Publications (21)45.26 Total impact
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Article: A new perspective to determine the severity of cases with Crimean-Congo hemorrhagic fever.
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ABSTRACT: We have established a severity grading score (SGS) system for predicting the fatality in Crimean - Congo hemorrhagic fever (CCHF) for the first time. This SGS has been set up by using several variables which were assumed to be associated with mortality according to the literature and also were considered to have clinical importance. In all, 237 patients who had symptoms of CCHF for <5 days were included. The patients were grouped into three categories according to the mortality risk by using SGS as follows : low or no risk, intermediate and high risk groups. A SGS <5 showed no association with mortality (there were 158 cases in this group and all survived). This group constituted 66.7% of all the patients with CCHF. A SGS 6-10 showed moderate risk of mortality (10%) and seven out of 70 patients in this group died. SGS >11 means high risk for mortality (67%) and six out of 9 patients in this group died (p = 0.001). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for >11 points of SGS were 67, 100, 98, 100, and 98%, respectively. This scoring system may help the clinicians to decide which patient to refer to a tertiary step hospital which may also decrease the cost and improve the functionality of healthcare staff.Journal of vector borne diseases 06/2012; 49(2):105-10. · 1.18 Impact Factor -
Article: Does electrocardiography at admission predict outcome in Crimean -Congo hemorrhagic fever?
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ABSTRACT: Crimean - Congo hemorrhagic fever is an acute viral hemorrhagic fever with considerable mortality. Despite increasing knowledge about hemorrhagic fever viruses, the pathogenesis of Crimean -Congo hemorrhagic fever and causes of death were not well described. We aimed to evaluate whether there were electrocardiographic parameters designating mortality among these patients. This retrospective study was performed among confirmed Crimean -Congo hemorrhagic fever cases in Turkey. Electrocardiography was available in 49 patients within 24 h of hospitalization. All electrocardiograms were evaluated by two expert cardiologists according to Minnesota coding system. Among patients with available electrocardiograms, there were 31 patients who survived, and 18 patients who died of Crimean - Congo hemorrhagic fever. Both groups were similar in terms of age, sex, body temperature, heart rate, and blood parameters. T-wave changes and bundle branch block were more frequently encountered among those who died. Presence of T-wave negativity or bundle branch block in this cohort of patients with Crimean -Congo hemorrhagic fever predicted death with a sensitivity of 72.7%, specificity of 92.6%, positive predictive value of 88.9%, negative predictive value of 80.6%. We think within the light of our findings that simple electrocardiography at admission may help risk stratification among Crimean-Congo hemorrhagic fever cases.Journal of vector borne diseases 09/2011; 48(3):150-4. · 1.18 Impact Factor -
Article: Evaluation of respiratory findings in Crimean-Congo hemorrhagic fever.
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ABSTRACT: Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic disease with a high mortality rate causing viral hemorrhagic fever. We studies the respiratory system findings, demographics, clinical and laboratory findings of patients with CCHF admitted to our hospital. In this retrospective study we evaluated 108 patients with CCHF confirmed by laboratory findings. The charts of all hospitalized patients were reviewed, and the age, sex, occupation, city of residence, history of tick bite or of removing a tick, smoking history, chest X-ray results, outcome and clinical and laboratory findings were recorded for each patient. Sixty of the chest radiographs were read as normal, 33 were read as showing unilateral pathology and 15 showed bilateral pathology. Seven of the 108 patients died due to severe pulmonary infection and hemorrhage. The frequency of pathological chest radiographs was higher among the CCHF patients who died than among the survivors, but the difference was not significant. Pulmonary parenchyma hemorrhage can occur in CCHF patients with hemoptysis, dyspnea, chest pain and infiltration on chest radiographs and may lead to morality.The Southeast Asian journal of tropical medicine and public health 09/2011; 42(5):1100-5. · 0.60 Impact Factor -
Article: Serum levels of Mannan-binding lectin in patients with Crimean-Congo hemorrhagic fever.
