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Öğe Antifungal susceptibility and risk factors in patients with candidemia(Atatürk Üniversitesi Tıp Fakültesi, 2016) Mermutluoğlu, Çiğdem; Deveci, Özcan; Dayan, Saim; Aslan, Emel; Bozkurt, Fatma; Tekin, RecepAmaç: Bu çalışmanın amacı bir üniversite hastanesinde yatan pediatrik ve erişkin hastalarda gelişen kandideminin risk faktörlerini, suşların tiplerini ve antifungal duyarlılıklarını araştırmaktır.Gereç ve Yöntem: Çalışma bir olgu - kontrol çalışması olarak planlandı. Aralık 2013- Aralık 2014 tarihleri arasında bir yıl boyunca hasta verileri retrospektif olarak kaydedildi. Vaka grubuna kandidemi gelişen hastalar alındı. Kontol grubuna, her vakaya karşılık bir kontrol hastası olmak üzere, kandidemi gelişmeyen hastalar seçildi. Kandidemi tanısı kan kültüründe Candida spp pozitifliği ve klinik tabloya uyumlu olarak konuldu. Her iki grup için demografik özellikler, SOFA (Sequental Organ Failure Assessment) skoru, eşlik eden hastalıklar, invaziv alet kullanımı, kullanılan antibiyotikler ve süreleri kaydedildi.Bulgular: 84 hastanın 42'sinde (%50) olgu grubuna, kalan 42'sinde (%50) kontrol grubuna dahil edildi. Tüm hastalardan 31 (%36.9) kadın, 53 (%63.1) erkekti. Olgu ve kontrol gruplarının klinik bulguları karşılaştırıldığında, olgu grubunda nozokomiyal enfeksiyonlar, sepsis, candidüri ve ateş prevalansı istatistiksel olarak anlamlı derecede yüksekti. Çalışmada izole edilen 42 suşun 22'si (%52,4) candia albicans, diğerleri non candida albicans olarak belirlendi. Candida albicans suşunun sadece birinde (%4,5) flukonazola direnç saptanırken, noncandida albicans suşlarının 7'sinde (%35) flukonazole direnç saptandı. Olgu grubunda batın cerrahi uygulaması, CVP (Santral Venöz Basınç) kateteri varlığı, Total parenteral nutrisyon(TPN), endotrakeal entübasyon, kan transfüzyonu sıklığı ve SOFA skoru kontrol grubuna göre anlamlı şekilde yüksek tespit edildi. Lojistik regresyon testi, TPN ve kan transfüzyonunun, kandidemi için en önemli risk faktörü olduğunu göstermiştir. Sonuç: Kandida enfeksiyonları ülkemizde ve hastanemizde önemli bir sağlık sorunu olmaya devam etmektedir. Sonuç olarak antibiotik tedavisine yanıt alınamayan, TPN alan, CVP kateteri takılan, kan transfüzyonu ve batın cerrahisi uygulanan hastalarda kandidemi riski göz ardı edilmemelidir.Öğe Bruselloz hastalarının D vitamini, ferritin, folik asit ve biyokimyasal düzeylerinin değerlendirilmesi(Dicle Üniversitesi Tıp Fakültesi, 2023) Sabancılar, İlhan; Şahin, İbrahim Halil; Mermutluoğlu, Çiğdem; Temiz, HakanAmaç: Bruselloz, bulaşıcı bir enfeksiyon hastalığı olmakla birlikte diğer enfeksiyon türlerine benzer semptomlar göstermektedir. Bruselloz bir enfeksiyon hastalığı olması nedeniyle, C-reaktif protein (CRP) ve Ferritin gibi akut faz reaktanları değerlerini yükseltmektedir. Çalışmamızda Bruselloz tanısı konmuş hastalarda D vitamini, Ferritin, Folik Asit, Alanin aminotransferaz (ALT), Aspartat aminotransferaz (AST) ve Gama Glutamil Transferaz (GGT) düzeylerinin klinik açıdan öneminin belirlenmesi amaçlandı. Yöntemler: Çalışmaya, Dicle Üniversitesi Hastaneleri Enfeksiyon Hastalıkları kliniği ve polikliniğine başvurmuş, Bruselloz tanısı konmuş 50 hasta (vaka grubu) ile 25 sağlıklı kişi (kontrol grubu) yaşları 18 yaşından büyük ve cinsiyetleri benzer kişiler dahil edildi. Kontrol grubuna dahil edilme kriterleri, herhangi bir kronik hastalık olmaması, sigara alkol ve madde bağımlılığı olmamasıdır. Brucella Coombs Testi’nde titrenin 1/320 ve üzerinde bulunması Bruselloz açısından pozitif olarak değerlendirildi. Hasta ve kontrol gruplarında D vitamini, ferritin, folik asit, immüno kemilüminesans yöntemi ile Roche Cobas E 601 cihazı (Roche Diagnostics, ABD); CRP, ALT, AST ve GGT düzeyleri ise spektrofotometrik yöntem