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Papers by Çiğdem Erol

Viruses

We evaluated neutralizing antibodies against the Omicron variant and Anti-Spike IgG response in s... more We evaluated neutralizing antibodies against the Omicron variant and Anti-Spike IgG response in solid organ (SOT) or hematopoietic stem cell (HSTC) recipients after a third dose of BNT162b2 (BNT) or CoronaVac (CV) following two doses of CV. In total, 95 participants underwent SOT (n = 62; 44 liver, 18 kidney) or HSCT (n = 27; 5 allogeneic, 22 autologous) were included from five centers in Turkey. The median time between third doses and serum sampling was 154 days (range between 15 to 381). The vaccine-induced antibody responses of both neutralizing antibodies and Anti-Spike IgGs were assessed by plaque neutralizing assay and immunoassay, respectively. Neutralizing antibody and Anti-Spike IgG levels were significantly higher in transplant patients receiving BNT compared to those receiving CV (Geometric mean (GMT):26.76 vs. 10.89; p = 0.03 and 2116 Au/mL vs. 172.1 Au/mL; p < 0.001). Solid organ transplantation recipients, particularly liver transplant recipients, showed lower antib...

Infectious Diseases and Clinical Microbiology

Objective: Candidemia is the most common form of invasive candidiasis, and it is associated with ... more Objective: Candidemia is the most common form of invasive candidiasis, and it is associated with end-organ involvement, prolonged hospitalization, increased mortality, and higher healthcare costs. Candidemia can lead to metastatic heart and ocular infections. This study aimed to define the incidence, characteristics, and mortality of candidemia episodes and compare the data with our center’s previous results. Materials and Methods: In this single-center retrospective observational study, we enrolled 250 patients over 18 years diagnosed with candidemia between January 2015 and December 2020. We obtained patients’ demographic, clinical, laboratory, and therapeutic data from medical records. An ophthalmologic examination and screening with echocardiography were carried out within the first week after candidemia diagnosis. Results: There were 275 candidemia episodes from 250 patients. The incidence of candidemia was 2.8/1000 admissions and 5.68/ 10,000 inpatient days, higher than our pr...

Infectious Diseases and Clinical Microbiology

Objective: Despite appropriate treatment and early diagnosis methods, Staphylococcus aureus bacte... more Objective: Despite appropriate treatment and early diagnosis methods, Staphylococcus aureus bacteremia (SAB) is still associated with a high mortality rate. This study aims to evaluate the clinical features and approaches to SAB and to analyze the parameters that may affect 7-day and 30-day mortality. Materials and Methods: Adult patients with SAB data between 2011 and 2018 were evaluated retrospectively. Clinical data, patient demographics, and 7-day and 30-day mortality rates were obtained from their medical records. Results: In total, 144 patients were included in the study; 57.6% (83/144) of patients were men, and the mean age was 65.2±16.5 years. The most common source of infection was the central-line catheter (38.9%), followed by intra-abdominal (21%), respiratory (16.7), infective endocarditis (5.6%), and osteoarticular foci (2.1%). Fifteen percent (15%) of the strains were methicillin resistant. Transthoracic echocardiography (TTE) was performed for 80.6% (116/144) patients...

Journal of Antimicrobial Chemotherapy

Synopsis Objectives To uncover clinical epidemiology, microbiological characteristics and outcome... more Synopsis Objectives To uncover clinical epidemiology, microbiological characteristics and outcome determinants of hospital-acquired bloodstream infections (HA-BSIs) in Turkish ICU patients. Methods The EUROBACT II was a prospective observational multicontinental cohort study. We performed a subanalysis of patients from 24 Turkish ICUs included in this study. Risk factors for mortality were identified using multivariable Cox frailty models. Results Of 547 patients, 58.7% were male with a median [IQR] age of 68 [55–78]. Most frequent sources of HA-BSIs were intravascular catheter [182, (33.3%)] and lower respiratory tract [175, (32.0%)]. Among isolated pathogens (n = 599), 67.1% were Gram-negative, 21.5% Gram-positive and 11.2% due to fungi. Carbapenem resistance was present in 90.4% of Acinetobacter spp., 53.1% of Klebsiella spp. and 48.8% of Pseudomonas spp. In monobacterial Gram-negative HA-BSIs (n = 329), SOFA score (aHR 1.20, 95% CI 1.14–1.27), carbapenem resistance (aHR 2.46, 95...

