Browsing by Author "Gultepe, Bilge"

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An Adult Form of Gaucher Disease Associated With Portal Hypertension: a Case
(derman Medical Publ, 2013) Dulger, Ahmet Cumhur; Karadas, Sevdegl; Gonullu, Hayriye; Gultepe, Bilge; Tasdemir, Mehmet
Gaucher disease (GD) is an inborn error of metabolism that affects the recycling of cellular glycolipids. Glucosylceramide (also called glucocerebroside) accumulate within the lysosomes of cells. Gaucher's disease is most common lysosomal storage disease and its incidence is 1/75.000. Three types of this disease have been defined. During the course of disease, it was reported that hepatosplenomegaly, portal hypertension, hyperferritinemia, splenic infarcts and splenic nodules might develop. Therefore, as in our case; Gaucher's disease must be remembered in the setting of hepatosplenomegaly, portal hypertension, hyperferritinemia, splenic infarcts and splenic nodules of unknown etiology.
Analysis of Cases With Tuberculous Peritonitis: a Single-Center Experience
(Aves, 2014) Dulger, A. Cumhur; Karadas, Sevdegul; Mete, Rafet; Turkdogan, M. Kursat; Demirkiran, Davut; Gultepe, Bilge
Background/Aims: Tuberculous peritonitis (TP) is a rare form of tuberculosis and is caused by peritoneal involvement with Mycobacterium tuberculosis. A distinctive correlation exists between socioeconomic state and disease prevalence. We aimed to evaluate the clinical, laboratory, and radiological findings of patients with TP. Materials and Methods: We conducted a retrospective study in patients with peritoneal tuberculosis from January 2004 to October 2008 at Yuzuncu Yil University Medical School Education and Research Hospital. During this time, the data of 21 patients (17 females) with TP were reviewed. Results: Fever, abdominal pain, and anorexia were the most common symptoms. An analysis of ascites showed lymphocyte predominance and low albumin gradient in all patients. Patients with TP had a median ascites adenosine deaminase (ADA) level of 139 U/L (range, 25 to 303U/L). Peritoneal involvement (wet peritonitis) was seen in all the cases. Following 6-month administration of combined anti-TBC treatment, mean serum CA-125 levels were within the normal range among patients who had previously higher serum CA-125 level. Mortality rate in the total cases was 4.6%. Conclusion: Peritoneal tuberculosis should be considered in the differential diagnosis of exudative ascites in eastern Turkey. A high level of suspicion is required, especially in high-risk populations living in rural areas. ADA seems to be a sufficient, safe, and inexpensive method to perform the diagnosis of peritoneal tuberculosis. Serum CA-125 levels may play a key role to support the diagnosis as well as disease management of TP.
Can D-Dimer Levels Predict the Treatment Outcome in a Patient With Tuberculosis
(Pakistan Medical Assoc, 2014) Dulger, Ahmet Cumhur; Karadas, Sevdegul; Gonullu, Hayriye; Beyazal, Mehmet; Bulut, Gulay; Gultepe, Bilge
Tuberculous peritonitis is a leading cause of mortality and morbidity particularly in the developing world. Delay in initiation of treatment distinctively increases mortality. Treatment response to anti-tuberculosis drugs is usually observed by regression of symptoms and clearance of ascites. With initiation of treatment, laboratory values including CA-125 levels generally return to normal levels in 3 months. However, there is still no consensus about treatment response during the follow-up period. Serum D-dimer level is used as an inflammation marker in some cases. A case with Tuberculous peritonitis successfully monitorised by serum D-dimer levels is presented.
