Gül Ergör

Historical epidemiology of hepatitis C virus (HCV) in selected countries

Chronic infection with hepatitis C virus (HCV) is a leading indicator for liver disease. New treatment options are becoming available, and there is a need to characterize the epidemiology and disease burden of HCV. Data for prevalence, viremia, genotype, diagnosis and treatment were obtained through literature searches and expert consensus for 16 countries. For some countries, data from centralized registries were used to estimate diagnosis and treatment rates. Data for the number of liver transplants and the proportion attributable to HCV were obtained from centralized databases. Viremic prevalence estimates varied widely between countries, ranging from 0.3% in Austria, England and Germany to 8.5% in Egypt. The largest viremic populations were in Egypt, with 6 358 000 cases in 2008 and Brazil with 2 106 000 cases in 2007. The age distribution of cases differed between countries. In most countries, prevalence rates were higher among males, reflecting higher rates of injection drug use. Diagnosis, treatment and transplant levels also differed considerably between countries. Reliable estimates characterizing HCV‐infected populations are critical for addressing HCV‐related morbidity and mortality. There is a need to quantify the burden of chronic HCV infection at the national level.

Strategies to manage hepatitis C virus (HCV) disease burden

The number of hepatitis C virus (HCV) infections is projected to decline while those with advanced liver disease will increase. A modeling approach was used to forecast two treatment scenarios: (i) the impact of increased treatment efficacy while keeping the number of treated patients constant and (ii) increasing efficacy and treatment rate. This analysis suggests that successful diagnosis and treatment of a small proportion of patients can contribute significantly to the reduction of disease burden in the countries studied. The largest reduction in HCV‐related morbidity and mortality occurs when increased treatment is combined with higher efficacy therapies, generally in combination with increased diagnosis. With a treatment rate of approximately 10%, this analysis suggests it is possible to achieve elimination of HCV (defined as a >90% decline in total infections by 2030). However, for most countries presented, this will require a 3–5 fold increase in diagnosis and/or treatment. Thus, building the public health and clinical provider capacity for improved diagnosis and treatment will be critical.

Normative data and discriminative properties of short form 36 (SF-36) in Turkish urban population

BackgroundSF-36 has been both translated into different languages and adapted to different cultures to obtain comparable data on health status internationally. However there have been only a limited number of studies focused on the discriminative ability of SF-36 regarding social and disease status in developing countries. The aim of this study was to obtain population norms of the short form 36 (SF-36) health survey and the association of SF-36 domains with demographic and socioeconomic variables in an urban population in Turkey.MethodsA cross-sectional study. Face to face interviews were carried out with a sample of households. The sample was systematically selected from two urban Health Districts in Izmir, Turkey. The study group consisted of 1,279 people selected from a study population of 46,290 people aged 18 and over.ResultsInternal consistencies of the scales were high, with the exception of mental health and vitality. Physical health scales were associated with both age and gender. On the other hand, mental health scales were less strongly associated with age and gender. Women reported poorer health compared to men in general. Social risk factors (employment status, lower education and economic strain) were associated with worse health profiles. The SF-36 was found to be capable of discriminating disease status.ConclusionOur findings, cautiously generalisable to urban population, suggest that the SF-36 can be a valuable tool for studies on health outcomes in Turkish population. SF-36 may also be a promising measure for research on health inequalities in Turkey and other developing countries.

