Person: SÜMBÜL, BİLGE
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Publication Metadata only Prognostic value of procalcitonin in infection-related mortality of cancer patients(2016-05-01) Sedef, Ali Murat; Kose, Fatih; Sumbul, Ahmet Taner; Dogan, Ozlem; Kursun, Ebru; Yurdakul, Zafer; Gultepe, BİLGE; Mertsoylu, Huseyin; Sezer, Ahmet; Ozyilkan, Ozgur; SÜMBÜL, BİLGEPurpose: Infectious diseases are a major cause of morbidity and mortality in cancer patients. Tumor-induced inflammatory responses may increase the value of classical inflammatory markers in blood, so these markers may not be as useful in cancer patients as in non-cancer patients. Serum procalcitonin (PCT) is a sensitive and specific biomarker for severe infection, and has been shown to be unaffected by tumor-induced inflammatory response. In this study we aimed to evaluate the possible role of PCT in mortality in cancer patients with infection.Publication Open Access High prevalence of chronic hepatitis D virus infection in Eastern Turkey: urbanization of the disease(2016-04-01) Dulger, Ahmet Cumhur; Suvak, Burak; Gonullu, Hayriye; GONULLU, Edip; Gultepe, BİLGE; Aydın, İbrahim; Batur, Abdussamet; Karadaş, Sevdegül; Olmezi, Sehmus; SÜMBÜL, BİLGEIntroduction: 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.Publication Metadata only Evaluation of nasal fluid beta-defensin 2 levels in children with allergic rhinitis(2017-06-01) DILEK, Fatih; EMIN, Ozkaya; Gultepe, BİLGE; Yazici, MEBRURE; Cakir, ERKAN; GEDIK, Ahmet Hakan; SÜMBÜL, BİLGE; YAZICI, MEBRURE; ÇAKIR, ERKANAim: Knowledge about the role of the innate immune system in the pathogenesis of allergic diseases has been expanding in recent years. Defensins are antimicrobial peptides that are components of the innate immune system. Defensins have strong efficacy against bacterial, viral, and fungal infections. Moreover, they have regulatory functions in many physiologic processes such as antitumoral immunity, chemotaxis, inflammation, and wound healing. In this study, we aimed to investigate a-defensin 2 levels in the nasal fluids of children with allergic rhinitis.Publication Metadata only Can D-dimer levels predict the treatment outcome in a patient with tuberculosis?(2014-07-01T00:00:00Z) Dulger, Ahmet Cumhur; Karadaş, Sevdegül; Gonullu, Hayriye; Beyazal, Mehmet; Bulut, Gulay; Gultepe, BİLGE; SÜMBÜL, BİLGETuberculous 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.Publication Metadata only <i>Clostridium difficile</i> infection: Is there a change in the underlying factors? Inflammatory bowel disease and <i>Clostridium difficile</i>.(2019-11-01T00:00:00Z) Durdu, B; Bolukcu, S; Okay, G; Hakyemez, IN; Gultepe, BİLGE; Koc, MELİHA; Aslan, T; SÜMBÜL, BİLGE; OKAY, GÜLAY; DURDU, BÜLENT; MERİÇ KOÇ, MELİHAPublication Metadata only Higher Seroprevalence of Hepatitis B Virus Antigen in Patients with Cystic Hydatid Disease than in Patients Referred to Internal Medicine Clinics in Turkey(2014-02-01T00:00:00Z) Esen, Ramazan; Gultepe, BİLGE; Dulger, Ahmet Cumhur; GULTEPE, Ilhami; Karadaş, Sevdegül; Ebinc, Senar; SÜMBÜL, BİLGETurkey 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.Publication Open Access The prevalence and impact of brucellosis in patients with hepatitis delta virus infection: inside the Brucella outbreak with cirrhosis(2017-03-01) Suvak, Burak; Dulger, Ahmet Cumhur; SUVAK, Ozlem; Yesilyurt, Aysun Ozel; Gultepe, BİLGE; Güdücüoğlu, Hüseyin; SÜMBÜL, BİLGEIntroduction: 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.Publication Open Access Risk Factors Affecting Patterns of Antibiotic Resistance and Treatment Efficacy in Extreme Drug Resistance in Intensive Care Unit-Acquired Klebsiella Pneumoniae Infections: A 5-Year Analysis(2019-01-07) KOC, Meliha Meric; Durdu, BÜLENT; HAKYEMEZ, Ismail N.; Akkoyunlu, YASEMİN; Daskaya, HAYRETTİN; Gultepe, BİLGE; ASLAN, Turan; DURDU, BÜLENT; MERİÇ KOÇ, MELİHA; AKKOYUNLU, YASEMİN; DAŞKAYA, HAYRETTİN; SÜMBÜL, BİLGEBACKGROUND: We investigated the factors affecting antibiotic resistance in the intensive care