozekinci, Tuncer; Dal, T.
    Objective: Tuberculosis is a globally prevalent life-threatening infectious disease. In this study we aimed to evaluate antibiotic suscebtibility rates of Mycobacterium tuberculosis complex strains. Materials and methods: A total of 150 culture-positive samples were included in. Among culture positive samples 86 were Mycobacterium tuberculosis complex and 64 were non-tuberculous mycobacterium. Of Mycobacterium tuberculosis complex isolated samples 45 were Ziehl-Neelsen positive. Of 64 non-tuberculous mycobacterium isolated samples 15 were Ziehl-Neelsen positive. Mean age of the patients with tuberculosis was 37.74 +/- 20.53 and non-tuberculous mycobacterium isolated patients was 46.80 +/- 23.32. Antibiotic susceptibility testing was performed for the four first-line anti-tuberculosis drugs by BACTEC MGIT-960 instrument (Becton Dickinson). Of M. tuberculosis strains 41 % was resistant to at least one or more of the drugs (isoniasid 27.9%, ethambutol 8.13%, streptomycin 12.79 %, rifampicine 9.3 %). Of the strains 5.8 % was resistant to two, 3.4 % to three and 3.4 % to four drugs. Conclusion: Mycobacterium tuberculosis complex and drug resistance of this microorganism continued to be a problem for our country and non-tuberculous mycobacterium species may become a problem in the future. We thought that a strong and cost-effective tuberculosis control programme contributes to reduce the incidence of drug resistance in the community.
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    Antibiotic Resistance in Gram-Negative Bacteria Isolated From Blood Cultures
    (Doc Design Informatics Co Ltd, 2014) Temiz, Hakan; Temiz, Sevim; Kaya, Safak; Celen, Mustafa Kemal
    Objective: The aim of this study was to retrospectively determine the antimicrobial susceptibilities of Gram-negative bacteria isolated from blood cultures of hospitalized patients in 2012. Methods: Antibiotic resistance rates of isolated Gram-negative bacteria were evaluated retrospectively from patients' files. In this study, 106 Gram-negative bacteria isolated from patients' blood culture samples in intensive care units and clinical services were evaluated. Blood samples inoculated into BacT/Alert (R) FA Plus aerobic bottles and were followed in a fully automated blood culture device, BacT/Alert (R) 3D (bioMerieux, Marcy l'Etoile, France). The identification and antibiotic sensitivity tests of the isolated microorganisms were performed using automated VITEK (R) 2 (bioMerieux, Marcy l'Etoile, France) system and the results were evaluated according to the standards of Clinical and Laboratory Standards Institute (CLSI). Results: The most frequently isolated Gram-negative bacteria were Escherichia coli (37.7%), Klebsiella pneumoniae (22.6%), Pseudomonas aeruginosa (12.3%) and Acinetobacter baumannii (13.2%). Extended-spectrum beta-lactamase (ESBL) production was detected in 52.5% of E. coli and 83.3% of K. pneumoniae strains. The most effective antibiotics in vitro for ESBL producing and non-producing strains of both types were found as imipenem and meropenem. Resistance to antibiotics tested in ESBL-producing strains of E. coli was found to be significantly higher than non-ESBL-producing strains (p<0.05). In our study, aminoglycosides, particularly amikacin, was found to be the most effective agents for P. aeruginosa and A. baumannii strains. Imipenem and amikacin were found as most effective antibiotics for the Enterobacter spp. isolated in this study. Conclusions: All institutions should determine their microbial agent and antibiotic resistance profiles and establish their own antibiotic treatment policies and follow current guidelines for empirical antibiotherapy.