Substance use among medical students and physicians in a medical school in Turkey

Abstract.Background:This study examined substance use and abuse, including nicotine and alcohol, in subjects who were at various stages of a medical career in Dokuz Eylül University Medical School in Turkey. Anxiety and depression levels were also assessed in order to determine the relationship of the substance use and anxiety and depression.Method:Using an anonymous, self-administered questionnaire, we surveyed 121 junior, and 52 senior medical students, 73 residents and 80 practicing physicians who completed the questionnaire.Results:Alcohol was the most frequently used substance in all groups. Two or more positive responses on the CAGE were obtained for 22.4% of the junior students, 20% of the senior students, 8.9% of the residents and 6.5% of the physicians. Lifetime smoking prevalence was as high as 50%. The age of onset for nicotine and alcohol use was earlier in first-year medical students than the other groups. Benzodiazepines (alprozolam, diazepam) were the most frequently used sedative-hypnotics. The use of illicit substances was rare in all four groups, with cannabis being the most commonly used illicit substance. The junior medical students (23.6 %) had the highest level of anxiety, while the senior students (44 %) had the highest level of depression, assessed by the Hospital Anxiety and Depression Scale. However, the levels of anxiety and depression did not correlate with the levels of cigarette and alcohol consumption.Conclusions:Smoking and alcohol abuse amongst medical students and physicians should be taken more seriously because their own attitudes towards substances may influence their professional behavior. There is a need for better education about substances.

Substance use in a sample of Turkish medical students

This study identifies the prevalence of smoking, alcohol, and illicit drug use in a sample of Turkish medical students. Information about substance use was obtained from 304 first-year, and 143 sixth-year medical students from three different medical schools in Turkey. Nearly half of the students (53.9%) were non-drinkers. Risky alcohol use was 7.4%. Lifetime smoking prevalence was 39.9 and 26.4% of the junior and 44.1% of the senior medical students (mean consumption of 13.9 and 15.5 cigarettes a day, respectively) reported regular smoking. Nicotine dependence was present in 3.1%. Only 4% of the students reported using illicit drugs (cannabis, ecstasy, cocaine) at least once in their lifetime. The mean ages of first use of cigarettes, alcohol and illicit drugs were earlier for junior medical students than senior students. Of the students, 25.5% had anxiety and 36.8% had depression scores in the clinically significant range. Our results suggest that although Turkish medical students are not at a high risk of substance abuse it should not be underestimated, and the risk factors as well as the protective factors must be identified in nation-wide studies.

Alterations in BDNF (brain derived neurotrophic factor) and GDNF (glial cell line-derived neurotrophic factor) serum levels in bipolar disorder: The role of lithium

OBJECTIVE Brain-derived neurotrophic factor (BDNF) has been consistently reported to be decreased in mania or depression in bipolar disorders. Evidence suggests that Glial cell line-derived neurotrophic factor (GDNF) has a role in the pathogenesis of mood disorders. Whether GDNF and BDNF act in the same way across different episodes in bipolar disorders is unclear. METHOD BDNF and GDNF serum levels were measured simultaneously by enzyme-linked immunosorbent assay (ELISA) method in 96 patients diagnosed with bipolar disorder according to DSM-IV (37 euthymic, 33 manic, 26 depressed) in comparison to 61 healthy volunteers. SCID- I and SCID-non patient version were used for clinical evaluation of the patients and healthy volunteers respectively. Correlations between the two trophic factor levels, and medication dose, duration and serum levels of lithium or valproate were studied across different episodes of illness. RESULTS Patients had significantly lower BDNF levels during mania and depression compared to euthymic patients and healthy controls. GDNF levels were not distinctive. However GDNF/BDNF ratio was higher in manic state compared to euthymia and healthy controls. Significant negative correlation was observed between BDNF and GDNF levels in euthymic patients. While BDNF levels correlated positively, GDNF levels correlated negatively with lithium levels. Regression analysis confirmed that lithium levels predicted only GDNF levels positively in mania, and negatively in euthymia. LIMITATIONS Small sample size in different episodes and drug-free patients was the limitation of thestudy. CONCLUSION Current data suggests that lithium exerts its therapeutic action by an inverse effect on BDNF and GDNF levels, possibly by up-regulating BDNF and down-regulating GDNF to achieve euthymia.

The effects of body fat distribution on pulmonary function tests in the overweight and obese.

