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Öğe Acute Onset Myositis Associated with Brucellosis, Quite a Rare Diagnosis(Japan Soc Internal Medicine, 2008) Celik, Aygul Dogan; Celik, Yahya; Yulugkural, Zerrin; Balci, Kemal; Utku, UfukBrucellosis is a zoonosis that is transmissible to humans. It is a disease with multi-systemic involvement caused by the genus Brucella. Neurological complications, including meningitis, meningo-encephalitis, myelitis-radiculoneuritis, brain abscess, epidural abscess and meningo-vascular syndromes, are rarely encountered. We present a patient presenting with acute onset myositis. This kind of presentation has not previously been reported in the English language literature. We conclude that the diagnosis of neuro-brucellosis should be considered in patients presenting with muscle weakness.Öğe Brucellosis Triggering Hemolytic Anemia in Glucose-6-Phosphate Dehydrogenase Deficiency(Karger, 2009) Pamuk, Gulsum Emel; Celik, Aygul Dogan; Uyanik, Mehmet SevkiObjectives: To present a case of acute brucellosis triggering acute hemolytic anemia in a subject with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Clinical Presentation and Intervention: A 17-year-old male patient presented with fever, malaise and jaundice. His blood and bone marrow cultures yielded Brucella species. In addition, he was found to have acute hemolytic anemia due to previously undiagnosed G6PD deficiency. He was started on folic acid supplementation and given a combination of doxycycline and rifampicin for 6 weeks. His response to antibiotic therapy was optimal; the hemolytic anemia resolved. There were no further episodes of hemolysis. Conclusion: This case showed that the differential diagnosis of acute hemolytic anemia in subjects with G6PD deficiency should include brucellosis, especially in regions where the infection is endemic. Copyright (c) 2009 S. Karger AG, BaselÖğe Candida glabrata: Etiologic agent of soft tissue abscess in a diabetic patient(Wolters Kluwer Medknow Publications, 2010) Celik, Aygul Dogan; Yulugkural, Zerrin; Kuloglu, Figen; Akata, Filiz[Abstract Not Available]Öğe Cost of acute ischemic and hemorrhagic stroke in Turkey(Elsevier, 2011) Asi, Talip; Celik, Yahya; Sut, Necdet; Celik, Aygul Dogan; Balci, Kemal; Yilmaz, Arif; Karaduman, FatihObjective: The aim of this study is to examine the direct medical costs and outcomes of patients with stroke. Material and methods: The records of the patients admitted with ischemic and hemorrhagic stroke to the University of Trakya, School of Medicine, Department of Neurology were reviewed retrospectively in year 2007. Direct medical costs (total costs, radiological, laboratory, medicine, and other) were calculated, additionally cost per life saved and per life-year saved were calculated for stroke patients. Results: The study group consisted of 328 patients (169 male/159 female) and mean age was 66.5 +/- 12.4 years. Length of hospital stay was 10.7 +/- 7.5 days. Mortality rate was 20.4% and the mRS score of the patients was 3.2 +/- 2.1. The average cost of stroke was US$ 1677 +/- 2964(29.9% medicine, 19.9% laboratory, 12.8% neuroimaging, and 38% beds and staff). Cost per life saved and per life-year saved were US$ 2108 and US$ 1070, respectively. Conclusion: This is the first study in order to determine direct medical cost of stroke in Turkey, therefore, it may be guideline for disease-cost management of stroke. (C) 2010 Elsevier B.V. All rights reserved.Öğe CTX-M Type Extended Spectrum ?-Lactamases in Escherichia coli Isolates From Community Acquired Upper Urinary Tract Infections at a University in the European Part of Turkey(Scientific Communications Int Ltd, 2010) Celik, Aygul Dogan; Yulugkural, Zerrin; Kuloglu, Figen; Eroglu, Cafer; Torol, Sinem; Vahaboglu, Haluk; Akata, FilizExtended spectrum beta-lactamase (ESBL) producing Escherichia coli has been an emerging etiologic agent in the community acquired infections. We investigated the occurrence of ESBL producing E. coli isolated from patients admitted with community acquired urinary tract infection (UTI) to the hospital of the Trakya University, Turkey during 2006. Eleven single patient isolates of E. coli harboring ESBL were identified among 30 E. coli isolated from patients admitted with symptoms corresponding to upper UTI. CTX-M type ESBLs were detected in all 11 ESBL-producers by isoelectric focusing and polymerase chain reaction screening. Sequence analysis revealed CTX-M-1 in one isolate, CTX-M-3 in three isolates and CTX-M-15 in seven isolates. ESBL-producing E. coli isolated from community acquired UTIs are widespread in the European parr of Turkey.