Intensive Care Medicine

In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with sign... more In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods: We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results: 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions: HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes.

Turkish Bulletin of Hygiene and Experimental Biology

Journal of Ankara University Faculty of Medicine

Objectives: Hospital-acquired infections are the leading causes of mortality in burn injuries fol... more Objectives: Hospital-acquired infections are the leading causes of mortality in burn injuries following the initial resuscitation phase. Studies on healthcare associated antimicrobial-resistant infections in burn patients are limited. In this study, we aimed to evaluate the main risk factors and predictors of extremely drug-resistant infections in burn patients to highlight the need for optimal infection control approaches and antimicrobial stewardship. Materials and Methods: This retrospective case-control study enrolled 92 adult patients with burn injuries admitted to the burn care department of our hospital from January 2015 to December 2018. Results: Infection was observed in 47.8% of the burn patients (44/92), with 84 infection episodes noted among these patients. For the prediction of infection, only C-reactive protein/albumin ratio cutoff value was found to be a predictor after logistic regression analysis. Extremely drugresistant infections accounted for 27% (23/84) of the episodes in 14 patients. The most common site of these infections was the lower respiratory tract. Extremely drug-resistant bacteria were isolated from nearly 80% of the respiratory samples. Broad spectrum and multiple antimicrobial usage were independent risk factors for the development of extremely drug-resistant infections and the presence of the resistant infection was the only independent risk factor for fatality (p=0.001; odds ratio 10.4; 95% confidence interval 1,923-56,359). Conclusion: This study showed that extremely drug resistance was the major risk factor for fatality in burn patients. Infection control and antimicrobial stewardship programmes, which are crucial for limiting the development and spread of antimicrobial resistance, may decrease fatality in burn patients. We are able to cope with most of these factors with the infection control procedures.

Journal of Ankara University Faculty of Medicine

Objectives: Many parameters are studied in coronavirus disease-2019 (COVID-19) to predict the pro... more Objectives: Many parameters are studied in coronavirus disease-2019 (COVID-19) to predict the progress of the disease. One of these parameters is the clinical significance of the reverse transcriptase-polymerase chain reaction (RT-PCR) cycle threshold (CT) value used in diagnostic tests. In this study, we evaluated the relationship between RT-PCR CT values and the clinical course of COVID-19. Materials and Methods: Symptomatic patients over the age of 18 years, who had positive severe acute respiratory syndrome-coronavirus-2 RT-PCR test results between June 1, 2020 and December 1, 2020, were screened retrospectively. Patients' CT values and other data were collected from the hospital's information management system. Results: The study included the data of 880 patients. The median age was 63 years, and 47% (415) were female. The severity of COVID-19 was mild in 69.7% (614), moderate in 20.4% (180), and severe/critical in 9.7% (86). There was no significant difference between median CT (mCT) levels of disease severity (mCT=22 in mild group; mCT=23 in moderate group; mCT=22 in severe/critical group, p=0.882). The results showed no correlation between these CT values and COVID-19's severity, prognosis, or laboratory values. Conclusion: Although there are some reports that propose a relationship between CT values and viral load, we believe that these test results cannot be considered quantitative and cannot be generalized because of the many factors known to affect CT values.

Infectious Diseases and Clinical Microbiology, 2021

Background: We described the outcomes of healthcare workers (HCWs) who have been exposed to COVID... more Background: We described the outcomes of healthcare workers (HCWs) who have been exposed to COVID-19. Materials and Methods: We included the HCWs exposed COVID-19 and admitted to the COVID-19 outpatient clinic between March 13 and August 31, 2020, at a university hospital in Ankara, Turkey. The clinical data and exposure status were retrospectively obtained from medical records. Results: We analyzed 809 admissions of 690 HCWs. In total, 490 HCWs were admitted after suspected exposure to COVID-19 patients. In 32% of these admissions, typical symptoms were observed, and 15% of them developed COVID-19. Polymerase chain reaction test for SARS-CoV-2 was positive in %10 of asymptomatic HCWs. Exposure outside the hospital was 2.3 times more common (OR 2.28, p=0.020, CI 1.141-4.543) than exposure in the hospital. In the hospital setting, exposure to a patient was 1.6 times higher than social contact with colleagues during work. Male gender and occupations other than doctors were independent risk factors. Among HCWs diagnosed with COVID-19, 13% required hospitalization; fortunately, there were no intensive care unit admissions and no deaths. Conclusion: After suspected exposure, HCWs should be screened for SARS-CoV-2 and monitored closely for symptom development. Strict infection control precautions and appropriate personal protective equipment use are crucial to reducing transmission of SARS-CoV-2 both in the hospital setting and in social life.

