Browsing by Author "Akçali, S"

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    DISTRIBUTION OF HEPATITIS C VIRUS GENOTYPES IN MANISA REGION, TURKEY
    Sanlidag, T; Akçali, S; Özbakkaloglu, B; Ertekin, D; Akduman, E
    The duration of hepatitis C virus (HCV) infection and the response to the standard therapy is strongly related to the HCV genotypes. In addition, the geographical distribution of HCV genotypes is important for the epidemiological studies in terms of distribution and possible risk groups. The aim of this retrospective study was to investigate the distribution of HCV genotypes in Manisa region (located at the Aegean part of Turkey). A total of 100 anti-HCV (microparticle EIA; Abbott Laboratories, USA) and HCV-RNA (real time RT-PCR; Applied Biosystems, USA) positive patients (53 female, 47 male; mean age: 44.4 +/- 10.4 years), who were admitted to Celal Bayar University Medical School Hospital between 2002-2005, were included to the study. Quantitative HCV-RNA levels of the patients were between 10(4)-10(8) copies/ml. Complementary DNAs obtained from HCV-RNAs isolated by Invitek RTP DNA/RNA Virus Mini Kit were used for genotyping with selected primers [primer 11 (5'-AGG TCT CTG AGA CCG TGC ACC ATG AGC AC-3') and primer 13 (5'-CTG TGA GGA ACT ACT GTC TT-3') for the first PCR; primer 12 (5'-ACT GCC TGA TAG GGT GCT TGC GAG TG-3') and primer 14 (5'-CAC GCA GAA AGC GTC TAG-3') for the second PCR]. The RT-PCR products were purified with Invisorb Spin PCRapid Kit and sequenced by BigDye Terminator v3.1 Cycle Sequencing Kit in ABI Prism 310 Genetic Analyzer. Genotype I was found in 92% of the patients (92%) and genotypes 2 and 4 were found in 7% of the patients, while HCV genotype could not be identified in one patient (1%). When evaluating the subtypes, genotype 1b was determined in 90 patients (90%), genotype 4a in five patients (5%), genotype 1 a in two patients (2%) and genotype 2a in two patients (2%). In conclusion, 1b was found to be the most common HCV genotype in Manisa region in concordance with the previous data obtained in Turkey, followed by genotype 4a, although a rare one. The data of this study is noteworthy especially for the arrangement of treatment and follow-up of HCV infected patients.
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    Clinical significance of TT virus infection in children with chronic hepatitis B
    Kasirga, E; Sanlidag, T; Akçali, S; Keskin, S; Aktas, E; Karakoç, Z; Helvaci, M; Sözen, G; Kuzu, M
    Background: The pathogenic role of TT virus (TTV) is not clear in patients with chronic hepatitis B. The aims of the present study were to determine the frequency of TTV positivity in serum and saliva samples and the possible role of TTV in children with chronic hepatitis B. Methods: Sera and saliva from 29 healthy children and 25 children with chronic hepatitis B were tested for TTV-DNA by means of real-time polymerase chain reaction (PCR). Results: Fifty-two percent (13/25) of the serum samples and 32% (8/25) of the saliva samples were positive for TTV-DNA in children with chronic hepatitis B. In healthy non-transfused children, TTV-DNA was detected in 58% (17/29) of the serum samples and 41% (12/29) of the saliva samples. Six (46%) of 13 children with chronic hepatitis and 10 (59%) of 17 healthy children had TTV-DNA positivity both in serum and saliva samples. Two serum samples were negative for TTV-DNA while the saliva samples were positive for TTV-DNA in chronic hepatitis B and control groups. Mean age, sex, serum alanine aminotransferase levels, hepatitis B virus (HBV)-DNA values were similar in TTV-positive and -negative children with chronic hepatitis B. However, total histologic activity index (HAI), periportal necrosis and portal inflammation scores were significantly higher in children with HBV-DNA and TTV-DNA viremia (P = 0.013, P = 0.008, P = 0.015, respectively). Conclusions: Because total HAI, periportal necrosis and portal inflammation scores were higher in children with TTV coinfection, TTV infection may contribute to the progression of liver damage in children with chronic hepatitis B.