Öğe Evaluation of Epidemiological Characteristics and Risk Factors of Candidemia in Adult Patients in a Tertiary-Care Hospital(Ankara Microbiology Soc, 2011) Kocak, Bahar Yenigun; Kuloglu, Figen; Celik, Aygul Dogan; Akata, FilizCandida species which are currently the fourth most common cause of nosocomial bloodstream infections, are associated with a significant morbidity and mortality. The aim of this retrospective case-control study which included adult patients was to determine the epidemiology of candidemia and to evaluate risk factors for the development of candidemia and mortality at a tertiary-care education hospital over a 1-year period. A total of 38 candidemia cases (23 were male; age range: 17-82 yrs; mean age: 61.4 +/- 13.5 years) were identified among 22.507 patients hospitalized during the study period (January 1-December 31, 2008) and the overall incidence was found as 16.8 per 10.000 hospital admissions. Control group (n= 36; 22 were male; mean age: 60.9 +/- 16.3 years) was selected among patients who had no signs and symptoms of candidemia and had negative blood cultures during the study period. Thirty-six (95%) patients with candidemia were identified as nosocomial infection. The most frequently isolated species were C.albicans (55.2%) and C.parapsilosis (28.9%) and the primarily identified origin of infection was central venous catheter use (39%). Candida spp. isolation was most frequent in patients hospitalized in intensive care units (13/38; 34.2%), followed by surgery (n= 8; 21%) and chest diseases (n= 5; 13). Univariate analysis revealed that presence of a central venous catheter [odds ratio (OR): 4.33; 95% confidence interval (Cl): 1.63-11.47, p= 0.003] and the length of hospitalization (OR: 0.97; CI: 0.94-1.00, p= 0.01) were the most frequently associated factors with an increased risk of candidemia compared to controls. However, multivariate analysis exhibited presence of a central venous catheter (OR: 2.90; CI: 1.04-8.11, p= 0.04) as the only independent risk factor for the development of candidemia. Therapy was initiated with intravenous fluconazole (mean duration of therapy 13.2 +/- 6.25 days) and in three patients following fluconazol use step-up therapy was initiated. Total mortality rate was 58% (22/38) in our case series. Risk factors for mortality due to candidemia in the univariate analysis were detected as no response to antifungal treatment (OR: 0.23; CI: 0.11-0.51, p< 0.001), underlying disease other than trauma (OR: 0.06; CI: 0.003-1.24, p= 0.02), and high Charlson index (OR: 0.60; CI: 0.38-0.93, p= 0.03), however those factors were not found significant by multivariate analysis. There was also a statistically significant correlation between Charlson index and treatment response (mean Charlson index was 3.5 +/- 1.9 in therapy-responded patients and 4.8 +/- 1.8 in non-responders; p= 0.03). Since the risk of developing candidemia was significantly higher in severely diseased patients using central venous catheter or with prolonged hospitalization, response to antifungal therapy may be insufficient, leading to higher mortality.Öğe Mediterranean spotted fever in the Trakya region of Turkey(Elsevier Gmbh, 2012) Kuloglu, Figen; Rolain, Jean Marc; Akata, Filiz; Eroglu, Cafer; Celik, Aygul Dogan; Parola, PhilippeMediterranean spotted fever (MSF) is caused by a tick-borne pathogen, Rickettsia conorii subsp. conorii, belonging to the spotted fever group (SFG) rickettsiae. The aim of the present study was to evaluate the cases with confirmed diagnosis of MSF from 2003 to 2009 in the Trakya region of Turkey. Patients with high fever, maculopapular rash (involving the palms or soles) and/or a black inoculation eschar at the site of the tick bite (tache noire) were included in the study. Before doxycycline treatment, skin biopsy specimens, preferably from the eschar or from the maculopapular rash, were obtained for DNA extraction. Immunofluorescence assay (IFA) was performed to detect IgM and IgG antibodies against R. conorii in acute and convalescent sera. Afterwards, a standard PCR reaction using primers suitable for hybridisation within the conserved region of genes coding for outer membrane protein A (ompA) and citrate synthase (gItA) and DNA sequencing were performed. There were 128 patients with confirmed MSF diagnosis. Using IFA, seroconversion or a fourfold or greater rise in titre was observed in 97(77%) patients, whereas a single high titre was demonstrated in 16(12.7%) patients. According to PCR analysis, 77(72.6%) of 106 biopsy samples showed positive results. Of these, 58(73%) of 79 biopsy specimens were from the eschar and 19 (70%) of 27 specimens were from the maculopapular rash. No significant difference was found between the rate of positive skin biopsies taken from the eschar and the maculopapular rash. DNA sequence analysis was performed to all PCR-positive cases, and R. conorii conorii (type strain: Mal ish, ATCC VR-613) was detected in each of them. MSF is prevalent, but has been underdiagnosed and underreported so far in Turkey. It is a potentially severe and even fatal disease resembling viral haemorrhagic fevers that has to be included in the differential diagnosis of febrile illness associated with thrombocytopenia, even in the absence of an eschar or a tick bite. While IFA allows for retrospective diagnosis in MSF, advanced molecular techniques provide the rapid detection of rickettsia in all skin samples, including eschar and maculopapular rash. (C) 2012 Elsevier GmbH. All rights reserved.