Comparison of Bacterial Culture and Microscopic Urine Analyzer in the Urinary Tract Infections
(Aves, 2013) Guducuoglu, Huseyin; Bektas, Abdullah; Gultepe, Bilge; Balahoroglu, Ragip; Bayram, Yasemin
Objective: The urine culture is the gold standard for diagnosis of urinary tract infection. Fully automated urine analyzer (FAUA) which gives quantitative results is also commonly used for urinalysis. This device identifies erythrocytes, leukocytes and epithelial cells as well as bacteria and renal elements performing a microscopic analysis. The aim of this retrospective study is to compare urine cultures with the FAUA used by the clinicians for rapid diagnosis of urinary tract infections. Methods: A total number of 23 065 urine specimens sent from various clinics to the Microbiology and Clinical Microbiology Laboratory in our hospital for both urinalysis and urinary culture between the dates of 1 June 2010 and 31 October 2011 were evaluated. Urinalysis was performed with iQ (R) 200 (Iris Diagnostics, Chatsworth, CA, USA). The FAUA values with >= 5 leukocytes and >= 1 bacteria were classified as FAUA-positive. Urine cultures growing >= 5x10(4) cfu/ml were included in the comparison. Results: Of the total FAUA and culture results, 11.7% were incompatible in terms of the number of leukocytes including leukocytenegative/culture-positive (0.4%) and leukocyte-positive/culturenegative (11.3%) results, and 6.6% were incompatible in terms of the number of germs including culture-positive/germ-negative (5%) results and germ-positive/culture-negative (1.6%) results. Conclusions: FAUA often used by clinicians for rapid diagnosis of urinary tract infection will contribute to the evaluation of the culture in a more efficient way, however, it should not replace the urine culture.
Evaluation of 257 Extra Pulmonary Tuberculosis Cases at the Tuberculosis Control Dispensary, Van, Turkey
(Pakistan Medical Assoc, 2018) Sunnetcioglu, Mahmut; Baran, Ali Irfan; Binici, Irfan; Esmer, Fatih; Gultepe, Bilge
Objective: To determine whether there were any changes in demographic and clinical features of extrapulmonary tuberculosis cases. Methods: This retrospective study was conducted at Yuzuncu Yil University, Van, Turkey, and comprised records of extrapulmonary tuberculosis patients treated between January 2009 and July 2014 at the tuberculosis control dispensary. Descriptive and clinical data, including age, gender, site of involvement, diagnostic method and coexisting systemic diseases, were noted. Any changes in terms of these parameters were investigated on a yearon- year basis. SPSS 20 was used for data analysis. Results: There were 257 cases detected. Of them, 50(19.45%) related to 2009, 61(23.75%) to 2010, 24(9.33%) to 2011, 50(19.45%) to 2012, 47(18.28%) to 2013 and 25(9.72%) to 2014. Although lymph nodes were by far most frequently affected in 2009, 2010, 2011 and 2013; pleura was most commonly involved in 2012 and 2014. Age and gender distribution displayed no changes between 2009 and 2014 (p>0.05). However, diagnostic method of choice and frequency of co-existent systemic disorders displayed remarkable alterations in this period (p<0.05). Conclusion: Improved insight of clinicians for atypical demographic and clinical features at presentation may provide reduction of rates of morbidity and mortality due to extrapulmonary tuberculosis.
Evaluation of Antibiotic Resistance in Acinetobacter Baumannii Strains Isolated From Various Clinical Samples
(Doc design informatics Co Ltd, 2013) Bayram, Yasemin; Gultepe, Bilge; Bektas, Abdullah; Parlak, Mehmet; Guducuoglu, Huseyin
Objective: Treatment of Acinetobacter baumanii infections has become increasingly difficult, due to the high resistance rates against commonly administered antibiotics. This study aims to determine the antibiotic resistance of A. baumannii strains isolated in our hospital. Methods: Antibiotic resistances of 377 A. baumannii strains isolated from various clinical specimens between 2007-2011 were assessed retrospectively. The isolates were identified by conventional methods and Phoenix 100 (Becton Dickinson Co., Sparks, MD, USA) automated system. Antibiotic susceptibility tests were performed according to the standards of Clinical and Laboratory Standards Institute. Results: Colistin resistance was not observed, and resistances to the other antibiotics were found to be 64% to amikacin, 55% to tetracycline, 71% to imipenem, 72% to meropenem, 89% to cefoperazone-sulbactam and 92% to ciprofloxacin, 90% to gentamicin, 94% to ceftazidime, 96% to piperacillin-tazobactam, 95% to cefepime and 96% to cefotaxime. Conclusions: Knowledge of susceptibilitys rates of these bacteria is essential, especially in situations compelling empirical treatment.