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    Approach to Treatment of Diabetic Foot Infection
    (Duzce Univ, 2012) Bozkurt, Fatma; Tekin, Recep; Celen, Mustafa Kemal; Ayaz, Celal
    Background: Foot infections in diabetic patients and frequently require a multidisciplinary approach to solving a problem. Taking the form of cellulite, soft tissue necrosis and osteomyelitis may present risks for limb amputation. Bakterolojik analysis for this reason, treatment is very important. Aim: This study aimed to determine the active micro-organisms and their antibiotic susceptibilities. Methods: A total of 63 patients with Diabetic foot infection, who were admitted to the clinics of Dicle University Hospital between October 2006 and November 2007, were included into the study. Wagner classification metod used for wound classification. Deep tissue culture was maked for bacteriological analysis. For aerobic and anaerobic culture were rapidly sent to laboratory. Results: While 38 (60%) of patients, Wagner classification <= 2, Wagner classification >= 3 was 25 (40%) The most common isolated microorganisms are S. aureus (20 patients, 31.7%) and it was followed by Klebsiella spp. and Enterobacter cloaca. All Gr (-) isolates the most effective antibiotics against amikacin, meropenem, piperacillin-tazobactam and cefepime, respectively. They are the most resistant to the antibiotics ciprofloxacin and cefuroxime-axetil, respectively. Conclusion: An effective treatment for diabetic foot infections, determination of causative organisms and their antibiotic susceptibility is crucial to know the sensitivity shown in most of the time.
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    Are sinus-track cultures reliable for identifying the causative agent in chronic osteomyelitis?
    (Springer, 2009) Ulug, Mehmet; Ayaz, Celal; Celen, Mustafa Kemal; Geyik, Mehmet Faruk; Hosoglu, Salih; Necmioglu, Serdar
    The infection of bone that contains bone marrow called osteomyelitis, and is caused by different microorganisms. In this study, we aimed to determine the diagnostic value and accuracy of cultures of material from a sinus track compared with those of cultures of bone specimens that have been controversial. Prospective study was conducted at Hospital University of Dicle, a 1,090-bed university-based hospital located in DiyarbakA +/- r, Turkey. Between May 2005 and September 2006, sinus-track cultures were compared with those of bone cultures from 43 patients with chronic osteomyelitis. The patients' mean age was 30.6 +/- A 3.6 years, and 29 (67%) male and 14 (33%) female. Organisms isolated from bone cultures were Staphylococcus 69% (29/42), Escherichia coli 9.5% (4/42), Pseudomonas aeruginosa 9.5% (4/42), Proteus mirabilis 7% (3/42), respectively. Cultures of sinus track and bone specimens gave identical results in 38% of patients. The value of bone culture in the therapy of osteomyelitis must be emphasized; it is the only reliable means of determining the responsible agent, up on which the antibiotic therapy is based. The correlation between sinus track and bone cultures was 38%, i.e., failure in the treatment for 6 patients out of 10.
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    Assessment of Hepatitis B Vaccination and HBV Infection in Family Practitioners in Batman Province
    (Bilimsel Tip Yayinevi, 2018) Akdemir Kalkan, Irem; Celen, Mustafa Kemal
    [Abstract Not Available]
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    Bacterial colonization due to increased nurse workload in an intensive care unit
    (Elsevier Science Inc, 2015) Aycan, Ilker Onguc; Celen, Mustafa Kemal; Yilmaz, Ayhan; Almaz, Mehmet Selim; Dal, Tuba; Celik, Yusuf; Bolat, Esef
    Introduction: the rates of multiresistant bacteria colonization or infection (MRB+) development in intensive care units are very high. The aim of this study was to determine the possible association between the risk of development of nosocomial infections and increased daily nurse workload due to understaffing in intensive care unit. Methods: we included 168 patients. Intensity of workload and applied procedures to patients were scored with the Project de Recherche en Nursing and the Omega scores, respectively. The criteria used for infections were those defined by the Centers for Disease Control. Results: of the 168 patients, 91 (54.2%) were female and 77 (45.8%) were male patients. The mean age of female and male was 64.9 +/- 6.2 years and 63.1 +/- 11.9 years, respectively. The mean duration of hospitalization in intensive care unit was 18.4 +/- 6.1 days. Multiresistant bacteria were isolated from cultures of 39 (23.2%) patients. The development of MRB+ infection was correlated with length of stay, Omega 1, Omega 2, Omega 3, Total Omega, daily PRN, and Total PRN (p < 0.05). There was no correlation between development of MRB+ infection with gender, age and Apache-II scores (p > 0.05). Conclusion: the risk of nosocomial infection development in an intensive care unit is directly correlated with increased nurse workload, applied intervention, and length of stay. Understaffing in the intensive care unit is an important health problem that especially affects care-needing patients. Nosocomial infection development has laid a heavy burden on the economy of many countries. To control nosocomial infection development in the intensive care unit, nurse workload, staffing level, and working conditions must be arranged. (C) 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.