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    Frequency of respiratory viruses in children with lower respiratory tract infection
    Akçali, S; Yilmaz, N; Güler, Ö; Sanlidag, T; Anil, M
    Aim: Lower respiratory tract infections (LRTI) have high morbidity rates in children. In this study, it was aimed to investigate the prevalence of respiratory viruses in children with LRTI symptoms. Material and Method: A total of 160 children who were diagnosed with LRTI between October 2009 and March 2010 were included into the study. The presence of respiratory syncytial virus (RSV) (A+B), influenza virus (A+B), parainfluenza virus (PIV) (1, 2, 3, 4), human metapneumovirus, rhinovirus and coronavirus (OC43+229E) in throat swab samples were investigated by real-time PCR The Real Accurate TM Respiratory RT PCR Kit (PathoFinder B.V., Netherlands). Results: In 67 samples (41.8%), at least one virus which could cause acute respiratory tract infection was found. Overall, RSV was the most frequently identified virus (52.2%), followed by rhinovirus (26.8%), coronavirus (5%), metapneumovirus (2.9%) and PIV 1 (1.4%). As the other viral agents, coronavirus was detected in 4 samples (5%), hMPV was detected in 2 samples (2.9%) and PIV was detected in 1 sample (1.4%). When the frequency of coinfections was evaluated, RSV-rhinovirus association was found in 4 samples, RSV-coronavirus association was found in 1 sample, rhinovirus-coronavirus association was found in 1 sample and RSV-rhinovirus-Coronavirus association was found in 1 sample. Conclusions: In 41.8% of the study group, a viral factor responsible for the clinical signs was detected. For that reason, rapid and sensitive diagnosis of viruses which lead to respiratory infections will guide the clinician for avoidance of redundant antibiotic therapy and preventing viral hospital infections.
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    Hepatitis B Virus Genotype E Infection in Turkey: The Detection of the First Case
    Sayan, M; Sanlidag, T; Akçali, S; Arikan, A
    Hepatitis B virus (HBV) infection is a global major health problem. Currently, 10 genotypes (A-J) of hepatitis B virus (HBV) are identified based on the nucleic acid sequence heterogeneity, and these genotypes have been shown to have distinct geographic distribution. Reports of the previous studies indicated that the genotype D is the predominant type among hepatitis B patients in different regions of Turkey. However, recent studies indicated that other HBV genotypes are also seen with an increasing rate. Although epidemiological and clinical information on genotype E infection is currently limited, it is known that genotype E infection is common in West and Central Africa. In this report, the first case of HBV genotype E infection in Turkey was presented. A 22-year-old Nigerian male employee who resided in Manisa for five years was admitted to Celal Bayar University Hospital Manisa, Turkey, for his routine check-up. Since HBsAg was found positive, other HBV markers were tested with a repeated serum sample. Laboratory findings were as follows; HBsAg (+), anti-HBs (-), HBeAg (-), anti-HBe (+), anti-HBc (+), anti-HCV (-), anti-HIV (-), ALT: 44 U/L and AST: 45 U/L. HBV-DNA level was detected as 700 IU/m1 by real-time PCR (Artus HBV QS RGQ Qiagen, Germany). HBV-DNA isolated from the serum sample of the patient was amplified by PCR and polymerase gene segment of HBV was directly sequenced. UPGMA method was used for phylogenetic analysis and Inno-LIPA HBV genotyping method (Innogenetics, Belgium) was performed to determine multiple HBV genotype infection. On the basis of those methods the genotype of the virus was identified as genotype E. The partial sequences of the HBV polymerase gene were loaded to the international DNA data bank (GenBank) for contribution to the global HBV surveillance. This report emphasized that besides genotype D the other HBV genotypes could be found in Turkey. Since the patient was an inactive HBsAg carrier before his residence in Turkey, this case was regarded as an imported HBV genotype E case. In conclusion, detection of different HBV genotypes, their epidemiology and molecular characteristics are important for both national and global HBV surveillance and better clinical approach.
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    Molecular Epidemiology of Hepatitis B Virus in Northern Cyprus
    Arikan, A; Sanlidag, T; Süer, K; Sayan, M; Akçali, S; Güler, E
    Identification of hepatitis B virus (HBV) strains and understanding of molecular epidemiological characteristics are important for the effective surveillance of HBV infections. Genotype D is dominant in studies performed in Turkey but it is known that cases infected with genotypes A, E, G and H also exists. In contrast, there are no data regarding the molecular epidemiologic characteristics of the HBV in Northern Cyprus. The aim of this study was to determine the distribution of genotypes and subgenotypes of HBV among the people living, educating and working in Northern Cyprus. A total of 160 cases (1.2%) who were HBsAg seropositive out of 13.892 subjects admitted to Nicosia, Near East University Hospital microbiology laboratory for the routine control and to blood center for donor screening tests between November 2011 to September 2014, were included in the study. HBV-DNA levels in the HBsAg positive cases were detected by real-time polymerase chain reaction and genotypes/subgenotypes were determined by sequence analysis of the viral pol gene (reverse transcriptase [rt] region, between 80-250. aminoacids). Sixty samples (60/160, 37.5%) were excluded from sequencing analysis due to negative and/or very low (<30 IU/ml) HBV-DNA levels, so 100 samples were included in sequence analysis. Ninety-six of those cases (13 female, 87 male; mean age: 35.51 +/- 12.88 years) were anti-HBc IgG, 95 were anti-HBe and five were HBeAg positive, with a mean HBV-DNA level of 5.36 x 106 +/- 3.58 x 107 IU/ml. As 32 (32%) samples yielded HBV-DNA level below the threshold of 1000 IU/ml, sequence analyses were unsuccesful, eventually 68 (68/160, 42.5%) samples could be phylogenetically analyzed. The distribution of HBV genotypes/subgenotypes were found as follows: 48 were (70.6%) D/D1; four were (5.9%) D/D2; one was (1.5%) D/D3, five were (7.4%) A/A1, two were (2.9%) A/A2 and eight were (11.8%) genotype E. Among the most frequent D1 strains, 60.4% (29/48) cases were from Turkish; single D/D3 strain from Benguela (Angola) and all eight genotype E strains were from Nigerian national cases. According to the data of this first study performed in TRNC on this subject, genotype D is dominant (53/68, 78%) in Northern Cyprus and consistent with the subgenotype distribution that is similar to Turkey and mediterranean basin. The prevalences of genotype A (7/68, 10.3%) and E (8/68, 11.8%) were also remarkable. In conclusion, although Northern Cyprus is an island country the heterogeneous distribution of HBV genotype/subgenotype may be contributed to the cosmopolitan characteristics of various populations from different countries who have come here for education, work or touristic purposes.