Acta Microbiologica et Immunologica Hungarica, 2021

This study aimed to detect carbapenemase genes and to determine the in vitro susceptibility of Ce... more This study aimed to detect carbapenemase genes and to determine the in vitro susceptibility of Ceftazidime-Avibactam (CZA) in Enterobacterales isolates. Carbapenemase genes were detected by polymerase chain reaction. CZA sensitivity of isolates was evaluated with broth microdilution (BMD) and disk diffusion methods. A total of 318 carbapenem-resistant Enterobacterales isolates were included. Most of the isolates (n = 290, 91.2%) were identified as Klebsiella pneumoniae. The most common carbapenemase type was OXA-48 (n = 82, 27.6%). CZA susceptibility was evaluated in 84 isolates with OXA-48 and KPC carbapenemase activity. Both BMD and disk diffusion methods revealed that 95.2% of the isolates were sensitive to CZA; whereas, 4 (4.76%) isolates were resistant to CZA. Among colistin resistant isolates, 96.5% (n = 80) of them were susceptible to CZA. Our study demonstrated high in vitro efficacy of CZA in Enterobacterales isolates producing OXA-48 carbapenemase. High susceptibility rate...

European Journal of Radiology Open, 2021

• CT pneumonia analysis program is an objective way to determine the disease severity. • The popu... more • CT pneumonia analysis program is an objective way to determine the disease severity. • The population over the age of 60 and with certain comorbidities such as DM, CHF, and COPD are more prone to severe disease than other patients. • CRP, Neutrophil/Lymphocyte, troponin levels are positive predictors for clinical worsening.

Transplantation, 2020

Introduction: Blood stream infections (BSIs)are the most frequent causes of mortality and the mor... more Introduction: Blood stream infections (BSIs)are the most frequent causes of mortality and the morbidity in immunosuppressive patients as solid organ transplant recipients. Particularly antimicrobial resistant pathogens are one of the major challenges in these patient group. Timing of appropriate empirical antimicrobial treatment is lifesaving and knowing the change of local microbial distribution and antimicrobial resistance patterns in years is crucial for updating empirical treatment decision. Materials and Methods: The data was collected retrospectively from 143 solid organ transplantation recipients BSI episodes occurred in 2009 and in 2019. We analysed the distribution and resistance patterns of isolates between the 2009 and 2019 years. The aim of our study was to evaluate the emerging of antimicrobial resistance during this time period in this patient group Results: In our study there were 57 BSI isolates in 2009 and 86 BSI isolates in 2019. Gram negative pathogens were the most common isolates for both periods; however, the ratio of gram negatives had decreased from 60% to 49%. While the ratio decreased, the resistance in gram negatives had increased. Klebsiella isolates became the most common gram negative pathogens and extended spectrum beta lactamase (ESBL) production and carbapenem resistance in Klebsiella spp. increased from 52% to 72%, and 25% to 36% respectively. The carbepenem resistance in Acinetobacter spp. had risen from 60% to 100% between 2009 to 2019. While there were no methicillin resistance in S.aureus isolates in 2009, 7 of 9 isolates are found resistant to methicillin in 2019. We found only one vancomycin resistant Enterococcus spp. in 2019. Conclusion: Antimicrobial resistance rates are rising year after year all around the world. Resistance to broad spectrum animicrobials like carbapenems, limits the treatment choices of critical infections in immunocompromised patients. The knowledge of distribution and resistance patterns of isolates provides infectious diseases specialists and transplantation teams effective administration of empirical antimicrobial treatment. Therefore, all centers have to fallow their local data.

