Haluk Vahaboglu - Academia.edu (original) (raw)

Papers by Haluk Vahaboglu

Hastane ve toplum kaynaklı infeksiyon etkenlerinde giderek artan antibiyotik direnci önemli bir s... more Hastane ve toplum kaynaklı infeksiyon etkenlerinde giderek artan antibiyotik direnci önemli bir sorundur. Özellikle Escherichia coli, Klebsiella pneumoniae, Enterobacter spp, Pseudomonas aeruginosa, Acinetobacter spp, metisilin-dirençli Staphylococcus aureus, KNS, vankomisin-dirençli enterococci, Streptococcus pneumoniae ve Mycobacterium tuberculosis gibi mikroorganizmalarda gözlenen direnç tedavide güçlüklere neden olmaktadır. Bu yazıda bu dirençli mikroorganizmaların neden olduğu infeksiyonlarda tedavi yaklaşımları değerlendirilmektedir.

Acta Scientific Gastrointestinal Disorders, 2019

Background: Hepatitis B Virus Serum DNA is a reliable and useful marker for the diagnosis and mon... more Background: Hepatitis B Virus Serum DNA is a reliable and useful marker for the diagnosis and monitoring of HBV infection. The limitation of HBV DNA serum assays are that they are not economical and also lack uniformity and standardization. Therefore, there is a need for a more reliable and economical marker for the diagnosis of HBV. HBsAg quantitation is one such substitute serological marker. The objective of this study is to compare the serum HBV DNA quantitative real time PCR with HBV reverse transcription PCR (rt-PCR) Methods: Patients diagnosed with HBV from all the departments of hospital were enrolled in this study. Patients, with undetectable Hepatitis B virus and those co-infected with HIV or HCV, were excluded from the study. All patients were tested for HBV DNA PCR and serological markers like HBeAg, HBsAg. HBsAg quantification was performed using conventional ELISA immunoassay. The comparison between HBV DNA (RT-PCR) and (rt-PCR) quantitation was done by using Chi-square. SPSS was used for statistical analysis and P-value of <0.05 was considered significant. Results: A total of 661 patients were included in this study. Out of these 661 patients, 373 serum samples were analyzed using HBV RT-PCR while 281 by HBV rt-PCR. The percentage of female patients in the group of HBV RT-PCR was 38.9% and 32.7 % in the group of HBV rt-PCR. The mean age of patients in the group of HBV RT-PCR was 33.01 years and 34.61 years in the group of HBV rt-PCR. In the group of HBV RT-PCR, the mean ALT level was 57.6 u/l and 51.00 in the group of HBV rt-PCR. In the group of HBV RT-PCR 16.5% (n=61) and 8.9% (n=33) were HBeAg positive. In the group of HBV RT-PCR 94.9% and in the group of HBV rt-PCR, 73.2% were HBsAg positive. The mean of HBV DNA positive in the group of HBV RT-PCR was 44.3% and in the group of HBV rt-PCR was 14.6%. The levels of HBV DNA (positive) were considerably higher in HBV RT-PCR patients as compared to HBV rt-PCR patients (164 versus 54; p=0.001). Neither HBsAg levels nor HBeAg levels were significant (p=0.573, 0.057). Therefore, this study concludes that HBV Real-Time RT-PCR is a better option for the diagnosis of HBV DNA PCR as clinically significant results obtained from this test. HBV RT-PCR is a useful and significant technology for diagnosis of HBV DNA PCR, it must be used appropriately. Conclusions: There is a significant difference between HBV DNA Real-Time PCR (RT-PCR) and HBV DNA reverse transcription PCR (rt-PCR) for the diagnosis of patients with hepatitis B virus but not in HBsAg and HBeAg.

