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Official websites use. Share sensitive information only on official, secure websites. Turk J Gastroenterol. The frequency of genotype 4 hepatitis C virus infection is significantly higher in a city compared to other provinces in Turkey. In this study, we aimed to investigate the epidemiology and risk factors of hepatitis C virus genotype 4 infection in Kayseri province of Turkey. A case—control study was conducted with 61 hepatitis C virus genotype 4-infected patients and 71 controls. A questionnaire was administered to the patients and controls, asking for information about the risk factors of hepatitis C virus transmission. Phylogenetic analysis and molecular clock analysis were performed. Logistic regression analysis was performed to determine the effect of risk factors by controlling for confounding variables. Kayseri isolates were closely related to type 4d sequences but formed a separate cluster. According to the molecular clock analysis, hepatitis C virus genotype 4d entered Kayseri province probably between and Blood transfusion and surgical intervention were found to be significant risk factors for the infection. Epidemiological data showed that hepatitis C virus genotype 4d infections are significantly associated with unsafe medical procedures. Hepatitis C virus HCV type 4d infections could be related to unsafe medical procedures unlike in Europe. Hepatitis C virus HCV can cause both acute and chronic hepatitis, ranging in severity from a mild illness to serious illness, including liver cirrhosis and cancer. Globally, an estimated 58 million people have chronic hepatitis C virus infection, with about 1. Hepatitis C virus is a blood-borne virus and most infections occur through exposure to blood from unsafe injection practices, unsafe health care, unscreened blood transfusions, injection drug use, and sexual practices that lead to exposure to blood. There are 8 genotypes of HCV and 86 subtypes based on genomic sequence heterogeneity. Genotype 5 is found primarily in South Africa and genotype 6 occurs throughout Asia. Genotypes 5, 7, and 8 originate in southern and central sub-Saharan Africa. Sanger sequencing is considered a gold standard for HCV genotype and subtype determination. Recent studies have shown that HCV epidemiology has changed in Turkey and genotype 3 infections have occurred due to intravenous drug use. In Europe, most of the genotype 4d patients were male and intravenous drug users. In this study, it was aimed to investigate the epidemiology and risk factors of HCV genotype 4 infection in Kayseri province of Turkey. A case—control study was designed to investigate the risk factors for HCV. Sixty-one treatment-naive and genotype 4-infected chronic hepatitis C patients, who were admitted to Erciyes University, Departments of Gastroenterology and Infectious Diseases in , were included in the study. There were 71 controls, matched to the patients for age within 8 years, gender who were selected among people living in the same neighborhood as the patients. All of the controls were anti-HCV negative. A questionnaire was administered to the patients and controls which contained information regarding the socioeconomic characteristics and risk factors of HCV transmission routes. Informed consent was obtained from all patients. The sequence analysis was performed bidirectionally. Phylogenetic analysis was done with the sequences of Kayseri isolates and reference sequences from different genotypes downloaded from the Los Alamos HCV database. MEGA software 5. The chi-square test was used for categorical variables when evaluating the association of independent variables with the dependent variable. Logistic models included variables that were significant in literature and in univariate analysis. Hosmer—Lemeshow test was used for model fit. Data were evaluated with the Statistical Package for Social Sciences version All of the patients were citizens of Kayseri province and The mean ages of patients were Histologic activity index and fibrosis results were 5. Univariate analysis of risk factors affecting HCV genotype 4 infection is shown in Table 1. None of the patients and controls were intravenous drug users and had hemodialysis treatment and got a tattoo. None of the patients had acupuncture and manicure—pedicure. None of the controls had sexually transmitted diseases. Surgical interventions were applied to patients before In addition, patients with a history of blood transfusion were transfused before Multivariate analysis of factors affecting HCV genotype 4 infection is shown in Table 2. The other sequences were not clear enough for the phylogenetic analyses. Hepatitis C virus genotype 4 isolates were closely related with type 4d sequences but formed a distinct cluster Figure 1a and b. All the sequences found in this study were deposited into GenBank. Bootstrap values lower than 70 are hidden. At the nucleotide level, Kayseri