Lale Ozisik - Academia.edu (original) (raw)

Papers by Lale Ozisik

Medical Science Monitor, 2017

Departmental sources Background: Immunization is one of the most effective public health measures... more Departmental sources Background: Immunization is one of the most effective public health measures to prevent disease, but vaccination rates in adult populations still remain below the targets. Patient and physician attitudes about vaccination are important for adult vaccination. In this study, we aimed to determine patient attitudes and perceptions about vaccination and the vaccination coverage rates of adult patients in a university hospital in Turkey. Material/Methods: A survey was conducted between October 2014 and May 2015 at the Internal Medicine Outpatient Clinics of a university hospital. Adult patients were asked to fill out a questionnaire on their perceptions and attitudes about vaccination and their vaccination status. Results: We interviewed 512 patients ages 19-64 years. Eighty percent of the study population thought that adults should be vaccinated, while only 36.1% of the patients stated that vaccination was ever recommended to them in their adult life. Forty-eight percent of the patients stated that they were vaccinated at least once in their adulthood. The most commonly received vaccine was tetanus vaccine in general, while influenza vaccine was the leading vaccine among patients with chronic medical conditions. While 71.4% of the patients to whom vaccination was recommended received the vaccine, 34.9% of the patients received a vaccine without any recommendation. Conclusions: Although the vaccine coverage rates among adults in this survey were low, the perceptions of patients about adult vaccination were mainly positive and of many of them positively reacted when their physician recommended a vaccine.

Many infectious diseases in adults can be prevented by a 'life-long vaccination strategy'. Hepati... more Many infectious diseases in adults can be prevented by a 'life-long vaccination strategy'. Hepatitis B disease burden was shown to be higher in diabetic patients. American Advisory Committee on Immunization Practices recommends to vaccinate diabetic patients against hepatitis B since 2011. In this study, we aimed to determine hepatitis B virus serology status to determine the rates of diabetic patients who have indications for hepatitis B vaccination. The electronic database of the hospital was searched to identify adult patients aged above 18 years and with hemoglobin A 1 C levels of 6.5% or above, who have been seen at General Medicine Outpatient Clinics of a university hospital during a 3-year period. A total of 5187 patients were included in the study. After exclusion of patients with an incomplete serological panel, 1358 patients were included for further analyses. Twenty-nine percent of the patients had indication for hepatitis B vaccination, whereas only 8% were vaccinated. This study showed that nearly one third of patients who had hepatitis B serological data had an indication for hepatitis B vaccination and this is a clear reflection of the need to keep a lifelong vaccination log and inquire vaccination data.

ÖZET Giriş: İnfluenza ve pnömokok infeksiyonları özellikle yaşlılarda ve yüksek riskli erişkinler... more ÖZET Giriş: İnfluenza ve pnömokok infeksiyonları özellikle yaşlılarda ve yüksek riskli erişkinlerde önemli morbidite ve mortaliteye sebep olmak-tadır. İnfluenza ve pnömokok aşılarının etkili ve maliyet-etkin olduğu yapılan çalışmalarla gösterilmiş olmasına rağmen risk altındaki erişkinlerin aşılanma oranları halen düşüktür. Biz bu çalışmamızda bir iç hastalıkları servisine yatırılan hastaların aşılanma oranları ve aşıya karşı tutumlarını araştırmayı amaçladık. Hastalar ve Metod: Bu amaçla Kasım 2014-Temmuz 2015 tarihleri arasında prospektif gözlemsel bir çalışma yapıldı. Akut bakım servisine yatırılan hastalara demografik özellikleri, komorbiditeleri, influenza ve pnömokok aşı durumları ve bu aşılara karşı algı, tutum-larına ilişkin bir anket uygulandı. Her iki aşı için endikasyon oluşturan risk faktörleri sorgulandı. Bulgular: Çalışmaya 155 hasta dahil edildi. Hastaların yaş ortalaması 70 (18-91) yıl, erkek hastaların oranı %41.3 idi. Hastaların %93.5 (n= 145)'inin hem pnömokok hem de influenza aşısı endikasyonu olduğu saptandı. Pnömokok aşısı endikasyonu olan hastaların sadece %17.2'si aşı olmuşken, influenza aşı endikasyonu olan hastaların aşılanma oranı %29.7 olarak bulundu. Aşı olan hastalara sorulduğunda; her iki aşıyı da en çok aile hekimi dışındaki hekimlerin önermesi sonucunda yaptırdıkları saptandı. Hastaların aşı olmama sebeplerinin başında bilgi yetersizliği gelmekteydi. Sonuç: Poliklinikte olduğu gibi yatan hastalarımızda da influenza ve pnömokok aşı endikasyon oranı oldukça yüksektir. Bu çalışma erişkinler için aşılanma oranlarının halen düşük olduğunu, hastaların bu konuda yeterince bilgi sahibi olmadığını ve hekimlerin gerek-tiğinde öneride bulunmadıklarını göstermiştir. Hekimlerin bu konuda farkındalığını artırmak ve her başvuruyu bir fırsat olarak değer-lendirmelerini sağlamak erişkin aşılama oranlarının artırılmasına önemli ölçüde katkı sağlayacaktır.

