Person: ENER, BEYZA
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ENER
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BEYZA
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Publication Evaluation of micafungin use in children(Ankara Microbiology, 2020-01-01) Hacimustafaoglu, Mustafa; Yeşil, Edanur; YEŞİL, EDANUR; Çelebi, Solmaz; ÇELEBİ, SOLMAZ; Sezgin Evim, Melike; SEZGİN EVİM, MELİKE; Özer, Arife; Turan, Cansu; TURAN, CANSU; Timur, Demet; TİMUR, DEMET; Çakır, Salih Cağrı; ÇAKIR, SALİH ÇAĞRI; Bülbül, Beyhan; BÜLBÜL, BEYHAN; Ener, Beyza; ENER, BEYZA; Güneş, Adalet Meral; MERAL GÜNEŞ, ADALET; Koksal, Nilgun; Özkan, Hilal; ÖZKAN, HİLAL; Sevinir, Betul; SEVİNİR, BETÜL BERRİN; Düzcan Kilimci, Duygu; Tıp Fakültesi; Pediatri Onkoloji Ana Bilim Dalı; 0000-0002-8926-9959; 0000-0003-3146-6391; 0000-0001-5761-4757; 0000-0002-5720-1212; 0000-0002-3232-7652; 0000-0003-4646-660X; AAG-8523-2021; AEZ-2469-2022; GSO-3630-2022; AAH-1570-2021; HJZ-4508-2023; AAE-6201-2021; AAG-8393-2021; JCD-9679-2023Micafungin is recommended especially in patients with liver and kidney failure and in the presence of other side effects due to antifungals apart from its known priority indications such as invasive candidiasis. The aim of this study was to evaluate the children who have received micafungin treatment. In the study, 125 children who were hospitalized in the pediatric wards and intensive care units of our hospital and had used micafungin between November 2016 and January 2019 were analyzed retrospectively. Clinical data, micafungin indication, blood values on the first and fourth days of the treatment, side effects of the drug and efficacy were evaluated. Sixty percent (75/125) of the patients were male and the mean age of all the patients were 58 +/- 67 (0-215, 30) months. Approximately half of the cases (48%) had malignancy and 13% of them were premature. Sixty-two percent (n= 37) of the malignencies were hematological (27 acute lymphocytic leukemia, nine acute myeloid leukemia, one myelodysplastic syndrome) and 38% (n= 23) were oncological (six neuroblastoma, four Hodgkin lymphoma, two Non-Hodgkin's lymphoma, five sarcomas, one hepatoblastoma, five others) malignencies. The major cause of hospitalization was sepsis (53%). The patients had several risk factors like immunosuppressive therapy (n= 68, 54%), neutropenia (n= 61, 49%), central venous catheter (n= 102, 82%), nasogastric tube (n= 63, 50%), endotracheal intubation tube (n= 49, 39%), urinary catheter (n= 14, 11%) and total parenteral nutrition (n= 81, 65%). Thirteen percent (n= 16) of the cases were post-operative patients. Candida species were cultivated in 97 clinical specimens (blood, endotracheal aspirate, sputum, urine, etc.) among 23 (18%) of the patients. Thirteen (10%) of the patients had candidemia and 62% of them were non-albicans strains. In all candidemias, strains were echinocandin susceptible, and blood cultures were negative within four days. When all the patients (n= 125) were evaluated, a significant decrease in C-reactive protein, an increase in sodium, and a decrease in alanine aminotransferase were observed on the fourth day of micafungin treatment (p< 0.05). A total of 39 (31%) patients underwent various antifungal treatments for median seven (1-60) days prior to micafungin treatment. Fourteen (36%) of these 39 patients, had elevated liver function tests (LFT), 10 (26%) of them had hypokalemia, and five (13%) of them had elevated renal function tests. Ten (26%) patients had antifungal-induced hypokalemia previously; and potassium levels were normalized after micafungin treatment (p= 0.0001). The patients for which micafungin treatment was chosen due to elevated liver function tests (n= 47, 38%), whether the antifungalinduced or not; alanine aminotransferase and aspartate aminotransferase levels were decreased after micafungin treatment (p= 0.0001 and p= 0.0001, respectively). Nineteen (15%) of the patients have died within the first 30 days of micafungin treatment and one of