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    Demographic, clinical and laboratory characteristics of extrapulmonary tuberculosis: Eight-year results of a multicenter retrospective study in Turkey
    (Sage Publications Ltd, 2024) Celik, Mehmet; Gurbuz, Esra; Cicek, Yeliz; Buyuktuna, Seyit Ali; Gundag, Omur; Gulderen Kuscu, Evrim; Mermutluoglu, Cigdem
    Extrapulmonary tuberculosis (EPTB) is an important public health problem due to its diverse clinical presentations, diagnostic complexities, and significant impact on patient outcomes and public health. Our study aimed to understand the sociodemographic, clinical, and laboratory characteristics as well as diagnostic and treatment modalities of adult patients with EPTB. This is a multicentric retrospective study that covers patients with EPTB cases followed up from January 2015 to December 2022 among tuberculosis (TB) dispensaries and Infectious Diseases and Clinical Microbiology clinics of 15 hospitals located in various regions of Turkey. The study included 64.6% women with a mean age of 44 years and a mortality rate of 3.5% within 1 year of diagnosis. Initial constitutional symptoms were predominantly fatigue (57%) and anorexia (53.7%). The most commonly affected sites were the lymph nodes (49.1%) and pleura (9.7%). The lumbar region was particularly involved in cases with spinal TB. Diagnostic findings included acid-fast bacilli positivity in 27.5% of cases, tuberculosis polymerase chain reaction positivity in 41%, elevated adenosine deaminase levels in 91.2% (especially in pleural and peritoneal fluids), and mycobacterial culture positivity in 40.9%. Pathology slides showed granulomatous inflammation in 97.7%. Increased C-reactive protein (CRP) levels correlated with the number of organs affected. Anti-TB treatment-related hepatotoxicity was detected in 8.9% of patients. In this study, it is important to note that the lumbar region is predominantly affected with involvement in spinal region. CRP level was consistent with the number of organ involvements and was one of the most critical results of this study.
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    Evaluation of inflammatory and hematological parameters in patients diagnosed with COVID-19
    (J Infection Developing Countries, 2022) Mermutluoglu, Cigdem; Dursun, Recep; Aktar, Fesih; Dayan, Saim; Celen, Mustafa Kemal; Kadiroglu, Ali Kemal; Inci, Erdal
    Introduction: This study aims to research the effects of hematological and inflammatory parameters on the prognosis of COVID-19 disease and Methodology: One hundred and eighty-six patients with COVID-19 and a control group consisting of 187 healthy individuals were included in the study. Hematological variables and inflammatory parameters of the patients were recorded on the first and the fifth days of hospitalization. Results: White blood cell count, lymphocyte count, and platelet count were statistically lower, and mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) levels were higher in the patient group compared to the control group. It was observed that the neutrophil count and MPV level were lower, and the platelet count and ferritin level were statistically higher on the fifth day of follow-up compared to the admission day. In contrast, there was a significantly positive correlation between the duration of hospitalization and the fifth day D-dimer (r = 0.546, p < 0.001) and ferritin (r = 0.568, p < 0.001); in addition, there was a negative correlation between the duration of hospitalization and admission day lymphocyte count and the fifth-day lymphocyte count. Conclusions: Increased levels of ferritin and D-dimer, and decreased count of lymphocytes are among the important factors affecting the duration of hospitalization for COVID-19 patients. Furthermore, we think that neutrophil count and MPV levels are low, and platelet count and ferritin levels are high during the disease. Therefore, these parameters can be used as prognostic indicators of the disease.
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    Investigation of the Effects of Total Oxidative Stress and Total Antioxidant Capacity on the Prognosis in Patients with Chronic Viral Hepatitis B
    (Galenos Publ House, 2022) Mermutluoglu, Cigdem; Bekcibasi, Muhammed; Deveci, Ozcan; Cerrah, Serkan; Kaplan, Ibrahim; Bozkurt, Fatma; Celen, Mustafa Kemal
    Objectives: Experimental studies showed the role of oxidative stress in cell destruction and DNA damage in chronic viral hepatitis, In this study, oxidative stress was measured in various clinical forms of chronic hepatitis B (CHB) and the role of oxidative stress was investigated in the development of hepatitis clinic.Materials and Methods: In total, 33 patients with inactive hepatitis B carrier (IHBC), 33 patients with active CHB infection, and 33 healthy adults were included in the study. Serum transaminases [alanine aminotransferase (ALT), aspartate aminotransferase, total antioxidant capacity, and total oxidative stress (TOS)] were measured and compared in the patient groups.Results: In 99 patients were included in the study (56 men, 43 women). The mean age of patients in CHB was 33.21 +/- 10.20, in IHBC 36.73 +/- 11.54, and the control group 33 +/- 11.71. The mean ALT value was 40.93 +/- 28.28 U/L in the patients with CHB and 36.33 +/- 28.99 U/L in the patients with IHBC. The TOS value115.46 +/- 139.64 pm H2O2 equivalent/L in the CHB and 52.67 +/- 40.36-pm H2O2 equivalent/L in IHBC.Conclusion: ALT and TOS levels were significantly higher in the CHB than in the other groups. The increased TOS levels in the CHB may be related to the activity of cell destruction in active cases.