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    Comparison of interferon-gamma whole blood assay with tuberculin skin test for the diagnosis of tuberculosis infection in tuberculosis contacts
    Öztürk, N; Sürücüoglu, S; Özkütük, N; Gazi, H; Akçali, S; Köroglu, G; Çiçek, C
    Tuberculin skin test which is used for the detection of latent tuberculosis (TB), has many disadvantages such as false positivities due to cross reactions between environmental mycobacteria and BCG strain, false negativities due to immunosuppression and malpractice, and also difficulties in application and evaluation. Recently a new diagnostic test which measures the production of interferon (IFN)gamma in whole blood upon stimulation with specific ESAT-6 and CFP-10 antigens of Mycobacterium tuberculosis has been introduced. Since most of the mycobacteria other than tuberculosis and BCG strain do not contain these antigens, the detection of IFN-gamma levels indicates the specific T-cell response against M.tuberculosis. The aim of the study was to compare the tuberculin skin test and whole blood IFN-gamma assay (QuantiFERON (R)-TB Gold, Cellestis Ltd, Carnegie, Victoria, Australia) for the identification of latent TB infection in the contacts with active TB patients. The tests results were evaluated by using Kappa (K) analysis, and K coefficients of < 0.4, 0.4-0.75 and > 0.75 were accepted as poor, moderate and excellent agreements, respectively. A total of 233 subjects from three risk groups were included to the study. Group 1 included the household members (n=133) who had contact with smear positive index cases, Group 2 included the subjects from community (n=46) who had contact with smear positive index cases, and Group 3 included health care workers (n=74) who had contact with TB patients or their specimens. The positivity rates of tuberculin skin test and IFN-gamma assay in the cases were found as 37% and 42%, respectively. There were no significant differences among the three patient groups with regard to the results of the tuberculin skin test (p > 0.05). However, the positive result of the IFN-gamma assay in Group 1 was found statistically higher than the other groups (51.3%, p=0.013). A poor agreement between the two tests was detected in the results taken from 233 subjects (65.7%, K=0.28), while agreement was moderate in unvaccinated group (72.7%, K=0.44). Evaluation of agreement rates of the tests according to the risk groups yielded 64.6% (K=0.3) for Group 1, 71.7% (K=0.32) for Group 2, and 63.5% (K=0.21) for Group 3, which all coefficients showed poor agreement. Although IFN-gamma blood assay has many advantages such as objective and quantitative results, no interference with vaccination due to the use of specific antigens and being practical, the high cost and the need for well-equipped laboratory are its disadvantages. As a result it was concluded that, IFN-gamma blood assay has limited value for the detection of latent TB infection in our country, since the prevalence of TB infection and BCG vaccination rates are high in Turkey.
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    Investigation of the Correlation Between Anti-HCV Levels (S/Co) with HCV-RNA in the Diagnosis of Hepatitis C Virus (HCV) Infection
    Sanlidag, T; Akçali, S; Ecemis, T; Süer, K; Erbay Dündar, P; Arikan, A; Güvenir, M; Güler, E
    Detection of borderline and/or low positive anti-HCV results by enzyme immunoassay (EIA) leads to severe problems in routine laboratories and needs confirmation with nucleic acid amplification tests which can increase the cost. In EIA tests, if the ratio of sample to cut-off (S/Co) is >= 1, the sample is accepted as positive according to the manufacturers' instructions. Although over the last decade the application of S/Co values have also applied to HCV-RNA readings, the current study aims to determine whether the S/Co value is adequate and applicable for the anti-HCV EIA test, and to determine whether a correlation exists between HCV-RNA and HCV infections. A total of 658 cases (402 female, 256 male; mean age: 49.4 +/- 17.0 years) who were found anti-HCV positive between January 2011-July 2013 were included in the study. Anti-HCV tests were performed by chemiluminescent EIA (Architect i2000SR, Abbott, USA and LiaisonXL Murex, DiaSorin, Italy) and HCV-RNA by real-time PCR (Cobas Ampliprep/Cobas TaqMan HCV, Roche, USA). The mean S/Co value of the cases was 7.3 +/- 4.8 (range: 1.00-17.59) and mean HCV-RNA value was 2.3x10(5) +/- 2.1x10(6) copies/ml. When the anti-HCV S/Co value of varying ranges was compared with HCV-RNA readings a particular trend was noted. In the anti-HCV S/Co values of 1.0-4.0; 4.1-7.0; 7.1-10.0; 10.1-13.0; 13.1-16.0 and (3)16.1, HCV-RNA positivity rates were detected as 1.9%, 24.7%, 37.1%, 46.7%, 56.4% and 75%, respectively. Statistical analysis indicated an intermediate positive correlation (r=0.454) between anti-HCV ve HCV-RNA readings (p=0.000). An adequate S/Co value was accepted as 5.0 based on the ROC analysis, and this value gave a performance confidence level of 95.6% when determining whether a patient is HCV positive. Based on the data of this study it became evident that further EIA testing is not required if the S/Co value is >= 5.0, however if the S/Co value is less than 5.0, then further clinical analysis and revaluation of the patient is required.