them had candidemia. No micafungin treatment related significant side effects were observed in any of the patients. Our study showed that micafungin could be a safe and effective option in pediatric cases including newborns with high liver and kidney function tests.Publication Frequency of azole resistance in clinical and environmental strains of aspergillus fumigatus in Turkey: A multicentre study(Oxford Univ Press, 2022-04-21) Ener, Beyza; Ergin, Çağrı; Gülmez, Dolunay; Ağca, Harun; Tikvesli, Melek; Aksoy, Seçil Ak; Otkun, Müşerref; Sığ, Ali Korhan; Ogunc, Dilara; Özhak, Betil; Topaç, Tuncay; Özdemir, Aslı; Metin, Dilek Yeşim; Polat, Suleyha Hilmioğlu; Öz, Yasemin; Koç, Nedret; Atalay, Mustafa Altay; Erturan, Zayre; Birinci, Asuman; Cerikçioğlu, Nilgün; Timur, Demet; Eksi, Fahriye; Genç, Gonca Erköse; Fındık, Duygu; Gürcan, Şaban; Kalkancı, Ayşe; Arıkan-Akdagli, Sevtap; ENER, BEYZA; AĞCA, HARUN; AKSOY, SEÇİL; TİMUR, DEMET; İnegöl Meslek Yüksekokulu; Mikrobiyoloji Ana Bilim Dalı; 0000-0002-2651-2034; AAG-8523-2021; AAH-8540-2021; DZV-6739-2022; ISU-9626-2023Objectives Aspergillus fumigatus causes several diseases in humans and azole resistance in A. fumigatus strains is an important issue. The aim of this multicentre epidemiological study was to investigate the prevalence of azole resistance in clinical and environmental A. fumigatus isolates in Turkey. Methods Twenty-one centres participated in this study from 1 May 2018 to 1 October 2019. One participant from each centre was asked to collect environmental and clinical A. fumigatus isolates. Azole resistance was screened for using EUCAST agar screening methodology (EUCAST E.DEF 10.1) and was confirmed by the EUCAST E.DEF 9.3 reference microdilution method. Isolates with a phenotypic resistance pattern were sequenced for the cyp51A gene and microsatellite genotyping was used to determine the genetic relationships between the resistant strains. Results In total, resistance was found in 1.3% of the strains that were isolated from environmental samples and 3.3% of the strains that were isolated from clinical samples. Mutations in the cyp51A gene were detected in 9 (47.4%) of the 19 azole-resistant isolates, all of which were found to be TR34/L98H mutations. Microsatellite genotyping clearly differentiated the strains with the TR34/L98H mutation in the cyp51A gene from the strains with no mutation in this gene. Conclusions The rate of observed azole resistance of A. fumigatus isolates was low in this study, but the fact that more than half of the examined strains had the wild-type cyp51A gene supports the idea that other mechanisms of resistance are gradually increasing.Publication Evaluation of serum indirect haemagglutination test results of suspected cystic echinococcosis cases from 2009-2017(Pakistan Medical Assoc, 2022-06-01) Tuzemen, Nazmiye Ulku; Alver, Oktay; Ozakin, Cuneyt; Ener, Beyza; Tuzemen, Nazmiye Ulku; TÜZEMEN, NAZMİYE ÜLKÜ; Alver, Oktay; ALVER, OKTAY; Ozakin, Cuneyt; ÖZAKIN, CÜNEYT; Ener, Beyza; ENER, BEYZA; Tıp Fakültesi; Mikrobiyoloji Ana Bilim Dalı; A-4290-2018Objective: This study aims to evaluate the serological, radiological and epidemiological analysis of suspected cystic echinococcosis patients, and to assess the positivity rate in the region. Method: The retrospective study was conducted at Bursa Uludag University Hospital, Turkey and comprised data from January 2009 to December 2017 related to patients of either gender with suspected cystic echinococcosis who underwent indirect haemagglutination testing. Demographic and clinical data of patients who tested positive were analysed. Statistical analysis was done using SPSS 23. Results: Of the 3910 patients with a mean age of 41.6 +/- 19.35 years (range: 0-93 years) who underwent indirect haemagglutination testing, 692(17.7%) tested positive; 390(56.4%) females, and 302(43.6%) males. The highest seropositivity rate 107(15.5%) was observed in 2011, followed by 104(15%) in 2016. Seropositive cases were predominantly seen in those aged 