Evaluation of the Effect of the COVID -19 ‘Lockdown Process’ on the Clinical and Metabolic Parameters of Obese Patients: A Single Center Cross-Sectional Study

Yıl: 2021 Cilt: 55 Sayı: 4 Sayfa Aralığı: 186 - 192 Metin Dili: İngilizce DOI: 10.25048/tudod.946756 İndeks Tarihi: 04-01-2022

Evaluation of the Effect of the COVID -19 ‘Lockdown Process’ on the Clinical and Metabolic Parameters of Obese Patients: A Single Center Cross-Sectional Study

Öz:
Aim: The COVID-19 “lockdown process” can cause weight gain due to sedentary lifestyle, dietary and sleep disturbances. In this study, we aimed to determine clinical and metabolic effects of weight change in obese patients caused by the quarantine. Material and Methods: This study included 44 patients with a BMI of 30 kg/m2 . In the study, patients’ pre-quarantine metabolic parameters were obtained from hospital records. The metabolic parameters of the patients were measured again after quarantine. Patients were questioned about weight tracking, eating habits, exercise, and the need for hospital admission during quarantine. Results: Of the patients (n=44), 72.7% were women and mean age was 39.9±13.9 (18.0-61.0) years. The BMI of patients was 36.0 (30.7- 46.0) kg/m² and 27.3% (n=12) of patients were morbidly obese. During the quarantine, patients’ weight (p<0.001) and BMI (p<0.001) increased. Patients’ dietary compliance changed from 27.3% to 13.6% (p=0.109) and home exercise from 29.5% to 31.8% (p=0.999). 68.2% of patients tracked weight and 52.3% experienced increased appetite. Obese patients tracked their weight significantly more often than morbidly obese patients (p=0.027). Weight gain wasn’t associated with dietary compliance (p=0.609) and exercise (p=0.633). A significant increase in patients’ glucose, insulin, HOMA- IR and cholesterol (p<0.001 for each) was observed. Conclusion: In this study, it was observed that the COVID -19 “Lockdown Process” increased BMI in obese patients regardless of diet and exercise. Consequently, a significant worsening was observed in obese patients’ insulin resistance and lipid parameters. Active follow-up strategies for obese patients in possible quarantines can prevent the negative consequences.
Anahtar Kelime:

Investigation of Group A Rotavirus G10, G12 Genotypes Emerging in Patients with Acute Gastroenteritis in a Tertiary Care Hospital

Öz:
Rotaviruses are the most common cause of viral gastroenteritis with the highest mortality and morbidity rates in children aged 0-5 years. The aim of this study was to determine the frequency of rotavirus infection in patients whose stool samples were sent to microbiology laboratory to investigate the etiology of diarrhea, to investigate the rotavirus genotypes that are common in our region and G10, G12 genotypes that have recently become common in the world. Fecal samples of 476 patients aged between 0-92 years who applied between November 2016 and February 2018 were studied via immunochromatographic rapid test and enzyme-linked immunosorbent assay (ELISA) methods. ELISA positive samples were studied by nested reverse transcriptase chain reaction (RT-PCR) and genotyped by agarose gel electrophoresis. Rotavirus was found positive in 18.3% and 17% of stool samples by immunochromatographic test and ELISA, respectively. All ELISA positive samples were also detected as positive by RT-PCR. 18.5% of female patients and 15.7% of male patients were found to be positive and rotavirus positivity was not statistically significant between genders. The frequency of rotavirus in different age groups was 23.5% (6-12 years), 17.3% (13-24 months) and 16% (25-36 months). It was determined that rotavirus cases were most common in the spring. G1, G2, G3, G4, G9, G10, and G12 were detected in 37%, 7.4%, 16.1%, 6.2%, 9.9%, 2.5%, 26% of the samples, respectively. G12 was the most common genotype after G1. The most common G and P genotype combination was G1P[8] (17.2%). This was followed by G12P[8] (11.11%) and G3P[8] (11.11%). P[8] (53%) was found to be the dominant P genotype. In this study, it was observed that rotavirus, which is the cause of childhood diarrhea, can also be encountered in advanced ages and even new genotypes that infect humans worldwide may also be the causative agents. Therefore, we concluded that it is important to investigate new genotypes such as G10 and G12 in molecular epidemiological studies.
