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The Frequency of MEFV Gene Mutations for Familial Mediterranean Fever

Year 2019, , 254 - 260, 31.08.2019
https://doi.org/10.24938/kutfd.548831

Abstract

Objective: Familial mediterranean fever is an
autosomal recessive genetic disease caused by mutations in the MEFV genes. It
was aimed to determine the types and frequency of MEFV mutations in Familial
mediterrenean fever cases due to the fact that there is a common genetic
disease in our region and a low epidemiological data related to the mutations.

Material and Methods: A
total of 212 FMF patients with MEFV mutations
were
included
in the study. The data of the patients were retrospectively reviewed. The MEFV mutation analyses were
performed using the
Next
Generation Sequence
method.

Results: Of these
patients, 116 (54.71%) were female
and 96
(45.29%) were male. M694V (34.9%) was the most common mutation type,
E148Q (26%), V726A (16%), M68OI (8.3%)
were the other common mutation types. When the distribution of patients
with MEFV mutation
was examined according to
gender
, it was observed that
M694V, E148Q, V726A, M68OI, and R761H mutations
were more frequent in men while
M694V, E148Q, V726A, M68OI, and P369S mutations were
more frequent in women.

Conclusion: In our study which was conducted to determine
the frequency of MEFV mutation types, it has been shown that familial
Mediterranean fever disease is observed in a high rate in some regions and it
has also shown that these different rates can lead to differences between
societies.
We think that the frequency of
MEFV mutation types
may change from region to region and from population
to population. Therefore, because of changing population and the instability of
neighboring countries, large population-based studies aimed to determine the
frequency of MEFV mutation types should be made due to the in our region and in
our country.