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ABSTRACT: Mannan-binding lectin (MBL) is a central component of the innate immune response. Genetic variations in the MBL gene that reduce circulating levels and alter functional properties of the MBL are associated with susceptibility for many infectious diseases. Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease caused by an arbovirus in the family Bunyaviridae. We have investigated serum MBL levels in CCHF patients and a possible association between circulating MBL concentrations and the severity of CCHF. Forty-seven patients found to have CCHF in Cumhuriyet University Hospital and 29 healthy controls were recruited for this study. There were no differences in terms of age and sex between the patients and the healthy controls (p = 0.64 and p = 0.484, respectively). This study was conducted between July 1 and August 31, 2007, in Cumhuriyet University Hospital in Sivas, a city located in the central Anatolian region of Turkey. Patients with CCHF were matched with healthy controls, and serum MBL levels were measured. The median serum MBL level was significantly lower in the patient group than in the healthy control group (48.0 ng/mL [inter-quartile range (QR) 30.4-128.0] and 212.0 ng/mL [IQR: 115.8-524.0], respectively; p < 0.001). No significant difference was found between serum MBL levels in CCHF patients with severe and nonsevere form of the disease (p = 0.167). MBL levels were significantly lower in patients with CCHF than in healthy controls. There was no meaningful correlation between the serum MBL level and severity of CCHF disease. Low serum MBL level may be associated with the high consumption of MBL in CCHF infection and/or MBL gene polymorphism.Vector borne and zoonotic diseases (Larchmont, N.Y.) 12/2010; 10(10):1037-41. · 2.61 Impact Factor -
Article: Toll-like receptor 8 and 9 polymorphisms in Crimean-Congo hemorrhagic fever.
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ABSTRACT: Crimean-Congo hemorrhagic fever (CCHF) is an acute viral hemorrhagic fever. The clinical course and outcome of the CCHF infection are different in humans. Toll-like receptors (TLRs) are a family of pathogen recognition receptors. TLR8 and TLR9 contribute to the recognition of viruses. We investigated frequency of TLR8 Met1Val, TLR8 -129C/G, TLR9 -1486T/C and TLR9 2458G/A polymorphisms in CCHF patients and healthy controls. Our study was conducted between June 1 and August 31, 2007 in Cumhuriyet University Hospital, Turkey. TLR genotypes were detected using the PCR-RFLP assay in 85 CCHF patients and 171 healthy controls. We found that heterozygous plus homozygous mutant genotypes frequency for TLR8 Met1Val and for TLR9 -1486T/C were significantly higher in CCHF patients than controls (p = 0.038 and p = 0.009, respectively). The frequency of TLR8 -129G/G genotype in the fatal CCHF patients was significantly higher than that of the non-fatal patients (p = 0.026). The frequency of TLR9 -1486C/C genotype was significantly higher in fatal CCHF patients than in healthy controls (p = 0.009) and in patients with severe disease compared to non-severe disease (p = 0.044). Our findings suggest that TLR8 Met1Val, TLR8 -129C/G, and TLR9 -1486T/C polymorphisms are important on clinical course of CCHF disease.Microbes and Infection 11/2010; 12(12-13):1071-8. · 3.10 Impact Factor -
Article: Crimean-Congo hemorrhagic fever virus in high-risk population, Turkey.
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ABSTRACT: In the Tokat and Sivas provinces of Turkey, the overall Crimean-Congo hemorrhagic fever virus (CCHFV) seroprevalence was 12.8% among 782 members of a high-risk population. CCHFV seroprevalence was associated with history of tick bite or tick removal from animals, employment in animal husbandry or farming, and being >40 years of age.Emerging Infectious Diseases 04/2009; 15(3):461-4. · 6.79 Impact Factor -
Article: Ocular findings in patients with Crimean-Congo hemorrhagic fever.
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ABSTRACT: To describe ocular findings of patients with Crimean-Congo hemorrhagic fever (CCHF). Prospective, interventional, consecutive case series. This study was conducted in Sivas, a city located in the central Anatolia, between July 1 and August 31, 2007. Confirmed CCHF patients were enrolled in the study and underwent ocular examination during hospitalization. Nineteen confirmed CCHF patients were included in this study. All patients were classified into 2 groups in terms of disease severity (severe vs nonsevere), according to the Swanepoel predictive criteria. Fourteen patients (73.7%) were classified as "nonsevere," and the remaining 5 patients (26.3%) were classified as "severe" in this study. One patient having severe disease died. Ocular findings were present in 14 patients (73.7%) and none of the patients presented any visual complaints. Ocular examination revealed that 7 patients (36.8%) had only bilateral multiple subconjunctival hemorrhage, and 2 patients (10.5%) (1 bilateral, 1 unilateral) had retinal hemorrhage. Five patients (26.3%) had subconjunctival hemorrhage and retinal hemorrhage. Follow-up examination 1 month later showed complete resorption of the subconjunctival hemorrhage and retinal hemorrhage. There was a statistically significant difference between patients with ocular findings and patients without ocular findings for prothrombin time (P = .011). There was no evidence of uveitis, retinal edema, sheathing of retinal vessels, or intravitreal hemorrhage in our patients. From the small sample study, CCHF caused a mild form of ocular disease. CCHF must be considered when subconjunctival or superficial retinal hemorrhages are seen in association with fever in endemic areas.American journal of ophthalmology 03/2009; 147(4):634-638.e1. · 3.83 Impact Factor -
Article: Efficacy of oral ribavirin treatment in Crimean-Congo haemorrhagic fever: a quasi-experimental study from Turkey.