Anahtar Kelime:

Hastanemize Başvuran Akut Gastroenteritli Hastalarda Yeni Görülmeye Başlayan A Grubu Rotavirüs G10, G12 Genotiplerinin Araştırılması

Öz:
Rotavirüsler dünyada 0-5 yaş arasındaki çocuklarda en sık karşılaşılan, mortalite ve morbidite oranı yüksek olan viral gastroenterit etkenidir. Bu çalışmada laboratuvarımıza ishal etiyolojisi araştırılması için dışkı örnekleri gönderilen hastalarda, rotavirüs enfeksiyonu sıklığını belirlemek, bölgemizde yaygın görülen rotavirüs genotiplerini ve son zamanlarda dünya genelinde sık görülmeye başlayan G10, G12 genotiplerini araştırmak amaçlanmıştır. Çalışmamızda Kasım 2016 ve Şubat 2018 tarihleri arasında başvuran, 0-92 yaş arasındaki 476 hastanın dışkı örnekleri immünokromatografik hızlı test ve “enzyme-linked immunosorbent assay (ELISA)” ile çalışılmıştır. ELISA pozitif örneklere nested revers transkriptaz polimeraz zincir reaksiyonu (nRT-PCR) çalışılarak agaroz jel elektroforezi yardımıyla genotiplendirme yapılmıştır. Dışkı örneklerinin %18.3’ünde ve %17’sinde sırasıyla immünokromatografik test ve ELISA ile rotavirüs pozitif bulunmuştur. Tüm ELISA pozitif örnekler, RT-PCR ile de pozitif olarak tespit edilmiştir. Kadın hastaların %18.5’i, erkek hastaların %15.7’si pozitif olarak saptanmış ve cinsiyetler arasında rotavirüs pozitifliği istatistiksel olarak anlamlı bulunmamıştır. Rotavirüs pozitifliği en fazla 6-12 (%23.5) yaş grubunda görülmüş; bunu 13-24 ay (%17.3), 25-36 ay (%16) yaş grupları izlemiştir. Rotavirüs olgularının en yaygın olarak ilkbaharda görüldüğü saptanmıştır. Örneklerin sırasıyla %37, %7.4, %16.1, %6.2, %9.9, %2.5, %26’sında G1, G2, G3, G4, G9, G10 ve G12 saptanmıştır. G12, G1’den sonra en sık görülen genotip olarak tespit edilmiştir. En yaygın G ve P genotip kombinasyonu G1P[8] (%17.2) olarak bulunmuştur. Bunu G12P[8] (%11.11) ve G3P[8] (%11.11)’in takip ettiği saptanmıştır. P genotipleri arasında P[8] (%53) dominant genotip olarak bulunmuştur. Çalışmamızda çocukluk çağı ishal etkeni olan rotavirüsün, ileri yaşlarda da karşımıza çıkabileceği ve hatta dünya genelinde insanlarda enfeksiyon yapan yeni genotiplerin de etken olabileceği gözlenmiştir. Bu nedenle moleküler epidemiyolojik çalışmalarda G10, G12 gibi yeni genotiplerin de araştırılmasının önemli olduğu kanaatine varmış bulunmaktayız.
Anahtar Kelime:

COVID-19 ‘Evde Kal’ Sürecinin Obez Hastalarının Klinik ve Metabolik Parametreleri Üzerine Etkisinin Değerlendirilmesi: Tek Merkez Kesitsel Çalışma

Öz:
Amaç: COVID-19’un ‘Evde Kal’ süreci obezite hastalarında hareketsiz bir yaşama, beslenme ve uyku bozukluğuna bağlı olarak kilo artışına neden olabilir. Biz bu çalışmada; karantina sürecinin obezite hastalarında oluşturduğu kilo değişiminin klinik ve metabolik etkilerini tespit etmeyi amaçladık. Gereç ve Yöntemler: Bu çalışmaya kliniğinimize ayaktan başvuran VKİ ≥30 kg/m2olan 44 hasta dâhil edildi. Çalışmada karantina öncesi tarafımızca takip edilen hastaların metabolik parametreleri kayıtlı dosyalardan elde edildi. Bu hastaların karantina sonrası polikliniğimize ilk başvuruları sırasındaki metabolik parametreleri tekrar ölçüldü. Ayrıca hastaların karantina sürecindeki kilo takibi, beslenme alışkanlıkları, fiziksel aktiviteleri yüz yüze sorgulandı. Bulgular: Hastaların (n=44) %72,7 ’si kadın, %27,3’ü erkeklerden oluşmaktaydı. Hastaların ortalama vücut kütle indeksleri (VKİ) 36 (30,70-46,00) kg/m² olup hastaların %27,3’ü (n=12)’ü morbid obezdi. Karantina sürecinde hastaların kilo (p<0,001) ve VKİ (p<0,001)’inde artış olduğu görüldü. Hastaların diyet uyumunun %27,3’ten %13,6’ya (p=0,109) düştüğü, ev içi egzersiz durumunun ise %29,5 iken %31,8 (p=0.999) olduğu ayrıca %68,2’sinin kilo takibi yaptığı, %52,3’ünün iştah artışı yaşadığı tespit edildi. Obez hastaların morbid obezlere kıyasla anlamlı şekilde daha fazla kilo takibi yaptıkları görüldü (p=0,027). Hastaların kilo artışı diyet uyumu (p=0,609) ve egzersiz (p=0,633) ile ilişkili değildi. Karantina sürecinde hastaların glukoz (p=0,001), insülin (p<0,001), homa-IR (p<0,001) ve kolesterol (p<0,001) değerlerinde artış görüldü. Sonuç: Bu çalışmada ‘Evde Kal Süreci’nin obez hastaların beslenme alışkanlığı ve egzersiz durumlarından bağımsız olarak VKİ’inde artış olduğu görülmüştür. Bununla ilişkili olarak obez hastaların insülin direnci ve lipid parametrelerinde belirgin bozulma gözlenmiştir. Bundan sonra olası karantina süreçlerinde obez hastalar için daha aktif takip stratejilerinin planlanması bu süreçte hastaların yaşadığı olumsuz sonuçların önüne geçebilir.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Greenberg HB, Estes MK. Rotaviruses: from pathogenesis to vaccination. Gastroenterology 2009; 136(6): 1939-51.