References

  • 1. Alghamdi M. Familial Mediterranean fever, review of the literature. Clin Rheumatol. 2017; 36(8):1707-13.
  • 2. Manna R, Cerquaglia C, Curigliano V, Fonnesu C, Giovinale M, Verrecchia E et al. Clinical features of familial Mediterranean fever: an Italian overview. Eur Rev Med Pharmacol Sci. 2009;13(Suppl 1):51-3.
  • 3. Jesus AA, Goldbach-Mansky R. IL-1 blockade in autoinflammatory syndromes. Annu Rev Med. 2014;65:223-44. Doi:10.1146/annurev-med-061512-150641.
  • 4. Fingerhutová Š, Jančová E, Tesařová M, Dvořáková L, Doležalová P. Periodic fevers and other autoinflammatory diseases. Summer. 2018;157(3):122-9.
  • 5. Özen S, Batu ED, Demir S. Familial Mediterranean fever: recent developments in pathogenesis and new recommendations for management. Front Immunol. 2017;8:253. Doi: 10.3389/fimmu.2017.00253.
  • 6. Bagheri M, Rad IA. Analysis of the most common three MEFV mutations in 630 patients with familial Mediterranean fever in Iranian Azeri Turkish population. Maedica (Buchar). 2017;12(3):169-73.
  • 7. Grandemange S, Aksentijevich I, Jeru I, Gul A, Touitou I. The regulation of MEFV expression and its role in health and familial Mediterranean fever. Genes Immun. 2011;12(7):497-503.
  • 8. Bozkurt Y, Demir A, Erman B, Gül A. Unified modeling of familial Mediterranean fever and cryopyrin associated periodic syndromes. Comput Math Methods Med. 2015;2015:893507. Doi: 10.1155/2015/893507.
  • 9. Ozdemir O, Sezgin I, Kurtulgan HK, Candan F, Koksal B, Sumer H et al. Prevalence of known mutations in the MEFV gene in a population screening with high rate of carriers. Mol Biol Rep. 2011;38(5):3195-200.
  • 10. Üstebay S, Üstebay DÜ, Yılmaz Y. Ailevi Akdeniz ateşi. JAREM. 2015;5:89-93.
  • 11. Zadeh N, Getzug T, Grody WW. Diagnosis and management of familial Mediterranean fever: integrating medical genetics in a dedicated interdisciplinary clinic. Genet Med. 2011;13(3):263-9.
  • 12. Pras M. Familial Mediterranean fever: from the clinical syndrome to the cloning of the pyrin gene. Scand J Rheumatol. 1998;27(2):92-7.
  • 13. Slobodnick A, Shah B, Pillinger MH, Krasnokutsky S. Colchicine: old and new. Am J Med. 2015;128(5):461-70.
  • 14. INFEVERS-2018. The registry of hereditary auto-inflammatory disorders mutations. Accessed date: 28 Novomber 2018: https://infevers.umai-montpellier.fr/web/.
  • 15. Sarı O, Tanoğlu A, Aydoğan Ü. Birinci basamakta ailevi Akdeniz ateşine genel yaklaşım. Konuralp Tıp Dergisi. 2013;5(2):75-80.
  • 16. Moradian MM, Babikyan D, Banoian D, Hayrapetyan H, Manvelyan H, Avanesian N et al. Comprehensive analysis of mutations in the MEFV gene reveal that the location and not the substitution type determines symptom severity in FMF. Mol Genet Genomic Med. 2017;5(6):742-50.
  • 17. Bilginer Y, Bakkaloğlu A. Ailevi Akdeniz ateşi ve amiloidoz. Turkiye Klinikleri J Int Med Sci. 2006;2(8):33-9.
  • 18. Erden G, Bal C, Torun OG, Uğuz N, Yıldırımkaya MM. Ailesel Akdeniz ateşi (Fmf) düşünülen olgularda MEFV gen mutasyonları sıklığının incelenmesi. Türk Hij Den Biyol Derg. 2008;65(1):1-5.
  • 19. Güleç D, Çelebiler A, Karaca B. İzmir bölgesinde ailesel Akdeniz ateşi ön tanılı hastalarda MEFV geni mutasyon dağılımı. Türk Klinik Biyokimya Derg. 2012;10(3):95-101.
  • 20. Tunca M, Akar S, Onen F, Ozdoğan H, Kasapçopur O, Yalçınkaya F et al. Turkish FMF study group. Familial Mediterranean fever (FMF) in Turkey: results of a nationwide multicenter study. Medicine. 2005;84(1):1-11.
  • 21. Çağlar A, Özçelik G, Akıncı N. Ailevi Akdeniz ateşi olan çocuklarda genotip-fenotip ilişkisi. İzmir Dr. Behçet Uz Çocuk Hast. Dergisi. 2018;8(2):144-50.
  • 22. Abuhandan M, Kaya C, Güzelçiçek A. Ailevi Akdeniz ateşi tanısı alan 186 olgunun klinik semptom ve MEFV geni mutasyonlarının incelenmesi. Dicle Tıp Derg. 2015;42(1):61-5.
  • 23. Jarjour RA. Familial Mediterranean fever in Syrian patients: MEFV gene mutations and genotype-phenotype correlation. Mol Biol Rep. 2010;37(1):1-5.
  • 24. Gumus E. The frequency of MEFV gene mutations and genotypes in Sanliurfa province, South-Eastern region of Turkey, after the Syrian Civil War by Using Next Generation Sequencing and report of a novel Exon 4 mutation (I423T). J Clin Med. 2018;7(5). pii: E105. Doi:10.3390/jcm7050105.
  • 25. Pasa S, Altintas A, Devecioglu B, Çil T, Daniş R, Isi H et al. Familial Mediterranean fever gene mutations in the Southeastern region of Turkey and their phenotypical features. Amyloid. 2008;15(1):49-53.
  • 26. Samli H, Dogru O, Bukulmez A, Yuksel E, Ovali F, Solak M. Relationship of Tel Hashomer criteria and Mediterranean fever gene mutations in a cohort of Turkish familial Mediterranean fever patients. Saudi Med J. 2006;27:1822-6.
  • 27. Akin H, Onay H, Turker E, Cogulu O, Ozkinay F. MEFV mutations in patients with familial Mediterranean fever from the Aegean region of Turkey. Mol Biol Rep. 2010;37(1):93-8.
  • 28. Yigit S, Bagci H, Ozkaya O, Ozdamar K, Cengiz K, Akpolat T. MEFV mutations in patients with familial Mediterranean fever in the Black Sea region of Turkey: Samsun experience [corrected]. J Rheumatol. 2008;35(1):106-13.
  • 29. Taştan H, Ayvalı C, Durgun İS. Direct detection of common mutations in the familial Mediterranean fever gene by using PCR methods. Turkiye Klinikleri J Med Sci. 2004;24:445-9.
  • 30. Göç İdaresi Genel Müdürlüğü. Erişim tarihi: 01.01.2019: http://www.goc.gov.tr/içerik3/teşkilat-şeması 273-274-281.
  • 31. Majeed H, Rawashdeh M, El-Shanti H, Qubain H, Khuri-Bulos N, Shahin HM. Familial Mediterranean fever in children: the expanded clinical profile. QJM. 1999;92:309-18.
  • 32. Cazeneuve C, Sarkisian T, Pecheux C, Dervichian M, Nédelec B, Reinert P et al. MEFV-Gene analysis in armenian patients with familial Mediterranean fever: diagnostic value and unfavorable renal prognosis of the M694V homozygous genotype-genetic and therapeutic implications. Am J Hum Genet. 1999;65(1):88-97.
  • 33. Gunel-Ozcan A, Sayin DB, Misirlioglu ED, Guliter S, Yakaryilmaz F, Ensari C. The spectrum of FMF mutations and genotypes in the referrals to molecular genetic laboratory at Kirikkale University in Turkey. Mol Biol Rep. 2009;36(4):757-60.
  • 34. Ece A, Çakmak E, Uluca U, Kelekci S, Yolbas İ, Gunes A et al. The MEFV mutations and their clinical correlations in children with familial Mediterranean fever in southeast Turkey. Rheumatol Int. 2014;34(2):207-12.
  • 35. Gunesacar R, Kasap H, Erken E, Ozer HT. Comparison of amplification refractory mutation system and polymerase chain reaction-restriction fragment length polymorphism techniques used for the investigation of MEFV gene exon 10 point mutations in familial Mediterranean fever patients living in Cukurova region (Turkey). Genet Test. 2005;9(3):220-5.
  • 36. Sönmezgöz E, Özer S, Gül A, Yılmaz R, Kasap T, Takçı Ş et al. Clinical and demographic evaluation according to MEFV genes in patients with familial Mediterranean fever. Biochem Genet. 2019;57(2):289-300.

