Mehmet Bitirgen's scientific contributions

Objective: Interferon alpha therapy is associated with series of adverse effects leading premature discontinuation of treatment. Here we aimed to determine the effects of Tumor necrosis alpha promoter polymorphisms on in-terferon related side effects during interferon alpha 2b treatment in chronic hepatitis B patients. Material and Methods: This observational study enrolled 50 chronic hepatitis B patients, who were treated with interferon alpha 2b 10 tiw plus lamivu-dine 100mg/day at were followed-up with complete blood count, transaminases and amylase monthly at out patient clinics of our department. All patients were asked to fill a questionnaire to evaluate the interferon related side effects at every visit. Tumor necrosis factor alpha-238 and-308 polymorphisms were investigated with PCR-Restriction fragment length polymorphisms. Results: Arthralgia was present in 93.8% of patients. Exhaustion, loss of appetite , mount dryness and fever are the leading complaints of the patients. Median complaint scores were 9, 9.5, 11 and 5 at 4 th , 12 th , 24 th and 48 th week visits, respectively. Thrombocytopenia and leucopenia were detected in 8 (16%) and 5 (10%) patients, respectively. One-third of the patients reported depressive mood however, depression was diagnosed in 5 (10%) patients. TNF alpha promoter 238GG and 308GG allele was present in 42/50 and 43/50 patients, respectively. No association was found between TNF promoter allele and certain patient-reported side effect, complaint score, hema-tological and psychological adverse effects. Conclusion: TNF alpha promoter polymorphisms do not contribute to occurrence of IFN alpha treatment related side effects. Keywords: TNF alpha promoter polymorphism, interferon alpha, interferon related side effect, chronic hepatitis B ORIGINAl ARTIClE acta medica

Objectives: Acute viral hepatitis B may lead to chronic hepatitis in 6% of adult population. We compared the frequency of Tumor necrosis factor alpha promo-tor polymorphisms in chronic hepatitis B patients and people with natural immunity against hepatitis B. Materials and Methods: Chronic hepatitis B patients and age matched control cases with natural immunity to hepatitis B virus were recruited 1:1 in this study. Tumor necrosis factor alpha-238G/A and-308G/A polymorphisms were studied with PCR-RFLP. χ2 test was performed in statistical analysis. Results: A total of 101 volunteers enrolled in two study groups. Thirty-eight men and 12 women constituted the chronic hepatitis B patient group and 40 men and 11 women recruited in natural immunity group. Frequency of-238G allele was 87.5% and 97% in chronic hepatitis B and natural immunity groups, respectively. Frequency of-308G allel was 93% and 92.1% in chronic hepatitis B and natural immunity groups, respectively. Frequencies of polymorphisms at positions-238 and-308 in the promotor of tumor necrosis factor alpha gene were not different between chronic hepatitis B and natural immunity groups. Discussion: Tumor necrosis factor alpha promoter polymorphisms at-238 and-308 positions do not effect the outcome hepatitis B infection in Turkish population. Clearance of hepatitis B virus infection is multifactorial. Thus, further studies needed to identify genetic predisposition to chronic hepatitis B infection.

Objective: To evaluate the personality and temperament traits in patients with chronic hepatitis B in comparison to healthy subjects and to determine whether there is a relation between personality trait and level of anxiety or depression. Materials/Subjects and Method: This was a case-control study in which 67 patients who had been under follow-up with diagnosis of chronic hepatitis B and 103 agedmatched healthy subjects were included. Study participants were asked to complete three self-report questionnaires— Temperament and Character Inventory (TCI) to define personality traits, Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) to evaluate presence and severity of depression and anxiety. Results: Total and sub-scale scores of five out of seven dimensions of TCI—reward dependence, persistence, self-directedness, cooperativeness, and self-transcence— were significantly higher in Group 1 than Group 2. Total BDI and BAI scores were significantly higher in Group 1 than Group 2. Significantly more patients had a BDI score of 17 or over in Group 1 than Group 2. There was no significant correlation between total scores of TCI dimensions and total BAI or BDI scores except weak correlations between harm avoidance or self-directedness and total BAI or BDI scores. Conclusion: In terms of personality trait, patients with chronic hepatitis B exhibit higher reward dependence, persistence, self-directedness, cooperativeness, and self-transcendence from healthy population. The personality traits of patients should be considered during the management of hepatitis B in order to optimize treatment outcome and to prevent development of new mental health problems during the course of the disease.

Predicting unfavorable outcome is of paramount importance in clinical decision making. Accordingly, we designed this multinational study, which provided the largest case series of tuberculous meningitis (TBM). 43 centers from 14 countries (Turkey) submitted data of microbiologically confirmed TBM patients hospitalized between 2000 and 2012. Unfavorable outcome was defined as survival with significant sequela or death. In developing our index, binary logistic regression models were constructed via 200 repli-cates of database by bootstrap resampling methodology. The final model was built according to the selection frequencies of variables. The severity scale included variables with arbitrary scores proportional to predictive powers of terms in the final model. The final model was internally validated by bootstrap resampling. A total of 507 patients' data were submitted among which 165 had unfavorable outcome. Eighty-six patients died while 119 had different neurological sequelae in 79 (16 %) patients. The full model included 13