  • 1. World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Geneva: The World Health Organization; 2000. Technical Report Series no. 894.
  • 2. Gleizes O, Desselberger U, Tatochenko V, Rodrigo C, Salman N, Mezner Z, et al. Nosocomial rotavirus infection in European countries: a review of the epidemiology, severity and economic burden of hospitalacquired rotavirus disease. Pediatr Infect Dis J 2006; 25(1 Suppl): S12-21.
  • 2. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017- 2018. NCHS Data Brief. 2020;(360):1-8.
  • 3. Glass RI, Bresee J, Jiang B, Parashar U, Yee E, Gentsch J. Rotavirus and rotavirus vaccines. Adv Exp Med Biol 2006; 582: 45-54.
  • 3. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW; the Northwell COVID-19 Research Consortium, Barnaby DP, Becker LB, Chelico JD, Cohen SL, Cookingham J, Coppa K, Diefenbach MA, Dominello AJ, Duer-Hefele J, Falzon L, Gitlin J, Hajizadeh N, Harvin TG, Hirschwerk DA, Kim EJ, Kozel ZM, Marrast LM, Mogavero JN, Osorio GA, Qiu M, Zanos TP. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with covid-19 in the New York City area. JAMA. 2020; 323(20):2052-2059.
  • 4. Parashar UD, Nelson EA, Kang G. Diagnosis, management, and prevention of rotavirus gastroenteritis in children. BMJ 2013; 347: f7204.
  • 4. Dietz W, Santos-Burgoa C. Obesity and its implications for COVID-19 mortality. Obesity (Silver Sipring).2020;28(6):1005.
  • 5. Stelzmueller I, Wiesmayr S, Swenson BR, Biebl M, Goegele H, Margreiter R, et al. Rotavirus enteritis in solid organ transplant recipients: an underestimated problem? Transpl Infect Dis 2007; 9(4): 281-5.
  • 5. Parameswaran K, Todd DC, Soth M. Altered respiratory physiology in obesity. Can Respir J. 2006;13(4):203‐210.
  • 6. Troeger C, Khalil IA, Rao PC, Cao S, Blacker BF, Ahmed T, et al. Rotavirus Vaccination and the Global Burden of Rotavirus Diarrhea Among Children Younger Than 5 Years. JAMA Pediatr 2018; 172(10): 958-65.
  • 6. Liu M, He P, Liu HG, Wang XJ, Li FJ, Chen S, Lin J, Chen P, Liu JH, Li CH. Clinical characteristics of 30 medical workers infected with new coronavirus pneumonia. Zhonghua Jie He He Hu Xi Za Zhi. 2020;43(0):E016.
  • 7. Rotavirus vaccines. WHO position paper - January 2013. Wkly Epidemiol Rec 2013; 88(5): 49-64.
  • 7. Peng YD, Meng K, Guan HQ, Leng L, Zhu RR, Wang BY, He MA, Cheng LX, Huang K, Zeng QT. Clinical characteristics and outcomes of 112 cardiovascular disease patients infected by 2019-nCoV. Zhonghua Xin Xue Guan Bing Za Zhi. 2020;48(6):450-455.
  • 8. Poelaert D, Pereira P, Gardner R, Standaert B, Benninghoff B. A review of recommendations for rotavirus vaccination in Europe: Arguments for change. Vaccine 2018; 36(17): 2243-53.