ile Beckman Coulter DxC 700 AU (Beckman Coulter, ABD) cihazıyla çalışıldı. Çalışma öncesinde Dicle Üniversitesi Tıp Fakültesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurul İzni alındı. Bulgular: Bruselloz hastaların 26’sı (%52) kadın, 24’ü (%48) erkek olup; kontrol grubunun ise 12’si (%48) kadın, 13’ü(%52) erkekten oluşmaktadır. Aglütinasyon gözlenen örnekler pozitif, gözlenmeyenler ise negatif kabul edildi. D vitamini seviyesi kontrol grubunda, hasta grubuna göre anlamlı düzeyde düşük tespit edildi (p:0,007). Hasta grupta HGB, PLT, Folik asit değerleri kontrol grubuna göre daha düşük iken, ferritin düzeyi daha yüksek bulunmasına rağmen her iki grup arasında anlamlı fark bulunmadı. Sonuç: Bu çalışma sonucunda, hasta ve kontrol grubu karşılaştırıldığında, sadece vitamin D seviyesi hasta grubunda anlamlı olarak yüksek bulunmuştur. Hasta grubunda inflamasyon belirteçlerinden olan CRP ve ferritin yüksek olduğu tespit edildi. Bu sonuçlar bize, D vitamininin; bruselloz patogenezinde tanısal parametrelerde rol oynayabileceğini düşündürmektedir. Yapmış olduğumuz bu ve buna benzer çalışmalarla bölgesel epidemiyolojik verilerin elde edilmesine de katkı sağlayacağını düşünmekteyiz.Öğe The clinical features, treatment and prognosis of neutropenic fever and Coronavirus disease 2019 results of the multicentre teos study(Nature Research, 2024) Elik, Dilşah Başkol; Kaya, Şafak; Alkan, Sevil; Demirdal, Tuna; Şener, Alper; Kaya, Selçuk; Tunçcan, Özlem Güzel; Mermutluoğlu, ÇiğdemThis multicentre (22 centres in Turkey) retrospective cohort study aimed to assess the clinical outcomes of patients with neutropenic fever and SARS-CoV-2 positivity. Study period was 15 March 2020–15 August 2021. A total of 170 cases (58 female, aged 59 ± 15.5 years) that fulfilled the inclusion criteria were included in the study. One-month mortality rate (OMM) was 44.8%. The logistic regression analysis showed the following significant variables for the mentioned dependent variables: (i) achieving PCR negativity: receiving a maximum of 5 days of favipiravir (p = 0.005, OR 5.166, 95% CI 1.639–16.280); (ii) need for ICU: receiving glycopeptide therapy at any time during the COVID-19/FEN episode (p = 0.001, OR 6.566, 95% CI 2.137–20.172), the need for mechanical ventilation (p < 0.001, OR 62.042, 95% CI 9.528–404.011); (iii) need for mechanical ventilation: failure to recover from neutropenia (p < 0.001, OR 17.869, 95% CI 3.592–88.907), receiving tocilizumab therapy (p = 0.028, OR 32.227, 95% CI 1.469–707.053), septic shock (p = 0.001, OR 15.4 96% CI 3.164–75.897), and the need for ICU (p < 0.001, OR 91.818, 95% CI 15.360–548.873), (iv) OMM: [mechanical ventilation (p = 0.001, OR 19.041, 95% CI 3.229–112.286) and septic shock (p = 0.010, OR 5.589,95% CI 1.509–20.700)]. Although it includes a relatively limited number of patients, our findings suggest that COVID-19 and FEN are associated with significant mortality and morbidity.Öğe COVID-19 erişkin hasta yönetimi(Dicle Üniversitesi Tıp Fakültesi, 2021) Mermutluoğlu, ÇiğdemKoronavirüs hastalığı (COVID-19), yeni ortaya çıkan koronavirüsün (SARS-CoV-2) sebep olduğu pnömoni ve solunum yetmezliği gibi ciddi solunum yolu hastalıklarına neden olan bir enfeksiyon hastalığıdır. Klinik seyir; asemptomatik enfeksiyondan, hafif, orta veya ağır seyirli pnömoni, çoklu organ yetmezliği ve ölüme kadar değişiklik gösterir. Çocuk ve gençlerde genellikle hastalık hafif veya asemptomatik seyir gösterirken, bu yaş grubunda ağır seyirli vakalar da bildirilmiştir. Asemptomatik olgular, komorbiditesi olan bireylere bulaş açısından önemli bir kaynak görevi görürler. Özellikle ileri yaş, diabetes mellitus, hipertansiyon, akciğer ve kalp hastalıkları gibi komorbiditesi bulunanlar ile transplantasyon ve malignite gibi immunsüpresif durumu olan bireylerin riskli grupta yer aldığı ve hastalığı şiddetli geçirebildikleri bilinmektedir. COVID-19 tanılı hastalarda, hastalığın ciddiyetinin erken tanınması ve agresif destek tedavisinin sağlanması hasta yönetiminin en önemli noktasıdır. Bu makalede Dicle Üniversitesi Tıp Fakültesi’nde COVID-19 pandemisinde erişkin hasta yönetimi ele alınmıştır.