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Öğe Anti-tuberculosis drug resistance in southeast of turkey(Acta Medica Mediterranea, 2013) Dal T.; Özcan N.; Tekin R.; Tekin A.; Çelen M.K.; Özekinci 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 costeffective tuberculosis control programme contributes to reduce the incidence of drug resistance in the community.Öğe Assessment of methicillin and clindamycin resistance patterns in staphylococcus aureus isolated from a tertiary hospital in Turkey(2013) Tekin A.; Dal T.; Deveci O.; Tekin R.; Atmaca S.; Dayan S.In order to detect the methicillin susceptibility and determine the prevalence of constitutive and inducible clindamycin resistance in Staphylococcus aureus strains, a total of 254 S. aureus isolates, including 139 (54.7%) methicillin-sensitive and 115 (45.3%) methicillin-resistant, were tested for clindamycin and erythromycin by Kirby-Bauer's disk diffusion method. The disk diffusion induction test or D-test was performed on erythromycin-resistant and clindamycin-sensitive strains using the disk diffusion method. The erythromycin-resistant and clindamycin-sensitive strains with a D-shaped zone around the clindamycin disk were considered positive for inducible clindamycin resistance. If a strain was found to be both erythromycin-resistant and clindamycin-resistant, it was considered to have constitutive clindamycin resistance. Overall, ten (3.9%) strains, including two methicillin-resistant S. aureus and eight methicillin-sensitive S. aureus, were found to be erythromycin-resistant and clindamycin-sensitive according to the disk diffusion method and all of these strains showed inducible clindamycin resistance by the D-test method. Constitutive clindamycin resistance was detected in 100 of all MRSA strains. In conclusion, the presence of inducible clindamycin-resistant strains may lead to clindamycin treatment failure in patients with S. aureus infection. The D-test method should be used for antimicrobial susceptibility testing of clindamycin.Öğe Brucellosis is a major problem: A five years experience(Acta Medica Mediterranea, 2013) Dal T.; Celen M.K.; Ayaz C.; Dal M.S.; Kalkanli S.; Mert D.; Yildirim N.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.Öğe Carbapenem resistance in Acinetobacter baumannii: Where is it heading?(2013) Deveci O.; Dal T.; Tekin R.; Bozkurt F.; Tekin A.; Dayan S.In the context of the substantial increase in antibiotic resistance rates of Acinetobacter baumannii, we aimed to evaluate the susceptibility rate changes of A. baumannii strains for carbapenems. A. baumannii strains isolated from patients diagnosed with healthcare-associated infections between 2007-2010 were included. A total of 127 A. baumannii strains [53 (42%) from the intensive care unit and 74 (58%) from the non-intensive care unit] were isolated. Conventional methods and an automated microbiology system were used for identification. Susceptibility testing was studied by Kirby-Bauer disk diffusion method. In 2007, five of 26 strains, in 2008, 18 of 31, in 2009, 10 of 35, in 2010, and 20 of 35 were obtained from intensive care unit patients. The susceptibility rate for imipenem was 50% in 2007 but 20% in 2010, while for meropenem it was 55% in 2007 but 12% in 2010. Prevention and control of antibiotic resistance among Acinetobacter species needs antibiotic usage restrictions and infection control precautions.Öğe The characteristics of patients with chronic hepatitis B in Turkey(Medical Association of Zenica-Doboj Canton, 2014) Kemal Celen M.; Tekin Koruk S.; Aygen B.; Dal T.; Karabay O.; Tosun S.; Koksal I.Aim To evaluate the characteristics of patients with hepatitis B virus (HBV) infection and summarize the treatment modalities. Methods By September 30, 2011 the data of 7871 HBsAg (+) patients were complied and analysed according to demographic and medical records (age, sex, laboratory tests, treatment with antiviral agents) in thirty centres of Turkey. Results Of the 7871 patients 3078 (39.1%) were females; mean (standard deviation) age was 35 (14) years, 3180 (40.4%) were HBsAg positive (+) after admission to a hospital, 1488 (18.9%) after blood donation and 967 (11.9%) were found during routine screening. The HBV