The role of healthcare workers in life-long vaccination is very important in the means of 2 sided... more The role of healthcare workers in life-long vaccination is very important in the means of 2 sided infection, rising patient awareness and being a role model for the patients. Numerous organizations publish guidelines for vaccination of HCWs, while healthcare facilities develop vaccination policies according to the accreditation standards. Nevertheless, vaccination rates among HCWs are far below targets.

Human Vaccines & Immunotherapeutics, 2017

The role of healthcare workers in life-long vaccination is very important in the means of 2 sided... more The role of healthcare workers in life-long vaccination is very important in the means of 2 sided infection, rising patient awareness and being a role model for the patients. Numerous organizations publish guidelines for vaccination of HCWs, while healthcare facilities develop vaccination policies according to the accreditation standards. Nevertheless, vaccination rates among HCWs are far below targets. The obstacles to getting vaccinated or recommending vaccination may include rather universal factors such as the vaccine paradox, however in the case of HCWs, probably a different set of factors are included. The aims of this article are to gain an overview of vaccination strategies for HCWs, to assess the coverage rates of HCWs and make in-depth analyses of the potential barriers to vaccination and potential factors to motivate HCWs for vaccination in Turkey and to compare them with the global picture to improve implementation of policies concerning vaccination of HCWs.

European Journal of Rheumatology, 2016

Osteoporosis -related to various factors including menopause and aging- is the most common chroni... more Osteoporosis -related to various factors including menopause and aging- is the most common chronic metabolic bone disease, which is characterized by increased bone fragility. Although it is seen in all age groups, gender, and races, it is more common in Caucasians (white race), older people, and women. With an aging population and longer life span, osteoporosis is increasingly becoming a global epidemic. Currently, it has been estimated that more than 200 million people are suffering from osteoporosis. According to recent statistics from the International Osteoporosis Foundation, worldwide, 1 in 3 women over the age of 50 years and 1 in 5 men will experience osteoporotic fractures in their lifetime. Every fracture is a sign of another impending one. Osteoporosis has no clinical manifestations until there is a fracture. Fractures cause important morbidity; in men, in particular, they can cause mortality. Moreover, osteoporosis results in a decreased quality of life, increased disability-adjusted life span, and big financial burden to health insurance systems of countries that are responsible for the care of such patients. With an early diagnosis of this disease before fractures occur and by assessing the bone mineral density and with early treatment, osteoporosis can be prevented. Therefore, increasing awareness among doctors, which, in turn, facilitates increase awareness of the normal populace, will be effective in preventing this epidemic.

Internal Medicine, 2016

Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe drug hypersensitivity react... more Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe drug hypersensitivity reaction characterized by rash, fever and multi-organ failure. Limbic encephalitis (LE) is a rare disorder characterized by cognitive dysfunction with memory disturbance, seizures and psychiatric symptoms. We herein present an unusual case of DRESS syndrome due to lamotrigine with reactivation of Epstein-Barr virus, which developed autoimmune LE and syndrome of inappropriate antidiuretic hormone secretion. Discontinuation of lamotrigine, administration of methylprednisolone and intravenous immunoglobulin led to improvement. The LE in this case might have been caused by an autoimmune inflammatory mechanism associated with DRESS syndrome.

European Journal of Internal Medicine, 2016

Immunization is one of the most effective public health measures to prevent disease. Despite rela... more Immunization is one of the most effective public health measures to prevent disease. Despite relatively good vaccination rates in childhood in many parts of the world, vaccines to prevent diseases are underused in the adult population and adult vaccination rates are still far below the target. The European Federation of Internal Medicine (EFIM), declared that 'internal medicine must focus on better care for individuals, better health care for populations and lower costs'. Adult vaccination is a good example of a public health initiative aimed at reducing morbidity and mortality, but awareness of the need for adult vaccination and uptake of the programs across Europe is variable. The Adult Vaccination Campaign in Europe (ADVICE) was developed with an aim to raise awareness for adult vaccination and to understand the dynamics of the vaccination practices and the possible barriers against achieving targeted vaccination rates in Europe. In order to reach vaccination targets, we need evidence based, up to date guidelines; recommendations at national and international levels; surveillance for vaccination rates; and opportunities to provide vaccines more readily. Leadership at a European level and a firm research and action agenda are crucial. The European Federation of Internal Medicine can take the lead as it declared its interest on 'better care for individuals, better health care for populations'. Hence, we consider ADVICE a very timely and very valuable initiative to draw a roadmap to improve adult vaccination rates in Europe.