unit (ICU)-related hospital-acquired infections caused by Klebsiella pneumoniae (KP-HAI) and the effects of antibiotics used for high-level antibiotic resistance on patient survival. MATERIAL AND METHODS: This retrospective study was performed at the adult ICU of Bezmialem Vakif University Hospital. Patients who were followed up between 01 January 2012 and 31 May 2017 were evaluated. Each KP strain was categorized according to resistance patterns and analyzed. The efficiency of antibiotic therapy for highly-resistant KP-HAI was determined by patients’ lifespans. RESULTS: We evaluated 208 patients. With the prior use of carbapenem, antibiotics against resistant Gram-positives, and tigecycline, it was observed that the resistance rate of the infectious agents had a significant increase. As the resistance category increases, a significant decrease was seen in the survival time. We observed that if the treatment combination included trimethoprim-sulfamethoxazole, the survival time became significantly longer, and tigecycline-carbapenem-colistin and tigecycline-carbapenem combination patients showed significantly shorter survival times. CONCLUSIONS: When the resistance increases, delays will occur in starting suitable and effective antibiotic treatment, with increased sepsis frequency and higher mortality rates. Trimethoprim-sulfamethoxazole can be an efficient alternative to extend survival time in trimethoprim-sulfamethoxazole-susceptible KP infections that have extensive drug resistance.Publication Metadata only Investigation of Antibiotic Resistance Patterns and Reduced Vancomycin Susceptibilities of Methicillin-Resistant Staphylococcus aureus Isolates: A Multi-Center Study(2015-04-01) Cikman, Aytekin; Aydin, Merve; Gulhan, Baris; Parlak, Mehmet; Gultepe, BİLGE; Kalayci, Yildiz; BILMEN, Fulya Bayindir; Solmaz, Sinem; Ozekinci, Tuncer; SÜMBÜL, BİLGEThe 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.Publication Open Access Helicobacter Pylory infection in patients with esophageal squamous cell carcinoma(2017-03-01) POYRAZOGLU, Omer Bilgehan; Dulger, Ahmet Cumhur; Gultepe, BİLGE; SÜMBÜL, BİLGEObjective:: Esophageal squamous cell carcinoma is one of the most common esophageal diseases in the developing world, but the relationship between esophageal squamous cell carcinoma and Helicobacter pylori infection remains a neglected topic. The primary objective of this study was to determine the association between Helicobacter pylori infection and esophageal squamous cell carcinoma. A second purpose was to determine the incidence and factors associated with Helicobacter pylori infection following esophagectomy. Method:: The microorganism was identified by testing the gastric biopsy materials from 95 esophageal squamous cell carcinoma patients (66 females; 39 were esophagectomized) for urease activity in a medium containing urea and a power of hydrogen detection reagent and comparing the results with those from a healthy population. Differences in patient characteristics were assessed with chi-square tests and t-tests for categorical and continuous factors, respectively. Results:: The patients with esophageal squamous cell carcinoma had a significantly lower prevalence of Helicobacter pylori compared with the healthy population (p<0.001). The naive and esophagectomized patients, in contrast, showed no significant differences in Helicobacter pylori infection (p>0.005). Patients with esophageal squamous cell carcinoma showed a significant association between leukocytosis and hypoglobulinemia and the presence of Helicobacter pylori infection (p=0.023 and p=0.045, respectively). Conclusion:: These results suggest that Helicobacter pylori is not an etiological factor in patients with esophageal squamous cell carcinoma. We found a statistically significant negative correlation between esophageal squamous cell cancer and Helicobacter pylori infection. These findings may guide new strategies for esophageal squamous cell carcinoma therapy.
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