SüleymanDemirel Üniversitesi TIP FAKÜLTESİ DERGİSİ: 2001 ; 8(1) Brusellozis: 127 Olgunun değerlendirmesi Emel Türk Arıbaş , Abdullah Yılmaz, Mehmet Bitirgen Özet Bu çalışmada, bruselloz tanısı ile izlenen 127 olguda bulaş yollan, klinik, laho¬ra t uva r ve tedavi özellikleri değerlendirildi. Yaşlan 14-86 (ort:45.79) arasında değişen olguların 72 (%56.69)' ı kadın, 55 (%43.30)' u erkek idi. Olguların 76 (%59.83)' smda bulaş yolu olarak hayvancılıkla uğraşma, çiğ süt ve süt ürünleri tüketimi saptandı. En sık rastlanan yakınmalar; ateş (%50.39), artralji (%46.45), halsizlik (%39.37) ve ter¬leme (%30.70) olarak belirlendi. Fizik muayene bulgusu olarak en sık saptanan anor¬mallikler sırasıyla ateş (%33.07), hepatomegali (%19.6), artrit (%J4.17) ve splenome-gali (%11.81) idi. Sadece 3 olguda menenjit ve birinde orşit vardı. Olguların tamamında STA testi > 11160 bulundu ve % 4.72' sinde Brıtcella spp. izole edildi. Tedavide 93 has¬taya doksisiklin + rifampisin ve 30 olguya doksisiklin +•- streptomisin 6 hafta süreyle uygulandı. Doksisiklin + rifampisin uygulanan hastalarda relaps %5.3 ve doksisiklin + streptomisin uygulananlarda %3 olarak saptandı. Aralarındaki fark istatistiksel olarak anlamlı değildi. Anahtar Kelimeler: Brusellozis,Tanı, Komplikasyon, Tedavi Abstract Brucellosis : Evaluation Of 127 Cases in this study, 127 patients diagnosed as brucellosis were evaluated about trans-mission routes, clinical, laboratory and therapeutic features. Ranging between 14-86 (mean:45.79) years, 72 (%56.96) of the patients werefemale, 55 (%43.30) were male. in 76 (%59.83) of the cases, infection was releated with stock raising and consuming unpasteurised milk and milk products. The most freauently complaints detected were fever (%50.39), arthralgy (%40.45), lack of appetite (%39.37) and sweating (%30.70). As physical examination fındings, the most frequently abnormaUties were detected as fever (%33.07), hepatomegaly (%19.60), arthritis (%14.17), splenomegaly (%11.81). Only in 3 cases meningitis and in öne orchitis had developed as complication of brucel¬losis. in ali cases the standart tube aglutination (STA) test ti ter was found > 1/160 and in %4.72 of the cases Brucella spp. could be isolated. 93 patients received a combina-tion therapy composed of doxycycline plus rifampinfor 6 weeks and 30 cases used doxy-cycline plus streptomycin for 6 weeks. The patients who received doxycycline plus rifampin had a relaps rate of%5.3, wherease the rate of the other groıtp which received doxycycline plus streptomycin w as found as %10. The difference between two groups was not statistically signifıcant (p>0.05). Key Words: Brucellosis,Diagnosis, Complications, Treatment

SüleymanDemirel Üniversitesi TIP FAKÜLTESİ DERGİSİ: 1995 Eylül; 2(3) Çeşitli Klinik Tanılarla İzlenen Hastalarda Subklavian Kateter Kültür Sonuçlarının Değerlendirilmesi Mustafa Sünbül Mehmet Bitirgen Emel Türk Arıbaş Özet Bu çalışmada, Selçuk Üniversitesi Tıp Fakültesi Genel Cerrahi Kliniği 'nde çeşitli tanılarla izlenen 36 hastadan alınan Subklavian kateter kültür sonuçları değerlendirildi. Geniş spektrumlu antibiyotik alan 22 hastanın 8'inde kültür sonuçları pozitif bulunurken 10'unda negatif idi. Antibiyotik almayan diğer 2 hastada da kültür sonuçları negatif idi. Kateter kültürü yapılan 36 hastanın 22'sinde stajilokok izole edildi. Bunların 16'sı koagulaz negatif stafılokok iken, yalnızca 2'si S. aureus idi. Bakteri kolonizasyonu kataterizasyon süresi ile ilişkili bulundu.Yedi günden daha kısa kateterizasyon süresi için bu oran % 44, yedi günden az olanlarda da % 5.5 idi (p

SüleymanDemirel Üniversitesi TIP FAKÜLTESİ DERGİSİ: 1999 Mart; 6(1) Meningoensefalit Komplikasyonu İle Seyreden İki Bruselloz Olgusu Emel Türk Arıbaş Zehra Abdulkadiroğlu İbrahim Eryaman Mehmet Bitirgen Abdullah Yılmaz Özet Brusellozisde nörolojik semptomlar sık olmakla beraber, sinir sistemi tutulumu yaygın değildir.Bu makalede nörobrusellozisli iki olgu klinik ve laboratuvar olarak incelenmiştir. Birinci olguda papilla ödeminin eşlik ettiği meningoensefalit ikinci olguda da yalnızca meningosefalit vardı. Tanı klinik olarak serolojik olarak ve beyin omurilik sıvısı (BOS) bulguları ile doğrulandı. Rifampisin, doksisiklin ve streptomisin tedavisi başlanan hastalar hızla düzeldi. Anahtar Kelimeler: Brusellozis, nörobnisellozis, meningoensefalit Absract