  • 8. Garg S, Kim L, Whitaker M, O’Halloran A, Cummings C, Holstein R, Prill M, Chai SJ, Kirley PD, Alden NB, Kawasaki B, Yousey-Hindes K, Niccolai L, Anderson EJ, Openo KP, Weigel A, Monroe ML, Ryan P, Henderson J, Kim S, ComoSabetti K, Lynfield R, Sosin D, Torres S, Muse A, Bennett NM, Billing L, Sutton M, West N, Schaffner W, Talbot HK, Aquino C, George A, Budd A, Brammer L, Langley G, Hall AJ, Fry A. Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019 - COVID-NET, 14 states, March 1-30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(15):458-464.
  • 9. Temel Sağlık İstatistikleri Modülü (TSİM). Available from: http://tsim.saglik.gov.tr/tsim
  • 9. Almandoz JP, Xie L, Schellinger JN, Mathew MS, Gazda C, Ofori A, Kukreja S, Messiah SE. Impact of COVID-19 stayat-home orders on weight-related behaviours among patients with obesity. Clin Obes. 2020;10(5):e12386.
  • 10. Durmaz R, Bakkaloglu Z, Unaldi O, Karagoz A, Korukluoglu G, Kalaycioglu AT, et al. Prevalence and diversity of rotavirus A genotypes cirulating in Turkey during a 2-year sentinel surveillance period, 2014-2016. J Med Virol 2018; 90(2): 229-38.
  • 10. Sidor A, Rzymski P. Dietary Choices And Habits During COVID-19 lockdown: Experience from Poland. Nutrients. 2020;12(6):1657.
  • 11. Durmaz R, Kalaycioglu AT, Acar S, Bakkaloglu Z, Karagoz A, Korukluoglu G, et al. Prevalence of rotavirus genotypes in children younger than 5 years of age before the introduction of a universal rotavirus vaccination program: report of rotavirus surveillance in Turkey. PLoS One 2014; 9(12): e113674.
  • 11. Zhang J, Wu W, Zhao X, Zhang W. Recommended psychological crisis intervention response to the 2019 novel coronavirus pneumonia outbreak in China: A model of West China Hospital. Precision Clinical Medicine. 2020; 3(1): 3-8.
  • 12. Dhital S, Sherchand JB, Pokhrel BM, Parajuli K, Shah N, Mishra SK, et al. Molecular epidemiology of Rotavirus causing diarrhea among children less than five years of age visiting national level children hospitals, Nepal. BMC Pediatr 2017; 17(1): 101.
  • 12. Sharafi S, Garmaroudi G, Ghafouri M, Shabnam Akhoundzadeh Bafghi M. Ghafouri M. Tabesh Z. Alizadeh Prevalence of anxiety and depression in patients with overweight and obesity. Obes Med. 2020;17:100169.
  • 13. Islamuddin M, Khan WH, Gupta S, Tiku VR, Khan N, Akdag AI, et al. Surveillance and genetic characterization of rotavirus strains circulating in four states of North Indian children. Infect Genet Evol 2018; 62: 253-61.
  • 13. Yılmaz C, Gökmen V. Neuroactive compounds in foods: Occurrence, mechanism and potential health effects. Food Res Int. 2020;128:108744 .
  • 14. Pongsuwanna Y, Guntapong R, Chiwakul M, Tacharoenmuang R, Onvimala N, Wakuda M, et al. Detection of a human rotavirus with G12 and P[9] specificity in Thailand. J Clin Microbiol 2002; 40(4): 1390-4.
  • 14. Pellegrini M, Ponzo V, Rosato R, Scumaci E, Goitre I, Benso A, Belcastro S, Crespi C, De Michieli F, Ghigo E, Broglio F, Bo S. Changes in weight and nutritional habits in adults with obesity during the “lockdown” period caused by the COVID-19 virus emergency. Nutrients. 2020;12(7):2016.
  • 15. Esona MD, Page NA, Akran VA, Armah GE, Steele AD. Characterization of 2 human genotype G10 rotavirus strains, 3008CM and 1784/CI/1999, isolated in Cameroon and Cote d’Ivoire during the 1999-2000 rotavirus season. J Infect Dis 2010; 202(Supp l): S212-9.
  • 16. Santos N, Lima RC, Pereira CF, Gouvea V. Detection of rotavirus types G8 and G10 among Brazilian children with diarrhea. J Clin Microbiol 1998; 36(9): 2727-9.
  • 17. Armah GE, Hoshino Y, Santos N, Binka F, Damanka S, Adjei R, et al. The global spread of rotavirus G10 strains: Detection in Ghanaian children hospitalized with diarrhea. J Infect Dis 2010; 202(Supp l): S231-8.