Human vaccines & immunotherapeutics, Jan 14, 2015

Many infectious diseases in adults can be prevented by a 'life-long vaccination strategy'... more Many infectious diseases in adults can be prevented by a 'life-long vaccination strategy'. Hepatitis B disease burden was shown to be higher in diabetic patients. American Advisory Committee on Immunization Practices recommends to vaccinate diabetic patients against hepatitis B since 2011. In this study, we aimed to determine hepatitis B virus serology status to determine the rates of diabetic patients who have indications for hepatitis B vaccination. The electronic database of the hospital was searched to identify adult patients aged above 18 years and with hemoglobin A1C levels of 6.5% or above, who have been seen at General Medicine Outpatient Clinics of a university hospital during a 3-year period. A total of 5187 patients were included in the study. After exclusion of patients with an incomplete serological panel, 1358 patients were included for further analyses. Twenty-nine percent of the patients had indication for hepatitis B vaccination, whereas only 8% were vaccina...

Renal failure, Jan 4, 2015

Continuous ambulatory peritoneal dialysis (PD) has become a treatment modality for end stage rena... more Continuous ambulatory peritoneal dialysis (PD) has become a treatment modality for end stage renal disease with a peak of its use in 1990s. The aim of this study was to examine the peritonitis rates, causative organisms and the risk factors of peritonitis in a large group of patients in our center. The study was conducted in the Nephrology Department of a University Hospital in Turkey. Patients in the PD programme between January 2000 and January 2006 were included. Cohort-specific and subject specific peritonitis incidence, and peritonitis-free survival were calculated. Causative organisms and risk factors were evaluated. Totally 620 episodes of peritonitis occurred in 440 patients over the six years period. Peritonitis rates showed a decreasing trend through the years (0.79 episodes/patient-year 2000-2003 and 0.46 episodes/patient-year 2003-2006). Cohort-specific peritonitis incidence was 0.62 episodes/patient-years and median subject-specific peritonitis incidence was 0.44 episod...

Journal of Critical Care, 2015

Angiogenesis plays an important role in the pathogenesis of inflammatory diseases, but the possib... more Angiogenesis plays an important role in the pathogenesis of inflammatory diseases, but the possible role of angiogenesis in Behçet's disease (BD) has not yet been studied. The aim of this study was to determine angiostatin levels in patients with BD and the role of angiogenesis in the pathogenesis of the disease. Thirty-seven patients with BD (mean age: 28·6±5·4 years, mean disease duration: 9·3±3·7 years) and 18 healthy controls were enrolled to the study. Twenty-four patients were in active and 13 patients were in inactive stage of the disease. The mean serum angiostatin level of patients with BD was 113·9±53·2 and 60·7±20·1 ng/ml in healthy controls. The mean serum angiostatin level was 142·7±43·1 ng/ml in active and 86·9±15·5 ng/ml in inactive patients with BD. Serum angiostatin levels were significantly high in patients with BD compared with healthy controls (P<0·001) and it was significantly high in active patients compared with inactive patients with BD (P<0·001). In inactive patients with BD, serum angiostatin concentrations were found to be higher compared with healthy controls (P<0·01). In active BD patients, the mean serum angiostatin level was correlated with the deep vein thrombosis (r = 0·482, P = 0·05), uveitis (r = 0·582, P = 0·01), and arthritis (r = 0·492, P = 0·05). According to these results; elevated serum angiostatin levels in patients with BD suggest the possible role of angiogenesis in the pathogenesis of the disease and its high levels in inactive Behçet's patients is related with the continuous activation of the disease even in the subclinical period.

The clinical respiratory journal, Jan 26, 2015

Although measles is usually considered a benign viral disease of childhood, adults may be affecte... more Although measles is usually considered a benign viral disease of childhood, adults may be affected at any age and may experience severe respiratory or neurologic consequences. We present three adult cases (one of whom was pregnant) admitted to our University Hospital who were diagnosed to have measles and who had uncommon clinical features such as hepatitis and hyponatremia. All patients were markedly hypoxic; one required mechanical ventilation. Two patients received therapy with intravenous ribavirin and all patients received high dose vitamin A for three days. Therapy with intravenous ribavirin and vitamin A were well tolerated by our patients except one patient who developed acute renal failure and were associated with reversal of respiratory compromise. Life-threatening measles pneumonitis in adults may be more common than previously appreciated, regardless of the patient's immune status, and ribavirin and high dose vitamin A might be a treatment option.