Open Forum Infectious Diseases, 2014

Turk Pediatri Arsivi-turkish Archives of Pediatrics, Sep 1, 1993

Group A beta haemolytic streptococcus GABHS is the leading etiology of bacterial pharyngitis whic... more Group A beta haemolytic streptococcus GABHS is the leading etiology of bacterial pharyngitis which may cause acute rheumatic fever ARF unless being treated properly Accurately diagnosing streptococsic pharyngitis is very important in order to prevent the development of ARF Culture and rapid antigen detection tests are commonly used methods In this study 410 patients were simultaneously studied by culture and Test Pack Strep A a widespread used rapid antigen test when compared to culture TSA was found to be 87 sensitive and 100 specific TSA was not found to be more sensitive but ten times expensive than culture there fore cost effectiveness of the test was argued At the some time antibiotic resistance test was performed on 61 of the strains isolated during this study which indicated 19 61 erythromycin resistance These data indicate that macrolide antibiotics should be used by caution in the treatment of Streptococcus infections Key words: Streptococcus Acut Rheumatic Fever Erythromycin Test Pack Strep A

The new microbiologica, 1997

Trimethoprim-sulphamethoxazole (SXT) resistance increased among Shigella flexneri isolates in 199... more Trimethoprim-sulphamethoxazole (SXT) resistance increased among Shigella flexneri isolates in 1995 relative to previous years, in the Trakya region, the European part of Turkey. Since this region is the entrance to Turkey from northern countries, a heavy traffic of travellers passing through should have been importing or exporting the resistant isolates. We studied the genetic basis and epidemiology of this resistance and monitored the clonal changes which have taken place in the meanwhile. During the study period, a total of 70 Shigella spp. were isolated. Of these 58 were S. flexneri, 10 were S. sonnei and two were S. boydii. S. dysenteriae was not isolated. Of S. flexneri isolates 32 were SXT, ampicillin, chloramphenicol and tetracycline resistant (pattern I), while two isolates were found to be resistant only to SXT (Pattern II). Transconjugation experiments revealed that an approximately 80 Kbp self-transmissible plasmid carried the SXT resistance genes in both groups. However,...

Cor et Vasa, 2012

Background: Cytomegalovirus (CMV) is a major cause of infection in the early period after heart t... more Background: Cytomegalovirus (CMV) is a major cause of infection in the early period after heart transplantation (HTx). There are limited data comparing universal prophylaxis with preemptive treatment of CMV infection in HTx recipients. Therefore, the goal of this study was to evaluate efficacy and safety of both strategies. Methods: A total of 17 HTx recipients were prospectively enrolled in the universal prophylaxis group. This study cohort was matched with 18 HTx recipients who had the same immunosuppressive regimen and received preemptive therapy for CMV infection. All patients were CMV-seropositive. The study group received oral valganciclovir in a dose of 900 mg daily for 100 days. The second group was treated in case of CMV viraemia higher than 500 copies/ml. The incidence of CMV infection, other opportunistic infections and acute graft rejection and adverse events were evaluated at 3 th , 6 th and 12 th months post-transplant. Results: Universal prophylaxis was well tolerated in 87.5% of the patients for a period of 100 days. Leukopenia was the most frequent side-effect that appeared in 25% of this group. This strategy decreased the rate of asymptomatic CMV infection during the first three months after HTx (11.7% vs 55.6%, p = 0.006) compared with preemptive therapy. This positive effect was associated with lower incidence of acute graft rejection at 12 months of follow up (6.3% vs 41.2%, p = 0.015). Conclusion: Universal prophylaxis with valganciclovir in CMV-seropositive HTx recipients was acceptably safe and compared with preemptive therapy of CMV infection reduced the incidence of asymptomatic CMV infection and of acute graft rejection. SOUHRN Kontext: Cytomegalovirus (CMV) je jedním z hlavních původců infekce v časném pooperačním období po transplantaci srdce (OTS). V současnosti existují pouze omezená data srovnávající univerzální profylaxi s preemptivní terapií CMV infekce u pacientů po OTS. Cílem naší prospektivní studie bylo posoudit účinnost a bezpečnost obou metod. Metody: Do skupiny s univerzální profylaxí bylo zařazeno celkem 17 příjemců OTS. Kontrolní skupinu tvořilo 18 pacientů, kterým byla podána preemptivní terapie. Všichni pacienti měli zavedenou stejnou imunosupresivní léčbu a byli CMV sérologicky pozitivní. Za účelem univerzální profylaxe byl podán perorální valganciclovir v dávce 900 mg denně po dobu 100 dnů. Ve skupině s preemptivní terapií byla zahájena léčba

