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    A 4-Year Surveillance of Device-associated Nosocomial Infections in a Neonatal Intensive Care Unit
    (Elsevier Taiwan, 2013) Tekin, Recep; Dal, Tuba; Pirinccioglu, Habibe; Oygucu, Seyhan Erisir
    Background: The aim of this study was to determine the rate of health care-associated infection (HC-AI) and device-associated health care-associated infections (DA-HAIs), and distribution of causative microorganisms and etiologic factors responsible for these infections in a neonatal intensive care unit (NICU) of a state hospital in southeastern Turkey. Methods: A laboratory-based, active, prospective nosocomial infection surveillance study was performed in NICUs from January 2008 to December 2011. The rates of HC-AIs were determined on a daily basis. The findings were evaluated by applying the definitions of the Centers for Disease Control and Prevention National Healthcare Safety Network. Results: In a 4-year period, 580 HC-AIs, 81 of which were DA-HAIs, were detected among 6932 patients. The rate of hospital acquired infection was 8.3% and 7.69/1000 patient days. Ventilator-associated pneumonia (YAP) was the second most frequent (13.1%) HC-AI and the most frequent was DA-HAI. The VAP rate was 6A per 1000 ventilator days. Mechanical ventilation was the most frequently used invasive device. Median time to diagnosis of VAP was 32.11 +/- 29.3 days from the time of admission. Acinetobacter baumannii (48%) and Pseudomonas aeruginosa (32%) were the most frequent microorganisms. Colistin was the most effective antibiotic by in vitro test. The antibiotic resistance ratios of A. baumannii were >= 54% for carbapenems, aminoglycosides, and cefoperazone-sulbactam; >= 88% for quinolones; and >= 92% for ceftazidime, ceftriaxone, and piperacillin-tazobactam. Conclusions: Device-associated nosocomial infections was a particularly important problem in NICU. Close monitoring will decrease the rates of device-related nosocomial infections. Copyright (C) 2013, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC. All rights reserved.
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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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    Assessment of the underlying causes of the immune thrombocytopenia: Ten years experience
    (Pakistan Medical Assoc, 2017) Dal, Mehmet Sinan; Karakus, Abdullah; Dal, Tuba; Aydin, Berrin Balik; Hattapoglu, Elif; Ekmen, Mehmet Onder; Ulas, Turgay
    Objective: Immune thrombocytopenia (ITP) is an immune haematologic disorder causing platelet destruction mediated by anti-platelet antibodies. In this study we aimed to evaluate the clinical and laboratory variables of ITP patients in southeast of Turkey. Methods: In this retrospective study 167 ITP patients between 2005 and 2015 were evaluated. All patients were screened for immunological parameters including ANA (antinuclear antibodies), anti dsDNA (anti-double-strandedDNA), ACA(anti-cardiolipin) IgM and IgG, LA (lupus anticoagulants). All patients were screened for Helicobacter pylori, HBsAg (Hepatitis B surface antigen), anti-HCV (hepatitis C virus antibody), and anti-HIV 1/2 (HIV antibody) and brucellosis. Results: Among the patients, 50 (29.9%) patients were male, 117 (70.1%) were female. The age range of patients was 18-86 (mean 38.16+/-14). In 56 patients (33.5%) splenectomy was performed. 36 patients (21.6%) were positive for ANA, 5 (3%) were positive for anti dsDNA, 14 (8.4%) for ACA Ig G, and 14 (8.4%) patients for ACA IgM. LA was tested in 165 patients and 30 (18%) patients were positive for LA. Microbiologic evaluation was as follows: 16 patients (9.6%) were positive for HbsAg, 109 (65.3%) positive for Anti-HBs, 5 positive for anti-HCV (3%), 56 (33.5%) patients were positive for Helicobacter pylori antigen, 5 (2.9%) for Brucella and one patient was positive for anti-HIV 1/2. Conclusion: Immune thrombocytopenia patients have to be evaluated according to their demographic characteristics and laboratory results. Secondary causes of ITP were HIV, HCV, Helicobacter pylori, brucellosis, tuberculosis, and autoimmune diseases in our region. Management of ITP patients can change in different regions.