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    Brucellar epididymo-orchitis in southeastern part of Turkey: an 8 year experience
    (Elsevier Brazil, 2010) Celen, Mustafa Kemal; Ulug, Mehmet; Ayaz, Celal; Geyik, Mehmet Faruk; Hosoglu, Salih
    Objective: the different clinical and laboratory features and response to treatment of patients with acute brucellar epididymo-orchitis (BEO) reporting to the reference hospital in Southeastern Anatolia of Turkey. Material and methods: in this study, 27 male patients with brucellosis, who presented with epididymitis or epididymo-orchitis (EO) at the university hospital in Diyarbakir from 1998 to 2006, were included. They were compared with the other male patients. Positive blood culture or high agglutination titers of >= 1/160 and positive clinical manifestations of brucellosis were the main criteria for diagnosing brucellosis. Results: fourteen patients had unilateral EO. Leukocytosis was present in 10 patients; all of them had initial agglutination titers of >= 1/160 and 10 patients had a positive blood culture. All patients received combined therapy with streptomycin for the first 21 days (or oral rifampicin for 6-8 weeks) with doxycycline or tetracycline for 6-8 weeks. All showed improvement, fever subsided in 3-7 days, and the scrotal enlargement and tenderness regressed. Only one patient had a relapse within one year. Conclusion: in brucellosis-endemic areas, clinicians encountering EO should consider the likelihood of brucellosis. In this study, young age was the most common risk factor, and leukocytosis and high CRP level were the most common laboratory findings. Most cases were unilateral. All patients responded to medical management very well. Conservative management with combination antibiotic therapy was adequate for managing BEO. Conclusively, brucellosis must be considered as a cause of orchitis, especially in endemic regions like Turkey.
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    BRUCELLOSIS IS A MAJOR PROBLEM: A FIVE YEARS EXPERIENCE
    (Carbone Editore, 2013) Dal, Tuba; Celen, Mustafa Kemal; Ayaz, Celal; Dal, Mehmet Sinan; Kalkanli, Sevgi; Mert, Duygu; Yildirim, Necmettin
    Brucellosis is a chronic granulomatous infection which is endemic in Mediterranean countries and Turkey. The aim of this study is to analyze the clinical, laboratory findings and therapeutic features in patients with brucellosis. A retrospective study was conducted with 91 patients who developed brucellosis between 2005 to 2009. The diagnosis was based on clinical findings compatible with brucellosis, serological tests positive, and/or isolation of Brucella species from blood, or other tissues. The mean age was 33 years (16-67 years). Sixty-threes of patients (69.2%) were male. Forty (44%) cases had an occupational history relevant for Brucella exposure and 85 (93%) cases consumption with contaminated animal product. The mean diagnostic delay was 15 days, much longer in focal brucellosis. A total of 77 (85 %) cases had acute brucellosis. The focal brucellosis complications were observed in 39 (42.8%) cases: osteoarticular involvement 32 (82%), epididymo-orchitis 4 (10%), and central nervous system involvement 3 (8%). Chronic brucellosis occurs in 3 (3.3%) cases. Clinical manifestations included non-specific symptoms such as fever (95%). sweats (90%), arthralgia and lower back pain (63%). Of the patients 84 (92%) had serological titre =1/160 and 28 (31%) blood cultures were positive. All of the patients were cured by antibiotic therapy (Doxycycline+rifampicin/streptomycine, streptomycine+rifampicin/Doxycycline, ceftiraxone/rifampicin). Relapse was observed in 5 (5.4%) patients. Brucellosis is an infection with multiple presentations. Its early diagnosis was mandatory to avoid severe complications.