prevalence among relatives of HBsAg (+) patients was 1764 (22.4%), and most frequently infected family members were siblings and mothers, 4961 (63.0%) and 2149 (27.3%), respectively). Anti-HDV was negative in 7407 94.1% of patients. Three-fourths of the patients 6383 (81.1%) were HBeAg negative (-). Mean (SD) ALT was 85.8 (266.4) U/L. Majority of patients, 5588 (71.0%) were chronic hepatitis-B patients under treatment, while 2283 (29.0%) were asymptomatic carriers without treatment and only 165 (2.1%) of patients were cirrhotic and 6612 (84.0%) of those were compensated. One-third of the patients 2983 (37.9%) were under a combined treatment, while others were under monotherapy. Lamivudine, entecavir and adefovir were the most frequently used oral therapies, used for 2583 (32.8%), 11.6% and 787 (10.0%) of patients, respectively), while 2975 (37.8%) of patients were under interferon treatment. Conclusion Hepatitis B is still a problem in our country. First task of the physicians and our state should be to prevent the development and spread of the disease with education and vaccination programs, safe blood transfusions, and control of barbers.Öğe The distribution according to the species of Gram-negative bacteria isolated from hospitalized patients's urine specimens and their antimicrobial susceptibility(2012) Dal T.; Tekin A.; Tekin R.; Deveci O.; Can S.; Özekinci T.; Dayan S.Objective: In this retrospective study, we aimed to determine the distribution according to the species of Gram-negative bacteria in isolates obtained from urine cultures of hospitalized patients with urinary tract infections and to detect their antimicrobial susceptibility pattern for contribute to empirical treatment approach to urinary tract infections in our hospital. Methods: Between the dates of January 2006 and September 2011, a total of 3,548 Gram-negative isolates obtained from urine cultures of hospitalized patients with urinary tract infection were identified by conventional methods and the BD PhoenixTM 100 (Becton Dickinson, MD, USA) fully automated microbiology system. Antimicrobial susceptibility testing of isolates was performed by Kirby- Bauer's disk diffusion method according to the Clinical and Laboratory Standarts Institute (CLSI) criteria. In addition, extended-spectrum beta-lactamase (ESBL) production of predominant urinary pathogenic bacteria was detected by the double-disk synergy method. Results: In this study, a significantly higher incidence of urinary tract infection was observed in females compared with males; 2,245 (63.3%) and 1,303 (36.7%), respectively. Escherichia coli was the predominant pathogenic bacterium and accounted for 2,341 (65.8%) of 3,548 hospitalized patients with urinary tract infections. In addition, Klebsiella pneumoniae accounted for 679 (19.1%), Acinetobacter spp. for 177 (5%), Enterobacter spp. for 176 (5%), Pseudomonas aeruginosa for 142 (4%), and other Gram-negative bacteria for 38 (1.1%). Antimicrobial susceptibility rates of Gram-negative bacteria isolated from urine cultures for ceftazidime, trimethoprim-sulfamethoxazole, ciprofloxacin, piperacillin-tazobactam, cefoperazonesulbactam, amikacin, imipenem, meropenem were detected as 34.5%, 38%, 42%, 50%, 70%, 87%, 90%, and 92%, respectively. In addition, the rates of ESBLproducing Escherichia coli and Klebsiella pneumoniae were detected as 38% and 36%, respectively. Conclusion: The present study and the other studies show that in the near future it is possible our therapeutic options may become more limited than ever due to the development of high-level resistance against broad-spectrum antibiotics such as cephalosporins, carbapenems and fluoroquinolones. Due to the highlevel resistance to ceftazidime, ciprofloxacin and trimethoprim-sulfamethoxazole, we recommend that these antibiotics should not be used for the empirical treatment of urinary tract infections.Öğe Effectiveness of "media mediated information and awareness project of hepatitis b" on diagnosis, monitoring and treatment of hepatitis B(Acta Medica Mediterranea, 2013) Dal T.; Çelen M.K.; Ulaş S.; Çelik Y.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.Öğe Epidemiology and risk factors of hepatitis delta infection in Turkey(2013) Ayaz C.; Koruk S.T.; Yalci A.; Yamazhan T.; Aygen B.; Tosun S.; Dal T.