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    Complement C1, C3 and C4 levels in sera of leishmaniasis cases in Turkey
    Limoncu, ME; Sanlidag, T; Balcioglu, IC; Akçali, S; Özensoy, S; Özbel, Y
    Leishmaniasis is still a problem for many countries including developed ones. The subgroups of the serum complements have significant roles on the onset of the infection. The aim of this study was to determine the serum complement (C1, C3, C4) levels of cases with definite diagnosis of leishmaniasis and compare them with healthy controls. The study group included 43 visceral leishmaniasis (VL) and 13 cutaneous leishmaniasis (CL) cases. Two control groups were formed for the study. The first control group included 50 individuals of the same age group having no health complaints, admitted for routine control and found to be serologically negative. The second control group included 28 individuals, consistent with the diagnostic criteria of VL. The serum complement levels of C1, C3 and C4 were measured by the nephelometric method. The average levels of C1 were found to be high in VL cases (78.98%) and low in CL (41.69%) group, which was statistically significant (p=0.011). In addition, the average levels of C3 were high in CL group (96.08%) and low in VL group (62.00%), which was also statistically significant (p=0.010). C4 levels were found to be high in the control group, while similar in VL and CL groups. C1, C3, C4 levels were found to be lower in the first control group of healthy individuals. The levels of the subgroups of complement system show statistically significant in both VL and CL cases, which suggested that they could be useful in verifying the results of the serological examinations.
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    β2-Microglobulin Levels in Hepatitis C Virus Infection
    Sanlidag, T; Akçali, S; Tosun, I; Özbakkaloglu, B
    The aim of this study is determine the relation between the beta(2)-microglobulin level and hepatitis C virus (HCV) infection. 77 haemodialysis (75.0% anti-HCV positive, 25% anti-HCV negative) and 34 control patients (58.8% anti-HCV positive, 41.2% anti-HCV negative) were evaluated in this study. The HCV antibodies were tested by using the enzyme immune assay (EIA) (UBI-HCV 4.0 Organon teknika) and the serum beta(2)-microglobulin levels were also tested by nephelometric assay (Dade Behring). beta(2)-microglobulin levels were measured higher than the normal value in three of 20 positive anti-HCV antibodies patients, and also higher in one of 14 negative anti-HCV antibodies patients. HCV antibodies was found positive in 58 of 77 haemodialysis patients. In this group, beta(2)-microglobulin levels were higher than the normal value in 39 patients. In nine of 19 haemodialysis patients, which have negative HCV antibodies, beta(2)-microglobulin levels were elevated. In patient group, beta(2)-microglobulin levels were elevated 12.4 fold in haemodialysis and 2.7 fold in HCV positivity. Multipl variants were also analyzed. Haemodialysis alone (independent from HCV seropositivity) was increased the level of beta(2)-microglobulin in 11.7 (3.7-36.8) (p<0.05) fold, however, HCV positivity alone (independent from haemodialysis) was increased the level in 2.3 fold (0.9-5.9) and this value was statistically insignificant (p>0.05). As a conclusion, the relation of haemodialysis and beta(2)-microglobulin levels were found statistically significant. In additionaly, the effect of HCV positivity in elevation of beta(2)-microglobulin levels should be investigated in wide series.