isolates differ from each other by 5. The distances of the isolates from the HCV genotype 4d isolates were 9. The NS5B sequences of Kayseri isolates were 4. According to the molecular clock analysis, HCV genotype 4d entered Kayseri province probably between and Genotypes 2, 3, and 4 infections are found at a low rate. We did not know how the HCV genotype 4d infection spreads, these infections may be healthcare related. It has been shown that genotype 1b infections in Turkey are associated with healthcare services. In our study, it was aimed to investigate the epidemiology and risk factors of HCV genotype 4d infection. Unsafe medical procedures in healthcare services can be the cause of the predominance of female patients. However, the hospitalization and biopsy in patients with HCV 4d can be due to reverse causality that patients had a biopsy because of HCV infection and are more likely to be hospitalized. Since the patients were HCV positive, it is thought that they had intercourse using condoms more than the control group. In multivariate analysis, blood transfusion and surgical intervention were found to be significant independent risk factors for HCV genotype 4d infection. Another study from Turkey reported that surgical intervention, blood transfusion, multiple sexual partners, and dental treatment were more frequent in patients with chronic HCV infection compared to the control group. A study from Mexico reported that intravenous drug use, blood transfusion, and tattooing are important risk factors when compared to patients with HCV infection and controls. This indicates that the risk factors influencing HCV transmission vary from country to country according to the geographical area. Murphy et al 24 did a case—control study in the US that identified risk factors for HCV infection in blood donors. Injecting drug use, blood transfusion among non-injecting drug users, and sexual act with injecting drug users were found to be risk factors for HCV infection. In Turkey, HCV antibody screening of blood donors was begun in Anti-HCV positivity in blood donors from various centers was found to be 0. Professional and public health education and implementation of infection control practices in all health facilities are of utmost importance. Kayman et al 16 detected that the subtype of genotype 4 isolates as 4d in Kayseri. In this study, we investigated the molecular epidemiology of HCV genotype 4 isolates. The isolates were type 4d and formed a separate cluster. Phylogenetic data of this study were similar to the study of Kayman et al 16 based on the analysis of identical regions Figure 1b. Cantaloube et al 26 showed that genotype 4d infections grow exponentially from the s to However, Ciccozzi et al 27 reported that the genotype 4d epidemic in Southern Italy had been maintained in a steady non-expanding phase until the late s after that it grew exponentially up to the s. HCV genotype 4d isolates from Kayseri province were analyzed together with European type 4d isolates and Kayseri isolates had a different origin being completely separated from the European one. According to molecular clock analysis, HCV genotype 4d entered Kayseri province between and , similar to Ciccozzi et al This period coincides with the significant increase in the number of medical procedures, such as blood transfusions and unsafe therapeutic injections, which are the main cause of the worldwide spread of HCV. Cicozzi et al 15 showed that HCV 4d gene flow mainly occurred from Kayseri to the periphery according to the migration pattern analysis. It is known that a lot of patients from the periphery of Kayseri province come to the center of the city to get health services. Our study is the first case control study that investigates the risk factors of HCV genotype 4d infection. The risk factors strongly suggest that genotype 4d infection is healthcare related. As HCV genotype 4d entered Kayseri between and , patients most probably contracted the virus in those years in a common healthcare facility. Since the exposure was many years ago, it is not easy to get specific and reliable information from patients. However, we still had statistically significant results for some of the risk factors. In conclusion, epidemiological data showed us that HCV type 4d infections could be related to unsafe medical procedures and phylogenetic data were similar to the previous studies done in Kayseri. Informed Consent: Written informed consent was obtained from the patients who participated in this study. Author Contributions: Concept — S. Declaration of Interests: The authors declare that they have no competing interest. As a library, NLM provides access to scientific literature. Find articles by Ceylan Polat. Find articles by Mustafa Altay Atalay. Find articles by Bilgehan Aygen. Open in a new tab. Peer-review: Externally peer-reviewed. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Number of sexual partners more than 1 partner.