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ABSTRACT: The aim of this study was to evaluate the efficacy of oral ribavirin treatment in patients with Crimean-Congo haemorrhagic fever (CCHF). In 2004, all patients diagnosed with CCHF were treated with oral ribavirin, however in 2003 none of the CCHF patients had been given treatment due to lack of confirmatory diagnostic information at that time in Turkey. In this study, patients treated with ribavirin in 2004 (n=126) were compared with ribavirin-untreated CCHF patients (n=92) in 2003. Patients only with a definitive diagnosis of CCHF (clinical symptoms plus the presence of specific IgM antibodies against CCHF virus and presence of viral antigen) were included in this study. There was no difference in the case-fatality rate between treated and untreated patients (7.1% vs. 11.9%; P>0.05). A Cox Proportional Hazards regression analysis revealed that altered sensorium and prolonged international normalized ratio were independent predictors of mortality. Our results showed that oral ribavirin treatment did not improve the survival rate in CCHF patients. Ribavirin and supportive care are the only available choices for treatment of CCHF patients, but to ascertain the efficacy of ribavirin, more laboratory and observational studies are necessary and ultimately, to elucidate these conflicting results and evaluate the efficacy undoubtedly, a multicenter randomised controlled trial will be needed.The Journal of infection 02/2009; 58(3):238-44. · 4.13 Impact Factor -
Article: Crimean-Congo hemorrhagic fever: does it involve the heart?
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ABSTRACT: Crimean-Congo hemorrhagic fever (CCHF) is an acute viral hemorrhagic fever with a high mortality rate. Despite increasing knowledge about viral hemorrhagic fevers, the pathogenesis of CCHF and causes of death have not been well described. In this study, we aimed to evaluate the cardiac functions of CCHF patients. This prospective study was performed among confirmed CCHF cases in Turkey in 2007. All the patients underwent a thorough cardiologic evaluation and transthoracic echocardiography examination within 24hours of hospitalization. In addition, the patients were classified into two groups - 'severe' CCHF and 'non-severe' CCHF. Demographic characteristics, findings of echocardiography, and outcomes were recorded for each patient. Among 52 consecutive patients with a tentative diagnosis of CCHF, 44 were confirmed as having CCHF. Seventeen (38.6%) patients were classified as severe, whereas the remaining 27 (61.4%) patients were classified as non-severe. Five of 17 severe CCHF patients died. Severe cases had a lower left ventricular ejection fraction (p=0.04), a higher systolic pulmonary artery pressure (p=0.02), and more frequent pericardial effusion (p<0.001) compared to non-severe cases. Fatal CCHF cases also had a lower left ventricular ejection fraction (p=0.03), a higher systolic pulmonary artery pressure (p=0.03), and more frequent pericardial effusion (p=0.01) compared to survivors. The results of this study indicate that severe and fatal CCHF cases have impaired cardiac functions, which may be associated with fatality in CCHF infection. Direct invasion of the heart muscles by the virus or endothelial damage of cardiac structures may have a role in this. Molecular testing methods would be useful in order to investigate direct invasion by the CCHF virus. Clinicians should be aware of this complication.International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 11/2008; 13(3):369-73. · 2.17 Impact Factor -
Article: Clinical investigation of the transient evoked otoacoustic emission test in Crimean-Congo hemorrhagic fever.