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    Antibody Sustainability in SARS-CoV-2 Healthcare Professionals' Patient Cohort
    Eser, E; Akar, SS; Akçali, S; Ecemis, T; Dündar, PE; Çiçek, K; Akman, D; Tüzün, E; Erkekoglu, GS; Buran, ZC; Arikan, ZÖÖ; Yalçin, FK
    In this study, it was aimed to evaluate one-year follow-up of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) specific antibodies formed against the virus binding site, in a coronavirus disease-2019 (COVID-19) positive case cohort (n= 413) between the period March 2020 to December 2020 in Manisa Celal Bayar University Hospital, until July 2021. SARS-CoV-2 antibodies were determined by the chemiluminescent enzyme immunoassay (CLIA) method. Values of 1.0 and above were considered positive. Chi-square tests and Joinpoint regression analysis (version 4.7.0) were used in the statistical analyses. The mean age of the participants was 34.9 +/- 9.3 and 60.2% of them were women. Between 21-30 days after the diagnosis of COVID-19, total antibody level was above the threshold value in 72.2% (n= 126) of the participants, while this rate increased to 79.1% (n= 240) in 31-60 day interval. In the following period, this rate decreased to 38.8% (n= 108) in days 211st to 240th. Antibody response could not be detected in 76 (20.7%) of 367 employees who have initially been followed up. The percentage of total antibody positivity prevalence ranged from 98.9% to 96.1% in the 31-210th day after diagnosis, in the follow-up of 291 employees whose total antibody positivity was detected after diagnosis. According to the results of the Joinpoint regression analysis, after the diagnosis of COVID-19, the curve showing the percentage of antibody positivity was broken at two points: The first breaking point was observed in 181-210th days (6-7 months) (p= 0.069), and the second breaking point was in 271-300th days (9-10 months) (p< 0.001). As a result, the highest antibody positivity rates were detected after the 30th day of the disease onset and antibody positivity was maintained in the first seven months after diagnosis; the antibody positivity rate decreased to 25% at the end of the first year.
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    Comparison of Two Different Commercial SARS-CoV-2 PCR Diagnostic Kits
    Senol Akar, S; Akçali, S
    Introduction: In our country RT-PCR is the only method used to diagnose COVID-19 infection, caused by SARS-CoV-2, one of the greatest epidemic in world history. In this study we aimed to compare two most frequently used commercial diagnostic kits. Materials and Methods: A total of 100 samples which were referred to our laboratory were used in this study. These nucleic acid samples were diagnosed as positive (50) or negative (50) by Coronex (R) COVID-19 (Ver.2.0) Multipleks RT-qPCR Diagnosis Kit (DS Bio and Nano Technology, Ankara, Turkey) and kept at -20 degrees C. The samples were cross checked with RealStar (R) SARS-CoV-2 RT-PCR Kit 1.0 (Altona Diagnostic, Hamburg, Germany). Extraction of the samples was performed by QlAsymphony (Qiagen, Hollanda). Data was evaluated with kappa analysis and t test. Results: All of the 50 positive samples were positive with Real Star (R) as well. Two of the negative samples were found positive when studied with Real Star (R) . There was a high concordance between the two kits (Kappa= 0.96). Mean Ct values were found as 24.1 +/- 4.9 and 19.6 +/- 4.2 for Real Stat (R) and Coronex (R), respectively. The Ct value was found less than 20 in 51.9% of the 52 positive samples studied with Real Star (R). Conclusion: There is a high concordance between the two commercial kits. Both kits may be used with confidence in symptomatic patients for the diagnosis of COVID-19.
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    Seasonal Trends and Interactions of Viral Pathogens in Children Presenting with Acute Respiratory Tract Infections in the Advancing Periods of SARS-Cov-2 Pandemic
    Türkmen Recen, Ö; Gazi, H; Bayturan Sen, S; Bal, A; Akçali, S
    Although various bacteria and viruses have been identified in the etiology of acute respiratory tract infections (ARI), 90% of acute ARIs that develop in children are of viral origin. The aim of this study was to investigate the seasonal trends and interactions between infectious agents and to determine the risk factors associated with ARI in children aged 1-15 years admitted to the Pediatric Emergency Department of Manisa Celal Bayar University Hospital in the advancing periods of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic. To determine the bacterial and viral agents, samples were taken from 314 patients attending to the hospital with symptoms suggestive for ARI, between 06/01/2021 and 05/31/2022. Viral and bacterial agents were identified by multiplex polymerase chain reaction (PCR) and automated identification system, respectively. Demographic data of the participants and possible risk fac- tors for ARI were recorded in the questionnaires. In the study, viral agents were detected in 77.3% of the children, and the most common infectious agent was rhinovirus/enterovirus (RV/EV) (36.3%), followed by influenza viruses (11.2%), and SARS-CoV-2 (10.5%). While RV/EV positivity was found to be higher in children with moderate and below average (p< 0.001) hand hygiene, influenza positivity was found higher in those attending school/preschool institution (p< 0.001) and whose mothers working full-time (p< 0.001). Respiratory syncytial virus positivity was associated with maternal smoking (p= 0.013) and home overcrowding (p= 0.014). Bacterial colonization was detected in 33 (11.6%) of 284 children whose swabs were taken for both bacterial and viral agents and the most frequently detected agents were Staphylococcus aureus (60.6%) and Pseudomonas aeruginosa (15.2%). Having siblings (p= 0.008) and maternal smoking (p= 0.012) were found to be associated with the detection of bacterial agents. In this study, in the advanced period of the pandemic, the most detected agents and seasonal characteristics were found to be similar to the pre-pandemic period. It is thought that knowing the regional etiology and risk factors will contribute to taking the necessary local control and protective measures.