  • 18. World Health Organization (WHO). Manual of rotavirus detection and characterization methods. Geneva: World Health Organization, 2009. Available from: http://www.who.int/iris/handle/10665/70122
  • 19. Gouvea V, Glass RI, Woods P, Taniguchi K, Clark HF, Forrester B, et al. Polymerase chain reaction amplification and typing of rotavirus nucleic acid from stool specimens. J Clin Microbiol 1990; 28(2): 276-82.
  • 20. Gunasena S, Nakagomi O, Isegawa Y, Kaga E, Nakagomi T, Steele AD, et al. Relative frequency of VP4 gene alleles among human rotaviruses recovered over a 10-year period (1982-1991) from Japanese children with diarrhea. J Clin Microbiol 1993; 31(8): 2195-7.
  • 21. Uchida R, Pandey BD, Sherchand JB, Ahmed K, Yokoo M, Nakagomi T, et al. Molecular epidemology of rotavirus diarrhea among children and adults in Nepal: detection of G12 strains with P[6] or P[8] and a G11P[25] strain. J Clin Microbiol 2006; 44(10): 3499-505.
  • 22. Iturriza-Gomara M, Kang G, Gray J. Rotavirus genotyping: keeping up with an evolving population of human rotaviruses. J Clin Virol 2004; 31(4): 259-65.
  • 23. Kasifoglu N, US T, Aslan FG, Akgun Y. 2005-2011 Yılları Arasında Saptanan Rotavirus Antijen Pozitiflikleri. Türk Mikrobiyol Cem Derg 2011; 41(3): 111-5.
  • 24. Samanci S, Kosker M, Celik M, Arac E. Akut Gastroenteritli Çocuk Hastalarda Rotavirüs Enfeksiyonu Sıklığı. Van Tıp Derg 2018; 25(4): 441-444.
  • 25. Alp Avci G, Akbaba M. Beş Yaşın Altındaki Akut Gastroenteritli Çocuklarda Rotavirüs, Enterik Adenovirüs ve Norovirüs İnsidansı. Türk Mikrobiyol Cem Derg 2018; 48(4): 264-72.
  • 26. Afrad MH, Hassan Z, Farjana S, Moni S, Barua S, Das SK, et al. Changing profile of rotavirus genotypes in Bangladesh, 2006-2012. BMC Infect Dis 2013; 13: 320.
  • 27. Tian Y, Chughtai AA, Gao Z, Yan H, Chen Y, Liu B, et al. Prevalence and genotypes of group A rotavirus among outpatient children under five years old with diarrhea in Beijing, China, 2011-2016. BMC Infect Dis 2018; 18(1): 497.
  • 28. WHO. Vaccine-Preventable Diseases, Surveillance Standards, Rotavirus, 2018.
  • 29. Bulut Y, Yenisehirli G, Durmaz R. Molecular Epidemiology of Rotavirus Strains in Under Five Children. Indian J Pediatr 2018; 85(5): 364-8.
  • 30. Bonkoungou IJ, Sanou I, Bon F, Benon B, Coulibaly SO, Haukka K, et al. Epidemiology of rotavirus infection among young children with acute diarrhoea in Burkina Faso. BMC Pediatr 2010; 10: 94.
  • 31. Güreser A, Karasartova D, Tasci L, İlkay BoyaciogLu Z, Taylan Ozkan A. Rotavirus and Adenovirus Frequency in Children with Acute Gastroenteritis. Flora 2017; 22(2): 58-6.
  • 32. Kırdar S, Kahyaoglu F, Yazıcı V, Aydın N. Investigation of The Agents of Viral Gastroenteritis by PCR İn Stool Specimens with Rota/Adenovirus Positive by Antigen Test. Journal of BSHR 2017; 1(3): 88-93.
  • 33. Borsa BA, Bahar Tokman H, Çağatay P. Mardin kadin doğum ve çocuk hastaliklari hastanesi’nde 0-5 yaş arasi akut gastroenteritli çocuklarda rotavirüs ve adenovirüs sıklığının belirlenmesi. Ankem Derg 2013; 27(2): 75-9.
  • 34. Dogan Y, Eksi F, Karslıgil T, Bayram A. Akut Gastroenteritli Hastalarda Rotavirüs ve Adenovirüs Varlığının Araştırılması. Türk Mikrobiyol Cem Derg 2014; 44(1): 18-22.
  • 35. Konca C, Tekin M, Akgun S, Bulbul M, Coban M, Kahramaner Z. Prevalence of Rotavirus in Children with Acute Gastroenteritis, Seasonal Distribution, and Laboratory Findings in the Southeast of Turkey. J Pediatr Inf 2014; 8: 7-11.
