Browsing by Author "Uzun, B"

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    An Alternative Biphasic Nutrient Medium for the Diagnosis of Cutaneous Leishmaniasis
    Gökmen, AA; Öncel, K; Özdemir, OA; Pektas, B; Çavus, I; Güngör, S; Uzun, B; Kaya, S; Karaca, S; Yula, E; Demirci, M; Özbilgin, A
    Cutaneous leishmaniasis (CL) caused by the Leishmania spp. parasites, is a disease characterized by nodulo-ulcerative lesions in the skin. CL is transmitted to humans by infected sandflies during blood sucking, and is endemic in about 98 countries over the world. The demonstration of amastigotes via microscopic examination, and the growth of promastigotes in NNN (Novy-MacNeal-Nicolle) medium are gold standard methods for laboratory diagnosis. The aim of this study was to compare the biphasic NNN medium that is frequently used in routine laboratories with the biphasic nutrient medium that can be prepared easily in microbiology laboratories, for the growth of promastigotes. In the study, the aspiration fluid sample was used as clinical sample which was obtained from the skin lesion of a 47-year-old female patient admitted to Izmir Katip Celebi Ataturk Education and Research Hospital dermatology outpatient clinic and pre-diagnosed as CL. The aspirate sample taken from the lesion was evaluated with microscopy, cultivation in two different media and real-time polymerase chain reaction (Rt-PCR) methods. In microscopic examination Leishmania amastigotes were observed in Giemsa-stained smears prepared from the aspiration fluid. In Rt-PCR performed by using specific primers and probes targeting ITS1 region of Leishmania parasite, a melting-curve compatible with L.tropica was detected. For cultivation, triple inoculations of the aspirate sample into NNN (NNN + RPMI 1640 + 10% fetal calf serum) and nutrient media (nutrient agar + nutrient broth + 10% fetal calf serum) were used. The cultures were incubated at 27 degrees C for 10 days, and the number of propagated promastigotes were counted on the third, seventh and tenth days. The growth of Leishmania promastigotes was detected in both media on the third day. The number of promastigotes grown in NNN medium on the third, seventh and tenth days were 10(5)/ml, 10(6)/ml and 10(8)/ml, respectively. Those values in nutrient medium were 10(6)/ml, 10(7)/ml and 10(8)/ml on the third, seventh and tenth days, respectively. Although the number of promastigotes on the third and seventh days were higher in nutrient medium than NNN medium, the number of cultivated promastigotes were equal on the tenth day. As a result, nutrient medium is considered to have an impact in the diagnosis of CL, by providing an alternative to the routine medium used and can readily be available in microbiology and parasitology laboratories with long shelf-life. It was concluded that biphasic nutrient medium could be used as a supplementary medium for diagnosis in laboratories in the absence of NNN medium or can not be provided.
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    Comparative Evaluation of the Treatment of COVID-19 with Multicriteria Decision-Making Techniques
    Yildirim, FS; Sayan, M; Sanlidag, T; Uzun, B; Ozsahin, DU; Ozsahin, I
    Objectives. The outbreak of coronavirus disease 2019 (COVID-19) was first reported in December 2019. Until now, many drugs and methods have been used in the treatment of the disease. However, no effective treatment option has been found and only case-based successes have been achieved so far. This study aims to evaluate COVID-19 treatment options using multicriteria decision-making (MCDM) techniques. Methods. In this study, we evaluated the available COVID-19 treatment options by MCDM techniques, namely, fuzzy PROMETHEE and VIKOR. These techniques are based on the evaluation and comparison of complex and multiple criteria to evaluate the most appropriate alternative. We evaluated current treatment options including favipiravir (FPV), lopinavir/ritonavir, hydroxychloroquine, interleukin-1 blocker, intravenous immunoglobulin (IVIG), and plasma exchange. The criteria used for the analysis include side effects, method of administration of the drug, cost, turnover of plasma, level of fever, age, pregnancy, and kidney function. Results. The results showed that plasma exchange was the most preferred alternative, followed by FPV and IVIG, while hydroxychloroquine was the least favorable one. New alternatives could be considered once they are available, and weights could be assigned based on the opinions of the decision-makers (physicians/clinicians). The treatment methods that we evaluated with MCDM methods will be beneficial for both healthcare users and to rapidly end the global pandemic. The proposed method is applicable for analyzing the alternatives to the selection problem with quantitative and qualitative data. In addition, it allows the decision-maker to define the problem simply under uncertainty. Conclusions. Fuzzy PROMETHEE and VIKOR techniques are applied in aiding decision-makers in choosing the right treatment technique for the management of COVID-19.