40-49 years 131 (18.9%), followed by those aged 50-59 years 124 (17.9%). Conclusion: Cystic echinococcosis was found to be a public health problem in South Marmara region of Turkey.Publication Investigation of parasitic infection rate in stool samples submitted to uludag university parasitology laboratory between 2011-2015(Bilimsel Tip Yayinevi, 2017-01-01) Tüzemen, Nazmiye Ülkü; TÜZEMEN, NAZMİYE ÜLKÜ; Alver, Oktay; Ener, Beyza; ENER, BEYZA; ALVER, OKTAY; Tıp Fakültesi; Tıbbi Mikrobiyoloji Ana Bilim Dalı; 0000-0003-3544-3509; AAA-5241-2021; A-4290-2018; AAG-8523-2021Introduction: Intestinal parasitic infections are among the most significant causes of morbidity and mortality in undeveloped countries, particularly in children. These infections may cause loss in physical and mental progress of children in particular, and loss of work and labour force in adults.Materials and Methods: In this study, patients who applied with various gastrointestinal complaints to the clinics of the Uludag University Medical Faculty, were thoroughly investigated for the presence of intestinal parasites. A total of 8981 stool and 854 cellophane tape samples were parasitologically evaluated. All stool samples were prepared using formal-ethyl acetate concentration method for helminth ova and protozoan cysts, and examined in lugol preparations microscopically with 10x and 40x magnifications. Preparations were examined by using oil-immersion objectives (100x) following trichrome and modified Erlich-Ziehl-Nielsen staining for the diagnosis of intestinal and coccidian protozoa, respectively. For the detection of Entamoeba histolytica adezin antigen in stools, commercial ELISA kit (Wampole (R) E. histolytica II Test Kit; TechLab, USA) was used.Results: In this study, one or more parasites were found in 327 (3.6%) of the 8981 stool samples (including nonpathogenic protozoa). Enterobius vermicularis eggs were detected in 29 (3.4%) out of 854 samples by using the cellophane tape method. Of the parasite detected cases, 165 (50.5%) were female and 162 (49.5%) were male. Giardia intestinalis (0.9%) and E. vermicularis (3.4%) were the most frequently detected protozoon and helmint parasites, respectively. The parasites were detected mostly in summer months (26.3%).Conclusion: Although the prevalence rates of intestinal parasites were lower than those in the previous studies carried out in the city, it is seen that the presence of intestinal parasites is still a serious public health problem in our region.Publication Histoplasmosis in Europe: Report on an epidemiological survey from the European confederation of medical mycology working group(Oxford Univ Press, 2008-01-01) Ashbee, H. R.; Evans, E. G. V.; Viviani, M. A.; Dupont, B.; Chryssanthou, E.; Surmont, I.; Tomsikova, A.; Vachkov, P.; Ener, B.; Zala, J.; Tintelnot, K.; ENER, BEYZA; Tıp Fakültesi; Mikrobiyoloji ve Enfeksiyon Hastalıkları Ana Bilim Dalı; CPS-5043-2022The purpose of this survey was to systematically collect data on individuals with histoplasmosis in Europe over a 5-year period (from January 1995 to December 1999). This included information on where and how the infection was acquired, the patient's risk factors, the causative organism, how the infection was diagnosed and what therapy the patients received. Data were sent on a standardized survey form via a national convenor to the coordinator. During the survey, 118 cases were reported, with 62 patients having disseminated disease, 31 acute pulmonary infection, chronic pulmonary infection in 6 and localized disease in 2 patients. For 17 patients, the diagnosis of histoplasmosis was incidental, usually secondary to investigations for lung cancer. Most patients had travelled to known endemic areas, but 8 patients (from Italy, Germany and Turkey) indicated that they had not been outside their countries of origin and hence these cases appear to be autochthonous. Notable observations during the survey were the reactivation of the disease up to 50 years after the initial