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.Öğe Evaluation of clinical and epidemiological features of children with facial viral warts(Dermatologia Pediatrica, 2014) Uçmak D.; Akkurt Z.M.; Dal T.; Acar G.; Arica M.Verrucae are viral lesions commonly encountered in the pediatric population. They occur relatively rarely on the face. The occurence of verrucae in the facial region leads to limitation in treatment modalities and increases patient discordance. The clinical and epidemiological data of 37 patients (26 females) seen at the Dicle University Faculty of Medicine Dermatology outpatient clinics from January 2012 to January 2013 were reported. The mean age of the patients was 10.43±4.51 (range 4-18). The mean duration of lesions was 16.59±14.90 months. Number of lesions ranged from 1 to 50 (mean: 15.92). The most common localization on the facial area was the cheek in 23/37. Extrafacial involvement was present in 5/37 patients. The most common type of verruca in the facial region was verruca plana (50%). Before admission to our clinic, 56.8% had not received any form of treatment. Treatment modalities included reassurance - 16% -, cryotherapy -10.8% -, topical treatment with tretinoin cream, salicylic acid + 5-FU solution - 5.4% - and cauterization -1%-. Twelve of the 21 patients who had not previously received therapy had periorbital lesions. Positive correlation was present between age and duration of lesions (p < 0.01, r = 0.42).Öğe Four-year study of entecavir efficacy and safety in nucleos (T)ide-naïve HBeAg positive chronic hepatitis B patients(Klinicka Bolnica Sestre Milosrdnice, 2014) Celen M.K.; Dal T.; Ayaz C.; Bayan K.; Mert D.; Deveci O.; Oruc E.K.Entecavir is a guanosine analogue with activity against hepatitis B virus. The aim of this 4-year trial was to evaluate entecavir treatment in nucleos(t)ide-naïve HBeAg-positive chronic hepatitis B patients. Forty-nine patients received entecavir and nine of them withdrew from the trial at the end of week 96. The initial mean value of alanine aminotransferase was 79.4±41.5 IU/L, and at the end of the 4-year study period, 90% of patients had alanine aminotransferase values within the normal range. At week 96, 91.7% of patients had HBV DNA <300 copies; at month 48, 90% of patients had HBV DNA <50 IU/mL. HBeAg loss was recorded in 7.1% of patients at week 96 and in 12.5% at month 48. The rate of HBeAg seroconversion was 4.8% at week 96 and 7.5% at month 48. The rate of HBsAg seroconversion was 2.1% at week 96 and 2.5% at month 48. Entecavir as a potent and safe agent leading to continuous viral suppression proved to be safe and well tolerated therapy.Öğe Idiopathic thrombocytopenic purpura associated with splenic tuberculosis: Case report(2013) Dal M.S.; Dal T.; Tekin R.; Bodakçi E.; Düzköprü Y.; Ayyildiz M.O.Tuberculosis is still one of the most prevalent and fatal infectious diseases in spite of considerable improvements in medical science. Splenic tuberculosis is a rare form of extrapulmonary tuberculosis. There are limited numbers of cases in which immune thrombocytopenia is associated with splenic tuberculosis. We report a case of immune thrombocytopenic purpura due to splenic tuberculosis. Our case was a 58-year-old female with headache, gum bleeding, redness in legs, and ecchymoses on the arms for 10 days. On admission to hospital, laboratory tests were as follows: platelet count 6.000/mm3 (150 000-450 000), haemoglobin: 12 g/dl, WBC: 8000/mm3, erythrocyte sedimentation rate: 58 mm/h and C-reactive protein was in normal ranges. After standard laboratory tests, the pa tient was diagnosed with idiopathic thrombocytopenic purpura. The patient presented abdominal lymphadenopathies and spleen in normal size in radiological examinations. Diagnostic laparotomy and splenectomy and lymph node excision was performed and splenic tuberculosis was detected in pathologic and microbiologic examination. The patient was successfully treated with apheresis platelets suspension, intravenous immunoglobulin and antituberculous therapy. In conclusion, splenic tuberculosis should be suspected in patients who have fever, abdominal lymphadenopathies and immune thrombocytopenic purpura. Histopathological examination is still an ideal method to confirm the diagnosis, suitably aided by microbiological examination.