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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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    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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    The comparison of adefovir dipivoxil or combination with lamivudine in patients with lamivudine resistant chronic hepatitis B
    (Elsevier Science Bv, 2015) Ayaz, Celal; Celen, M. Kemal; Geyik, M. Faruk; Bayan, Kadim; Dal, Tuba; Altindis, Mustafa
    [Abstract Not Available]
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    Cryptococcus liquefaciens meningitis in a patient with T cell non Hodgin lymphoma
    (Edizioni Minerva Medica, 2019) Ozcan, Nida; Dal, Tuba; Akpolat, Nezahat; Durmaz, Riza; Yakut, Salim; Zeybek, Hasan; Gul, Kadri
    Invasive fungal cryptococcosis including meningitidis is a growing threat to immunocompromised patients. Cryptococcus neoformans and Cryptococcus gattii are the main agents of human cryptococcosis. In recent years, there has been an increased incidence of opportunistic infections caused by other species, such as C. liquefaciens. In this study, we presented a meningitis case report caused by Cryptococcus liquefaciens in a 12 years old girl with T cell NHL (Non Hodgin lymphoma). A 12-year-old female patient with a diagnosis of T-NHL (T cell Non-Hodgkin's lymphoma) under the chemotherapy was hospitalized in Hematology Clinic with the complaints of fever and occasional headache for three days. The yeast colonies were isolated from cerebrospinal fluid material (CSF). MALDI-TOF MS (Matriks assisted laser desorption ionization time of flight mass spectrometry, Bruker Daltonics, USA) and Nested PCR (polymerase chain reaction) were used to identify the yeast. Isolated yeast is identified as Cryptococcus liquefaciens by MALDI-TOF MS and Nested PCR. In conclusion, C. liquefaciens can be a causative agent of menigitidis in cases with NHL. Nested PCR was a good, time-saving and economical method for the accurate and early diagnosis of C. liquefaciens infections. Our presented case also showed that result of MALDI-TOF method was compatible with nested PCR method in identification of C. liquefaciens.
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    Culture and culture-independent diagnostic tests in Campylobacter enteritis
    (Journal of Infection Developing Countries, 2022) Özcan, Nida; Bacalan, Fatma; Çakır, Fatih; Bilden, Alican; Genişel, Neslihan; Dal, Tuba
    Introduction: Campylobacter infections are among the most common causes of bacterial enteritis. This study aims to determine the sensitivity, specificity and positive predictive values (PPV) of culture and culture-independent tests for the diagnosis of Campylobacter enteritis. Methodology: A total of 400 stool samples were included in the study. BD MAX enteric bacterial panel (BD Diagnostics, Franklin Lakes, NJ, USA) and EntericBio Gastro Panel II (Serosep, Limerick, Ireland) were used as commercial molecular tests. RIDA??QUICK Campylobacter (R-Biopharm, Darmstadt,, Germany) and CerTest (Biotec, Zaragoza, Spain) were used to detect Campylobacter antigens. Samples were cultured in CCDA media and subjected to bacterial identification by mass spectrometry. Results: Among the 400 specimens, 41 (10.2%) were evaluated as Campylobacter positive; 21 were culture-positive and 20 were detected as positive by both PCR methods. Of the 21 isolates grown in culture, 16 (76.2%) were identified as C. jejuni and 5 (23.8%) as C. coli. While all 21 culture-positive specimens were detected as positive by both molecular tests, 18 of the specimens were found positive by RidaQuick, and 16 by Certest ICA. Of the 20 culture-negative Campylobacter cases, 18 were positive by RidaQuick and 12 by Certest ICA. Sensitivities of culture, ICA-RidaQuick and ICA-CerTest were 51.2%, 87.8 and 68.3, respectively. The specificities of all tests were in the range of 90-100 %. PPV of molecular tests, ICA-RidaQuick and ICA-CerTest were > 95%, 72 % and 48.3 %, respectively. Conclusions: Molecular tests were superior to culture and ICA in terms of sensitivity, specificity, and positive predictive value.
