Browsing by Author "Bodur, Mehmet Sinan"

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Diagnostic Shifts in Extrapulmonary Tuberculosis during COVID-19: Evidence of Vulnerability among Migrants in a Border Province
(BMC, 2026) Kabak, Mehmet; Bodur, Mehmet Sinan; Cil, Baris
BackgroundThe diagnosis of extrapulmonary tuberculosis (EPTB) often depends on advanced imaging, invasive tissue sampling, and multidisciplinary referral pathways. These complex, procedure-dependent diagnostic processes are particularly vulnerable to disruption during periods of health system strain. During the COVID-19 pandemic, the reallocation of healthcare resources, restrictions on elective procedures, and delays in diagnostic services may have disproportionately affected EPTB detection, leading to missed or delayed diagnoses. Migrant populations, who already face structural barriers to healthcare access related to language, socioeconomic factors, and referral processes, may be especially vulnerable to such diagnostic disruptions during public health emergencies.MethodsWe conducted a retrospective observational study using complete provincial tuberculosis dispensary records from Mardin, a border province in southeastern Turkey. All tuberculosis cases diagnosed between 2017 and 2025 were included. Diagnostic periods were defined as pre-COVID (2017-2019), COVID (2020-2022), and post-COVID (2023-2025). Cases with concomitant pulmonary and extrapulmonary involvement were classified as pulmonary tuberculosis (PTB). Distributions of PTB and EPTB by diagnostic period and nationality (local vs. migrant) were compared using chi-square or exact tests, as appropriate. For microbiological analyses, hypothesis testing was restricted to cases with available results. Factors associated with EPTB were evaluated using Firth penalized logistic regression to reduce small-sample bias and separation.ResultsA total of 525 tuberculosis cases diagnosed between 2017 and 2025 were included (mean age 37.8 +/- 19.3 years; 51.2% male), of whom 49 (9.3%) were migrants. Overall, 235 cases (44.8%) were classified as extrapulmonary tuberculosis (EPTB). In the local population, EPTB proportions varied across periods (47.4% pre-COVID, 35.2% during COVID, and 54.9% post-COVID; p = 0.0034). Among migrants, EPTB proportions also differed across periods (26.9%, 16.7%, and 63.6%, respectively; exact p = 0.0425), although estimates were imprecise due to small strata sizes. Among locals, AFB positivity among performed tests and culture positivity among determinate results varied across periods (p = 0.0041 and p = 0.0001, respectively). In Firth penalized logistic regression male sex and the COVID period were associated with lower odds of EPTB. Migrant status showed lower odds but did not reach statistical significance, and the post-COVID period was not statistically significant. These findings reflect changes in the PTB/EPTB case-mix among notified TB cases rather than population incidence.ConclusionWe observed a transient shift in the PTB/EPTB case-mix during the COVID period with a post-COVID rebound. While these patterns are compatible with pandemic-related changes in diagnostic pathways, mechanisms cannot be directly assessed in registry data without denominators and service-level diagnostic volumes. Maintaining access to referral- and procedure-dependent diagnostic pathways remains important, particularly for vulnerable populations.Clinical trailNot applicable.
Syrian Civil War and Assessment of Tuberculosis Among Syrian Refugees and Local Citizens in Mardin
(Frontiers Media SA, 2025) Cil, Baris; Kabak, Mehmet; Bodur, Mehmet Sinan; Sanmak, Erkan; Gunes, Guldan; Alakas, Yusuf; Oktay, Hamza
Background: We compared tuberculosis (TB) characteristics and outcomes between Syrian refugees and local citizens in Mardin, Turkey (2016-2023), a border province with substantial population mobility. Methods: Retrospective, registry-based cross-sectional analysis of 491 patients (locals n = 456; refugees n = 35). Descriptive comparisons used chi(2)/Fisher (categorical) and Mann-Whitney U (age). Annual incidence per 100,000 used mid-year denominators (locals: ABPRS/NVI; refugees: DGMM/PMM and UNHCR). For outcomes with significant crude differences (treatment success, BCG scar, transferred-out), age- and sex-adjusted bias-reduced (Firth) logistic regression was applied; p-values from penalized likelihood-ratio (PLR) tests. Results: BCG-scar positivity was lower in refugees than locals (62.9% vs. 93.2%, p < 0.001). Microbiological confirmation remained below WHO targets in both groups. Crude treatment success was lower in refugees (68.6%) than locals (90.4%, p = 0.03), while transferred-out was higher (25.7% vs. 5.3%, p = 0.001). In adjusted Firth models including all cases, refugee status was associated with lower odds of success (aOR 0.224, 95% CI 0.103-0.488; PLR p < 0.001); after excluding transferred-out cases the association attenuated and was not significant (aOR 0.562, 95% CI 0.121-2.605; PLR p = 0.42). In pulmonary-only analyses, the association persisted (aOR 0.216, 95% CI 0.083-0.567; PLR p = 0.002). Refugee incidence dipped in 2020-2021 and rebounded in 2022-2023. Conclusion: Differences likely reflect operational barriers-especially transfers disrupting continuity-rather than intrinsic factors. Refugee-inclusive TB services with robust inter-provincial transfer tracking, patient navigation, and expanded bacteriological testing (notably for extrapulmonary disease) should be prioritized. Given the small refugee subgroup and denominator uncertainties, findings are hypothesis-generating.
Underutilization of Bacteriological Testing in Extrapulmonary Tuberculosis: A Retrospective Single-Center Study from Mardin, Türkiye
(Galenos Publ House, 2026) Kabak, Mehmet; Bodur, Mehmet Sinan; Cil, Baris
OBJECTIVE: Extrapulmonary tuberculosis (EPTB) poses diagnostic challenges due to the low bacillus burden of the disease and the limited use of bacteriological tests. The aim of this study was to evaluate bacteriological confirmation rates, diagnostic methods, and sampling practices among patients diagnosed with tuberculosis (TB) in a southeastern province of Türkiye. MATERIAL AND METHODS: This retrospective study included a total of 456 TB cases diagnosed between 2014 and 2019. The cases were classified as pulmonary tuberculosis (PTB), EPTB, and cases with both types of involvement. Bacteriological and histopathological confirmation rates were compared between the groups. RESULTS: 41.0% of all cases were classified as EPTB. The most commonly involved site was lymph node TB (22.4%). Bacteriological confirmation rates were significantly lower in EPTB cases: acid-fast bacilli (AFB) smear positivity was 3.2% and culture positivity was 4.3%, whereas the histopathological confirmation rate was 88.8%. No bacteriological samples were taken from 63.1% of patients in the EPTB group. Among PTB cases, AFB smear positivity (71.4%) and culture positivity (66.5%) were significantly higher (P < 0.001). CONCLUSION: The findings suggest that bacteriological tests are both underused and of low diagnostic efficiency in EPTB cases. Most diagnoses are based on histopathology rather than on bacteriological confirmation. Strengthening sampling strategies and promoting the use of rapid molecular testing are critical for enhancing bacteriological validation in EPTB.