BÖLGEMİZDEKİ AİLESEL AKDENİZ ATEŞİ HASTALARININ MEFV GEN MUTASYON TİPLERİNİN SIKLIĞI

Year 2019, , 254 - 260, 31.08.2019
https://doi.org/10.24938/kutfd.548831

Abstract

Amaç: Ailesel Akdeniz ateşi otozomal resesif
geçen ve MEFV genindeki mutasyonların yol açtığı genetik bir hastalıktır.
Bölgemizde sık görülen genetik bir hastalık olması ve mutasyonlarla ilgili
epidemiyolojik verilerin az olması nedeniyle ailesel Akdeniz ateşi vakalarında,
MEFV mutasyonlarının tiplerinin ve sıklığının belirlenmesi amaçlandı.

Gereç ve Yöntemler:
Çalışmaya 212 MEFV
mutasyonu saptanmış hasta dâhil edildi. Hastaların verileri retrospektif olarak
tarandı. MEFV mutasyon analizi Next Generation Sequence yöntemi ile yapıldı.

Bulgular: Çalışma
hastalarının 116 (%54.71)’ı kadın ve 96 (%45.29)’ı erkekti. En sık saptanan
MEFV mutasyonu M694V (%34.9) idi. E148Q (%26), V726A (%16) ve M68OI (%8.3)
diğer sık saptanan mutasyon tipleriydi. MEFV mutasyonu saptanan hastaların
cinsiyetlere göre dağılımları incelendiğinde; erkeklerde M694V, E148Q, V726A,
M68OI ve R761H mutasyonları, kadınlarda ise M694V, E148Q, V726A, M68OI ve P369S
mutasyonlarının daha sık olduğu izlendi.

Sonuç: MEFV
mutasyon tiplerinin sıklığını belirlemek amacıyla yapılan çalışmamızda ailevi
Akdeniz ateşi hastalığının bazı bölgelerde yüksek oranda gözlendiği ve bu
farklı oranların toplumlar arasında farklılıklara yol açabileceği
gösterilmiştir. MEFV mutasyon tiplerinin sıklığının bölgeden bölgeye ve
popülasyondan popülasyona değişebileceğini düşünüyoruz. Bu nedenle, değişen
nüfus ve komşu ülkelerin istikrarsızlığı nedeniyle, bölgemizde ve ülkemizde
MEFV mutasyon tiplerinin sıklığını belirlemeye yönelik geniş nüfus temelli
çalışmalar yapılmalıdır.