Öğe In vitro antimicrobial susceptibility pattern among stenotrophomonas maltophilia strains isolated from clinical specimens(Duzce University Medical School, 2014) Tekin A.; Dal T.; Tekin R.; Deveci Ö.; Demirkaya S.; Mete M.; Dayan S.Aim: In this study, the determination of in vitro antimicrobial susceptibility rates among Stenotrophomonas maltophilia strains isolated from clinical specimens was aimed. Method: A total of 60 S. maltophilia strains isolated from various clinical specimens sent to Dicle University Hospital clinical microbiology laboratory between January 2006 and September 2011 were included retrospectively in this study. Urine samples were inoculated onto 5% sheep blood agar and Eosin-Methylene Blue (EMB) agar media, quantitatively; other clinical samples were inoculated, qualitatively. Identification of S. maltophilia isolates was performed by conventional methods and fully automated microbiology system. Antimicrobial susceptibility tests were performed by Kirby-Bauer’s disk diffusion method and by broth dilution. Results: A total of 60 S. maltophilia strains isolated from clinical specimens as 24 urine, 15 blood, 11 sputum, four synovial fluids, three cerebrospinal fluids, two wound swabs and one middle ear materials. The resistance rates against antibiotics were detected as 85% (n=51) for piperacillin-tazobactam, 75% (n=45) for levofloxacin, 73% (n=44) for ciprofloxacin, 57% (n=34) for trimethoprim-sulfamethoxazole, 5% (n=3) for meropenem and imipenem, and 0% (n=0) for amikacin. Conclusion: In this study, it was detected that piperacillin-tazobactam can be used as an alternative option other than trimethoprim-sulfamethoxazole, for the treatment of infections due to S. maltophilia at least in our region. © 2012 Düzce Medical Journal.Öğe In vitro efficiency of ertapenem among escherichia coli strains isolated from clinical specimens(2013) Tekin A.; Deveci Ö.; Dal T.; Tekin R.; Bacalan F.; Akpolat N.In this study, in vitro efficiency of ertapenem and extanded-spectrum beta-lactamase (ESBL) producing among Escherichia coli strains isolated from clinical specimens were investigated. 334 E. coli strains isolated from clinical specimens that sent to Dicle University Hospital clinical microbiology laboratory between December 2010 and August 2011 were included in this study. Identification of isolates was performed by conventional methods and a fully automated microbiology system. Antimicrobial susceptibility testing of strains was performed by Kirby- Bauer's disc diffusion method and E-test method. Double-disk synergy method was used for the detection of ESBL-producing. 334 E. coli strains were isolated from clinical specimens as 233 (69.8%) urine, 55 (16.4%) blood, 32 (9.6%) wound swabs and 14 (4.2%) others. In 177 (53%) from 334 E. coli strains were determined the ESBL activity. Ertapenem sensitivity rate among strains was determined as 93.4%. Although there was no resistance to ertapenem in ESBL-non-producing strains, ertapenem resistance rate was found as 12.4% in ESBL-producing strains. The high resistance rate for ertapenem in ESBL-producing strains according to the ESBL-non-producing strains was found to be statistically significant (p<0.001). In the light of present study, we think as the better option of ertapenem which has got a high sensitivity rate in the treatment with antimicrobial agents of infections caused by ESBL-producing E. coli strains at least in our hospital.Öğe Is chryseobacterium indologenes a shunt-lover bacterium? a case report and review of the literature(2013) Ozcan N.; Dal T.; Tekin A.; Kelekci S.; Can S.; Ezin O.; Kandemir I.Chryseobacterium indologenes is a non-fermentative Gram-negative bacillus formerly belonging to the Flavobacterium genus. It is widely found in water and soil, also on wet surfaces of the hospital environment. It rarely causes infections and is usually associated with altered immune status or indwelling devices. We present a case of ventriculoperitoneal shunt infection caused by C. indologenes in a premature pediatric patient. A sixmonth-old male infant with congenital hydrocephalus