Protein & Peptide Letters, 2010

Familial mediterranean fever (FMF) is a systemic disorder characterized by recurrent attacks of f... more Familial mediterranean fever (FMF) is a systemic disorder characterized by recurrent attacks of fever and polyserositis. In FMF, several pro-inflammatory cytokines have been found to be elevated during the attacks. In recent years, it is shown that some proteins originated from adipose tissue play important role in inflammatory process. One of them, adiponectin decreases the expression of adhesion molecules and inhibits the attachment of active macrophages to the endothelial surface, so that it acts antiinflammatory effect. In this study, we analyzed the possible role of serum adiponectin in the pathogenesis of FMF. Thirty five patients with FMF and 13 healthy controls (5 female,8 male; mean age 22.3 ± 4.2 years) were enrolled in this study. Fifteen patients were in active stage (6 female, 9 male, mean age; 22.4 ± 4.1 years, mean disease duration 6.1±2.3 years) and 20 patients were in inactive stage (6 female,14 male, mean age;22.6 ±4.2 years, mean disease duration; 5.7 ± 1.6 years). Serum adiponectin and IL-6 levels were determined by ELISA. The mean serum adiponectin levels were 5.3 ±1.6 ng/ml in healthy controls, 55.3 ± 21.8 ng/ml in active FMF patients and 17.1 ± 4.7 ng/ml in inactive FMF patients. The mean serum IL-6 levels were 1.9 ± 0.4 ng/ml in healthy controls, 4.7 ± 1.1 ng/ml in active FMF patients and 2.9 ± 1.3 ng/ml in inactive FMF patients. Serum adiponectin levels in patients with FMF were significantly higher than in healthy controls (p<0.001). Serum adiponectin levels were significantly high both in active FMF patients and in inactive FMF patients compared with healthy control (p<0.001, p<0.001 respectively). Serum IL-6 levels were significantly higher both in patients with active and inactive disease as compared with healthy controls (p<0.01 and p<0.05 respectively). In serum adiponectin levels were correlated with high levels of serum IL-6 in the active and inactive patients. Serum adiponectin and IL-6 levels were during both active and inactive stages in patents with FMF.

Nephrology, 2008

Peritoneal dialysis patients have diminished quality of life scores compared with healthy subject... more Peritoneal dialysis patients have diminished quality of life scores compared with healthy subjects. Measures of quality of life have been reported to have a significant predictive value for patient survival and hospitalization in peritoneal dialysis patients. The purpose of this study is to determine the clinical, biochemical and psychological predictors for the quality of life in continuous ambulatory peritoneal dialysis (CAPD) patients. This cross-sectional study included 60 CAPD patients (male/female 33/27; age 45.5 +/- 15.7 years, CAPD duration 43.4 +/- 32.7 months). Pittsburg Sleep Quality Index was used for assessing sleep quality. We evaluated each patient's depressive symptoms with Beck Depression Inventory (BDI). Quality of life parameters were assessed by the self-administered SF-36 generic health survey questionnaire. In all patients, demographic variables, personality traits and habits, Charlson Comorbidity Index, clinical and laboratory parameters were recorded and analysed. A Pearson bivariate correlation analysis revealed that total quality of life score was negatively correlated with Pittsburg Sleep Quality Index (-0.533, P < 0.0001), BDI (-0.642, P < 0.0001) scores, C-reactive protein (-0.588, P = 0.001), and positively correlated with blood urea nitrogen (0.336, P = 0.02) and albumin (0.351, P = 0.01). BDI scores (beta = -0.505, P = 0.001) and the serum albumin levels (beta = 0.324, P = 0.009) were the significant independent predictors of quality of life. Poor sleep quality, presence of depression, higher C-reactive protein and lower albumin levels are associated with poorer quality of life. In order to improve life quality in CAPD patients, quality of sleep, depression and nutritional status should be serially evaluated and given appropriate treatment when required.

American Journal of Kidney Diseases, 2006

Peritonitis is the most common complication in patients undergoing continuous ambulatory peritone... more Peritonitis is the most common complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Brucellosis is a rare cause of bacterial peritonitis. Only 1 case was reported of a patient with brucella peritonitis during CAPD therapy. In that case, CAPD peritonitis was accompanied by acute brucellosis. We present the case of a patient with isolated brucella peritonitis receiving CAPD therapy without systemic manifestations of brucellosis who works as a farmer. Results of a serum agglutination test and blood cultures were negative; however, the patient's peritoneal fluid agglutination titer was 1:160 and samples inoculated into BACTEC (Becton Dickinson, NJ) bottles yielded Brucella melitensis. Because we were unable to isolate the organism in blood samples, transmission seems to be the result of direct inoculation, rather than hematogenous spreading. Therefore, our patient represents the first case of isolated brucella peritonitis during CAPD therapy. Successful treatment was obtained by using a treatment regimen of rifampin and doxycycline. Am J Kidney Dis 47:E65-E66.