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ABSTRACT: The aim of this study was to investigate cochlear damage in Crimean-Congo hemorrhagic fever (CCHF) infection. Thirty-two CCHF patients (study group) and 13 healthy people (controls) were included in the study. CCHF patients were also grouped for the presence of fever. CCHF was diagnosed with the presence of CCHF virus-specific IgM antibody or CCHF virus (CCHFV) antigen by ELISA. Cochlear damage was determined by a 'fail' in the transient evoked otoacoustic emission (TEOAE) test. The proportion of TEOAE test 'fail' results in the CCHF patients was significantly higher than in the control group (p<0.05). We found no increase in the proportion of TEOAE test 'fail' results related to fever in the study group. CCHF disease damages cochlear function regardless of fever.International Journal of Infectious Diseases 04/2008; 12(2):162-5. · 1.94 Impact Factor -
Article: Characteristics and analysis of risk factors for mortality in infective endocarditis.
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ABSTRACT: The aim of our study was to establish the etiology of and risk factors for infective endocarditis (IE) and determine the prognostic factors for adverse outcome during hospital admission in a Turkish population. Between January 2002 and January 2004, the clinical and laboratory features of 112 consecutive adult patients (>18 years) with diagnosis of IE who were referred to the infectious diseases clinics/departments of 17 teaching hospitals in Turkey were evaluated. Cases of IE were defined according to the modified Duke Criteria. Mortality was defined as death occurring within 30 days or during hospital stay period. Univariate and multivariate analyses were performed to predict the factors related to fatal outcome. A total of 112 consecutive patients presented with 101 definite and 11 probable IE episodes were defined according to the modified Duke Criteria. The mean age was 45.2+/-19.9. Fifty percent of the patients were male. Ninety (60.4%) of the 112 patients had risk factors for IE and 48 (42.9%) of them had >or=2 risk factors. On the other hand, 49.1% of patients had cardiac risk factors. Blood cultures were positive in 94 (83.9%) cases. Staphylococci were the most common agents (50.0%), followed by streptococci (28.7%) and enterococci (16.0%). Native cardiac valves were detected in 93 (83%) of the episodes of suspected IE. Valvular involvement was present in 103 (92%) patients; the mitral valve, alone or in combination with other valves, was affected in 70 (62.5%) of the patients. Echocardiography detected vegetations in 105 patients (93.8%). The mortality rate was 28.6%. Three factors were independently associated with mortality: haemodialysis OR: 14.5 (95% CI: 1.5-138.2), mobile vegetation OR: 4.8 (95% CI: 1.5-15.4) and mental alteration OR: 4.1 (95% CI: 1.1-15.6). Mortality is still high in IE. Our data indicate that patients with altered mental status, mobile vegetation, or on haemodialysis had poorer prognosis.European Journal of Epidemiology 01/2006; 21(1):25-31. · 4.71 Impact Factor -
Article: Crimean-Congo haemorrhagic fever outbreak in Middle Anatolia: a multicentre study of clinical features and outcome measures.
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ABSTRACT: A Crimean-Congo haemorrhagic fever (CCHF) outbreak emerged from 2001 to 2003 in the Middle Anatolia region of Turkey. This study describes the clinical characteristics and outcome features of CCHF patients admitted to four tertiary care hospitals in Turkey. Definitive diagnosis was based on the detection of CCHF virus-specific IgM by ELISA or of genomic segments of the CCHF virus by RT-PCR. Related data were collected by a retrospective chart review. Hospital costs were extracted from the final discharge bills. Univariate and multivariate analyses were conducted to determine the independent predictors of mortality. CCHF virus-specific antibodies or genomic segments were detected in the sera of 99 cases. Seven cases that were treated with ribavirin were excluded from the study. Cases were mostly farmers (83 cases, 90 %), and 60 % had a tick-bite history before the onset of fever. Impaired consciousness and splenomegaly were independent predictors of a fatal outcome.Journal of Medical Microbiology 05/2005; 54(Pt 4):385-9. · 2.50 Impact Factor -
Article: Molecular genotyping of methicillin-resistant Staphylococcus aureus strains in a teaching hospital in Turkey.
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ABSTRACT: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the major causes of nosocomial infections in our hospital. Therefore, we aimed to characterize MRSA isolates phenotypically from patients with nosocomial infections at Cumhuriyet University Hospital between December, 1999, and June, 2001, in Sivas by analysis of antibiotic patterns and genotypically using pulsed-field gel electrophoresis (PFGE) and repetitive element sequence-based polymerase chain reaction (rep-PCR). Forty-three nosocomial isolates were collected from various wards. All isolates were resistant to penicillin, tetracycline, oxacillin, and gentamicin. By rep-PCR and by separation of SmaI fragments of genomic DNA using PFGE, one major type (eight subtypes with PFGE) was identified among the strains. This clone was found to be different than some clones such as Iberian, Brazilian, and a major clone that was found in another Turkish University Hospital in Ankara. According to our results, there is a major MRSA clone with a potential to spread in our hospital. Infection control measures should be directed toward restricting the further spread of this clone. Therefore, in accordance with these findings, a surveillance culturing program should be established.Microbial Drug Resistance 02/2004; 10(2):154-9. · 2.15 Impact Factor -
Article: Antimicrobial susceptibility of Bacillus anthracis in an endemic area.