References

  • 1. Alghamdi M. Familial Mediterranean fever, review of the literature. Clin Rheumatol. 2017; 36(8):1707-13.
  • 2. Manna R, Cerquaglia C, Curigliano V, Fonnesu C, Giovinale M, Verrecchia E et al. Clinical features of familial Mediterranean fever: an Italian overview. Eur Rev Med Pharmacol Sci. 2009;13(Suppl 1):51-3.
  • 3. Jesus AA, Goldbach-Mansky R. IL-1 blockade in autoinflammatory syndromes. Annu Rev Med. 2014;65:223-44. Doi:10.1146/annurev-med-061512-150641.
  • 4. Fingerhutová Š, Jančová E, Tesařová M, Dvořáková L, Doležalová P. Periodic fevers and other autoinflammatory diseases. Summer. 2018;157(3):122-9.
  • 5. Özen S, Batu ED, Demir S. Familial Mediterranean fever: recent developments in pathogenesis and new recommendations for management. Front Immunol. 2017;8:253. Doi: 10.3389/fimmu.2017.00253.
  • 6. Bagheri M, Rad IA. Analysis of the most common three MEFV mutations in 630 patients with familial Mediterranean fever in Iranian Azeri Turkish population. Maedica (Buchar). 2017;12(3):169-73.
  • 7. Grandemange S, Aksentijevich I, Jeru I, Gul A, Touitou I. The regulation of MEFV expression and its role in health and familial Mediterranean fever. Genes Immun. 2011;12(7):497-503.
  • 8. Bozkurt Y, Demir A, Erman B, Gül A. Unified modeling of familial Mediterranean fever and cryopyrin associated periodic syndromes. Comput Math Methods Med. 2015;2015:893507. Doi: 10.1155/2015/893507.
  • 9. Ozdemir O, Sezgin I, Kurtulgan HK, Candan F, Koksal B, Sumer H et al. Prevalence of known mutations in the MEFV gene in a population screening with high rate of carriers. Mol Biol Rep. 2011;38(5):3195-200.
  • 10. Üstebay S, Üstebay DÜ, Yılmaz Y. Ailevi Akdeniz ateşi. JAREM. 2015;5:89-93.
  • 11. Zadeh N, Getzug T, Grody WW. Diagnosis and management of familial Mediterranean fever: integrating medical genetics in a dedicated interdisciplinary clinic. Genet Med. 2011;13(3):263-9.
  • 12. Pras M. Familial Mediterranean fever: from the clinical syndrome to the cloning of the pyrin gene. Scand J Rheumatol. 1998;27(2):92-7.
  • 13. Slobodnick A, Shah B, Pillinger MH, Krasnokutsky S. Colchicine: old and new. Am J Med. 2015;128(5):461-70.
  • 14. INFEVERS-2018. The registry of hereditary auto-inflammatory disorders mutations. Accessed date: 28 Novomber 2018: https://infevers.umai-montpellier.fr/web/.
  • 15. Sarı O, Tanoğlu A, Aydoğan Ü. Birinci basamakta ailevi Akdeniz ateşine genel yaklaşım. Konuralp Tıp Dergisi. 2013;5(2):75-80.
  • 16. Moradian MM, Babikyan D, Banoian D, Hayrapetyan H, Manvelyan H, Avanesian N et al. Comprehensive analysis of mutations in the MEFV gene reveal that the location and not the substitution type determines symptom severity in FMF. Mol Genet Genomic Med. 2017;5(6):742-50.
  • 17. Bilginer Y, Bakkaloğlu A. Ailevi Akdeniz ateşi ve amiloidoz. Turkiye Klinikleri J Int Med Sci. 2006;2(8):33-9.
  • 18. Erden G, Bal C, Torun OG, Uğuz N, Yıldırımkaya MM. Ailesel Akdeniz ateşi (Fmf) düşünülen olgularda MEFV gen mutasyonları sıklığının incelenmesi. Türk Hij Den Biyol Derg. 2008;65(1):1-5.
  • 19. Güleç D, Çelebiler A, Karaca B. İzmir bölgesinde ailesel Akdeniz ateşi ön tanılı hastalarda MEFV geni mutasyon dağılımı. Türk Klinik Biyokimya Derg. 2012;10(3):95-101.
  • 20. Tunca M, Akar S, Onen F, Ozdoğan H, Kasapçopur O, Yalçınkaya F et al. Turkish FMF study group. Familial Mediterranean fever (FMF) in Turkey: results of a nationwide multicenter study. Medicine. 2005;84(1):1-11.