Medical Science Monitor, 2017

Departmental sources Background: Immunization is one of the most effective public health measures... more Departmental sources Background: Immunization is one of the most effective public health measures to prevent disease, but vaccination rates in adult populations still remain below the targets. Patient and physician attitudes about vaccination are important for adult vaccination. In this study, we aimed to determine patient attitudes and perceptions about vaccination and the vaccination coverage rates of adult patients in a university hospital in Turkey. Material/Methods: A survey was conducted between October 2014 and May 2015 at the Internal Medicine Outpatient Clinics of a university hospital. Adult patients were asked to fill out a questionnaire on their perceptions and attitudes about vaccination and their vaccination status. Results: We interviewed 512 patients ages 19-64 years. Eighty percent of the study population thought that adults should be vaccinated, while only 36.1% of the patients stated that vaccination was ever recommended to them in their adult life. Forty-eight percent of the patients stated that they were vaccinated at least once in their adulthood. The most commonly received vaccine was tetanus vaccine in general, while influenza vaccine was the leading vaccine among patients with chronic medical conditions. While 71.4% of the patients to whom vaccination was recommended received the vaccine, 34.9% of the patients received a vaccine without any recommendation. Conclusions: Although the vaccine coverage rates among adults in this survey were low, the perceptions of patients about adult vaccination were mainly positive and of many of them positively reacted when their physician recommended a vaccine.

Many infectious diseases in adults can be prevented by a 'life-long vaccination strategy'. Hepati... more Many infectious diseases in adults can be prevented by a 'life-long vaccination strategy'. Hepatitis B disease burden was shown to be higher in diabetic patients. American Advisory Committee on Immunization Practices recommends to vaccinate diabetic patients against hepatitis B since 2011. In this study, we aimed to determine hepatitis B virus serology status to determine the rates of diabetic patients who have indications for hepatitis B vaccination. The electronic database of the hospital was searched to identify adult patients aged above 18 years and with hemoglobin A 1 C levels of 6.5% or above, who have been seen at General Medicine Outpatient Clinics of a university hospital during a 3-year period. A total of 5187 patients were included in the study. After exclusion of patients with an incomplete serological panel, 1358 patients were included for further analyses. Twenty-nine percent of the patients had indication for hepatitis B vaccination, whereas only 8% were vaccinated. This study showed that nearly one third of patients who had hepatitis B serological data had an indication for hepatitis B vaccination and this is a clear reflection of the need to keep a lifelong vaccination log and inquire vaccination data.

ÖZET Giriş: İnfluenza ve pnömokok infeksiyonları özellikle yaşlılarda ve yüksek riskli erişkinler... more ÖZET Giriş: İnfluenza ve pnömokok infeksiyonları özellikle yaşlılarda ve yüksek riskli erişkinlerde önemli morbidite ve mortaliteye sebep olmak-tadır. İnfluenza ve pnömokok aşılarının etkili ve maliyet-etkin olduğu yapılan çalışmalarla gösterilmiş olmasına rağmen risk altındaki erişkinlerin aşılanma oranları halen düşüktür. Biz bu çalışmamızda bir iç hastalıkları servisine yatırılan hastaların aşılanma oranları ve aşıya karşı tutumlarını araştırmayı amaçladık. Hastalar ve Metod: Bu amaçla Kasım 2014-Temmuz 2015 tarihleri arasında prospektif gözlemsel bir çalışma yapıldı. Akut bakım servisine yatırılan hastalara demografik özellikleri, komorbiditeleri, influenza ve pnömokok aşı durumları ve bu aşılara karşı algı, tutum-larına ilişkin bir anket uygulandı. Her iki aşı için endikasyon oluşturan risk faktörleri sorgulandı. Bulgular: Çalışmaya 155 hasta dahil edildi. Hastaların yaş ortalaması 70 (18-91) yıl, erkek hastaların oranı %41.3 idi. Hastaların %93.5 (n= 145)'inin hem pnömokok hem de influenza aşısı endikasyonu olduğu saptandı. Pnömokok aşısı endikasyonu olan hastaların sadece %17.2'si aşı olmuşken, influenza aşı endikasyonu olan hastaların aşılanma oranı %29.7 olarak bulundu. Aşı olan hastalara sorulduğunda; her iki aşıyı da en çok aile hekimi dışındaki hekimlerin önermesi sonucunda yaptırdıkları saptandı. Hastaların aşı olmama sebeplerinin başında bilgi yetersizliği gelmekteydi. Sonuç: Poliklinikte olduğu gibi yatan hastalarımızda da influenza ve pnömokok aşı endikasyon oranı oldukça yüksektir. Bu çalışma erişkinler için aşılanma oranlarının halen düşük olduğunu, hastaların bu konuda yeterince bilgi sahibi olmadığını ve hekimlerin gerek-tiğinde öneride bulunmadıklarını göstermiştir. Hekimlerin bu konuda farkındalığını artırmak ve her başvuruyu bir fırsat olarak değer-lendirmelerini sağlamak erişkin aşılama oranlarının artırılmasına önemli ölçüde katkı sağlayacaktır.