and ventriculoperitoneal shunt was admitted with complaints of irritability, high fever and projectile vomiting. He was diagnosed as suffering from meningitis based on the clinical symptoms and laboratory findings of cerebrospinal fluid. The ventriculoperitoneal shunt was externalized and cerebrospinal fluid samples were sent for bacterial cultures. The isolated bacterium was identified as C. indologenes by conventional methods and the BD Phoenix™ 100 (Becton Dickinson, MD, USA) fully automated microbiology system. Antimicrobial susceptibility testing was performed by the microdilution method and Kirby-Bauer's disk diffusion method according to the Clinical and Laboratory Standards Institute guidelines. The isolate was found susceptible to ciprofloxacin, levofloxacin, cefoperazone and trimethoprim-sulfamethoxazole, while it was resistant to amikacin, aztreonam, cefepime, ceftazidime, gentamicin, imipenem and ticarcillinclavulanic acid. The treatment was started with trimethoprim-sulfamethoxazole and cefoperazone-sulbactam The ventriculoperitoneal shunt was then removed. The patient was fully healed after two weeks and discharged. Central nervous system infection is a rare form of C. indologenes infections. The case presented herein may make a useful contribution to the existing literature.Öğe Molecular typing of nosocomial enterococci by pulsed-field gel electrophoresis(Refik Saydam National Public Health Agency (RSNPHA), 2015) Güldemir D.; Karagöz A.; Dal T.; Tekin A.; Özekinci T.; Durmaz R.Objective: Enterococci are the second most common cause of nosocomial urinary tract and wound infections, also third most common cause of nosocomial bacteremia. Currently, especially vancomycin-resistant enterococci (VRE) are one of the significant pathogens that cause nosocomial infections and increase mortality, morbidity, and healthcare costs. Therefore prevention and control of the nosocomial VRE outbreaks and epidemiological analysis of the infection are important. Pulsed-Field Gel Electrophoresis (PFGE) is accepted as a "gold standard" method in the molecular epidemiological analysis of enterococcal infections. The aims of this study are to determine the clonal relationship among the nosocomial enterococcal isolates and the rate of cross-contamination between them. Method: Thirty-six Enterococcus strains isolated from hospitalized patients with nosocomial infection in different clinics of Dicle University Hospital between November 2010 and June 2012 were included in this study. A total of 36 isolates were obtained from various clinical samples including urine (n=18), blood (n=6), bronchoalveolar lavage (BAL) fluid (n=5), wound biopsy sample (n=5), vaginal smear (n=1) and catheter tip (n=1). Nine of the thirty-six isolates were VRE. Isolation and identification of the isolates were conducted in the bacteriology laboratories of Dicle University Medical Faculty, Department of Medical Microbiology. The conventional methods and BD PhoenixTM 100 (Becton Dickinson, MD, USA) fully automated microbiology system were used for the identification. Antimicrobial susceptibilities of enterococcal strains were determined by a fully automated microbiology system according to the Clinical and Laboratory Standards Institute (CLSI). In addition, vancomycin susceptibilities of the isolates were performed by E-test method. Staphylococcus aureus ATCC 25923 strain was used for quality control. PFGE was studied for determining of rate of cross-contamination. PFGE was performed in National Molecular Microbiology Referance Laboratory, Public Health Institution of Turkey (PHIT). DNA restriction fragments were obtained by cutting bacterial DNA with the SmaI enzyme. DNA restriction fragments were used by CHEF DR II (Bio-Rad Laboratories, Nazareth, Belgium) system. PFGE results were evaluated by Bionumerics software system (version 6.01; Applied Maths, Sint-Martens-Latem, Belgium). Results: DNA patterns of the isolates were obtained by PFGE, and dendrogram of DNA patterns were made. Comparison of DNA patterns obtained by PFGE showed that 26 E. faecium strains were divided into four different clusters and one major group, 10 E. faecalis strains were three clusters and one major group. Twenty-six Enterococcus faecium isolates were involved in a joint cluster (97% similarity). The cluster rate was found to be 77% (20/26), number of E. faecium strains in each cluster ranged from 2 to 14 strains. Conclusion: In this study, cross-contamination was highlighted among enterococcal strains causing nosocomial infections in Dicle University Hospital between November 2010 and June 2012. Our data revealed that more effective infection control programs should be implemented to prevent cross-transmission.