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    Detection of class 1 integron in Acinetobacter baumannii isolates collected from nine hospitals in Turkey
    (2013) Çiçek, Ayşegül Çopur; Düzgün, Azer Özad; Saral, Ayşegül; Kayman, Tuba; ÇIzmecI, Zeynep; Balcı, Pervin Özlem; Dal, Tuba; 0000-0002-3673-9670
    Objective: To investigate the antibiotic resistance genes inserted into class 1 and class 2 integrons in Acinetobacter baumannii (A. baumannii) isolates obtained from nine different cities in Turkey. Methods: A collection of 281 A. baumannii clinical isolates were collected from nine diferent state hospitals in Turkey and were confirmed as A. baumannii by conventional biochemical, API testing and bla-OXA-51 specific PCR. The isolates were examined by PCR for existence of class 1 and 2 integron gene cassettes. Results: They were characterized by antimicrobial susceptibility testing and the highest resistance rates were determined for piperacillin (90.03%), ciprofloxacin (87.54%), cefepime and trimethoprim/sulfamethoxazole (81.13%). The lowest resistance rates was for cefotaxime (3.55%). class I integrons were detected in 6.4% (18/281) of A. baumannii strains and no class 2 integron was detected. The gene cassettes of class 1 integrons AacC1-AAC(3) I-aadA1, AacC1-aadA1, AAC(3)-I, AAC(3)-I -AAC(3)-I -aadA1, TEM-1, AAC(3)-I-aadA1 - AAC(3)-I -AAC(3)-I, AAC(3)-I -AAC(3)-I -AAC(3)-I -aadA1, AAC(3)-I - aadA1, AAC(3)-I-AAC(3)-I, AAC(3)-I-aadA1-AAC(3)-I-aadA1, AAC(3)-I-AAC(3)-I-aadA1-AAC(3)-I-aadA1 were detected in eighteen strains. The aac genes family were most frequently found integrated into the class 1 integrons and it was followed by aadA genes and TEM-1 genes. Conclusions: This is an extensive study on the distribution of class 1 integron among A. baumannii in Turkey. In addition to these, two new alleles were observed. Their percentage rates of similarity to other cassettes are 95% aadA1 (TKA18) and 89% aadA1 (ANKA3).
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    Diyarbakır ilinde çocuklarda gözlenen brusellozun çapraz bulaş dinamiği ve izolatların filogenetik soyağacının araştırılması
    (2017) Dal, Tuba; Ceylan, Ali
    Bruselloz enfekte hayvanlarla doğrudan temas, süt ve süt ürünlerinin taze olarak tüketilmesi, enfekte damlacıkların inhalasyonu ile bulaşabilen, brusella türlerinin neden olduğu bir hastalıktır. Özellikle çocuk hastaların tedavisinde güçlüklere ve nükslere neden olmaktadır. Bu tezde brusellozun endemik olduğu Diyarbakır yöresinde izole edilen Brucella suşlarının tür düzeyinde tanımlanması, antibiyotik duyarlılıklarının belirlenmesi multilocus variable number tandem repeat analysis (MLVA) yöntemiyle moleküler epidemiyolojik analizlerinin yapılması amaçlandı. Çalışmaya 2000-2013 yıllarında Diyarbakır Çocuk Hastalıkları Hastanesi’nde, brusella enfeksiyonu tanısı alan çocuklardan izole edilmiş toplam 77 Brucella suşu dahil edildi. Konvansiyel yöntemler ile suşların tür düzeyine tayini ve antibiyotik duyarlılık testleri gerçekleştirildi. Polimeraz zincir reaksiyonu yöntemiyle Brusella türleri tanımlandı ve ardından MLVA yöntemi ile suşların genotip tayini yapıldı. 