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Kayseri , Airport Car Rental. Reserve a Rental Car. Pick up Location You can make your selection by searching from the list. Use my current location. Kayseri , Airport. Pick up Date Date - Time. Return Date Date - Time. Renter Age Please, select your age information to see the vehicles that suit you. Return to a different location You can return your vehicle to a different location. Return Location Please choose your drop off location. Promotion Code You can rent a car using a promotional code. Promotion type. Promotion code. Pick - up Location Address. Welcome E-mail: kayseri enterprise. Rental Policies. In case of damage or malfunction in the rented vehicle, the tenant is responsible for delivering the vehicle to the authorized service in a safe and non-damaging manner. At the stage of delivering the vehicle to the service, if the support is not received from the Enterprise offices or the Enterprise Road Assistance call center, the tower's cost will be paid by the tenant. Our vehicles are delivered to the full warehouse and returned to the full warehouse. If it is stated that the legal speed limit has been exceeded and the accident occurred in the accident detection form due to the speed, d. In unilateral accidents, the accident report is not prepared, in the case of double-sided accidents, the declaration is missing, the alcohol report is not received, and in the case of deliberate accidents, the use of vehicles with high turnover rate etc. In case of damages due to carelessness and intent, damages caused by the use of wrong or illegal fuel, as a result of tire explosion, damages due to driving on the rim, if a vehicle against the traffic laws is used, in case of using a driver's license against the traffic laws, other than the drivers specified in the rental agreement. Material losses, treatment expenses to the vehicle and passengers in the vehicle are limited to the mandatory traffic insurance limits of the vehicle, and all responsibilities and liabilities, including moral hazards, belong exclusively to the tenant. Tire split, tire damage, rim damage regardless of accident unless LCF fuse has been purchased g. Wheel cover and spare wheel loss h. License, license plate, fire extinguisher and in-vehicle equipment damage I. Any damage and loss not covered by insurance During the delivery of the vehicle, the tenant will realize the determined fee and the costs to be incurred by the credit card, voucher or cash at the end of the rental. Current account tenants will make their payments related to the debt that will occur in cash or through the bank. The tenant accepts and undertakes that YES OTO is authorized to take a precautionary lien and precautionary decision without providing any collateral foreclosure or injunction if the rental fee is not paid. At the beginning of the lease, vehicle users are required to present their driver's license and available credit cards. Payments are made with a valid credit card at the beginning of the rental. At the beginning of the lease, temporary blockage is applied in the amount that varies according to the vehicle group in the nature of the tenant's credit card. If the rental period is more than 1 month, the blocked amount is equal to the monthly rental price. Tenant, over the block, additional rental days, fuel shortage, damage, traffic fines, etc. If the tenant requests, the following additional insurances that can extend the insurance coverage can be purchased; - Mini Damage Insurance covers material damages excluding tire, glass, headlight damages up to the determined price varying according to the vehicle group without the need for a customer report and a police report. In case of damages over the price determined by the mini damage insurance, the customer is responsible for the entire damage price. Our prices include car rental and standard car rental insurance. The scope of the standard insurance included in the daily price; - Double-sided accident; The drivers of both vehicles involved in the accident must fill in the accident reports with a wet signature and deliver them to the Enterprise office. If the police report and alcohol test are complete, repair will take place within the vehicle's damaged area. If you wish, you can benefit from our Baby seat, Additional driver, Winter tire, Comprehensive additional insurance and GPS Navigation services for additional fees. The rental is at least 1 day 24 hours. For shorter rentals, daily price is applied. The tenant will return and deliver the vehicle on the day agreed. Cancellation and refund policies If you add assurance package to your reservation from additional services, you will be not charged and get full refund, except the amount of package, when you cancel until pick up time. If you don't have assurance package; For the reservations which are the pick up dates are on a date except the period between 1st of June and 31st of August; If there is more than 24 hours to your pick up time, there is no cancellation charge. If there is between 24 hours-1 hour to your pick up time, there is cancellation charge as 1 day rental amount. If there is less than 1 hour to ypur pick up time, there is cancellation charge as 2 days rental amount. If you don't pick up without cancellation prior to pick up time, there will be no refund. For the reservations which are the pick up dates are on a date between 1st of June and 31st of August; If there is more than 48 hours to your pick up time, there is no cancellation charge. If there is less than 48 hour to your pick up time, there is cancellation charge as 3 days rental amount. In other offices, there is a daily limit of km in economic and middle groups, and km in upper groups. It is forbidden to take the vehicles rented from our Enterprise offices abroad. Our vehicles can only be used within the borders of the country. You can book quickly in any of your offices in 85 countries served by Enterprise company for your car rental requests abroad. The tenant is obliged to comply with the regulations on highways. In case of criminal proceedings due to the use of vehicles contrary to laws and regulations, the tenant is responsible for the costs penalty, vehicle binding, vehicle withdrawal, etc. The tenant is responsible for the criminal proceedings to be applied as a result of the accidents caused by the roads violating traffic rules and their personals traffic penalties, expenses incurred by towing and towing the vehicle and other expenses. Other Offices.
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