The role of healthcare workers in life-long vaccination is very important in the means of 2 sided... more The role of healthcare workers in life-long vaccination is very important in the means of 2 sided infection, rising patient awareness and being a role model for the patients. Numerous organizations publish guidelines for vaccination of HCWs, while healthcare facilities develop vaccination policies according to the accreditation standards. Nevertheless, vaccination rates among HCWs are far below targets.

Human Vaccines & Immunotherapeutics, 2017

The role of healthcare workers in life-long vaccination is very important in the means of 2 sided... more The role of healthcare workers in life-long vaccination is very important in the means of 2 sided infection, rising patient awareness and being a role model for the patients. Numerous organizations publish guidelines for vaccination of HCWs, while healthcare facilities develop vaccination policies according to the accreditation standards. Nevertheless, vaccination rates among HCWs are far below targets. The obstacles to getting vaccinated or recommending vaccination may include rather universal factors such as the vaccine paradox, however in the case of HCWs, probably a different set of factors are included. The aims of this article are to gain an overview of vaccination strategies for HCWs, to assess the coverage rates of HCWs and make in-depth analyses of the potential barriers to vaccination and potential factors to motivate HCWs for vaccination in Turkey and to compare them with the global picture to improve implementation of policies concerning vaccination of HCWs.

European Journal of Rheumatology, 2016

Osteoporosis -related to various factors including menopause and aging- is the most common chroni... more Osteoporosis -related to various factors including menopause and aging- is the most common chronic metabolic bone disease, which is characterized by increased bone fragility. Although it is seen in all age groups, gender, and races, it is more common in Caucasians (white race), older people, and women. With an aging population and longer life span, osteoporosis is increasingly becoming a global epidemic. Currently, it has been estimated that more than 200 million people are suffering from osteoporosis. According to recent statistics from the International Osteoporosis Foundation, worldwide, 1 in 3 women over the age of 50 years and 1 in 5 men will experience osteoporotic fractures in their lifetime. Every fracture is a sign of another impending one. Osteoporosis has no clinical manifestations until there is a fracture. Fractures cause important morbidity; in men, in particular, they can cause mortality. Moreover, osteoporosis results in a decreased quality of life, increased disability-adjusted life span, and big financial burden to health insurance systems of countries that are responsible for the care of such patients. With an early diagnosis of this disease before fractures occur and by assessing the bone mineral density and with early treatment, osteoporosis can be prevented. Therefore, increasing awareness among doctors, which, in turn, facilitates increase awareness of the normal populace, will be effective in preventing this epidemic.

Internal Medicine, 2016

Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe drug hypersensitivity react... more Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe drug hypersensitivity reaction characterized by rash, fever and multi-organ failure. Limbic encephalitis (LE) is a rare disorder characterized by cognitive dysfunction with memory disturbance, seizures and psychiatric symptoms. We herein present an unusual case of DRESS syndrome due to lamotrigine with reactivation of Epstein-Barr virus, which developed autoimmune LE and syndrome of inappropriate antidiuretic hormone secretion. Discontinuation of lamotrigine, administration of methylprednisolone and intravenous immunoglobulin led to improvement. The LE in this case might have been caused by an autoimmune inflammatory mechanism associated with DRESS syndrome.

European Journal of Internal Medicine, 2016

Immunization is one of the most effective public health measures to prevent disease. Despite rela... more Immunization is one of the most effective public health measures to prevent disease. Despite relatively good vaccination rates in childhood in many parts of the world, vaccines to prevent diseases are underused in the adult population and adult vaccination rates are still far below the target. The European Federation of Internal Medicine (EFIM), declared that 'internal medicine must focus on better care for individuals, better health care for populations and lower costs'. Adult vaccination is a good example of a public health initiative aimed at reducing morbidity and mortality, but awareness of the need for adult vaccination and uptake of the programs across Europe is variable. The Adult Vaccination Campaign in Europe (ADVICE) was developed with an aim to raise awareness for adult vaccination and to understand the dynamics of the vaccination practices and the possible barriers against achieving targeted vaccination rates in Europe. In order to reach vaccination targets, we need evidence based, up to date guidelines; recommendations at national and international levels; surveillance for vaccination rates; and opportunities to provide vaccines more readily. Leadership at a European level and a firm research and action agenda are crucial. The European Federation of Internal Medicine can take the lead as it declared its interest on 'better care for individuals, better health care for populations'. Hence, we consider ADVICE a very timely and very valuable initiative to draw a roadmap to improve adult vaccination rates in Europe.