infection in some patients and transmission of the infection by a transplanted liver. Itraconazole was the most commonly used therapy in both pulmonary and disseminated disease. The observation of autochthonous cases of disease suggests that the endemic area of histoplasmosis is wider than classically reported and supports continued surveillance of the disease throughout Europe.Publication Nine-month course of SARS-CoV-2 antibodies in individuals with COVID-19 infection(Springer London Ltd, 2022-01-20) Türkkan, Alpaslan; Sağlık, İmran; Turan, Cansu; Şahin, Ahmet; Akalın, Halis; Ener, Beyza; Kara, Ateş; Çelebi, Solmaz; Şahin, Emre; Hacımustafaoğlu, Mustafa; TÜRKKAN, ALPASLAN; SAĞLIK, İMRAN; TURAN, CANSU; AKALIN, EMİN HALİS; ENER, BEYZA; ÇELEBİ, SOLMAZ; ŞAHİN, EMRE; HACIMUSTAFAOĞLU, MUSTAFA KEMAL; Tıp Fakültesi; Halk Sağlığı Ana Bilim Dalı; 0000-0003-0864-4989; 0000-0003-3146-6391; 0000-0002-4415-076X; 0000-0001-7530-1279; 0000-0002-1654-3232; 0000-0003-4646-660X; GFL-2282-2022; GCM-3391-2022; IVB-4013-2023; AAU-8952-2020; CNK-0895-2022; ENK-4130-2022; JFP-8395-2023; CTG-5805-2022Background The continual course of the pandemic points to the importance of studies on the rate and durability of protective immunity after infection or vaccination. Aims In this study, we aimed to monitor anti-nucleocapsid (N) and anti-spike (S) antibodies against SARS-CoV-2 nearly 9 months duration after infection. Methods Anti-nucleocapsid (N) (at 11-15-20-29-38 weeks) and anti-spike antibodies (at 11 and 38 weeks) against SARS-CoV-2 were monitored during 38 weeks after the initial symptoms of COVID-19. Results Of 37 cases between 18 and 57 years old, 54% were women. The findings showed that anti-N antibodies decreased significantly after the 15th week (between 15 and 20 weeks, p = 0.016; 20-29 weeks, p = 0.0009; and 29-38 weeks, p = 0.049). At the 38th week, mean antibody levels decreased 35% compared to the 11th week, and 8% of the cases turned negative results. Anti-N antibody average level was 56.48 on the 11th week (the cut-off index threshold >= 1). It was estimated statistically that it would decrease to an average of 20.48 in weeks 53-62. In females, average antibody levels of all measurements were lower than males (p > 0.05). Anti-S antibody levels 14% increased at 38th week compared to 11th week (quantitative positivity threshold >= 0.8 U/ml), and no cases were negative at 38th week. Conclusions Patients had >= 90% positivity after at least 9 months of symptoms, both anti-N and anti-S antibodies. In all samples, both anti-N and anti-S antibody levels were lower in females. The findings suggest that the quantitative values of anti-S antibodies remained high for at least 9 months and could provide protection.Publication Is the extraction by Whatman FTA filter matrix technology and sequencing of large ribosomal subunit D1-D2 region sufficient for identification of clinical fungi?(Wiley, 2015-10-01) Kiraz, Nuri; Öz, Yasemin; Aslan, Hüseyin; Erturan, Zayre; Ener, Beyza; Akdağlı, Sevtap Arıkan; Müslümanoğlu, Hamza; Çetinkaya, Zafer; ENER, BEYZA; Tıp Fakültesi; Mikrobiyoloji Ana Bilim Dalı; 0000-0002-4803-8206; AAG-8523-2021Although conventional identification of pathogenic fungi is based on the combination of tests evaluating their morphological and biochemical characteristics, they can fail to identify the less common species or the differentiation of closely related species. In addition these tests are time consuming, labour-intensive and require experienced personnel. We evaluated the feasibility and sufficiency of DNA extraction by Whatman FTA filter matrix technology and DNA sequencing of D1-D2 region of the large ribosomal subunit gene for identification of clinical isolates of 21 yeast and 160 moulds in our clinical mycology laboratory. While the yeast isolates were identified at species level with 100% homology, 102 (63.75%) clinically important mould isolates were identified at species level, 56 (35%) isolates at genus level against fungal sequences existing in