Öğe Non-invasive parameters in the assessment of liver fibrosis(Scientific Publishers of India, 2017) Dayan S.; Dal T.; Tekin R.; Deveci O.; Ipek D.; Ozcan N.; Bozkurt F.Liver biopsy and histopathological evaluation are the main methods to assess liver pathology. However, liver biopsy is not widely used due to implementation challenge. We aimed to investigate non-invasive parameters for evaluation of liver fibrosis in chronic Hepatitis B patients. A total of 65 patients who admitted to outpatient clinic and diagnosed as chronic hepatitis were included in this study. Liver puncture biopsy was performed for all patients and was evaluated according to the Modified Ishak Fibrosis Score. The patients without fibrosis or with mild and moderate fibrosis were evaluated as Group I (Stage O, I, II), the patients with advanced fibrosis were evaluated as Group II (stage III, IV, V, VI). Among 65 patients, 42 were male and 23 were female; 48 of the patients were in group I while 17 patients belonged to group II. Gamma-Glutamyl Transferase (GGT), Alkaline Phosphatase (ALP), Aspartat Transaminaz (AST) and Alanin Aminotransferaz (ALT) levels were significantly higher in Group II patients. In the assessment of liver fibrosis, liver biopsy remains the gold standard diagnostic method but AST, ALT, GGT, ALP parameters have contribution to this evaluation. Non-invasive testing may be useful in cases which biopsy cannot be performed or repeat biopsy required. © 2017, Scientific Publishers of India. All rights reserved.Öğe Tenofovir disoproxil fumarate treatment in HbeAg-positive patients(EDIMES Edizioni Medico Scientifiche, 2015) Ayaz C.; Çelen M.K.; Dal T.; Deveci Ö.; Bayan K.; Mert D.; Oruç E.Tenofovir disoproxil fumarate (Tenofovir DF) is a nucleotide analogue. This multicentre study reports retrospectively the long-term efficacy and safety data with tenofovir DF treatment in nucleosid(t)e-naive, hepatitis B e antigen (HBeAg)-positive chronic hepatitis B patients. Thirty-one patients (11 females, 20 males) received 245 mg tenofovir DF per diem. All patients’ initial serum hepatitis B virus (HBV) DNA levels were over 2,000 IU/ml. Serum alanine aminotransferase (ALT) levels, HBeAg, hepatitis B e antibodies (anti-HBe), hepatitis B surface antigen (HBsAg), hepatitis B surface antibodies (Anti-HBs), HBV DNA, creatinine and urea levels were evaluated at baseline, and at weeks 12, 24, 48 and 96 during therapy. Thirtyone patients completed 96 weeks of treatment. Mean age was 37.6±9.4 years. The initial mean value of ALT was 79±39.9 IU/L. At baseline, mean of fibrosis (Ishak) of liver biopsies was 2.3±0.7. Two of the patients (5.9%) achieved HBV DNA<300 copy at week 12 of treatment and 97.1% at week 96. HBeAg loss was observed in 6.7% of patients. At week 96, HBsAg loss was not observed in any of the patients. Mean ALT at week 48 was 32.7 U/L, at week 96 32.6 U/L. Renal safety was good. Creatinine remained stable. Tenofovir DF was well tolerated and produced potent, continuous viral suppression with increasing HBeAg loss. © 2015, EDIMES Edizioni Medico Scientifiche. All rights reserved.Öğe Tinea Corporis in an infant mimicking acrodermatitis enteropathica(2013) Meltem Akkurt Z.; Dal T.; Ucmak D.; Kelekci S.; Karabel M.; Aliosmanoglu C.A 5-month-old female infant presented with widespread periorificial erythematous plaques suggestive of acrodermatitis enteropathica. The patient was in good condition without any systemic complaints and/or relevant past medical history. Mycological culture revealed Microsporum canis and complete clearance of lesions was achieved with systemic fluconazole. This case is presented to emphasize that dermatophytoses should be borne in mind in healthy infants presenting with widespread erythematous eruptions.