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    Efficacy of Homologous and Heterologous Vaccine Applications on SARS-CoV-2 Omicron Variant: Cohort of Manisa Celal Bayar University Healthcare Workers
    Çiçek, K; Özkaya, Y; Eser, E; Buran, ZC; Öztürk Arikan, ZÖ; Akçali, S; Erbay Dündar, P; Cengiz Özyurt, B; Senol Akar, S; Özer, D; Karadag Yalçin, F
    This study was aimed to determine the efficacy of homologous (only CoronaVac or only Pfizer-BioN- Tech) and heterologous (CoronaVac and Pfizer-BioNTech) vaccines during the period when the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) Omicron variant was dominant in T0rkiye. Coro- navirus disease-2019 (COVID-2019) infection was confirmed by reverse transcriptase polymerase chain reaction and data on vaccination status against COVID-19 were evaluated during the period of 15 January 2022-1 May 2022 when the SARS-CoV-2 Omicron variant was dominant among 1854 employees fol- lowed in the SARS-CoV-2 Vaccine Cohort of Manisa Celal Bayar University (MCBU) Hospital Health Work-ers. Two separate reference groups were used in the evaluation of vaccine efficacy: those who were never vaccinated and those who received only two doses of CoronaVac. The efficacy of homologous and heter- ologous vaccine models was evaluated with relative risks and attributable risk percentages. MS Excel, SPSS 23.0 and STATA 14.1 package programs were used for statistical analysis. The mean age of the participants was 36.6 +/- 10.0. During the period from January 15th to May 1st 2022, 372 hospital workers were infected with COVID-19. Taking the never vaccinated as the reference group, the most effective model was found to be only the three or more doses of the Pfizer-BioNTech primary vaccination model (85.8%, 95% CI= 40.7-96.6). Models consisting of a single dose of CoronaVac (6.5%, 95% CI=-56.3-44.2) or a single dose of Pfizer-BioNTech (17.7%, 95% CI=-30.2-48.0) booster dose administered after two doses of primary CoronaVac vaccination was not found to be effective against the SARS-CoV-2 Omicron variant. When only two doses of primary CoronaVac vaccination model was taken as the reference group, the model consist-ing of two doses CoronaVac followed by two Pfizer-BioNTech booster doses was effective as 38.4% (95% CI= 15.4-55.3), whereas three doses of Pfizer-BioNTech booster model was effective as 56.4% (95% CI= 33.9-71.3). To conclude, none of the models other than the homologous or heterologous vaccine models containing at least three doses of Pfizer-BioNTech vaccine were effective compared to those unvaccinated. Compared with those who received only two doses of primary Coronavac, models with at least three dos-es of Pfizer-BioNTech reminder doses were more effective against the Omicron variant than other models.
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    In vitro susceptibility of Staphylococcus aureus and coagulase-negative Staphylococcus strains to fusidic acid
    Tünger, Ö; Arisoy, A; Kurutepe, S; Akçali, S; Özbakkaloglu, B
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    Factors Affecting Side Effects, Seroconversion Rates and Antibody Response After Inactivated SARS-CoV-2 Vaccination in Healthcare Workers
    Senol Akar, S; Akçali, S; Özkaya, Y; Gezginci, FM; Cengiz Özyurt, B; Deniz, G; Karadag Yalçin, F; Özer, D; Dündar Erbay, P; Eser, E
    In this study, it was aimed to prospectively evaluate the efficacy, side effects and seroconversion data of inactive severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), CoronaVac (R) (Sinovac, China) vaccine in healthcare workers. A total of 1053 healthcare workers who were initially seronegative (COV2T (R) SARS-CoV-2 Total Siemens, USA) and vaccinated with inactivated SARS-CoV-2 were included in the study. Quantitative IgG antibodies (ADVIA Centaur (R) SARS-CoV-2 IgG, Siemens, USA) were investigated 28 days after the first vaccine (n=939) and the second vaccine (n=771). In addition, neutralizing antibodies were evaluated via enzyme linked immunosorbent assay (ELISA) test (ACE2-RBD Neutralization Assay, Dia-Pro, Italy) 28 days after the first vaccine. Antibody response of the vaccine was evaluated statistically by univariate (Chi-square, Fisher's exact test, Student's t test, Mann-Whitney U, one-way ANOVA and Kruskall Wallis ANOVA tests) analysis and linear regression models. The consistency between quantitative IgG test and neutralizing antibody test was also evaluated in blood samples taken 28 days after second vaccination. Statistical analysis was determined in logarithmically transformed data with statistical analysis with SPSS 23.0 and Stata, and type 1 error level was accepted as 0.05. At least one side effect was reported by 31.3% and 26.8% of the participants after the first and second vaccine, respectively. The most frequent side effect was pain at the injection site with a frequency of 20.4% vs 21.7%. The frequency of applying to a health center due to side effects was 1.0% after the first vaccine and 0.8% after the second vaccine. The percentage of those who produced sufficient quantitative IgG was found as 25.3% (95% CI=22.5-28.1) 28 days after the first vaccine and 97.9% (95% CI=96.9198.93) after the second vaccine. Neutralizing test antibody positivity was found as 97.7% 28 days after the second vaccine. In univariate analysis, the characteristics that significantly increased the quantitative IgG response against inactivated SARS-CoV-2 vaccine were young age (p<0.01), female gender (p< 0.01), being a non-smoker (p<0.001), not having a chronic disease (p=0.019), having had the flu vaccine this year (p=0.012), not being overweight or obese (p=0.020), and having a SARS-CoV2 infection prior to vaccination (p<0.001). In addition, allied health personnel showed significantly lower antibody responses than the other workers (p<0.001). Multiple linear regression models revealed that, female gender, younger age, smoking and previous COVID-19 polymerase chain reaction test positivity significantly affected the quantitative IgG response after vaccination. A 99% agreement was found between the ELISA-based neutralizing antibody test and the quantitative IgG test (Kappa p=0.783) performed on the 28th day after the second vaccination. CoronaVac (R) provides adequate antibody response in 25% of healthcare workers aged 18-64, after 28 days from a single vaccine, and 97% after 28 days from the second vaccine. Antibody response was significantly higher in younger ages, women, non-smokers, and those who had previously encountered SARS-CoV-2. Phase 3 and phase 4 results are needed to show effectiveness of this vaccine in real life.