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    A Case of Necrotizing Fasciitis due to Intramuscular Injection and Review of the Literature
    (Aves, 2009) Ulug, Mehmet; Celen, Mustafa Kemal; Geyik, Mehmet Faruk; Hosoglu, Salih; Ayaz, Celal
    Necrotizing fasciitis is a life-threatening soft-tissue infection characterized by progressive necrosis of the skin, subcutaneous tissue, and fascia. A twenty-three year-old female patient presented with erythema and pain in the left thigh; both had started 15 days previously. Physical examination revealed swelling, warmth in the left thigh and pain related to passive movement. During follow up, the area involved developed echymotic bullous lesions which shortly spread to the perineal region. Despite appropriate antibiotic therapy and supportive management, the lesions progressed and surgical debridement was carried out. Deep wound and blood cultures revealed Staphylococcus aureus. Clearly, the mortality and morbidity can be decreased with clinical awareness, early diagnosis, effective surgical debridement, and intensive supportive care. In this study, we present a rare case of necrotizing fasciitis in an adult who had no predisposing factor and discuss its clinical manifestations and the best therapeutic choice for this potential life threatening disease, together with a review of the literature.
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    A Case of Salmonellosis Caused by a Multidrug-Resistant Strain of Salmonella typhimurium
    (Doc Design Informatics Co Ltd, 2009) Ulug, Mehmet; Celen, Mustafa Kemal; Ayaz, Celal
    Salmonellosis occurs both in epidemic and endemic forms and remains a public health problem in developing countries. Non-typhoidal Salmonella are important foodborne pathogens that cause gastroenteritis, bacteremia, and subsequent focal infection. Resistant bacteria are especially problematic in a wide variety of immunocompromised individuals, including patients with malignancy, and those receiving corticosteroid therapy or treatment with other immunotherapy agents. In this study, a 21 year old female patient with tuberculous meningitis who developed salmonellosis due to Salmonella typhimurium was presented.
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    A case report and literature review: osteomyelitis caused by community-associated methicillin resistant Staphylococcus aureus
    (J Infection Developing Countries, 2011) Ulug, Mehmet; Ayaz, Celal; Celen, Mustafa Kemal
    Osteomyelitis in adolescents is a serious disease with the potential for lifelong disability. The key to successful management is early diagnosis, including bone sampling for microbiological and pathological examination to allow targeted and long-lasting antibiotic therapy. Staphylococcus aureus is the most frequently isolated microorganism in these patients. Methicillin-resistant S. aureus (MRSA) is usually considered a nosocomial pathogen, but increasingly it is acquired in the community. We present a case of acute osteomyelitis caused by community-associated MRSA (CA-MRSA) who had never been hospitalized and had no other known risk factors for MRSA. The changing epidemiology of MRSA became evident when infections occurred in previously healthy patients without established risk factors. MRSA infections have been increasingly reported in pediatric patients, but they are uncommon in adults. Skin and soft tissue infections remain the most common manifestations of CA-MRSA infections. Glycopeptides can be used as initial therapy and oral trimetoprim-sulfamethoxazole as sequential therapy for these patients.
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    Churg-Strauss syndrome occurring during omalizumab treatment
    (Aves, 2015) Bekcibasi, Muhammed; Barutcu, Sezgin; Celen, Mustafa Kemal; Dayan, Saim; Hosoglu, Salih
    [Abstract Not Available]
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    Comparison of Laboratory Values of Prisoner and Civil Patients with Chronic Hepatitis B
    (Galenos Yayincilik, 2014) Deveci, Ozcan; Uysal, Cem; Korkmaz, Mustafa; Tekin, Recep; Celen, Mustafa Kemal; Dayan, Saim
    Objective: Since immune processes play a role in the pathogenesis of HBV infection, the immune system of the host is an important factor in the healing of the infection. The aim of the present study is to compare the laboratory findings related to hepatitis B in inmates with chronic hepatitis B, who live in a confined space and whose immune system is affected by various stress factors, and civilian chronic hepatitis B patients. Materials and Methods: The approval of the Dicle University Medical School, Non-Invasive Clinical Studies Ethics Committee was obtained for the study. Inmates and civilians with hepatitis B who presented to the infectious diseases outpatient clinic between December 2010 and June 2013 were enrolled in the study. Both groups were statistically compared in terms of HBV DNA, ALT, AST and HBeAg. Results: A total of 34 inmates and 34 civilian patients were evaluated. While no difference was observed in terms of the liver enzymes, HBeAg positivity was significantly higher among the inmates. Also, a HBV DNA > 104 copies/ml was more frequently observe din the group of inmates, although the difference was statistically insignificant. Conclusion: Studies comparing chronic hepatitis B patients who are leading different lifestyles will help select the patients with priority for treatment.