Hbsag, Anti-Hbs and Anti-Hcv Seroprevalence of the Patients Applied To the Medical Faculty of Bezmialem Foundation University
(Galenos Publ House, 2013) Iraz, Meryem; Gultepe, Bilge; Doymaz, Mehmet Ziya
Objective: The infections caused by hepatitis B and hepatitis C virus are still remain one of most important health problems for our country. The purpose of this study was to determine the frequency of HBsAg, anti-HBs and anti-HCV positivity in the patients who were admitted to the Research Hospital of the Medical Faculty of Bezmialem Vakif University between November 2011 and May 2013. Materials and Methods: The blood samples were tested for HBsAg, Anti-HBs and anti-HCV by chemiluminescent microparticle immunoassey (CMIA) (Advia Centaur, Siemens, Almanya) Results: In our laboratuary serologically 53.593 patients are tested for HBsAg, 22.300 patients are tested for Anti-HBs and 39.877 patients are tested for Anti-HCV. In our study 5.5%, 42.2% and 1.3% of the patients are found to be seropositive for HBsAg, Anti-HBs and Anti-HCV respectively. Conclusion: The results detected for hepatitis B and hepatitis C virus seropositivity in our region are comparable to those found in other regions of Turkey.
High Prevalence of Chronic Hepatitis D Virus Infection in Eastern Turkey: Urbanization of the Disease
(Termedia Publishing House Ltd, 2016) Dulger, Ahmet Cumhur; Suvak, Burak; Gonullu, Hayriye; Gonullu, Edip; Gultepe, Bilge; Aydin, Ibrahim; Olmezi, Sehmus
Introduction: Both hepatitis B virus (HBV) and hepatitis D virus (HDV) infection play an increasingly important role in liver diseases. The main objective of this study was to investigate the socio-epidemiological, laboratory and radiological aspects of both HBV and HDV infection near the Iranian border of Turkey. Material and methods: The study included 3352 patients with HBV and HDV infection. Socioepidemiological, laboratory and radiological aspects of the study subjects were retrospectively examined. Comorbid metabolic diseases were not assessed due to the retrospective design of the study. Results: Most of the study subjects were HBe antigen negative. No significant difference in terms of HBV-DNA levels or HBe antigen seropositivity was detected between the city centre and rural areas (p > 0.005). The mean HBV-DNA level in the anti-HDV-positive group was significantly lower than in the anti-HDV-negative group (p < 0.001). The rate of HDV-RNA positivity in women was higher than in their male counterparts (p = 0.017). Anti-HDV-IgG was detected in 18.4% of tested subjects who came from an urban area. In contrast, 12.5% of subjects of the rural group had a positive result for anti-HDV-IgG. Among 134 ultrasonographically evaluated delta hepatitis patients, 37.3% had liver cirrhosis. On the other hand, in 1244 patients with hepatitis B monoinfection, there were 90 patients with liver cirrhosis. Radiologically, the rate of hepatic steatosis in delta hepatitis patients was lower than in those with HBV monoinfection. Conclusions: Hepatitis D virus infection was particularly prevalent among the urban population as well as in female subjects. More broadly, the current observations are the first to suggest an inverse correlation between delta hepatitis and ultrasonography-proven hepatic steatosis.
Higher Seroprevalence of Hepatitis B Virus Antigen in Patients With Cystic Hydatid Disease Than in Patients Referred To Internal Medicine Clinics in Turkey
(Korean Soc Parasitology, Seoul Natl Univ Coll Medi, 2014) Gultepe, Bilge; Dulger, Ahmet Cumhur; Gultepe, Ilhami; Karadas, Sevdegul; Ebinc, Senar; Esen, Ramazan
Turkey remains an intermediate area for prevalence of hepatitis B virus (HBV) surface antigenemia. The sheepraising areas of Turkey also pose a high risk for cystic hydatid disease (CHD). Both HBV infection and CHD are major public health issues particularly in eastern parts of Turkey; however, there is no data regarding HBV infection in patients who have had CHD. The aims of this study were to evaluate the association between HBV infection and CHD and suggest ways to reduce HBV infection which is still widespread in Turkey. A retrospective study was conducted with 94 adult patients with active CHD referred to the hepatology department, Yuzuncuyil University School of Medicine from December 2010 to December 2012. All subjects came from rural areas of the region and underwent ultrasonography of abdomen which detected CHD of the liver. All the patients were serologically positive for Echinococcus granulosus. The control group consisted of 500 patients (300 men and 200 women) referred to the internal medicine clinics for other reasons. The patients with CHD and in the control group were tested for the existence of HBs antigen according to the standard procedures. The seroprevalence of HBs antigen was significantly higher in patients with active CHD than those in the control group (12.7% vs 5.2%; P=0.0017). Our data indicate that there is significant association between HBV infection and CHD. All patients with CHD should be screened for HBV infection.