77 hastanın 40’ı erkek, 37’si kız olup yaş aralığı 2-16 yaş (ortalama 9.14 ± 3.4 yaş) arasındaydı. Bütün hastalarda yakın zamanda pastörize edilmemiş süt veya süt ürünleriyle beslenme hikayesi mevcuttu. Karın ağrısı (58%), artralji (%56), miyalji (%40) en sık şikayetlerdi. En sık klinik bulgular arasında ateş, artrit, hepatomegali ve splenomegali yer alıyordu. Mevsimsel dağılım açısından sonbahar sonu ve yaz aylarında sıklık gösteriyordu. Suşların tamamının B.melitensis biovar 3 olduğu saptandı. İki izolat seftriaksona dirençli bulunurken, suşların tamamı doksisiklin, streptomisin ve trimetoprim-sülfametoksazole duyarlıydı. Tigesiklin ve Rifampisin için MİK aralıkları 0,016-0,23 ve 0,38-1,5 µg/ml olarak belirlendi. Moleküler epidemiyolojik analizler sonucunda 77 suşta 42 farklı MLVA-16 profili belirlendi. Bu 42 profilin 18 tanesi en az iki veya daha fazla suş içermekteydi. Geriye kalan 24 suş ise özgü profil gösterdi. Suşlar arasındaki kümeleşme oranı %66.7 olarak tespit edildi. Lokuslardan ayırım gücü en yüksek lokus Bruce 30 iken, bunu sırasıyla Bruce 16, Bruce 9, Bruce 7, Bruce 4 takip etti. Suşlarının tamamının MLVA-11'e göre genotip 122, MLVA-8'e göre ise genotip 43 olduğu ve Doğu Akdeniz genotipinde yer aldığı belirlendi. Sonuç olarak yörede çocuklarda bruselloz halen önemli bir halk sağlığı sorunudur. Suşlar arasında çapraz bulaş oranı yüksektir. Çalışmamız bölgede hayvan hareketliliğin kontrol altına alınmasının, et ve süt ürünlerinin denetim altına alınmasının, çocukların beslenmesinde kontamine ürünlerden kaçınılmasına yönelik eğitim faaliyetlerinin gerekliliğini ortaya koymuştur. Anahtar Sözcükler: Brusella, MLVA, bulaş dinamiği
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    Effect of routine Hepatitis B vaccination program in Southeast of Turkey? Comparing of the results of HBV DNA in terms of age groups for the years 2002 and 2012
    (Termedia Publishing House Ltd, 2014) Ozekinci, Tuncer; Atmaca, Selahattin; Dal, Tuba
    Diyarbakir is the largest residential area in the Southeastern Anatolia of Turkey. Routine HBV vaccination has begun to be implemented by the Ministry of Health in Turkey in 1998. The purposes of this study were to detect the levels of HBV DNA in patients with HBV in 2012, and to compare the results of the year 2002 according to age groups. HBV DNA results of patients were divided in to seven age groups (0-14, 15-20, 21-30, 31-40, 41-50, 51-60, and > 61 years) and for comparison of HBV DNA levels of 2002 and 2012, HBV DNA values in pg/ml of year 2002 were translated into IU/ml and HBV DNA levels were grouped as <5 pg/ml < 2.43 x 10(5) IU/ml, 5-100 pg/ml 2.43 x 10(5)-4.86 x 10(6) IU/ml, 101-2000 pg/ml 4.87 x 10(6)-9.72 x 10(7) IU/ml, > 2000 pg/ml > 9.72 x 10(7) IU/ml 2-3. A statistically significant decrease was seen in the number of individuals in 0-14 age group in 2012 compared with 2002. In 2002 the rate of individuals in 0-14 age group was 18.8% whereas 4.8% in 2012. Our study was suggested that that routine HBV vaccination program, contributed to the reduced risk of HBV infection in our region.
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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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    Effects of Formaldehyde and Vimentin Expression in Rat Skin
    (Soc Chilena Anatomia, 2013) Kalkanli, Sevgi; Kalkanli, Nevin; Deveci, Engin; Dal, Tuba; Baran, Ozlem
    The Wistar rats (9 weeks old, 180-200 g body weight) used in these trials were divided into two groups of 16 animals each (Control group and Experimental group). 100x65x100 in the sizes of the experimental group were taken into a glass vase. During the time period of 8 weeks, 5 days a week with 8 hours the inhalation of 10 ppm formaldehyde was made. Skin was removed and placed in 10% formaline. Sections were stained with Hematoxylene-Eosine, Trichrome-Masson and observed under light microscope. In this study, histopathological and immunohistochemical techniques due to the impact of the changes in formaldehyde and examined the distribution of vimentin.