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    The Threshold Value of Anti-HCV Test in the Diagnosis of HCV Infection
    Ecemis, T; Akçali, S; Dündar, PE; Sanlidag, T
    Objective: The initial step in the diagnosis of hepatitis C virus (HCV) infection is to screen for anti-HCV antibody, followed by confirmation of positive results with nucleic acid amplification tests. In the recent studies, using reactivity threshold, S/Co (signal to cut-off) ratio greater than 1 has yielded results that are highly consistent with HCV-RNA test. We aimed to determine the most appropriate S/Co level for anti-HCV enzyme immunoassay (ETA) that would predict HCV infection. Material and Methods: We compared the results of 387 patients acquired by Anti-HCV using microparticle ETA and HCV-RNA using hybridization methods. Taking the HCV-RNA test as gold standard for HCV infection, the sensitivity, specificity and predictive values of ETA test were determined and receiver operating characteristic (ROC) analysis was performed to detect the best threshold of reactivity. Results: ETA test showed 197 (49.2%) positive and 190 (50.9%) negative results, and the sensitivity and specificity were calculated as 94.9% and 60.4%, respectively. Positive and negative predictive values were 38.1% and 97.9%, respectively. ROC analysis revealed that the best S/Co level was 5 and, based on this value, sensitivity and specificity were 92.4% and 76.6%, respectively. Computed positive predictive value was 50.3% and negative predictive values was 97.5%. Conclusion: We investigated the best values of reactivity for anti-HCV ETA test and found S/Co >= 5.
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    Impact of hemostatic gene single point mutations in patients with non-diabetic coronary artery disease
    Var, A; Ütük, O; Akçali, S; Sanlidag, T; Uyanik, BS; Dinç, G
    Single point mutations in the genes coding for hemostatic factors were shown to be major inherited predisposing factors for venous thromboembolism. However, their contribution in the development of non-diabetic coronary artery disease [nDCAD] remains controversial. Angiographically demonstrated nDCAD patients (n = 86) and healthy controls (n = 90) were included in the study. Genotype analysis of hemostatic gene polymorphisms were assessed by using CVD strip assay, based on allele specific oligonucleotide probes. The carrier frequency of factor V (FV) H1299R, prothrombin G20210A, glycoprotein (Gp) IIIa L33P, plasminogen activator inhibitor-I (PAI-1) 4G/5G, 4G/4G, 5G/5G, methylenetetrahydrofolate reductase (MTHFR) A1298C and beta-fibrinogen -455 G > A were similar between patients and controls. In contrast, frequency of FV Leiden was significantly higher among patients (12.5%) than controls (5%, OR: 7.94; 95%CI: 1.9-49.6) and FXIII V34L was significantly lower among patients (23.7%) than controls (40%, OR: 0.24; 95%CI: 0.1-0.89). In addition, the frequency of the MTHFR C677T polymorphism was 32.5% among patients compared with 42.5% in controls, of which the T/T genotype was significantly lower among patients (5%) than controls (17.5%, OR: 0.06; 95%CI: 0.01-0.58). No difference was observed in prevalence of prothrombin G20210A, FV H1299R, Gp IIIa L33P, PAI-1 4G5G, MTHFR A1298C, beta fibrinogen 455 G > A mutations between patients and controls. However, lower frequency of FXIII Val34Leu and MTHFR C677T polymorphisms may decrease, while FV Leiden polymorphism may increase development of nDCAD.