Viral Hepatitis Journal

Objectives: Patients with hepatitis B e antigen-negative chronic infection (inactive carriers) ac... more Objectives: Patients with hepatitis B e antigen-negative chronic infection (inactive carriers) account for most of the people living with hepatitis B virus (HBV). This study investigated the direct medical cost of monitoring patients within this group. Materials and Methods: A total of 293 outpatients receiving regular monitoring in a large university hospital were included in the study. Direct medical costs included laboratory tests, imaging, liver biopsies and co-payments. Linear mixed effect models were applied to investigate the effect of follow-up time on the annual cost of monitoring. We made quarterly, semi-annual and annual monitoring cost trajectories in accordance with international guideline recommendations. Results: The average annual direct medical cost per patient was 160 USD and the average laboratory visit cost per patient was 68.5 USD. HBV DNA testing contributed to a majority percentage of the total cost (59.6%). As follow-up time increased, the total annual cost (β=-2.07) and annual cost for DNA testing (β=-1.03) decreased. The cost trajectory of the first two years of monitoring remained above the semi-annual follow-up strategy. After three years, the cost trajectory of monitoring, while reducing slightly, remained between the semi-annual and annual follow-up strategy trend lines. Conclusion: Due to high-patient numbers, the total cost of monitoring presents a large economic burden. Taking into consideration the generally benign nature of the disease; the length of intervals between outpatient hospital visits could be reviewed and alternative strategies implemented with the aim of reducing expenditure.

Infectious Diseases in Clinical Practice

ObjectivesProgressive respiratory failure is the main cause of clinical worsening in Coronavirus ... more ObjectivesProgressive respiratory failure is the main cause of clinical worsening in Coronavirus disease (COVID-19) patients. The decision to intubate during the follow-up of COVID-19 patients is critical because of high mortality rates.MethodsWe analyzed the COVID-19 related intubation and in-hospital mortality risk factors of patients admitted to two tertiary hospitals.ResultsOf the 275 patients included in the study, 44 (16%) were intubated, while 30 of them were patients (53%, 30/56) who had previously received steroid therapy. In 23 patients (77%) who received steroid therapy and were intubated, antiviral therapy was started in the first 6 days and Lymphocyte / White blood cells (LYM/WBC) ratios were lower than 0.18. The LYM/WBC ratio was found to be less than 0.12 in 14 patients who were intubated but did not receive steroid treatment before. 30(11%) of the patients included in the study died. While the number of deaths among those who did not receive steroid treatment was 10 ...

Asia Pacific Journal of Public Health, 2020

This study aims to provide both a model by using cumulative cases and cumulative death toll for S... more This study aims to provide both a model by using cumulative cases and cumulative death toll for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) outbreak in four countries, China, Italy, South Korea, and Turkey, starting from the first diagnosis and to compare associated indicators. The most successful estimation was obtained from the cubic model with natural logarithm for China, Italy, South Korea, and Turkey. The success of the models was around 99%. However, differences began to emerge in China, Italy, and South Korea after the second week. Although the highest number of new cases per 1 million people in China was 9.8 on February 28, 2020; it was 108.4 on March 21, 2020, in Italy; and this was 16.6 on March 5, 2020, in South Korea. On the other hand, the number of new cases was 24.6 per 1 million people on March 27, 2020, in Turkey. The log-cubic model proposed in this study has been set forth to obtain successful results for aforementioned countries, as well as to es...