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    Efficacy and safety of tenofovir disoproxil fumarate in pregnancy for the prevention of vertical transmission of HBV infection
    (Baishideng Publishing Group Inc, 2013) Celen, Mustafa Kemal; Mert, Duygu; Ay, Muzeyyen; Dal, Tuba; Kaya, Safak; Yildirim, Necmettin; Gulsun, Serda
    AIM: To evaluate the effects of tenofovir disoproxil fumarate (TDF) use during late pregnancy to reduce hepatitis B virus (HBV) transmission in highly viremic mothers. METHODS: This retrospective study included 45 pregnant patients with hepatitis B e antigen (+) chronic hepatitis B and HBV DNA levels > 10(7) copies/mL who received TDF 300 mg/d from week 18 to 27 of gestation (n = 21). Untreated pregnant patients served as controls (n = 24). All infants received 200 IU of hepatitis B immune globulin (HBIG) within 24 h postpartum and 20 mu g of recombinant HBV vaccine at 4, 8, and 24 wk. Perinatal transmission rate was determined by hepatitis B surface antigen and HBV DNA results in infants at week 28. RESULTS: At week 28, none of the infants of TDF-treated mothers had immunoprophylaxis failure, whereas 2 (8.3 %) of the infants of control mothers had immunoprophylaxis failure (P = 0.022). There were no differences between the groups in terms of adverse events in mothers or congenital deformities, gestational age, height, or weight in infants. At postpartum week 28, significantly more TDF-treated mothers had levels of HBV DNA < 250 copies/mL and normalized alanine aminotransferase compared with controls (62% vs none, P < 0.001; 82% vs 61%, P = 0.012, respectively). CONCLUSION: TDF therapy during the second or third trimester reduced perinatal transmission rates of HBV and no adverse events were observed in mothers or infants. (C) 2013 Baishideng Publishing Group Co., Limited. All rights reserved.
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    Epidemiology and Risk Factors of Hepatitis Delta Infection in Turkey
    (Dr M N Khan, 2013) Ayaz, Celal; Koruk, Suda Tekin; Yalci, Aysun; Yamazhan, Tansu; Aygen, Bilgehan; Tosun, Selma; Dal, Tuba
    This study is aimed to investigate the prevalence and risk factors of HDV co-infection in patients with chronic HBV infection in Turkey, where HBV infection is endemic. The date of this study was obtained from Turk-Hep-Net project. The project includes real-life cohort of HBV patients from 15 centers in Turkey and is supported by Viral Hepatitis Society. Of the 7366 HBsAg positive individuals tested for the presence of anti-HDV antibodies, 63,6 were male and 36.4 % were female. Of the 7366 HBsAg positif patients, 206 (2.8%) contained anti-HDV. Southeastern Anatolia Region of the country's anti-HDV positivity rate was found to be 4.5%. The risk factors in anti-HDV positivity patient were; male gender, long-term (>5 year) HBsAg positivity and living in Southeastern Anatolia. Our study revealed that recognizing the risk factors associated with HBV and HDV co-infection will be beneficial to control of these infections.
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    Etkin eğitim müdahalesi HIV hastalarında uyumu ilaç pozolojisinden bağımsız olarak etkiler mi?