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    Real-World Data on the Use of Glecaprevir/Pibrentasvir in the Treatment of Hepatitis C: Is Shorter Treatment Possible?
    (Galenos Publ House, 2024) Tuzun, Ahmet Yekta; Mermutluoglu, Cigdem; Celen, Mustafa Kemal
    Objectives: This study aimed to present real-world data on the efficacy of glecaprevir/pibrentasvir (G/P) in chronic hepatitis C (CHC) patients treated at our center. Materials and Methods: Non-cirrhotic, treatment-naive, and treatment-experienced (TN/TE) CHC patients with CHC who started G/P treatment in 2022 were included in this retrospective, cross-sectional, single-center, national study. Sustained virological response (SVR) was defined as undetectable hepatitis C virus- ribonucleic acid (HCV-RNA) for at least 12 weeks following the discontinuation of antiviral therapy. Results: Sixty patients with non-cirrhotic TN/TE CHC who started G/P were included in the study. All patients received G/P treatment for 8 weeks. The median age of the patients was 45 years (interquartile range 22-3) and 44 (73.3%) were males. The most frequently identified risk factor for CHC was substance use (n=7, 11.7%), whereas the most common comorbidities were cardiovascular disease, hypertension (n=8,13.3%), and diabetes mellitus (n=7, 11.7%). HCV genotype was evaluated in all patients. Genotype distribution: Genotype 1b was detected in 53 patients (88.3%) and genotype 1 was detected in 7 patients (11.7%). The median pretreatment HCV-RNA level of the patients was 137,000 IU/mL. HCV-RNA was evaluated in all patients at the 4 th and 8 th weeks of treatment and at the 12th th week after treatment. All patients were HCV-RNA-negative in the 1 st month of treatment. Additionally, HCV-RNA negativity continued in all patients at the end of treatment and at 12 week follow-up. No mild, moderate, or serious adverse events were observed during or after treatment. All patients were successfully treated. Conclusion: All patients extremely well tolerated the drug. The SVR response was found to be 100%. In addition, the fact that the viral load of all patients in our study was negative in the 4 th week of treatment suggested the possibility of shorter-term treatment. More studies on this subject.
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    Risk factors for relapse after discontinuation of tenofovir or entecavir in hepatitis B e antigen-negative patients
    (Kare Publ, 2024) Mermutluoglu, Cigdem; Karasahin, Omer; Celen, Mustafa Kemal
    Background and Aim: This study aimed to define the relapse frequency and risk determinants in chronic hepatitis B (CHB) patients who discontinued nucleoside analog (NA) treatment, were HBeAg-negative, and had achieved both a virological and biochemical response. Materials and Methods: This retrospective cohort study reviewed patients with HBeAg-negative CHB who received antiviral therapy for at least 65 months between January 1, 2013, and December 31, 2020. These patients discontinued treatment after demonstrating a biochemical and virological response and were evaluated at 6, 12, and 24 months post-treatment discontinuation. Results: Sixty-seven patients with CHB who received NA therapy for at least 65 months, discontinued treatment, and had undetectable HBV DNA and normal ALT values were evaluated. After cessation of NA therapy, a relapse was observed in 38 patients (56.7%). The relapse rate was 71.0% in patients treated with tenofovir disoproxil fumarate (TDF) as the last NA type and 37.9% in patients treated with entecavir (ETV) (p=0.017). The cutoff value for the best estimate of age for predicting relapse was 42 years. The relapse rate was 69.2% in patients aged >42 years and 39.2% in patients aged <42 years (p=0.007). The relapse rate was 51.3% in patients with a pre-treatment fibrosis score of 2, 56.0% in those with a fibrosis score of 3, and 100% in those with a fibrosis score of 4 (p=0.089). Conclusion: Among HBeAg-negative CHB patients who achieved a virological and biochemical response to long-term antiviral therapy, those aged 42 years and older, those with high fibrosis scores before treatment, treatment.