Investigation of Antibiotic Resistance Patterns and Reduced Vancomycin Susceptibilities of Methicillin-Resistant Staphylococcus Aureus Isolates: a Multi-Center Study
(Ankara Microbiology Soc, 2015) Cikman, Aytekin; Aydin, Merve; Gulhan, Baris; Parlak, Mehmet; Gultepe, Bilge; Kalayci, Yildiz; Ozekinci, Tuncer
The aims of this study were to determine the minimum inhibitory concentration (MIC) values of vancomycin, teicoplanin, daptomycin, quinupristin/dalfopristin, linezolid, tigecycline, chloramphenicol, rifampicin, ofloxacin and tetracycline and to investigate the reduced vancomycin susceptibility among methicillin-resistant Staphylococcus aureus (MRSA) strains isolated in hospitals located in different geographical regions of Turkey. A total of 100 MRSA strains isolated from patients (of which 50% were from intensive care units) hospitalized in seven centers in Turkey [Istanbul (n= 15), Ankara (n= 15), Izmir (n= 15), Adana (n= 15), Diyarbakir (n=15), Erzincan (n= 15), Van (n= 10)], between August 201 3 August 2014, were included in the study. Fourty-three strains were isolated from blood, whereas 21 were from lower respiratory tract, 17 from wounds, eight from catheters, six from urine, four from nasal swab and one from cerebrospinal fluid samples. Methicillin resistance of the isolates was determined by using cefoxitin (30 mu g) disk with standard disk diffusion method, while the MIC values of other antibiotics were determined with E-test in accordance with the recommendations of Clinical and Laboratory Standards Institute (CLSI). MIC results obtained for quinupristin-dalfopristin (Q/D) were evaluated according to the CLSI criteria used for methicillin-susceptible S.aureus and for tigecycline according to the criteria recommended by the Food and Drug Administration for MRSA. Primarily, agar screening method (ASM) was used for determination of vancomycin-intermediate S.aureus (VISA) and heterogeneous VISA (hVISA) strains. Brain heart infusion agar containing 6 mu g/ml vanconnycin was used in ASM, and the strains with suspicion of VISA/hVISA were screened by standard E-test and macro E-test methods. All MRSA strains were susceptible to vancomycin, teicoplanin, daptomycin, Q/D and linezolid by E-test method; and their rates of susceptibility for tigecycline, chloramphenicol, rifampicin, ofloxacin and tetracycline were detected as 89%, 97%, 40%, 39% and 32%, respectively. MIC50/MIC90 values were 1.5/2 mu g/ml for vancomycin, 2/4 mu g/ml for teicoplanin, 0.19/0.38 mu g/ml for daptomycin, 0.19/0.38 mu g/ml for Q/D, 0.75/1 mu g/ml for linezolid, 0.19/0.75 mu g/ml for tigecycline, 3/6 mu g/ml for chloramphenicol, 32/32 mu g/ml for rifampicin, 32/32 mu g/ml for ofloxacin and 32/64 mu g/ml for tetracycline, respectively. For the evaluation of reduced vancomycin susceptibility, 2% (2/100) of MRSA strains were defined as VISA and 5% (5/100) as hVISA with ASM. One of those seven isolates identified as VISA/hVISA with ASM was evaluated as suspected hVISA by using both standard E-test and macro E-test methods. In conclusion, no MRSA resistant strain to vancomycin, teicoplanin, daptomycin, Q/D and linezolid was determined in our study. However tigecycline resistance (11%) was found higher than expected. As the glycopeptide resistance is increasing in the world and because of the intense use of these drugs in Turkey, the rates of vancomycin resistance among MRSA strains should be investigated periodically.