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    Cure in Chronic Hepatitis C! Does it Prevent the Risk of Hepatocellular Carcinoma?
    (Bilimsel Tip Yayinevi, 2018) Celen, Mustafa Kemal; Akdemir, Irem; Bayan, Kadim
    In 5%-20% of chronic HCV patients, cirrhosis or other complications like liver cancer may be seen and these may be directly or undirectly related. The development of a sustained viral response (SVR) does not change this fact. In the case of a 52-year-old female diabetic patient whose Anti-HCV was positive, HCV-RNA 2.230.000 IU/mL was decided to be followed up due to an ALT 68 UI/L, AST 55 UI/L. As a result of the biopsy (ISHAK, fibrozis= 2, HAI= 8), Pegile interferon alfa 2a 180 mu g/week + ribavirin 1000 mg/day was started. The patient was put under treatment for 48 weeks and as a result, SVR was obtained and the patient accepted as cure. The patient was told to come for check-up every six months. This patient who had actually started getting better stopped coming to our center in 2015 and did not return for a long time. The patient came back in 2016 with a fatigue complaint. As a result of the examination, AFP was 38.6 and all other parameters were found normal. Although there was no sign of a mass image in her liver ultrasound, there was a hepatocellular carcinoma (HCC) compatible lesion which was 190 x 150 x 90 mm in segment 6-7 in her contrasted MR result. The patient was urgently referred to a transplant center. However, it was determined at the center that since the tumor had made a vein invasion, there was no chance for a transplant. The patient died in June 2017. The cure in HCV treatment does not exclude the reality of HCC, which shows that patients who get the treatment must be followed up very closely. Routine clinical follow up, AFP level screening, effective ultrasound and dynamic imagination are of utmost importance.
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    CURRENT STATUS OF HIV/AIDS-SYPHILIS CO-INFECTIONS: A RETROSPECTIVE MULTICENTRE STUDY
    (Natl Inst Public Health, 2019) Sargul, Figen; Sayan, Murat; Inan, Dilara; Deveci, Aydin; Ceran, Nurgul; Celen, Mustafa Kemal; Cagatay, Atahan
    Objective: Treponema pallidum and HIV are transmitted frequently through sexual contact, these agents with epidemiological similarities co-infect the same host. The current number of HIV-infected cases in Turkey is increasing. For this reason, we aimed to reveal the characteristics of syphilis in HIV/AIDS cases. Methods: A retrospective longitudinal cohort study was performed, patients were followed up at 24 clinics in 16 cities from all seven regions of Turkey between January 2010 to April 2018. We examined the socio-demographic characteristics, laboratory parameters and neurosyphilis association in HIV/AIDS-syphilis co-infected cases. Results: Among 3,641 patients with HIV-1 infection, 291 (8%) patients were diagnosed with syphilis co-infection. Most patients were older than 25 years (92%), 96% were males, 74% were working, 23% unemployed, and 3% were students. The three highest prevalence of syphilis were in Black Sea (10.3%), Mediterranean (8.4%) and Marmara Regions (7.4%). As for sexual orientation, 46% were heterosexuals, 42% men who have sex with men (MSM), and no data available for 12%. Patients with the number of CD4+<= 350 mm(3) reached 46%, 17% of the patients received antiretroviral therapy and neurosyphilis association reached 9%. Conclusion: Although HIV/AIDS-syphilis co-infection status appeared high in heterosexuals, MSM had a moderate level increase in cases. Our results suggested syphilis co-infection in HIV/AIDS cases should be integral part of monitoring in a national sexual transmitted diseases surveillance system. However, our data may provide base for HIV/syphilis prevention and treatment efforts in the future.