  • 36. Sugeçti S, Çelen U, Azaklı Taşkın P, Yenice S, Koçer F. Akut Gastroenteritli Çocuklarda İmmünokromatografik Olarak Enterik Adenovirus ve Rotavirus Antijen Varlığının Mevsimsel Prevelansı. Çocuk Enfeksiyon Dergisi 2015; 9(4): 161-5.
  • 37. Custodio H, Masnita-Iusan C, Wludyka P, Rathore MH. Change in rotavirus epidemiology in northeast Florida after the introduction of rotavirus vaccine. Pediatr Infect Dis J 2010; 29(8): 766-7.
  • 38. Tate JE, Panozzo CA, Payne DC et al. Decline and change in seasonality of US rotavirus activity after the introduction of rotavirus vaccine. Pediatrics 2009; 124(2): 465-71.
  • 39. Matthijnssens J, Heylen E, Zeller M, Rahman M, Lemey P, Van Ranst M. Phylodynamic analyses of rotavirus genotypes G9 and G12 underscore their potential for swift global spread. Mol Biol Evol 2010; 27(10): 2431-6.
  • 40. Crawford SE, Ramani S, Tate JE, Parashar UD, Svensson L, Hagbom M, et al. Rotavirus infection. Nat Rev Dis Primers 2017; 3: 17083.
  • 41. Azaran A, Makvandi M, Teimoori A, Ebrahimi S, Heydari F, Nikfar R. Distribution of Rotavirus Genotypes Circulating in Ahvaz, Iran in 2016. Iran Biomed J 2018; 22(2): 107-16.
  • 42. Meral M, Bozdayi G, Ozkan S, Dalgic B, Alp G, Ahmed K. [Rotavirus prevalence in children with acute gastroenteritis and the distribution of serotypes and electropherotypes]. Mikrobiyol Bul 2011; 45(1): 104- 12.
  • 43. Rajendran P, Kang G. Molecular epidemiology of rotavirus in children and animals and characterization of an unusual G10P[15] strain associated with bovine diarrhea in south India. Vaccine 2014; 32 (Suppl 1): A89-94.
  • 44. Konstantopoulos A, Tragiannidis A, Fouzas S, Kavaliotis I, Tsiatsou O, Michailidou E, et al. Burden of rotavirus gastroenteritis in children <5 years of age in Greece: hospital-based prospective surveillance (2008-2010). BMJ Open 2013; 3(12): e003570.
  • 45. Cataloluk O, Iturriza M, Gray J. Molecular characterization of rotaviruses circulating in the population in Turkey. Epidemiol Infect 2005; 133(4): 673-8.
  • 46. Islamuddin M, Khan WH, Gupta S, Tiku VR, Khan N, Akdag AI, et al. Surveillance and genetic characterization of rotavirus strains circulating in four states of North Indian children. Infect Genet Evol 2018; 62: 253-61.
  • 47. Luchs A, Cilli A, Morillo SG, Gregorio Dde S, de Souza KA, Vieira HR, et al. Detection of the emerging rotavirus G12P[8] genotype at high frequency in brazil in 2014: Successive replacement of predominant strains after vaccine introduction. Acta Trop 2016; 156: 87-94.
  • 48. Azaran A, Makvandi M, Teimoori A, Ebrahimi S, Heydari F, Nikfar R. Distribution of Rotavirus Genotypes Circulating in Ahvaz, Iran in 2016. Iran Biomed J 2018; 22(2): 107-16.
  • 49. Moure UAE, Banga-Mingo V, Gody JC, Mwenda JM, Fandema J, Waku-Kouomou D, et al. Emergence of G12 and G9 rotavirus genotypes in the Central African Republic, January 2014 to February 2016. BMC Res Notes 2018; 11(1): 5.
  • 50. Aydin H, Aktas O. Rotavirus genotypes in children with gastroenteritis in Erzurum: first detection of G12P[6] and G12P[8] genotypes in Turkey. Prz Gastroenterol 2017; 12(2): 122-7.
  • 51. Tacharoenmuang R, Komoto S, Guntapong R, Ide T, Singchai P, Upachai S, et al. Characterization of a G10P[14] rotavirus strain from a diarrheic child in Thailand: Evidence for bovine-to-human zoonotic transmission. Infect Genet Evol 2018; 63: 43-57.
  • 52. Jain S, Vashistt J, Changotra H. Rotaviruses: is their surveillance needed? Vaccine 2014; 32(27): 3367-78.