Scandinavian Journal of Gastroenterology, 2019

Aim: This meta-analysis aimed to pool available data regarding the efficacy of ganciclovir treatm... more Aim: This meta-analysis aimed to pool available data regarding the efficacy of ganciclovir treatment among cytomegalovirus-detected ulcerative colitis patients. Methods: We screened PubMed, Ovid, Web of Science and Cochrane databases for relevant studies, and four investigators independently evaluated the studies for eligibility. The primary outcome was surgical resection or death from ulcerative colitis. The data were then pooled via DerSimonian-Laird estimator and Mantel-Haenszel (MH) method, two points added for continuity correction and randomeffects model fitted in the Bayesian framework. We first constructed a Bugs model with Student t-distribution as prior for between-study heterogeneity. The model was fitted by Gibbs sampler (JAGS) to produce a marginal posterior distribution. Results: Our screening identified 15 eligible studies for final data synthesis and combined data from 191 ganciclovir-treated and 166 non-treated patients. Effect estimates from the fixed-effects meta-analysis model did not encourage ganciclovir treatment (OR, 1.43; 95% CIs [0-95, 2.16]), with a negligible unaccounted heterogeneity (I 2 ¼ 0%). The Bayesian random-effects model generated high-density credible intervals, suggesting a high probability, that future studies will also not encourage ganciclovir treatment (mu, 1.028; 95% credible intervals [0.054, 2.238]; 80% credible intervals [0.401, 1.703]) which indicates that future studies will favor non-treatment of ulcerative colitis with ganciclovir. Conclusions: Data produced in this study do not encourage ganciclovir treatment for UC patients. However, studies included in this analysis were observational, and thus, inherited severe selection bias. We suggest randomized controlled studies be conducted to make firm recommendations in this context.

Parasitology International, 2019

Toxocariasis is a clinical syndrome caused by the larvae of two ascarid nematodes, namely, Toxoca... more Toxocariasis is a clinical syndrome caused by the larvae of two ascarid nematodes, namely, Toxocara canis and T. cati that live in dogs and cats as definitive hosts. Humans acquire Toxocara infection by accidental consumption of eggs contaminated foods, soil, water or larvae encapsulated in the viscera or meats of various paratenic hosts e.g., chicken. After oral ingestion, the ova hatch and the free larvae penetrate the intestinal wall to migrate to distant tissues throughout the body. Larvae may also infiltrate the intestinal wall and cause enteritis and mass occupying lesions. Here, we present a T. canis related gastroenteritis and peritonitis case successfully treated with albendazole. We reviewed the literature and found seven previously published Toxocara related peritonitis cases. To our knowledge, this is the first review about nondisseminated toxocariasis that restricted to the intestine and presented as eosinophilic ascites due to peritoneal inflammation. The most common abdominal symptoms were abdominal pain and nausea, and the most common findings were eosinophilic infiltrations on endoscopic biopsy specimens and eosinophilia in the peripheric blood samples.

Journal of Pediatric Urology, 2018

Purpose: To determine changes in antimicrobial resistance and demographics of UTIs in pediatric p... more Purpose: To determine changes in antimicrobial resistance and demographics of UTIs in pediatric patients in a single institution over a 6-year period. Materials and methods: The current study examined outpatient urinary isolates from patients aged <18 years. A retrospective cross-sectional analysis of bacteria isolated from children with UTI was performed between 2009-2014. The most common bacterial pathogens were determined in the following four age groups: <2 years; 2-5 years; 6-12 years; and 13-17 years. The study analyzed the prevalence and antibiotic resistance patterns for the six most common uropathogens: Escherichia coli, Proteus, Klebsiella, Enterobacter, Pseudomonas and Enterococcus. The antibiotic resistance pattern for UTI during 2009-2014 was also examined. Results: A total of 6515 urinary cultures was examined. The majority of these isolates were from female patients (66.8%). E. coli was the most common uropathogen overall, but the prevalence of E. coli was higher among females (79.5%) than males (54.9%). The biggest percentage of isolates in males was from children aged <2 years (46.1%). Conversely, the majority of isolates in females were from children aged >6 years (46.8%). Results of antimicrobial resistance for E. coli were the highest for ampicillin (70%) and lowest for meropenem (0.19%). Comparing the hospital network data from 2009 to 2014, E. coli resistance increased for ampicillin (from 47.1% to 89%), trimethoprim-sulfamethoxazole (TMP-SMX) (from 44.8% to 56%) and nitrofurantoin (from 5.3% to 15.1%). In contrast, cephalosporins have maintained low antibiotic resistance. Conclusion: UTI in females was nearly twice as common than in males. E. coli remained the most common pediatric uropathogen. Although widely used in other tract infections, ampicillin was a poor empiric choice for pediatric UTIs. Cephalosporins were appropriate alternatives given their low resistance rates. A successful empirical treatment protocol should be based on local epidemiology and susceptibility rates.