Transplantation, 2020

Introduction and Purpose: Flu can cause serious complications and death especially in young child... more Introduction and Purpose: Flu can cause serious complications and death especially in young children, elderly, pregnant women, patients with chronic diseases and immunosuppressive patients. In this study, solid organ transplantation recipients which were positive for influenza in laboratory in Baskent University Ankara Hospital in 2018-2019 and 2019-2020 influenza seasons were examined. Method: Patients who were admitted to our hospital with the diagnosis of influenza-like illness last two influenza seasons (September 2018March 2019 and September 2019February 2020) and who had positive influenza rapid antigen test (SofiaTM) or influenza PCR (VIASURE) test were included in the study. Demographic characteristics, laboratory and radiological findings, hospitalization and need for intensive care were recorded in IBM SPSS 25 program and their statistical analyzes were performed. Results: A total of 2060 tests were studied in the winter season of 20182019 and winter season2019-2020 in adults (≥18).Flu rapid antigen or PCR tests positivity was found in 521 tests (25.2%). Thirty-nine attacks were recorded in 38 patients with solid organ transplants. Twenty-four (63.1%) of these patients were male. Twenty-three (58.9%) of these attacks were due to Influenza A, ten (25.6%) of them were Influenza B. During this period three patients (7.6%) had combined influenza A and influenza B infections. Four patients (10.2%) had combined influenza B and RSV infections, while three patients (7.6%) had only RSV infections. The patients applied to the emergency department in 20 (51.3%) attacks and outpatient clinic in 11 (28.2%) attacks. Eight (20.5%) attacks developed in the inpatient. Only two patients (5.1%) were known to have been vaccinated. Twenty-five patients (64.1%) underwent chest X-ray. Thoracic CT was performed in 19 (48.7%) patients. All patients were given oseltamivir treatment, 26 (66.7%) patients received antibiotic treatment. Twenty-five patients (64.1%) were hospitalized due to influenza. Five of these patients (12.8%) needed intensive care support, two of them needed mechanical ventilator. Influenza was mortal in two patient (5.2%). Laboratory values of the patients were leucosyte 9898 ± 7829 (min 2380max 35600), CRP 60.6 ± 72.5 (min 1max 348). Discussion and Conclusion: Timely diagnosis and early treatment with antivirals reduce the duration of symptoms and reduces the risk of complications and hospitalizations. In addition, awareness of vaccination, which is the most important prevention method of influenza in solid organ transplant recipients, should be increased at the patient and physician awareness. P-9.23

Experimental and Clinical Transplantation, Mar 1, 2022

OBJECTIVES Cytomegalovirus infection is an important problem for transplantation. Although effect... more OBJECTIVES Cytomegalovirus infection is an important problem for transplantation. Although effective antivirals for prophylaxis or preemptive therapy have reduced the severity and consequences of infection, cytomegalovirus viremia and cytomegalovirusrelated disease are still matters for patients and for graft survival. The aim of our study was to determine the frequency of cytomegalovirus infections during the first year after transplant. MATERIALS AND METHODS In this study, we analyzed the data of 252 liver and kidney transplant patients who had procedures between May 2016 and May 2020. Demographic and laboratory data of patients were recorded retrospectively and analyzed with the SPSS version 25 statistical program. RESULTS Our study included 35 liver (14%) and 217 kidney transplant recipients. The ratio of male to female was 3.8, and the median age was 41 years (range, 18-71 years). In our study group, there were 32 patients (12.7%) with cytomegalovirus DNAemia, 13 patients (5%) with cytomegalovirus syndrome, and 6 patients (2.4%) with cytomegalovirus endorgan diseases. Four patients were diagnosed with gastrointestinal disease with histopathology, and 2 patients were diagnosed with cytomegalovirus pneumonia with bronchoscopy and radiology. The mortality rate was 0.8% in the first year. CONCLUSIONS Cytomegalovirus reactivations in the first year after transplant play a critical role on graft survival in solid-organ transplant. Regular follow-up of cytomegalovirus DNAemia is crucial for modifying prophylactic and preemptive antiviral regimens.