Öğe Electrocardiographic ventricular repolarization variables in children diagnosed with COVID-19(Aves, 2021) Akın, Alper; Şen, Velat; Yılmaz, Kamil; Aktar, Fesih; Türe, Mehmet; Mermutluoğlu, Çiğdem; Pirinççioğlu, Ayfer GözüCoronavirus disease 2019 (COVID-19) originated in China in 2019, and it quickly became a global pandemic within months, continues to be an important health problem. The outbreak was first encountered in our country in March 2020 and rapidly spread to thousands of people.1 Although children as well as adults can become infected; it has been reported that children are less symptomatic or develop less severe symptoms.2 However, most studies on the subject cover patients in the adult age groupÖğe Evaluation of elabela, visfatin, and chemerin levels as inflammation biomarkers in COVID-19(2023) Mermutluoğlu, Çiğdem; Tekin, RecepOBJECTIVE: The aim of this study was to investigate if inflammation biomarkers elabela, visfatin, and chemerin will be useful in the diagnosis of patients with COVID-19. PATIENTS AND METHODS: This prospective case-control study included 33 patients with COVID-19 and 30 healthy matched controls. 33 patients, aged 18 years and older, diagnosed with COVID-19 and followed up for one month were included in the study. Blood samples were taken from the patients on the first day they were diagnosed with COVID-19, and levels of elabela (ELA), visfatin, chemerin, white blood cells (WBC), C-reactive protein (CRP) and procalcitonin (PCT) were assessed. Blood samples were also taken from 30 healthy volunteers for the control group. The ELA, visfatin and chemerin levels measured in the patients on day one were compared with those measured in the control group and with the WBC, CRP and PCT levels measured in the patients. RESULTS: Visfatin levels measured in COVID-19 patients were significantly higher than in the healthy control group. There was no significant difference in ELA and chemerin levels between the two groups. A significant positive correlation was found between chemerin and visfatin levels in the patients. A significant negative correlation was found between the levels of ELA-chemerin and ELA-visfatin in the patients. There was no significant correlation between elabela, visfatin and chemerin levels and WBC, CRP, PCT levels. CONCLUSIONS: Measurement of visfatin levels may be helpful in patients with COVID-19. However, two other biomarkers in our study, ELA and chemerin, were found not to be useful in diagnosing COVID-19. New inflammatory biomarkers may help to diagnose a disease in which the inflammatory response is at the forefront, such as COVID-19. New studies are needed on this subject.Öğe Evaluation of parameters predicting in-hospital mortality and septic embolisms in patients with infective endocarditis(Termedia Publishing House Ltd., 2024) Kış, Tuba Tatlı; Kış, Mehmet; Güzel, Tuncay; Mermutluoğlu, ÇiğdemIntroduction: Infective endocarditis (IE) is the infection of the cardiac endothelium and heart valves. The incidence of IE has recently increased due to the widespread use of cardiac device therapies and prosthetic heart valves. Despite modern medical and surgical treatment methods, morbidity and mortality are still high, and it leads to serious complications. Evaluation of predictive factors leading to septic embolism, which is one of the most important complications in terms of mortality and morbidity, is