DNA databases and two (1.25%) isolates could not be identified. Consequently, Whatman FTA filter matrix technology was a useful method for extraction of fungal DNA; extremely rapid, practical and successful. Sequence analysis strategy of D1-D2 region of the large ribosomal subunit gene was found considerably sufficient in identification to genus level for the most clinical fungi. However, the identification to species level and especially discrimination of closely related species may require additional analysis.Publication Mixed fungal infection in early period after kidney transplantation: A case report(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2015-01-01) Işıktaş Sayılar, Emel; Ersoy, Alparslan; ERSOY, ALPARSLAN; Akalın, Halis; AKALIN, EMİN HALİS; Ayar, Yavuz; Girgin, Nermin Kelebek; KELEBEK GİRGİN, NERMİN; CEYLAN, İLKAY; DEMİR, UYGAR LEVENT; Ener, Beyza; ENER, BEYZA; Tıp Fakültesi; Anestezi ve Reanimasyon Ana Bilim Dalı; 0000-0003-4607-9220; 0000-0001-7530-1279; 0000-0003-3306-3107; AAU-8952-2020; AAH-5054-2021; O-9948-2015; AAH-7250-2019; GSE-0029-2022; AGF-0767-2022; AAG-8523-2021Invasive fungal infections have a rapid and frequently fatal course in patients with solid organ transplantations. Mostly Aspergillus spp., Mucorales spp., Candida spp. and Cryptococcus neoformans are causal pathogens for opportunistic infections. Aspergillus spp. and Mucorales spp. especially lead to invasive fungal infections at rhino-cerebral area; they show similar radiological and clinical signs and they lead to invasive fungal co-infections. In case of any doubt about invasive fungal infections, antifungal treatment should be initiated as soon as possible and immunosuppressive treatment should be considered. This case presentation is about a patient at 51 years of age who developed invasive rhino-cerebral mixed fungal infection in 4 weeks following renal transplant.Publication Conventional amphotericin b associated nephrotoxicity in patients with hematologic malignancies(Cureus, 2021-07-17) Gürsoy, Vildan; Özkalemkaş, Fahir; Özkocaman, Vildan; Yeğen, Zafer Serenli; Pınar, İbrahim Ethem; Ener, Beyza; Akalın, Halis; Kazak, Esra; Ali, Rıdvan; Ersoy, Alparslan; ÖZKALEMKAŞ, FAHİR; ÖZKOCAMAN, VİLDAN; PINAR, İBRAHİM ETHEM; ENER, BEYZA; AKALIN, EMİN HALİS; ALİ, RIDVAN; ERSOY, ALPARSLAN; Tıp Fakültesi; Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Ana Bilim Dalı; Nefroloji Bilim Dalı; 0000-0001-9907-1498 ; 0000-0002-4803-8206; DLR-8474-2022 ; JIR-6730-2023 ; JGM-6601-2023 ; AAG-8523-2021 ; AAU-8952-2020; AAG-8459-2021; GXD-8209-2022; CPX-5894-2022Introduction: Amphotericin B (AmB-d) is one of the most effective therapeutic options against frequently life-threatening systemic fungal infections in patients with hematologic malignancies. However, significant adverse effects including nephrotoxicity associated with its use limit its more widespread use. The objectives of our study were to determine the incidence of AmB-d associated nephrotoxicity, to evaluate clinical and epidemiological characteristics of patients, and to support the notion that conventional amphotericin B remains a valid therapeutic option among hematologic patients with proper patient selection.Materials and methods: A total of 110 patients with hematologic malignancies were admitted to our Hematology Unit between January 2014 and November 2017 who required anti-fungal therapy during intensive systemic chemotherapy. The incidence of AmB-d associated nephrotoxicity, side effect profile, time to nephrotoxicity, and clinical and epidemiological characteristics associated with treatment success were assessed retrospectively.Results: Of the 110 patients receiving AmB-d, 70 (63.6%) were male and 40 (36.4%) were female. The mean age of participants was 44 years. The most common diagnosis was acute myeloid leukemia (n=53, 48.2%), and the most common chemotherapy protocol was 7 + 3 remission-induction (cytarabine 100 mg/m(2) days 1-7, Idarubicin 12 mg/m(2) days 1-3; n=24, 21.8%). In 56.4% of the