Journal of Medical Microbiology, 2001

ABSTRACT

The Journal of Urology, 2015

Disease and Molecular Medicine, 2015

Journal of Microbiology and Infectious Diseases, 2011

Objectives: The primary aim of this study was to determine the activities of ceftazidime and cefe... more Objectives: The primary aim of this study was to determine the activities of ceftazidime and cefepime combined to sulbactam against class A extended-spectrum β lactamases (ESBLs). Materials and methods: Eight university hospitals participated to the study by submitting isolates those were recovered during a six-month period in 2010 from various clinical materials. Sulbactam was tested in two fixed concentrations of 4 mg/l and 8 mg/l. Isolates showing a fourfold or more decrease in the MIC of an oxyimino-cephalosporin with sulbactam were defined as ESBL producers. Isolates were screened for CTX-M group 1 extended-spectrum β lactamases by PCR. Results: A total of 149 ESBL-positive E.coli were studied. Isolates were uniformly susceptible to carbapenems and highly resistant to ciprofloxacin. According to CLSI breakpoints, 28% (42/149) of isolates were susceptible to ceftazidime and 32% (47/149) to cefepime. With 4 mg/L and 8 mg/L sulbactam supplement, ceftazidime susceptibility rose to 69% (103/149) and 88% (131/149), while cefepime susceptibility rose to 86 % (128/149) and 95% (141/149), respectively. PCR screening revealed that 63% (94/149) of the isolates were positive for blaCTX-M and 38% (36/94) of these were on the O25b-ST131 clone. Conclusion: Ceftazidime plus sulbactam and cefepime plus sulbactam showed remarkable activity against ESBL-positive E.coli.

Tropical Doctor, 2013

We describe the epidemiological, clinical features and risk factors for the morbidity and mortali... more We describe the epidemiological, clinical features and risk factors for the morbidity and mortality of imported Plasmodium falciparum malaria cases during the last 10 years in Istanbul, Turkey. The epidemiological, clinical and laboratory data of cases in six tertiary care hospitals in Istanbul between 2002 and 2012 were analysed. Seventy patients (65 males, five females; median age 37; range: 14-84) were included. Sixty-five (93%) patients had travelled to African countries and the remaining five to other malarious countries. Seventeen (24%) had a history of previous malarial episodes; eight (13%) developed recrudescence during the first month; 22 (31%), 17 (24%), 20 (29%) and three (4%) cases had cerebral malaria, cholestatic icterus, malarial hepatitis and respiratory distress syndrome on admission, respectively. Six of 12 patients with severe falciparum malaria died. Clinically, the presence of alteration in mental status, icterus, hypoglycaemia, disseminated intravascular coagulation and malarial hepatitis were statistically significant for the development of severe malaria and mortality. Recrudescence should not be forgotten, especially in uncomplicated cases.

The new microbiologica, 2003

Kocaeli University Medical School was established in 1995. The first methicillin resistant Staphy... more Kocaeli University Medical School was established in 1995. The first methicillin resistant Staphylococcus aureus isolate was detected two years later in a patient transferred from a different city. Six months after this, we detected a small MRSA outbreak in the intensive care unit involving four patients, two of whom had bacteremia, and a staff nasal carrier. All isolates, including the first, appeared to be a single outbreak strain, demonstrated by pulsed field gel electrophoresis profiles which different by at most two bands, identical randomly amplified polymorphic DNA profiles, and identical coagulase gene types by PCR. Antibiogram were identical except that one isolate was additionally resistant to cotrimoxazole. These results show that MRSA isolates can spread between hospitals with infected or colonized patients and can apparently persist in the hospital for six months without causing infection. Screening of asymptomatic patients on wards affected by MRSA or transferred from ...

Journal of Antimicrobial Chemotherapy, 1998