important for improving outcomes in infective endocarditis. Aim: In this study, we aimed to determine the predictive parameters of in-hospital mortality and septic embolism in patients with IE. Material and methods: This was a retrospective cohort study. The patients were divided into two groups: group 1 (septic embolism or mortality +, 21 patients) and group 2 (septic embolism or mortality –, 43 patients). ROC analysis was performed to determine the cut-off value of the predictive parameters. Univariable and multivariable regression analysis was performed to identify parameters significantly associated with in-hospital mortality/septic embolism in infective endocarditis. Results: A total of 64 patients diagnosed with IE were included in the study. In the multivariable regression analysis, the parameters vegetation size (OR = 1.227; 95% CI: 1.019–1.477, p = 0.031), aortic valve vegetation (OR = 0.088; 95% CI: 0.009–0.820, p = 0.033), mitral valve vegetation (OR = 0.082; 95% CI: 0.009–0.760, p = 0.028), albumin (OR = 0.185; 95% CI: 0.039–0.889, p = 0.035) and D-dimer (OR = 1.004; 95% CI: 1.000–1.009, p = 0.045) were found to be independent predictors for septic embolism and mortality in IE patients. Conclusions: Vegetation size, high D-dimer and low serum albumin levels are predictors of in-hospital mortality and septic embolism in patients with IE. © 2024 Termedia Publishing House Ltd.. All rights reserved.Öğe Evulation of prolidase enzyme, and galectin levels as a marker for fibrosis in patients with chronic hepatitis B(Verduci Editore s.r.l, 2022) Mermutluoğlu, Çiğdem; Tekin, Recep; Tekin, Rojbin Ceylan; Tekin, Salih; Erkan, Revşa Evin Canpolat; Deveci, Özcan; Aydoğdu, Gülay; Çelen, Mustafa Kemal; Dayan, SaimOBJECTIVE: The fibrosis can be detected using non-invasive methods including prolidase activity, proline levels and galectin-3 (GAL-3) detection in the serum. The aim of this study was to investigate the liver fibrosis through non-invasive methods in chronic hepatitis B patients. PATIENTS AND METHODS: This prospective case control study includes 56 patients with Chronic Active Hepatitis B (CAHB), 57 patients with Inactive Hepatitis B (IHB), and 60 healthy matched control subjects. The first group included the CAHB [hepatitis B surface antigen (HBsAg): positive; HBV DNA >2,000 IU/mL; normal or high alanine aminotransferase (ALT) value] undergo a liver biopsy, while the second group included the IHB (HBsAg: positive; HBV DNA: negative; normal ALT value). The third group comprised the healthy controls. Serum prolidase enzyme activities (SPEA), proline and galectin-3 levels were measured for each group. RESULTS: Patients with CAHB had significantly higher SPEA levels (1,004.3±186.8 IU/L) than did the controls (196.5±306 IU/L) (p<0.001). Significantly higher serum GAL-3 levels were found in the CHB group compared with HBV carrier and the control groups (27.4±32.2 ng/ mL, 6.5±13.4 ng/mL, 3.1±5.7 ng/mL, respectively, p<0.001). The relationship between serum prolidase activity, hidroxiprolyne and fibrosis (p<0.05). There were no significant differences in ALT levels between inactive HBV carriers and the control groups (p>0.05). CONCLUSIONS: We suppose that hidroxiprolyne levels and prolidase enzyme activity might be an indicator as a marker for fibrosis in CAHB and the evaluation of response to treatment.