    (Dicle Üniversitesi Tıp Fakültesi, 2019) Kalkan, İrem Akdemir; Karaşahin, Ömer; Dal, Tuba; Ören, Meryem Merve; Ayhan, Merve; Demir, Yakup; Yıldız, Yeşim; Aktar, Fesih; Çelen, Mustafa Kemal
    Amaç: Ülkemizde 2017 verileriyle 17.000 kişinin HIV (insan immün yetmezlik virüsü) ile enfekte olduğu bilinmektedir. Hastalığın tedavisinde ilaç uyumu en önemli noktalardandır. HIV/AIDS tedavisinde hasta eğitimi çok önemlidir. Bu çalışmanın amacı eğitim müdahalesi yapılan hasta grubunda ilaç uyumunun değerlendirilmesidir.Yöntemler: Çalışma retrospektif verilerin analiz edildiği bir müdahale çalışması olarak gerçekleştirilmiştir. MayısTemmuz 2017 tarihleri arasında Dicle Üniversitesi Tıp Fakültesi Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji bölümünde izlenmekte olan 107 HIV/AIDS hastası çalışmaya dahil edilmiştir. Hastalığa özgü detaylı eğitim almayı kabul eden hastalar 1. Grup olarak değerlendirilmiştir. Eğitim almak istememiş olan 25 hasta ise (2. Grup/Kontrol grubu) standart poliklinik bilgilendirmesi almıştır. Her iki grubun eğitimleri aynı hekim tarafından verilmiştir. Hastaların tedavinin 3. ve 6. aylarındaki ilaç uyumları tablet sayma yöntemiyle değerlendirilmiştir. Bulgular: Tedavi almakta olan 107 hastanın yaş ortalaması 28.6 yıldır. Hastaların 86’sı (%80,4) erkektir. Hastaların eğitim durumları incelendiğinde %8,4’ü (n=9) sadece okuryazar, %67,3’ü (n=72) ilk ve orta öğretim mezunu olarak tespit edilmiştir. Hastaların öğrenim durumları ile 3. ve 6. aydaki ilaç uyumları arasında istatistiksel olarak anlamlı bir fark tespit edilmemiştir (sırasıyla p=0,159 ve p=0,274). Günlük tablet sayısından bağımsız olarak, ilaç uyumu, eğitim verilenlerde istatistiksel olarak anlamlı düzeyde yüksek saptanmıştır ( p<0,001).Tartışma ve Sonuç: HIV enfeksiyonu olan hastalarda, hastalığa özgü eğitim vermek tablet sayısından ve temel öğrenim üzeyinden bağımsız olarak, ilaç uyumunu anlamlı düzeyde arttırmaktadır. Daha az sayıda tablet içeren rejimler kullanmak da ilaç uyumunu arttırmaktadır.
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    Evaluation of cutaneous palpebral anthrax
    (Taylor & Francis Ltd, 2013) Tekin, Recep; Ari, Seyhmus; Dal, Tuba; Kaya, Safak; Kortak, Mehmet Zeki; Dursun, Birgul; Dayan, Saim
    Context: Anthrax is a rare disease caused by Bacillus anthracis. Antrax is zoonotic disease and is often encountered in persons engaged in animal husbandry. Cutaneous anthrax is approximately 95% of anthrax in humans. Palbebral involvement is rare. Objective: In this study, we aimed to evaluate the clinical presentation, diagnosis and treatment of cases with cutaneous palpebral anthrax. Methods: In this study, the patients diagnosed of cutaneous palpebral anthrax between January 2000 and December 2012, were investigated and evaluated, retrospectively. Cutaneous palpebral anthrax was diagnosed by the presence of typical anthrax lesion and/or observation of gram-positive encapsulated bacilli in gram prepations and/or culture positive of samples taken from lesions. In the cases who were culture-negative and without bacilli in gram-staining, the diagnosis was based on the presence of characteristic clinical presentation with a history of severe scarring formation, swelling, black eschar and positive response to the treatment. Results: A total of 21 patients with cutaneous palpebral anthrax admitted to the two hospitals between January 2000 and December 2012. Eight patients were male (38.1%) and 13 patients were female (61.9%), and the mean age was 31 +/- 21.2 (range 1-82 years). The most common symptoms on admission to the hospital were swelling and redness on the skin. Periorbital lesions were in the right eye in 14 cases and the most common eyelid involvement was seen in upper eyelid with 15 cases. The diagnosis was based on isolation of bacteria in five (23.8%) cases, detection of gram-positive bacilli in direct examination of characteristic lesion material in six (28.5%) cases. Ten (47.7%) cases were diagnosed by the characteristic appearance of the lesion. Malignant pustule was seen in all of our patients and seven cases (33.4%) had malignant edema. In the treatment, penicilin was used for 10 (47.7%) cases, ampicillin-sulbactam for five (23.8%) cases and, ciprofloxacin for three (14.3%) cases. Cicatricial ectropion was observed in 10 (47.7%) patients, lagophthalmos developed in four (19%) patients, and corneal scar in two (9.5%) patients. The distribution of the cases did not differ by the year but showed a density in the months from July to September (62.7%). Conclusion: Early diagnosis and high dose antibiotic treatment can facilitate the treatment and prevent development of eyelid complications including cicatricial ectropion, corneal scars and palpebral symphysis. Prolonged follow-up is necessary in patients who develop complications and surgical intervention.