Human vaccines & immunotherapeutics, Jan 14, 2015

Many infectious diseases in adults can be prevented by a 'life-long vaccination strategy'... more Many infectious diseases in adults can be prevented by a 'life-long vaccination strategy'. Hepatitis B disease burden was shown to be higher in diabetic patients. American Advisory Committee on Immunization Practices recommends to vaccinate diabetic patients against hepatitis B since 2011. In this study, we aimed to determine hepatitis B virus serology status to determine the rates of diabetic patients who have indications for hepatitis B vaccination. The electronic database of the hospital was searched to identify adult patients aged above 18 years and with hemoglobin A1C levels of 6.5% or above, who have been seen at General Medicine Outpatient Clinics of a university hospital during a 3-year period. A total of 5187 patients were included in the study. After exclusion of patients with an incomplete serological panel, 1358 patients were included for further analyses. Twenty-nine percent of the patients had indication for hepatitis B vaccination, whereas only 8% were vaccina...

Renal failure, Jan 4, 2015

Continuous ambulatory peritoneal dialysis (PD) has become a treatment modality for end stage rena... more Continuous ambulatory peritoneal dialysis (PD) has become a treatment modality for end stage renal disease with a peak of its use in 1990s. The aim of this study was to examine the peritonitis rates, causative organisms and the risk factors of peritonitis in a large group of patients in our center. The study was conducted in the Nephrology Department of a University Hospital in Turkey. Patients in the PD programme between January 2000 and January 2006 were included. Cohort-specific and subject specific peritonitis incidence, and peritonitis-free survival were calculated. Causative organisms and risk factors were evaluated. Totally 620 episodes of peritonitis occurred in 440 patients over the six years period. Peritonitis rates showed a decreasing trend through the years (0.79 episodes/patient-year 2000-2003 and 0.46 episodes/patient-year 2003-2006). Cohort-specific peritonitis incidence was 0.62 episodes/patient-years and median subject-specific peritonitis incidence was 0.44 episod...

Journal of Critical Care, 2015

Angiogenesis plays an important role in the pathogenesis of inflammatory diseases, but the possib... more Angiogenesis plays an important role in the pathogenesis of inflammatory diseases, but the possible role of angiogenesis in Behçet's disease (BD) has not yet been studied. The aim of this study was to determine angiostatin levels in patients with BD and the role of angiogenesis in the pathogenesis of the disease. Thirty-seven patients with BD (mean age: 28·6±5·4 years, mean disease duration: 9·3±3·7 years) and 18 healthy controls were enrolled to the study. Twenty-four patients were in active and 13 patients were in inactive stage of the disease. The mean serum angiostatin level of patients with BD was 113·9±53·2 and 60·7±20·1 ng/ml in healthy controls. The mean serum angiostatin level was 142·7±43·1 ng/ml in active and 86·9±15·5 ng/ml in inactive patients with BD. Serum angiostatin levels were significantly high in patients with BD compared with healthy controls (P<0·001) and it was significantly high in active patients compared with inactive patients with BD (P<0·001). In inactive patients with BD, serum angiostatin concentrations were found to be higher compared with healthy controls (P<0·01). In active BD patients, the mean serum angiostatin level was correlated with the deep vein thrombosis (r = 0·482, P = 0·05), uveitis (r = 0·582, P = 0·01), and arthritis (r = 0·492, P = 0·05). According to these results; elevated serum angiostatin levels in patients with BD suggest the possible role of angiogenesis in the pathogenesis of the disease and its high levels in inactive Behçet's patients is related with the continuous activation of the disease even in the subclinical period.

The clinical respiratory journal, Jan 26, 2015

Although measles is usually considered a benign viral disease of childhood, adults may be affecte... more Although measles is usually considered a benign viral disease of childhood, adults may be affected at any age and may experience severe respiratory or neurologic consequences. We present three adult cases (one of whom was pregnant) admitted to our University Hospital who were diagnosed to have measles and who had uncommon clinical features such as hepatitis and hyponatremia. All patients were markedly hypoxic; one required mechanical ventilation. Two patients received therapy with intravenous ribavirin and all patients received high dose vitamin A for three days. Therapy with intravenous ribavirin and vitamin A were well tolerated by our patients except one patient who developed acute renal failure and were associated with reversal of respiratory compromise. Life-threatening measles pneumonitis in adults may be more common than previously appreciated, regardless of the patient's immune status, and ribavirin and high dose vitamin A might be a treatment option.