Öğe İmmünsüpresif hastalarda HBV reaktivasyonunun önlenmesi için tenofovir alafenamid profilaksisi: Çok merkezli bir çalışma(Çukurova Üniversitesi Tıp Fakültesi, 2022) Akar, Şebnem Şenol; Sönmez, Ufuk; Demirdal, Tuna; Şen, Pınar; Özer, Deniz; Atalay, Sabri; Akyol, Deniz; Mermutluoğlu, Çiğdem; Çelen, Mustafa Kemal; Yamazhan, Tansu; Pullukçu, HüsnüAmaç: İmmünsupresif tedavi altındaki yüksek riskli hastalarda hepatit B reaktivasyonu antiviral profilaksi ile önlenebilir. Antiviral seçiminde entekavir (ETC) veya tenofovir disoproksil fumarat (TDF) uzun zamandır kullanılabilmekteyken yakın zamanda kullanıma giren tenofovir alafenamid (TAF) güvenli yan etki profili ile iyi bir alternatif olmuştur. Bu çok merkezli geniş hasta sayılı çalışmada immünsüpresif hasta grubunda tenofovir alafenamidin (TAF) etkinliği ve güvenliği araştırılmıştır. Gereç ve Yöntem: Altı eğitim ve araştırma hastanesinin 1 Ocak 2019- 30 Eylül 2021 arasındaki kayıtları retrospektif olarak incelenerek immünsüpresif tedavi altında iken hepatit B için antiviral profilaksi başlanan ve en az 6 ay süre ile takip edilen hastalar çalışmaya dahil edilmiştir. Aldıkları immünsüpresif tedavi veya kemoterapiye ayrıca hepatit B serolojilerine göre risk grupları belirlenmiş, hepatit B reaktivasyon varlığı ve yan etkileri yönünden incelenmiştir. Bulgular: Yaş ortalaması 62.5±29 yıl olan 148 hastanın 85’i (%57.4) TAF, 63’ü (%42.6) tenofovir disoproksil fumarate (TDF) veya entekavir (ETC) ile profilaksi almaktaydı. %83.1’i HBsAg (-) antiHBc (+) %16.9’u HBsAg (+) olarak bulundu; kronik HBV’li hastaların %36 sının HBV DNA’sı saptanabilir düzeyin üzerindeydi. Çoğu (%69.6) hematolojik bir malinite nedeni ile immünsüpresif alırken %89.2’sinin aldığı tedavi yüksek riskli ilaç grubunda idi. Riskler açısından TAF ve diğer tedavileri alanlar arasında farklılık yoktu. Tedavi gruplarının hiçbirinde reaktivasyon ya da yan etkiye rastlanmadı. Sonuç: Kronik HBV tedavisinde olduğu gibi immünsüpresif tedavi alan bireylerde HBV reaktivasyonunun önlenmesinde de TAF en az TDF ve ETC kadar etkindir. TDF nin böbrek ve kemik yan etkilerinin TAF da görülmemesinin etkin ve güvenli bu tedavi seçeneğini immünsüpresif hastalarda öne çıkaracağını düşünmekteyiz.Öğe A Novel Predictor of Vegetation Size in Infective Endocarditis: MAPH Score(Yuzuncu Yil Universitesi Tip Fakultesi, 2024) Mermutluoğlu, Çiğdem; Güzel, Tuncay; Kış, Tuba TatlıThe aim of this study is to evaluate the predictive value of the MAPH score in patients with, a novel score that includes blood viscosity biomarkers such as hematocrit, mean platelet volume (MPV), age, and total protein, on the extent of vegetation in infective endocarditis. This study was retrospective. Fifty-four patients older than 18 years who were diagnosed with infective endocarditis (IE) between June 2017 and June 2023 were inclu ded. The study included patients from three different tertiary healthcare centers. Hematocrit, C-reactive Protein (CRP), MPV, total protein, serum albumin, kidney and liver function tests were analyzed on the first day of hospitalization. The Youden Inde x was used to determine the cut points for predicting age and MPV, hematocrit and total protein values for vegetation size. The MAPH score has been calculated as a total of 0 or 1 point with the cutoff in each ratio, and values above the cut-off were considered 1 point. Thirty-eight patients were found to have large vegetations (>10 mm). The mean age of the patients was 54.78 ± 17.32 years. The other clinical characteristics and demographic data were similar to each other. total protein level, MPV, and MAPH score were significantly higher in the vegetation size >10 mm group than in the vegetation size ≤ 10 mm group when analyzing the clinical laboratory characteristics of the study. The results of our study were that the MAPH score can be used as an estima te of the extent of vegetation cover. © 2024, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.