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ABSTRACT: We aimed to test the antimicrobial susceptibility of 28 Bacillus anthracis strains isolated from cutaneous anthrax cases to various antimicrobial agents using the Sceptor automatic system in an anthrax endemic area. All strains tested were susceptible to penicillin (MIC < or = 0.03 microg/ml). Piperacillin-tazobactam and carbapenems showed good activity towards all strains. Trimethoprim-sulfamethoxazole and cefepime had no activity. Strains were also tested with other antimicrobials.Scandinavian Journal of Infectious Diseases 02/2002; 34(8):564-6. · 1.72 Impact Factor -
Article: Resistance of Salmonella and Shigella in Turkey.
Clinical Microbiology and Infection 10/1999; 5(9):588-590. · 4.54 Impact Factor -
Article: The role of parasites and candida in 100 gastroenteritis cases.
Turkiye parazitolojii dergisi / Turkiye Parazitoloji Dernegi = Acta parasitologica Turcica / Turkish Society for Parasitology 01/1994; 18(4):475-478. -
Article: The resistance of Escherichia coli strains isolated from community-acquired urinary tract infections.
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ABSTRACT: Urinary tract infections (UTIs) are the most common infections caused by Escherichia coli. Most recent research demonstrates that antibiotic resistance has reached a critical point throughout the world, as increased use of antibiotics among nonhospitalized patients encourages the growth of drug-resistant pathogens among that population. The goal of this study was to determine the antimicrobial drug resistance of E coli strains isolated from community-acquired UTIs in 5 different regions in Turkey. The minimum inhibitory concentrations of ciprofloxacin, gentamicin, sulfamethoxazole, trimethoprim, trimethoprim-sulfamethoxazole, and ampicillin and for E coli were determined with the agar dilution method. Among the 480 strains isolated, 8.3% were resistant to ciprofloxacin, 3.3% to gentamicin, 35.4% to sulfamethoxazole, 33.3% to trimethoprim, 27.9% to trimethoprim-sulfamethoxazole, and 40.8% to ampicillin. These results show that the antibiotics currently most effective against E coli are ciprofloxacin and gentamicin. Local epidemiologic trends should be considered when prescribing antibacterial therapy. More research in bacterial gene mapping will be necessary to elucidate the influence of regional antimicrobial drug use and resistance in epidemiologic trends among the general population.Advances in Therapy 22(5):419-23. · 2.11 Impact Factor -
Article: Burn Infections: Current Status
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Article: Factitious Disorder or Spuious Parasitosis: Case Report
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ABSTRACT: SUMMARY Factitious disorder or Munchausen syndrome is an example of an abnormal ilness-affirming behavior and patients with factitious disorder imitate symptoms and clinical findings of any disease according to their intention. These patients usually play a role of sickness as an occupation. Whereas spurious parasite or parasitosis is the finding of non-parasitic organisms or the parasites of other animals in various parts of human body or in its secretions or excreations. It is difficult to diagnose these patients when the laboratory findings are normal. They mislead the physicians to make false diagnosis and treatment for a long time. 24 year-old single female with rectal and vaginal bleeding and with complaint of discharging worms both orally and through anal route was presented. These worms were identified as earthworms (Lumbricus spp.). Since these worms are not parasites the case defined as a pseudoparasitism or factitious disorder or Munchausen syndrome. -
Article: Selülitte Ardişik İntravenöz Levofloksasin ve Oral Levofloksasin ile İntravenöz Seftriakson ve Oral Sefiksim Tedavisinin Etkinliğinin Karşilaştirilmasi The Comparison of Treatment Regimens Between Consecutive İntravenous Plus Oral Levofloxacin and Intravenous Ceftriaxone Plus Oral Cefixim in Cellulitis
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2004–2012
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Cumhuriyet University
- Faculty of Medicine
Sivas, Sivas, Turkey
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