  • 21. Çağlar A, Özçelik G, Akıncı N. Ailevi Akdeniz ateşi olan çocuklarda genotip-fenotip ilişkisi. İzmir Dr. Behçet Uz Çocuk Hast. Dergisi. 2018;8(2):144-50.
  • 22. Abuhandan M, Kaya C, Güzelçiçek A. Ailevi Akdeniz ateşi tanısı alan 186 olgunun klinik semptom ve MEFV geni mutasyonlarının incelenmesi. Dicle Tıp Derg. 2015;42(1):61-5.
  • 23. Jarjour RA. Familial Mediterranean fever in Syrian patients: MEFV gene mutations and genotype-phenotype correlation. Mol Biol Rep. 2010;37(1):1-5.
  • 24. Gumus E. The frequency of MEFV gene mutations and genotypes in Sanliurfa province, South-Eastern region of Turkey, after the Syrian Civil War by Using Next Generation Sequencing and report of a novel Exon 4 mutation (I423T). J Clin Med. 2018;7(5). pii: E105. Doi:10.3390/jcm7050105.
  • 25. Pasa S, Altintas A, Devecioglu B, Çil T, Daniş R, Isi H et al. Familial Mediterranean fever gene mutations in the Southeastern region of Turkey and their phenotypical features. Amyloid. 2008;15(1):49-53.
  • 26. Samli H, Dogru O, Bukulmez A, Yuksel E, Ovali F, Solak M. Relationship of Tel Hashomer criteria and Mediterranean fever gene mutations in a cohort of Turkish familial Mediterranean fever patients. Saudi Med J. 2006;27:1822-6.
  • 27. Akin H, Onay H, Turker E, Cogulu O, Ozkinay F. MEFV mutations in patients with familial Mediterranean fever from the Aegean region of Turkey. Mol Biol Rep. 2010;37(1):93-8.
  • 28. Yigit S, Bagci H, Ozkaya O, Ozdamar K, Cengiz K, Akpolat T. MEFV mutations in patients with familial Mediterranean fever in the Black Sea region of Turkey: Samsun experience [corrected]. J Rheumatol. 2008;35(1):106-13.
  • 29. Taştan H, Ayvalı C, Durgun İS. Direct detection of common mutations in the familial Mediterranean fever gene by using PCR methods. Turkiye Klinikleri J Med Sci. 2004;24:445-9.
  • 30. Göç İdaresi Genel Müdürlüğü. Erişim tarihi: 01.01.2019: http://www.goc.gov.tr/içerik3/teşkilat-şeması 273-274-281.
  • 31. Majeed H, Rawashdeh M, El-Shanti H, Qubain H, Khuri-Bulos N, Shahin HM. Familial Mediterranean fever in children: the expanded clinical profile. QJM. 1999;92:309-18.
  • 32. Cazeneuve C, Sarkisian T, Pecheux C, Dervichian M, Nédelec B, Reinert P et al. MEFV-Gene analysis in armenian patients with familial Mediterranean fever: diagnostic value and unfavorable renal prognosis of the M694V homozygous genotype-genetic and therapeutic implications. Am J Hum Genet. 1999;65(1):88-97.
  • 33. Gunel-Ozcan A, Sayin DB, Misirlioglu ED, Guliter S, Yakaryilmaz F, Ensari C. The spectrum of FMF mutations and genotypes in the referrals to molecular genetic laboratory at Kirikkale University in Turkey. Mol Biol Rep. 2009;36(4):757-60.
  • 34. Ece A, Çakmak E, Uluca U, Kelekci S, Yolbas İ, Gunes A et al. The MEFV mutations and their clinical correlations in children with familial Mediterranean fever in southeast Turkey. Rheumatol Int. 2014;34(2):207-12.
  • 35. Gunesacar R, Kasap H, Erken E, Ozer HT. Comparison of amplification refractory mutation system and polymerase chain reaction-restriction fragment length polymorphism techniques used for the investigation of MEFV gene exon 10 point mutations in familial Mediterranean fever patients living in Cukurova region (Turkey). Genet Test. 2005;9(3):220-5.
  • 36. Sönmezgöz E, Özer S, Gül A, Yılmaz R, Kasap T, Takçı Ş et al. Clinical and demographic evaluation according to MEFV genes in patients with familial Mediterranean fever. Biochem Genet. 2019;57(2):289-300.
There are 36 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Muharrem Bayrak 0000-0003-2760-4181