The Prevalence and Impact of Brucellosis in Patients With Hepatitis Delta Virus Infection: Inside the Brucella Outbreak With Cirrhosis
(Termedia Publishing House Ltd, 2017) Suvak, Burak; Dulger, Ahmet Cumhur; Suvak, Ozlem; Yesilyurt, Aysun Ozel; Gultepe, Bilge; Guducuoglu, Huseyin
Introduction: Hepatitis D virus (HDV) infection is a serious health problem leading to cirrhosis and hepatocellular carcinoma (HCC). Despite evidence that zoonotic infections are associated with end-stage liver disease, brucellosis in patients with delta hepatitis related to liver disease has not been well characterized. So, we examined this relationship using recent hospital-based data. Material and methods: We analyzed data from 96 delta hepatitis patients (mean age: 52.5 +/- 12.8 years; 50 male; 52 cirrhotics) and 117 (mean age: 50.4 +/- 7 years; 60 male) control subjects who were selected from patients with splenomegaly. The BruceIla Wright test in connection with blood culture was used to detect active BruceIla infection. Demographic features, laboratory data, results of ultrasonographic examination of the abdomen and Wright agglutination titers were compared between groups. Results: There were 9 (9%) patients with active brucellosis in delta hepatitis patients. Compared to the control group, there was a statistically significant difference between groups in terms of having active brucellosis (9 vs. 2 patients; p < 0.001). Higher MELD scores were also associated with active BruceIla infection (p < 0.005). Conclusions: Patients with chronic hepatitis D related cirrhosis (CHD-C) were at risk of developing brucellosis requiring hospitalization. Higher Wright titers among patients with more advanced liver disease may reflect a unique phenomenon that requires further investigation to determine underlying causative factors.
The Seroprevalence of Coxiella Burnetii in Erzincan, Turkey: Identification of the Risk Factors and Their Relationship With Geographical Features
(Wolters Kluwer Medknow Publications, 2017) Cikman, Aytekin; Aydin, Merve; Gulhan, Baris; Karakecili, Faruk; Ozcicek, Adalet; Kesik, Ozan Arif; Gultepe, Bilge
Background & objectives: Coxiella burnetii (C. burnetii) bacterium, the causative agent of Q fever has regained importance due to the increasing cases of infections and outbreaks. A cross-sectional descriptive study was conducted to investigate the seroprevalence of C. burnetii in human populations of Erzincan province located in the eastern Turkey, identify the risk factors, and to explore the relationship between geographical features. Methods: A total of 368 people residing in the rural (306) and urban (62) areas of the province were included in the study. Serum samples were analyzed for the presence of C. burnetii phase II IgG antibody using ELISA (Virion/Serion, Wurzburg, Germany). Spatial analyses were performed to evaluate correlations between seroprevalence and geographical features. Results: The overall seroprevalence of C. burnetii was found to be 8.7% (32/368). In rural residents it was 8.5% (26/306), while in urban population it was 9.7% (6/62). Cattle breeding and contact with animal afterbirth waste were found to be major risk factors, and were significantly correlated with seropositive cases (p < 0.05). The seropositive cases were only observed in the areas between 1067 and 1923 masl. Of the total seropositive cases, 65.6% were within 1000 m and 87.5% within 4000 m of rivers and their main tributaries. Around 59.4% cases were observed in areas with a slope of 0 to 5 degrees. Interpretation & conclusion: The results of the study showed that C. burnetii seroprevalence was higher than expected, and significantly differs according to geographical features of a region. Significant risk factors include raising cattle and exposure to infected animals or their birth products/secretions. It is also more frequent in areas with higher number of rivers and streams, higher altitude and lower slope.
Three Eyelid Localized Cutaneous Anthrax Cases
(Taylor & Francis Ltd, 2014) Esmer, Oktay; Karadag, Remzi; Bilgili, Serap Gunes; Gultepe, Bilge; Bayramlar, Huseyin; Karadag, Ayse Serap
Anthrax is primarily seen in the developing countries, but it can be a worldwide medical concern due to bioterrorism threats. Palpebral anthrax is a rare form of cutaneous anthrax. Untreated cutaneous anthrax can be lethal. Patients with palpebral anthrax can develop complications including cicatrisation and ectropion. Thus, anthrax should be considered in differential diagnosis for patients presenting with preseptal cellulitis in high-risk regions. Herein, we report three anthrax cases (with different age) involving eyelids that were cured without any complications due to early diagnosis and treatment.