Experimental and Clinical Transplantation, 2021

OBJECTIVES Vaccination against SARS-CoV-2 may reduce COVID-19 mortality and complications in soli... more OBJECTIVES Vaccination against SARS-CoV-2 may reduce COVID-19 mortality and complications in solidorgan transplant recipients, and we evaluated the associated antibody responses and adverse effects in this high-risk population. MATERIALS AND METHODS This prospective observational study (April-June 2021) included 10 liver and 38 kidney transplant recipients who received 2 vaccine doses (Sinovac, n = 31; or BioNTech, n = 17) and 56 healthy adults (Sinovac), all of whom provided 3 blood samples (prevaccination, 4 weeks after first dose, and 4-6 weeks after second dose) for quantitative tests (Abbott Quant assay forimmunoglobulin G antibodies against SARS-CoV-2 spike protein). Type I error was α = .05 in all statistical analyses (SPSS, version 25). RESULTS We analyzed demographic data, antibody responses, and adverse events after 2 doses of SARSCoV-2 vaccine, comparedimmune responses from solidorgan transplant recipients (median age, 36.5 years) versus healthy patients (median age, 37.5 years), and observed significantly higher seropositivity in healthy versus transplant patients after Sinovac vaccination (100% vs 67.5%; P = .001). However, we observed no significant seropositive differences for Sinovac versus BioNTech second doses in transplantrecipients. Median SARS-CoV-2 immunoglobulin G level after second dose was significantly higher in BioNTech (1388.6 AU/mL) versus Sinovac patients (136.6 AU/mL) (P = .012). The seropositivity difference between the 2 vaccines was significant in participants 24 to 44 years old (P = .040). The rate of at least 1 side effect was 82.4% (n = 14) for BioNTech vaccine and 32.3% (n = 10) for Sinovac vaccine, and the difference was statistically significant.The most common side effect was arm pain (significantly higher in BioNTech group). CONCLUSIONS Solid-organ transplant recipients demonstrated inadequate vaccine responses (higher risk of complications and mortality) versus healthy patients. Furthermore, immune responses may differ between vaccines. Therefore, additional vaccine doses and strict control measures remain crucial.

Experimental and Clinical Transplantation, 2021

OBJECTIVES The clinical features and treatment approaches, outcomes, and mortality predictors of ... more OBJECTIVES The clinical features and treatment approaches, outcomes, and mortality predictors of COVID-19 in solid-organ transplant recipients have not been well defined. This study investigated the clinical features of COVID-19 infection in solid-organ transplant recipients at our center in Turkey. MATERIALS AND METHODS Our study included 23 solidorgan transplant recipients and 336 nontransplant individuals (143 previously healthy and 193 patients with at least 1 comorbidity) who were hospitalized due to COVID-19 disease in our hospital between March 2020 and January 2021. Demographic, clinical, and laboratory data of patients were compared. We used SPSS version 20.0 for statistical analysis. All groups were compared using chi-square and Mann-Whitney U tests. P < .05 was considered statistically significant. RESULTS Mean age of solid-organ transplant recipients was 49.8 ± 13.7 years (78.3% men, 21.7% women). Among the 23 recipients, 17 (73.9%) were kidney and 6 (26.1%) were liver transplant recipients. Among nontransplant individuals, 88.7% (n = 298) had mild/moderate disease and 11.3% (n = 38) had severe disease. Among transplant recipients, 78.3% (n = 18) had mild/moderate disease and 21.7% (n = 5) had severe disease (P = .224). Transplant recipients had greater requirements for nasal oxygen (P = .005) and noninvasive mechanical ventilation (P = .003) and had longer length of intensive care unit stay (P = .030) than nontransplant individuals. No difference was found between the 2 groups in terms of mortality (P = .439). However, a subgroup analysis showed increased mortality in transplant recipients versus previously healthy patients with COVID-19 (P < .05). Secondary infections were major causes of mortality in transplant recipients. CONCLUSIONS COVID-19 infection resulted in higher mortality in solid-organ transplant recipients versus that shown in healthy patients. More attention on secondary infections is needed in transplant recipients to reduce mortality.