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    Evaluation of febrile neutropenic patients hospitalized in a hematology clinic
    (Hainan Medical University, 2015) Görük, Mücahit; Dal, Mehmet Sinan; Dal, Tuba; Karakuş, Abdullah; Tekin, Recep; Özcan, Nida; Ayyıldız, Orhan; 0000-0003-2090-4392
    Objective: To evaluate the febrile neutropenic patients with hematological malignancies hospitalized in hematology clinic with poor hygiene standards. Methods: A total of 124 patients with hematological malignancies (69 male, 55 female) hospitalized in hematology clinic with poor hygiene conditions depending on hospital conditions, between January 2007 and December 2010, were evaluated, retrospectively. Results: In this study, 250 febrile neutropenia episodes developing in 124 hospitalized patients were evaluated. Of the patients, 69 were men (56%) and 55 women (44%). A total of 40 patients (32%) had acute myeloid leukemia, 25 (20%) acute lymphoblastic leukemia, 19 (15%) non-Hodgkin's lymphoma, 10 (8%) multiple myeloma, and 8 (8%) chronic myeloid leukemia. In our study, 56 patients (22%) were diagnosed as pneumonia, 38 (15%) invasive aspergillosis, 38 (15%) sepsis, 16 (6%) typhlitis, 9 (4%) mucormycosis, and 4 (2%) urinary tract infection. Gram-positive cocci were isolated from 52% (n = 20), while Gram-negative bacilli 42% (n = 16) and yeasts from 6% (n = 2) of the sepsis patients, respectively. The most frequently isolated Gram-positive bacteria were methicillin-resistant coagulase-negative staphylococci (n = 18), while the most frequently isolated Gram-negative bacteria was Escherichia coli (n = 10). Conclusions: Febrile neutropenia is still a problem in patients with hematological malignancies. The documentation of the flora and detection of causative agents of infections in each unit would help to decide appropriate empirical therapy. Infection control procedures should be applied for preventing infections and transmissions.
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    Öğe
    Expression of the adeB gene and responsiveness to 1-(1-naphthylmethyl)-piperazine and phenylalanyl-arginyl-?-naphthylamide in clinical isolates of Acinetobacter baumannii
    (Oxford Univ Press, 2013) Dal, Tuba; Aksu, Burak; Pages, Jean-Marie; Over-Hasdemir, Ufuk
    [Abstract Not Available]
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    First year real life experience with tenofovir alafenamide fumarate: The pythagorean cohort
    (Kare Publishing, 2023) Karaşahin, Ömer; Kalkan, İrem Akdemir; Dal, Tuba; Toplu, Sibel Altunışık; Harputluoğlu, Murat; Mete, Ayşe Özlem; Aktar, Fesih; Demir, Yakup; Çelen, Mustafa Kemal
    Background and Aim: In chronic hepatitis B infection, antiviral therapy significantly reduces the incidence of complications. This study aimed to present real-life 12-month effectiveness and safety data for TAF. Materials and Methods: This Pythagoras Retrospective Cohort Study included patients from 14 centers in Turkiye. The study presents 12-month results of 480 patients treated with TAF as initial therapy or after switching from another antiviral drug. Results: The study shows treatment of about 78.1% patients with at least one antiviral agent (90.6% tenofovir disoproxil [TDF]). The rate of unde-tectable HBV DNA increased in both treatment-experienced and naive pa-tients. In TDF-experienced patients, the rate of alanine transaminase (ALT) normalization increased slightly (1.6%) within 12 months, but the change was not statistically significant (p=0.766). Younger age, low albumin, and high body mass index and cholesterol were identified as risk factors for abnormal ALT after 12 months, but no linear relationship was detected. In TDF-experienced patients, renal and bone function indicators showed significant improvement three months after the transition to TAF and remained stable for 12 months. Conclusion: Real-life data demonstrated effective virological and biochemical responses with TAF therapy. After switching to TAF treat-ment, gains in kidney and bone functions were achieved in the early period.