Öğe Role of vitamin D, folic acid, ferritin, inflammation and oxidative stress in the pathogenesis of COVID-19(Mattioli 1885, 2022) Unsal, Velid; Sabancılar, İlhan; Özbek, Erdal; Mermutluoğlu, Çiğdem; Temiz, HakanThe COVID-19 pandemic is one of the most devastating and significant events of recent times. COVID-19 has so far become one of the worst infectious disease outbreaks of recent times, with more than 635 million cases and more than 6.6 million deaths. Viruses cause an explosion of inflammatory cytokines and reactive oxygen types. Oxidative stress is thought to have a key role in COVID-19. vitamin D, folic acid, calcium (Ca), magnesium (Mg) and ferritin levels are thought to be associated with COVID-19. This study aims to investigate the role of oxidative stress, inflammation, vitamin D and folic acid, ferritin, Ca and Mg in the pathogenesis of COVID-19. Materials and Methods: 45 patients diagnosed with COVID-19 and 45 healthy persons (control group) were included in the study. Vitamin D, ferritin, folic acid, CRP, Ca, Mg and Phosphorus were measured in an autoanalyzer, and SOD, GSH-Px and MDA were spectrophotometrically measured in the serum of the participants. TNF-α, IL-1β and IL6 levels were studied by the ELISA method. Results: The activity of SOD, GSH-px, antioxidant enzymes, Serum vitamin D, folic acid, Ca and Mg of the COVID-19 group was found to be significantly lower than the control group (p<0.05). Conclusion: Again, the levels of MDA, TNF-α, IL-1β, IL-6, CRP and ferritin in the Covid-19 group were found to be significantly higher than in the control group (p<0.05).Antioxidant enzyme activities were low and oxidative stress was high in patients with COVID-19. At the same time, the levels of serum ferritin, CRP, TNF-α, IL-1β and IL6 were high, and levels of Ca and Mg were low in patients with COVID-19.According to these results, we hypothesize think that the level of oxidative stress, inflammation, vitamin D, and serum ferritin, Ca, and Mg levels play a role in the pathogenesis of COVID-19. Future clinical trials should be conducted to further clarify the pathogenesis in patients with COVID-19.Öğe Which COVID-19 patients die in intensive care unit (ICU) in Turkey(Dicle Üniversitesi Tıp Fakültesi, 2022) Dursun, Recep; Mermutluoğlu, Çiğdem; Aktar, Fesih; Tekin, Recep; Kuyumcu, Mahir; Yıldız, İsmail; Kadiroğlu, Ali Kemal; Türe, Mehmet; Erbaş, Erkan; Çelen, Mustafa KemalObjective: The World Health Organization labelled the COVID-19 outbreak a pandemic on March 11, 2020, the first day COVID-19 cases were diagnosed in Turkey. Since then, people's main concerns have been whether their lives or the lives of their relatives would be at risk if they became infected. The objective of this study was to determine the risk factors that increase mortality in COVID-19 patients treated in ICUs and to facilitate the appropriate precautions. Methods: In this study, patients who were diagnosed with COVID-19 [positive on a polymerase chain reaction (PCR) test] and monitored in the Pandemic Hospital at Diyarbakır Dicle University between 15 March 15 and 15 May, 2020, were evaluated for risk factors for mortality. Results: A total of 50 ICU patients were included in the study. Of them, 52% were males, and the mean age was 63.8±17.6 years. A comparison of deceased and surviving patients showed that being female, older than 62, and a smoker and having diabetes mellitus, hypertension, and/or coronary artery disease significantly increased mortality. An investigation of the findings from the patients' lung tomography examinations revealed that relatively prominent pulmonary involvement and localization did not affect mortality. Conclusions: Because patients who are advanced in age, female and smokers and have comorbidities are in the high-risk group, measurements related to treating the COVID-19 disease should be improved. Laboratory parameters are useful for the evaluation of mortality and morbidity, while mechanical ventilation increased mortality.