Journal of Ankara University Faculty of Medicine, 2021

Objectives: Influenza (flu) causes seasonal epidemics and has led to numerous pandemics worldwide... more Objectives: Influenza (flu) causes seasonal epidemics and has led to numerous pandemics worldwide. Its rapid diagnosis and treatment are critical. This study evaluated the correlation between rapid influenza diagnostic test (RIDT) results and clinical reflection. Materials and Methods: A total of 795 patients who were performed the RIDT during the 2018-2019 influenza season were included. According to the test results, the patients were then divided into two groups. The Flu+ group was composed of patients with positive diagnostic test results, while the Flu-group was those with negative test results. Results: The data of 795 patients with 248 positive RIDTs were compared with the data of 547 patients with negative test results. Fever was present in 199 (80.2%) patients in the Flu+ group and in 209 (38.2%) patients in the Flu-group (p<0.001). Cough was noted in 170 (68.5%) patients in the Flu+ group and in 251 (45.9%) patients in the Flu-group (p<0.001). There were 106 patients (42.7%) in Flu+ group and 44 (7.9%) in the Flugroup (p<0.001), who had myalgia. The presence of fever was 4.7-fold, myalgia was 4.5-fold, and cough was 2.4-fold, signifying the risk of being influenza-positive (74.9% sensitivity, 79.7% specificity). Conclusion: The results of our study are compatible with the known influenza clinic. Myalgia is almost as common as fever in patients. While limited, RIDTs are useful to clinicians in the diagnosis of influenza infection. While rapid influenza diagnostic tests are preferred due to their ease of use and low cost, even if negative, the clinician's examination findings and clinical diagnosis are important, particularly in patients in the risk group.

Turkish Journal of Clinics and Laboratory, 2021

To cite this article: Erol C, Sari N, Aki SZ, Senol E. The frequency, epidemiology and risk facto... more To cite this article: Erol C, Sari N, Aki SZ, Senol E. The frequency, epidemiology and risk factors of bloodstream infections in febrile neutropenic patients with hematologic malignancies.

Turkish Journal of Clinics and Laboratory, 2021

The challenge in establishing an early-sown wheat crop in southern Australia is the need for cons... more The challenge in establishing an early-sown wheat crop in southern Australia is the need for consistently high seedling emergence when sowing deep in subsoil moisture (>10 cm) or into dry top-soil (4 cm). However, the latter is strongly reliant on a minimum soil water availability to ensure successful seedling emergence. This study aimed to: (1) evaluate 233 Australian and selected international wheat genotypes for consistently high seedling emergence under limited soil water availability when sown in 4 cm of top-soil in field and glasshouse (GH) studies; (2) ascertain genetic loci associated with phenotypic variation using a genome-wide association study (GWAS); and (3) compare across loci for traits controlling coleoptile characteristics, germination, dormancy, and pre-harvest sprouting. Despite significant (P < 0.001) environment and genotype-by-environment interactions within and between field and GH experiments, eight genotypes that included five cultivars, two landraces, and one inbred line had consistently high seedling emergence (mean value > 85%) across nine environments. Moreover, 21 environment-specific quantitative trait loci (QTL) were detected in GWAS analysis on chromosomes 1B, 1D, 2B, 3A, 3B, 4A, 4B, 5B, 5D, and 7D, indicating complex genetic inheritance controlling seedling emergence. We aligned QTL for known traits and individual genes onto the reference genome of wheat and identified 16 QTL for seedling emergence in linkage disequilibrium with coleoptile length, width, and cross-sectional area, pre-harvest sprouting and dormancy, germination, seed longevity, and anthocyanin development. Therefore, it appears that seedling emergence is controlled by multifaceted networks of interrelated genes and traits regulated by different environmental cues.

Viruses

Infectious Diseases and Clinical Microbiology

Journal of Antimicrobial Chemotherapy

Intensive Care Medicine

Turkish Bulletin of Hygiene and Experimental Biology

Journal of Ankara University Faculty of Medicine

Infectious Diseases and Clinical Microbiology, 2021

Acta Microbiologica et Immunologica Hungarica, 2021

European Journal of Radiology Open, 2021

Transplantation, 2020

Experimental and Clinical Transplantation, Mar 1, 2022

Experimental and Clinical Transplantation, 2021

Journal of Ankara University Faculty of Medicine, 2021

Turkish Journal of Clinics and Laboratory, 2021