  • 53. Santos N, Hoshino Y. Global distribution of rotavirus serotypes/genotypes and its implication for the development and implementation of an effective rotavirus vaccine. Rev Med Virol 2005; 15(1): 29-56.
APA TÜFEKÇİ D, Kahraman H, Coşkun H, Altay Kocak A, UNAL M.D. E, Albakkour K, EMÜR GÜNAY Y, MUFTAH H, DEMİR A, Dalgıç B, Bilginer M, Çağlar K, nuhoglu i, Ahmed K, ÜÇÜNCÜ O, Bozdayi G, KOCAK M (2021). Evaluation of the Effect of the COVID -19 ‘Lockdown Process’ on the Clinical and Metabolic Parameters of Obese Patients: A Single Center Cross-Sectional Study. , 186 - 192. 10.25048/tudod.946756
Chicago TÜFEKÇİ Damla,Kahraman Hande,Coşkun Hülya,Altay Kocak Aylin,UNAL M.D. Egemen,Albakkour Katren,EMÜR GÜNAY YASEMİN,MUFTAH Hager,DEMİR AHMET SUAT,Dalgıç Buket,Bilginer Muhammet Cuneyt,Çağlar Kayhan,nuhoglu irfan,Ahmed Kamruddin,ÜÇÜNCÜ OZGE,Bozdayi Gulendam,KOCAK Mustafa Evaluation of the Effect of the COVID -19 ‘Lockdown Process’ on the Clinical and Metabolic Parameters of Obese Patients: A Single Center Cross-Sectional Study. (2021): 186 - 192. 10.25048/tudod.946756
MLA TÜFEKÇİ Damla,Kahraman Hande,Coşkun Hülya,Altay Kocak Aylin,UNAL M.D. Egemen,Albakkour Katren,EMÜR GÜNAY YASEMİN,MUFTAH Hager,DEMİR AHMET SUAT,Dalgıç Buket,Bilginer Muhammet Cuneyt,Çağlar Kayhan,nuhoglu irfan,Ahmed Kamruddin,ÜÇÜNCÜ OZGE,Bozdayi Gulendam,KOCAK Mustafa Evaluation of the Effect of the COVID -19 ‘Lockdown Process’ on the Clinical and Metabolic Parameters of Obese Patients: A Single Center Cross-Sectional Study. , 2021, ss.186 - 192. 10.25048/tudod.946756
AMA TÜFEKÇİ D,Kahraman H,Coşkun H,Altay Kocak A,UNAL M.D. E,Albakkour K,EMÜR GÜNAY Y,MUFTAH H,DEMİR A,Dalgıç B,Bilginer M,Çağlar K,nuhoglu i,Ahmed K,ÜÇÜNCÜ O,Bozdayi G,KOCAK M Evaluation of the Effect of the COVID -19 ‘Lockdown Process’ on the Clinical and Metabolic Parameters of Obese Patients: A Single Center Cross-Sectional Study. . 2021; 186 - 192. 10.25048/tudod.946756
Vancouver TÜFEKÇİ D,Kahraman H,Coşkun H,Altay Kocak A,UNAL M.D. E,Albakkour K,EMÜR GÜNAY Y,MUFTAH H,DEMİR A,Dalgıç B,Bilginer M,Çağlar K,nuhoglu i,Ahmed K,ÜÇÜNCÜ O,Bozdayi G,KOCAK M Evaluation of the Effect of the COVID -19 ‘Lockdown Process’ on the Clinical and Metabolic Parameters of Obese Patients: A Single Center Cross-Sectional Study. . 2021; 186 - 192. 10.25048/tudod.946756
IEEE TÜFEKÇİ D,Kahraman H,Coşkun H,Altay Kocak A,UNAL M.D. E,Albakkour K,EMÜR GÜNAY Y,MUFTAH H,DEMİR A,Dalgıç B,Bilginer M,Çağlar K,nuhoglu i,Ahmed K,ÜÇÜNCÜ O,Bozdayi G,KOCAK M "Evaluation of the Effect of the COVID -19 ‘Lockdown Process’ on the Clinical and Metabolic Parameters of Obese Patients: A Single Center Cross-Sectional Study." , ss.186 - 192, 2021. 10.25048/tudod.946756
ISNAD TÜFEKÇİ, Damla vd. "Evaluation of the Effect of the COVID -19 ‘Lockdown Process’ on the Clinical and Metabolic Parameters of Obese Patients: A Single Center Cross-Sectional Study". (2021), 186-192. https://doi.org/10.25048/tudod.946756