Objectives: To determine the predominant pulmonary function abnormality in overweight and moderately obese subjects and to evaluate the correlation between the severity of lung function impairment and the degree of obesity. Methods: Fifty-three volunteers underwent physical examination, skin fold measurements, and standardized pulmonary function tests. Thirty-one women and 22 men with a mean age of 40.2 (18–66) years were studied. Results: The reduction in functional residual capacity (FRC) and expiratory reserve volume (ERV) were the most common abnormalities in overweight and obese subjects. The reduction in static lung volume was correlated with the degree of obesity in women and men. Stepwise multiple regression coefficients were obtained separately for women and men. Subscapular skinfold was the best predictor in women for FRC and waist-to-hip ratio (WHR) and BMI were found the best for ERV. WHR was found predictive for forced vital capacity, total lung capacity, and FRC in men. Conclusions: The lung volumes are substantially affected in our overweight and obese subjects. This influence is focused on different parameters of respiratory functions in men and women in relation to body fat distribution.

PREVALENCE OF ALCOHOL USE IN ISTANBUL

The current research assessed the prevalence of alcohol use in Istanbul, Turkey along with characteristics and severity of related problems. The data were collected from structured interviews including the CAGE Questionnaire to eliminate the severity of alcohol-related problems of 1,550 residents (743 women, 807 men) of Istanbul, ages 12 to 65 years. Current alcohol use was 25.6% (397 persons, 118 women and 279 men), including 15.9% of the women and 34.5% of the men. 67% reported never having used alcohol. The rate of alcohol use was highest in the 40- to 49-yr. age group; the onset of use was reported as most common for the 16- to 19-yr.-olds. Prevalence of risky drinking was 6.8% (106 persons). Men were more likely to have an earlier initiation to alcohol use, to consume more [5.2 standard drinks (SD = 3.4) vs 3.6 standard drinks (SD = 2.5)] and be problem drinkers (31.5% vs 15.2%) than women. Prevalence of alcohol use seems to be relatively low in Istanbul. Data on characteristics of alcohol use are important in estimating groups at risk for problems and in planning prevention strategies.

New generation IQ-200 automated urine microscopy analyzer compared with KOVA cell chamber.

Objective: The examination of the urine remains to be one of the most commonly performed tests in laboratory practice. Currently, laboratories also need to accredit their urine diagnostics by comparing their measurement methods to acceptable references. In this study we compared particle counts obtained by new generation automated technique, image capture analysis (IQ‐200) with those of a standardized chamber counts. Design and Methods: The same 258 urine samples from different departments of a hospital assayed by IQ‐200 were analyzed in parallel with the KOVA cell chamber system. Clinically significant discrepancy results (positive vs. negative) for red blood cell (RBC) and white blood cell (WBC) were also compared with those obtained by dipstick testing. Results: There was a good agreement between the automated system and sediment microscopy for RBCs, WBCs, and squamous epithelial cells (SCs) (r=0.90; r=0.80; r=0.72, respectively: P<0.001). The IQ‐200 was more sensitive for determining RBCs, WBCs, and SCs than other formed elements. Conclusions: IQ‐200 can perform accurate quantification of microscopic element in urine. However, automated techniques are not completely free of error. Therefore, by adopting an appropriate algorithm and combining the results with stript analysis and other laboratory tests allows further reduction of clinically important errors. J. Clin. Lab. Anal. 24:67–71, 2010.  © 2010 Wiley‐Liss, Inc.

Female vulnerability for thyroid function abnormality in bipolar disorder: role of lithium treatment.

Previous studies have provided evidence of subtle thyroid hormone metabolism abnormalities in patients with mood disorders. Although these studies are informative, the precise role of the hypothalamic‐pituitary‐thyroid axis in bipolar disorder, especially in women, remains unclear. We sought to further corroborate thyroid function in patients with bipolar disorder in comparison to patients with other psychiatric, as well as non‐psychiatric, diagnoses.