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    Capacity Evaluation of Diagnostic Tests For COVID-19 Using Multicriteria Decision-Making Techniques
    Sayan, M; Yildirim, FS; Sanlidag, T; Uzun, B; Ozsahin, DU; Ozsahin, I
    In December 2019, cases of pneumonia were detected in Wuhan, China, which were caused by the highly contagious coronavirus. This study is aimed at comparing the confusion regarding the selection of effective diagnostic methods to make a mutual comparison among existing SARS-CoV-2 diagnostic tests and at determining the most effective one. Based on available published evidence and clinical practice, diagnostic tests of coronavirus disease (COVID-19) were evaluated by multi-criteria decision-making (MCDM) methods, namely, fuzzy preference ranking organization method for enrichment evaluation (fuzzy PROMETHEE) and fuzzy technique for order of preference by similarity to ideal solution (fuzzy TOPSIS). Computerized tomography of chest (chest CT), the detection of viral nucleic acid by polymerase chain reaction, cell culture, CoV-19 antigen detection, CoV-19 antibody IgM, CoV-19 antibody IgG, and chest X-ray were evaluated by linguistic fuzzy scale to compare among the diagnostic tests. This scale consists of selected parameters that possessed different weights which were determined by the experts' opinions of the field. The results of our study with both proposed MCDM methods indicated that the most effective diagnosis method of COVID-19 was chest CT. It is interesting to note that the methods that are consistently used in the diagnosis of viral diseases were ranked in second place for the diagnosis of COVID-19. However, each country should use appropriate diagnostic solutions according to its own resources. Our findings also show which diagnostic systems can be used in combination.
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    Efficacy Evaluation of Antiretroviral Drug Combinations for HIV-1 Treatment by Using the Fuzzy PROMETHEE
    Sayan, M; Ozsahin, DU; Sanlidag, T; Sultanoglu, N; Yildirim, FS; Uzun, B
    The Human Immunodeficiency Virus (HIV) causes disease by damaging the immune system. If treatment is not initiated, the immune system collapses and this leads to Acquired Immune Deficiency Syndrome (AIDS). The drugs used in the treatment of HIV infection slow or stop the damage caused by the virus to the immune system. In this study, we analyzed the treatment options of HIV since there are many antiretroviral drug combinations available for the treatment and each combination has different properties. The variety of different combinations can cause confusion for physicians in practice. Based on this aim, we proposed the fuzzy PROMETHEE technique, a multi-criteria decision making technique based on mutual comparison of the options. The most common antiretroviral drug combinations used in the HIV treatment were evaluated and compared corresponding to their parameters by the PROMETHEE technique. According to our results, integrase-based inhibitor drug combinations were predominantly preferred. BIC + TAF/FTC (bictegravir + tenofoviralafenamide/emtricitabine) outranked the other antiretroviral drug combinations with a net flow of 0.0437, followed by DTG + ABC/3TC (dolutegravir + abacavir/lamivudine) then DTG + TAF/FTC (dolutegravir + tenofoviralafenamide/emtricitabine). The results obtained with the application of decision-making theories on these option treatment methods will provide significant information for relevant patients, HIV treatment specialists and drug-makers.
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    Evaluating the Efficacy of Adult HIV Post Exposure Prophylaxis Regimens in Relation to Transmission Risk Factors by Multi Criteria Decision Method
    Sayan, M; Sanlidag, T; Sultanoglu, N; Uzun, B; Yildirim, FS; Ozsahin, DU
    There are approximately 39 million people living with the human immunodeficiency virus (HIV) worldwide. Although antiretroviral treatment (ART) has revolutionized the treatment and management of the HIV infection, a cure still remains elusive. In addition to ART's success at prolonging the lives of the infected individuals, it also has its uses in other cases. For example, post exposure prophylaxis (PEP) ART regimens are used after potential exposure to HIV to prevent the establishment of the HIV infection by up to 80% when administered in a timely manner. There are many guidelines available for these situations; however, they have differences in terms of their content and very few guidelines suggest specific PEP ART regimens for particular risk factors. Our study uses a multi criteria decision making method called Fuzzy PROMETHEE to evaluate the effectiveness of selected PEP ART regimens according to specified transmission risk factors for HIV. The risk factors were the criteria in this study and were weighted according to experts' opinions in terms of their relative importance.