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    Lung Cancer and the Relationship Between Lung Cancer - Human Metapneumovirus
    Kaya, E; Coskun, AS; Akçali, S; Çelik, P; Sanlidag, T; Yorgancioglu, A
    It is aimed to investigate the prevelance of human metapneumovirus (hMPV) in bronchial lavage and blood samples of patients with lung cancer and the relationship between hMPV and lung cancer. Seventy patients with lung cancer and 30 healthy controls were included in the study. Bronchial lavage from patients with lung cancer and blood samples from patients with lung cancer and healthy controls were investigated for presence of hMPV with PCR. The mean age of 65 (93%) male and 5 (7%) female cases was 61.44 +/- 9.65 (44-81) in lung cancer patients. In control group the mean age of 20 (67%) male and 10 (33%) female cases was 51 (40-55). There were 54 (77%) nonsmall cell lung carcinoma (NCCLC) and 16 (23%) small cell lung carcinoma (SCLC). Nine (54%) patients with SCLC were staged as limited disease. Diagnosis of patients with NSCLC were 22 (41%) squamous cell carcinoma, 14 (26%) adenocarcinoma, 2 (4%) others. In 16 (29%) patients, histological type of the cancer was not identified. The number of patients with NSCLC was 2 (4%) in stage I, 1 (1%) in stage II, 2 (4%) in stage IIIA, 27 (50%) in stage IIIB, and 16 (30%) in stage IV. hMPV was not found in bronchial lavage and blood samples in patients with lung cancer and blood samples in controls with PCR method. Although it is estimated that the study population is at risk for hMPV presence because of old age, immune deficiency and smoking, no relationship between hMPV and lung cancer was observed. This may be a result of the small number of study population, absence of symptoms or methodological problems.
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    Miller Fisher Syndrome/Pharyngeal-Cervical-Brachial Variant of GBS Overlap and Human Herpes Virus-6 Reinfection: May There BE A Relationship?
    Mavioglu, H; Kisabay, A; Sari, S; Akçali, S; Oktan, B
    Miller Fisher Syndrome (MFS) is a rare variant of Gulliain Barre syndrome (GBS) characterized by external ophthalmoplegia, ataxia, areflexia, and usually by positive anti GQ1b antibody. It occurs through an autoimmune mechanism most frequently after Campylobacter jejuni, followed by Haemophilus influenzae infection. Although occurrence with other viruses and bacteria has been reported, the concurrence of MFS and Human Herpes Virus-6 (HHV-6) has not been reported so far. There are a few publications reporting association of GBS with HHV-6. In the present study, HHV-6 DNA with PCR was detected in the cerebrospinal fluid (CSF) of a 59 year-old female patient diagnosed with MFS/pharyngeal-cervical-brachial variant of GBS overlap from clinical findings and positive anti-GQ1b antibody in the serum. This article aims to create awareness of a possible relationship between MFS, GBS and HHV-6.
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    Common viral etiologies of community acquired lower respiratory tract infections in young children and their relationship with long term complications
    Yüksel, H; Yilmaz, Ö; Akçali, S; Sögüt, A; Çiftdogan, DY; Urk, V; Ertan, P; Sanlidag, T
    Viral lower respiratory tract infections (LRTIs) and their late complications are important causes of morbidity and mortality in childhood. The aims of this study were the detection of viral agents that cause community-acquired LRTIs in young children and investigation of the relationship between viral etiology and bronchiolitis obliterans (130) which is one of the late complications of LRTIs. A total of 151 children (86 male, 65 female; mean age: 2.9 +/- 1.9 years) who were diagnosed to have LRTIs between the period of 2002-2004, at Pediatric Allergy and Pulmonology Department of a University Hospital in Manisa (located in the Aegean region of Turkey) were included to the study. The presence of respiratory viruses [respiratory syncytial virus (RSV), influenza virus type A and B, parainfluenza virus types 1, 2 and 3, adenovirus] in the nasopharyngeal aspirate specimens collected from children have been searched by direct fluorescence antibody test (Biotrin, Ireland). Respiratory viruses were detected in 25.2% (38/151) of the patients with LRTIs, while this rate was 46.8% (22147) for 2002 period, 13.3% (8/60) for 2003 period and 18.2% (8/44) for 2004 period. RSV and adenoviruses both detected with a frequency of 31.5% (n = 12/38); were the most common agents encountered, and followed by parainfluenza (110/38, 26.3%) and influenza (9/38, 23.6%) viruses. Postinfectious BO have been diagnosed in 7.3% (11/151) of the patients; seven in 2002, one in 2003 and three in 2004 periods. Viral etiology were present in all of the patients who developed BO in 2002, while viral infection was detected in one of the patients who developed BO in 2003-2004 periods. Adenoviruses were the most frequently detected agents (n = 5) in BO cases with viral etology (n = 8). Viral agents were found positive in 72.7% (8/11) and 21.4% (30/140) of the patients with and without BO development, respectively, and this difference was found statistically significant (p = 0.02). Besides, BO development was detected in 21.1% (8/38) and 2.6% (3/113) of LRTI patients with and without viral etiology, respectively, and this difference was also significant (p<0.05). In conclusion, the long term follow-up is important in young children with viral LRTIs for the early diagnosis of complications. Thus the identification of viruses might aid in estimation of prognosis.