Öğe Negative serology: could exclude the diagnosis of brucellosis?(Springer Heidelberg, 2012) Celik, Aygul Dogan; Yulugkural, Zerrin; Kilincer, Cumhur; Hamamcioglu, Mustafa Kemal; Kuloglu, Figen; Akata, FilizTwo cases of brucellar spondylodiscitis of the lumbar area were presented. Although both cases showed typical radiological changes, serological tests could not detect Brucella agglutinating antibodies. One of the patients was bacteremic and Brucella spp. was identified from blood culture. In the second patient needle biopsy was required for definite diagnosis. Although small, serologic tests have a certain rate of false negative results in brucellosis. Thus, a negative serology should not exclude the diagnosis of brucellosis, as it is demonstrated in the current cases.Öğe Screening for Hepatocellular Carcinoma: What Is Missing?(John Wiley & Sons Ltd, 2017) Mehta, Neil J.; Celik, Aygul Dogan; Peters, Marion G.While there are guidelines from all major liver societies for the screening and management of hepatocellular carcinoma (HCC), many issues remain surrounding the actual practice of screening. This review discusses how to diagnose and screen HCC and more importantly, how well we diagnose and screen for HCC. Improved survival and outcomes after HCC diagnosis depend upon accurate diagnosis of cirrhosis and the timeliness of screening. With all oral direct-acting antivirals now widely available for hepatitis C, there are increasing numbers of patients who may be cured but are still at risk of HCC. Some uncontrolled studies suggest that direct-acting antiviral therapy may even increase the risk of HCC. Before we discuss expansion of who should be screened, we need physicians to realize how poorly we screen those patients who are already recommended for screening by guidelines.Öğe Spondylodiscitis due to an emergent fungal pathogen: Blastoschizomyces capitatus, a case report and review of the literature(Springer Heidelberg, 2009) Celik, Aygul Dogan; Ozaras, Resat; Kantarcioglu, Serda; Mert, Ali; Tabak, Fehmi; Ozturk, RecepThe study includes a case report and a literature review. The main objective of this study is to present a case of spondylodiscitis due to a fungal pathogen, Blastoschizomyces capitatus and to review the published literature on this emergent fungus in etiology of spondylodiscitis, and osteomyelitis. Osteoarticular involvement due to B. capitatus has been reported in six cases, and vertebral involvement has been seen in five of them. All of these cases had underlying malignancy. Infection is usually advanced at presentation. Case notes and online databases were reviewed. Organism was isolated from bone material in all of the cases and antibiotic treatment by antifungal agents cured the infection. We present another case of infectious spondylodiscitis due to B. capitaus, which is reported first in Turkey and tried to attract attendance to this emergent fungal pathogen as an etiologic agent of spine infections in cancer patients.Öğe Successfull High PEEP Application in a Pregnant Woman with ARDS Diagnosed with H1N1 Virus Infection(Aves, 2010) Edis, Ebru Cakir; Hatipoglu, Osman Nuri; Celebi, Derya; Celik, Aygul Dogan; Uzmezoglu, Bilge; Altiay, GundenizA seven-month pregnant woman who admitted to the hospital with high fever, cough and fatigue and developed respiratory failure within one day, was admitted to the intensive care unit with the diagnosis of acute respiratory distress syndrome (ARDS) and suspected H1N1 infection. The patient, who had bilateral infi ltration on her chest X-ray, did not respond to the ventilator adjustments appropriate to ARDS, empirical Oseltamivir treatment. In spite of this treatment, her oxygenation became worse and she was treated by caesarean section. When the patient's saturation fell to 35%, 18 cmH2O pressure PEEP was implemented, then it was observed that her oxygenation began to show improvement. The patient's initial H1N1 diagnosis was confirmed. The patient's overall health returned to normal, while no serious health problem was observed in the baby. Since pregnant patients with H1N1 may develop serious respiratory failure within a very short time, we found this report significant because lung expansion may increase with section and this condition assists the treatment of using high PEEP pressures.