patients, antifungal therapy was given empirically. In 40 patients (36.4%), nephrotoxicity was observed following antifungal treatment, and only four patients had stage 3 renal failure. The mean duration of time to nephrotoxicity from initiation of amphotericin B was four days (min: 2, max: 31). All patients were found to receive at least one additional potential nephrotoxic treatment during the antifungal treatment process.Conclusion: AmB-d is associated with a significant risk of nephrotoxicity. In most hematological patients, antifungal treatment is initiated empirically, and patients received prolonged courses of treatment. Therefore, it is plausible to initiate such treatment with AmB-d, when one considers the already high treatment costs in this patient group as well as the fact that AmB-d offers similar efficacy to antifungal agents at a lower cost. AmB-d may be recommended as a first-line agent in this patient group with the introduction of newer and more costly antifungal agents when needed, on the basis of the fact that these patients can be closely monitored in a hospital setting, reversible nature of nephrotoxicity upon discontinuation, and rare occurrence of severe renal failure requiring dialysis.Publication Invasive fungal infections in children with leukemia: Clinical features and prognosis(Galenos Yayıncılık, 2022-01-01) Evim, Melike Sezgin; Tüfekci, Özlem; Baytan, Birol; Ören, Hale; Çelebi, Solmaz; Ener, Beyza; Elmas, Kevser Üstün; Yılmaz, Şebnem; Erdem, Melek; Hacımustafaoğlu, Mustafa Kemal; Güneş, Adalet Meral; SEZGİN EVİM, MELİKE; Baytan, Birol; ÇELEBİ, SOLMAZ; ENER, BEYZA; ÜSTÜN ELMAS, KEVSER; HACIMUSTAFAOĞLU, MUSTAFA KEMAL; MERAL GÜNEŞ, ADALET; Tıp Fakültesi; Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı; 0000-0002-4803-8206 ; AAH-1452-2021; DVW-8108-2022; JHN-1091-2023; AAG-8523-2021; JLB-6134-2023; CTG-5805-2022; JGX-6145-2023Objective: The incidence of invasive fungal infections (IFIs) has increased due to intensive chemotherapy in childhood leukemia. The aim of this study was to evaluate the incidence, risk factors, causative pathogens, and impact on survival of IFIs among pediatric leukemia patients. Materials and Methods: The hospital records of 307 children with acute lymphoblastic leukemia (ALL, n=238), acute myeloid leukemia (AML, n=51), and relapsed leukemia (n=18) between January 2010 and December 2015 were retrospectively evaluated. Results: A total of 1213 febrile neutropenia episodes were recorded and 127 (10.4%) of them were related to an IFI. Of 307 children, 121 (39.4%) developed IFIs. The mean age was significantly older in the IFI group compared to children without IFIs (p<0.001). IFIs were defined as possible, probable, and proven in 73.2%, 11.9%, and 14.9% of the attacks, respectively. Invasive aspergillosis (81.9%) was the most frequent infection, followed by invasive candidiasis (13.4%) and rare fungal diseases (4.8%). The majority of IFI attacks in both ALL and AML occurred during the induction phase. In total, the death rate was 24% and the IFI-related mortality rate was 18%. The mortality rate among children with IFIs was found to be significantly higher than that of children without IFIs (p<0.001). Overall and event-free survival rates at 5 years were also found to be significantly lower in the IFI group (p<0.001). Relapse (odds ratio: 8.49) was the most effective risk factor for mortality, followed by developing an IFI episode (odds ratio: 3.2) and AML (odds ratio: 2.33) according to multivariate regression analysis. Conclusion: Our data showed that IFIs were more common in older children. Although proven and probable IFI episodes were more frequently diagnosed in cases of relapse and AML, children with ALL and AML had similar frequencies of experiencing at least one episode of IFI. Rare fungal diseases were also identified as a major problem. Despite success in treatment, IFIs increased the rate of mortality in children with acute leukemia.
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