Protein & Peptide Letters, 2010

Familial mediterranean fever (FMF) is a systemic disorder characterized by recurrent attacks of f... more Familial mediterranean fever (FMF) is a systemic disorder characterized by recurrent attacks of fever and polyserositis. In FMF, several pro-inflammatory cytokines have been found to be elevated during the attacks. In recent years, it is shown that some proteins originated from adipose tissue play important role in inflammatory process. One of them, adiponectin decreases the expression of adhesion molecules and inhibits the attachment of active macrophages to the endothelial surface, so that it acts antiinflammatory effect. In this study, we analyzed the possible role of serum adiponectin in the pathogenesis of FMF. Thirty five patients with FMF and 13 healthy controls (5 female,8 male; mean age 22.3 ± 4.2 years) were enrolled in this study. Fifteen patients were in active stage (6 female, 9 male, mean age; 22.4 ± 4.1 years, mean disease duration 6.1±2.3 years) and 20 patients were in inactive stage (6 female,14 male, mean age;22.6 ±4.2 years, mean disease duration; 5.7 ± 1.6 years). Serum adiponectin and IL-6 levels were determined by ELISA. The mean serum adiponectin levels were 5.3 ±1.6 ng/ml in healthy controls, 55.3 ± 21.8 ng/ml in active FMF patients and 17.1 ± 4.7 ng/ml in inactive FMF patients. The mean serum IL-6 levels were 1.9 ± 0.4 ng/ml in healthy controls, 4.7 ± 1.1 ng/ml in active FMF patients and 2.9 ± 1.3 ng/ml in inactive FMF patients. Serum adiponectin levels in patients with FMF were significantly higher than in healthy controls (p<0.001). Serum adiponectin levels were significantly high both in active FMF patients and in inactive FMF patients compared with healthy control (p<0.001, p<0.001 respectively). Serum IL-6 levels were significantly higher both in patients with active and inactive disease as compared with healthy controls (p<0.01 and p<0.05 respectively). In serum adiponectin levels were correlated with high levels of serum IL-6 in the active and inactive patients. Serum adiponectin and IL-6 levels were during both active and inactive stages in patents with FMF.

Nephrology, 2008

Peritoneal dialysis patients have diminished quality of life scores compared with healthy subject... more Peritoneal dialysis patients have diminished quality of life scores compared with healthy subjects. Measures of quality of life have been reported to have a significant predictive value for patient survival and hospitalization in peritoneal dialysis patients. The purpose of this study is to determine the clinical, biochemical and psychological predictors for the quality of life in continuous ambulatory peritoneal dialysis (CAPD) patients. This cross-sectional study included 60 CAPD patients (male/female 33/27; age 45.5 +/- 15.7 years, CAPD duration 43.4 +/- 32.7 months). Pittsburg Sleep Quality Index was used for assessing sleep quality. We evaluated each patient's depressive symptoms with Beck Depression Inventory (BDI). Quality of life parameters were assessed by the self-administered SF-36 generic health survey questionnaire. In all patients, demographic variables, personality traits and habits, Charlson Comorbidity Index, clinical and laboratory parameters were recorded and analysed. A Pearson bivariate correlation analysis revealed that total quality of life score was negatively correlated with Pittsburg Sleep Quality Index (-0.533, P < 0.0001), BDI (-0.642, P < 0.0001) scores, C-reactive protein (-0.588, P = 0.001), and positively correlated with blood urea nitrogen (0.336, P = 0.02) and albumin (0.351, P = 0.01). BDI scores (beta = -0.505, P = 0.001) and the serum albumin levels (beta = 0.324, P = 0.009) were the significant independent predictors of quality of life. Poor sleep quality, presence of depression, higher C-reactive protein and lower albumin levels are associated with poorer quality of life. In order to improve life quality in CAPD patients, quality of sleep, depression and nutritional status should be serially evaluated and given appropriate treatment when required.

American Journal of Kidney Diseases, 2006

Peritonitis is the most common complication in patients undergoing continuous ambulatory peritone... more Peritonitis is the most common complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Brucellosis is a rare cause of bacterial peritonitis. Only 1 case was reported of a patient with brucella peritonitis during CAPD therapy. In that case, CAPD peritonitis was accompanied by acute brucellosis. We present the case of a patient with isolated brucella peritonitis receiving CAPD therapy without systemic manifestations of brucellosis who works as a farmer. Results of a serum agglutination test and blood cultures were negative; however, the patient's peritoneal fluid agglutination titer was 1:160 and samples inoculated into BACTEC (Becton Dickinson, NJ) bottles yielded Brucella melitensis. Because we were unable to isolate the organism in blood samples, transmission seems to be the result of direct inoculation, rather than hematogenous spreading. Therefore, our patient represents the first case of isolated brucella peritonitis during CAPD therapy. Successful treatment was obtained by using a treatment regimen of rifampin and doxycycline. Am J Kidney Dis 47:E65-E66.