APA TÜFEKÇİ D, Kahraman H, Coşkun H, Altay Kocak A, UNAL M.D. E, Albakkour K, EMÜR GÜNAY Y, MUFTAH H, DEMİR A, Dalgıç B, Bilginer M, Çağlar K, nuhoglu i, Ahmed K, ÜÇÜNCÜ O, Bozdayi G, KOCAK M (2021). Evaluation of the Effect of the COVID -19 ‘Lockdown Process’ on the Clinical and Metabolic Parameters of Obese Patients: A Single Center Cross-Sectional Study. Türkiye Diyabet ve Obezite Dergisi , 55(4), 186 - 192. 10.25048/tudod.946756
Chicago TÜFEKÇİ Damla,Kahraman Hande,Coşkun Hülya,Altay Kocak Aylin,UNAL M.D. Egemen,Albakkour Katren,EMÜR GÜNAY YASEMİN,MUFTAH Hager,DEMİR AHMET SUAT,Dalgıç Buket,Bilginer Muhammet Cuneyt,Çağlar Kayhan,nuhoglu irfan,Ahmed Kamruddin,ÜÇÜNCÜ OZGE,Bozdayi Gulendam,KOCAK Mustafa Evaluation of the Effect of the COVID -19 ‘Lockdown Process’ on the Clinical and Metabolic Parameters of Obese Patients: A Single Center Cross-Sectional Study. Türkiye Diyabet ve Obezite Dergisi 55, no.4 (2021): 186 - 192. 10.25048/tudod.946756
MLA TÜFEKÇİ Damla,Kahraman Hande,Coşkun Hülya,Altay Kocak Aylin,UNAL M.D. Egemen,Albakkour Katren,EMÜR GÜNAY YASEMİN,MUFTAH Hager,DEMİR AHMET SUAT,Dalgıç Buket,Bilginer Muhammet Cuneyt,Çağlar Kayhan,nuhoglu irfan,Ahmed Kamruddin,ÜÇÜNCÜ OZGE,Bozdayi Gulendam,KOCAK Mustafa Evaluation of the Effect of the COVID -19 ‘Lockdown Process’ on the Clinical and Metabolic Parameters of Obese Patients: A Single Center Cross-Sectional Study. Türkiye Diyabet ve Obezite Dergisi , vol.55, no.4, 2021, ss.186 - 192. 10.25048/tudod.946756
AMA TÜFEKÇİ D,Kahraman H,Coşkun H,Altay Kocak A,UNAL M.D. E,Albakkour K,EMÜR GÜNAY Y,MUFTAH H,DEMİR A,Dalgıç B,Bilginer M,Çağlar K,nuhoglu i,Ahmed K,ÜÇÜNCÜ O,Bozdayi G,KOCAK M Evaluation of the Effect of the COVID -19 ‘Lockdown Process’ on the Clinical and Metabolic Parameters of Obese Patients: A Single Center Cross-Sectional Study. Türkiye Diyabet ve Obezite Dergisi . 2021; 55(4): 186 - 192. 10.25048/tudod.946756
Vancouver TÜFEKÇİ D,Kahraman H,Coşkun H,Altay Kocak A,UNAL M.D. E,Albakkour K,EMÜR GÜNAY Y,MUFTAH H,DEMİR A,Dalgıç B,Bilginer M,Çağlar K,nuhoglu i,Ahmed K,ÜÇÜNCÜ O,Bozdayi G,KOCAK M Evaluation of the Effect of the COVID -19 ‘Lockdown Process’ on the Clinical and Metabolic Parameters of Obese Patients: A Single Center Cross-Sectional Study. Türkiye Diyabet ve Obezite Dergisi . 2021; 55(4): 186 - 192. 10.25048/tudod.946756
IEEE TÜFEKÇİ D,Kahraman H,Coşkun H,Altay Kocak A,UNAL M.D. E,Albakkour K,EMÜR GÜNAY Y,MUFTAH H,DEMİR A,Dalgıç B,Bilginer M,Çağlar K,nuhoglu i,Ahmed K,ÜÇÜNCÜ O,Bozdayi G,KOCAK M "Evaluation of the Effect of the COVID -19 ‘Lockdown Process’ on the Clinical and Metabolic Parameters of Obese Patients: A Single Center Cross-Sectional Study." Türkiye Diyabet ve Obezite Dergisi , 55, ss.186 - 192, 2021. 10.25048/tudod.946756
ISNAD TÜFEKÇİ, Damla vd. "Evaluation of the Effect of the COVID -19 ‘Lockdown Process’ on the Clinical and Metabolic Parameters of Obese Patients: A Single Center Cross-Sectional Study". Türkiye Diyabet ve Obezite Dergisi 55/4 (2021), 186-192. https://doi.org/10.25048/tudod.946756