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    The Diagnostic Value of Sinus-Track Cultures in Secondary Pediatric Chronic Osteomyelitis
    (Kuwait Medical Assoc, 2011) Ulug, Mehmet; Ayaz, Celal; Celen, Mustafa Kemal; Necmioglu, Serdar
    Objective: To determine and compare the diagnostic value and accuracy of culture of material from a sinus track with culture of material from bone specimens Design: Retrospective study Setting: Dicle University Medical School and Batman State Hospital, Turkey Subjects: Twenty-one patients with secondary chronic osteomyelitis (COM). Material for culture was taken from the sinus as well as the bone specimens Interventions: Surgery for COM Main outcome measures: The diagnostic value of sinus track culture Results: The mean age of patients was 8.5 +/- 3.8 years. 15 (71.4%) were male and six (28.6%) were female. Organisms isolated from bone cultures were Staphylococcus 71.4% (15 / 21), Pseudomonas aeruginosa 9.5% (2 / 21), Escherichia coli 9.5% (2 / 21), Proteus mirabilis 4.8% (1 / 21), Klebsiella pneumoniae 4.8% (1 / 21), respectively. Cultures of sinus track material and bone specimens gave identical results in 47.6% of patients. Conclusion: This study shows that if treatment of COM was planned according to the microbiological analysis of material from the sinus-track, it may not result in recovery every time. We found approximately 48% concordance between sinus-track and bone cultures. In other words, antimicrobial therapy guided by antibiograms of bacteria isolated from sinus-track would be inappropriate in 52% of patients with COM and result in treatment failure.
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    EFFECTIVENESS OF MEDIA MEDIATED INFORMATION AND AWARENESS PROJECT OF HEPATITIS B ON DIAGNOSIS, MONITORING AND TREATMENT OF HEPATITIS B
    (Carbone Editore, 2013) Dal, Tuba; Celen, Mustafa Kemal; Ulas, Sevilay; Celik, Yusuf
    Background: Incidence of hepatitis B is 8-12% in Southeastern Anatolia Region of Turkey. In Diyarbakir, Batman, Siirt, Mardin, which are residential areas with a population of 2.2 million, 95000-144000 persons are suffering from this infectious disease. We aimed to increase the awareness of the public about Hepatitis B through the media, to monitor the impact of this disease on patients, and to determine prevention and treatment strategy. Methods: In four cities, 12 television programs lasting about 60-90 minutes, have been broadcasted 60 days apart between 01.01.2010-31.12.2011. At the same time, in a local newspaper, which was read in the whole region, a corner of hepatitis B formed and different topics, opinions, problems, and wrong treatment methods were discussed in, one day a week. Results: Admission of Diyarbakir patients to Dicle University Hospital was increased by 19% and Batman patients was increased by 23%. A significant difference (p < 0.028) was observed in the number of patients admitted to the infectious diseases clinic for hepatitis B. between the years 2009-2011. Conclusion: Continuous media programs, especially in areas with low levels of socioeconomic status will be effective in diagnosis of new cases, monitoring and treatment, preventing of disease, and preventing of the spread.
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    The Effects of the COVID-19 Pandemic on Clinical and Laboratory Follow-up of Patients Diagnosed With Chronic Hepatitis B: A Multicenter, Prospective, Observational Study
    (Briefland, 2022) Akgul, Fethiye; Arslan, Yusuf; Celik, Mehmet; Karasahin, Omer; Celen, Mustafa Kemal
    Background: Chronic hepatitis B (CHB) patients who are under the treatment of antiviral agents should be monitored in routine control visits. However, during the COVID-19 pandemic, the visits were interrupted. Objectives: This study aimed to investigate whether these patients were affected regarding clinical, laboratory, and treatment outcomes. Methods: This prospective study consisted of CHB patients aged > 18 who were applied to 3 tertiary centers between 14 February and 30 March 2022. The patients were selected from the ones who regularly applied to outpatient clinics and under the treatment of antiviral agents before the pandemic. The demographic and laboratory values, including serologic, biochemistry, and molecular results, were compared between the 2 groups who came and did not come to control visits. Results: A total number of 220 patients were included. More than half (n = 142, 64.5%) were female. The median age was 44 years (19 - 73). A hundred and forty-two (64.5%) patients did not come to control visits during the pandemic. The most common reason was anxiety about COVID-19. The tenofovir treatment was replaced with entecavir (ETV) due to osteopenia and with alafenamide due to osteopenia and/or renal failure. The previous agents were re-started in 27 (79.5%) patients who discontinued the treatment. Conclusions: The COVID-19 pandemic negatively impacted the follow-up of CHB patients. In this regard, 15.5% of patients stopped their treatments. The patients who stopped their follow-ups and continued tenofovir disoproxil fumarate (TDF) had proteinuria and decreases in bone mineral density (BMD) and estimated glomerular filtration rate (eGFR) levels.