Kenan Çadırcı 0000-0002-2765-4288

Oğuzhan Yaralı This is me 0000-0002-0107-5720

Publication Date August 31, 2019
Submission Date April 3, 2019
Published in Issue Year 2019

Cite

APA Bayrak, M., Çadırcı, K., & Yaralı, O. (2019). BÖLGEMİZDEKİ AİLESEL AKDENİZ ATEŞİ HASTALARININ MEFV GEN MUTASYON TİPLERİNİN SIKLIĞI. The Journal of Kırıkkale University Faculty of Medicine, 21(2), 254-260. https://doi.org/10.24938/kutfd.548831
AMA Bayrak M, Çadırcı K, Yaralı O. BÖLGEMİZDEKİ AİLESEL AKDENİZ ATEŞİ HASTALARININ MEFV GEN MUTASYON TİPLERİNİN SIKLIĞI. Kırıkkale Üni Tıp Derg. August 2019;21(2):254-260. doi:10.24938/kutfd.548831
Chicago Bayrak, Muharrem, Kenan Çadırcı, and Oğuzhan Yaralı. “BÖLGEMİZDEKİ AİLESEL AKDENİZ ATEŞİ HASTALARININ MEFV GEN MUTASYON TİPLERİNİN SIKLIĞI”. The Journal of Kırıkkale University Faculty of Medicine 21, no. 2 (August 2019): 254-60. https://doi.org/10.24938/kutfd.548831.
EndNote Bayrak M, Çadırcı K, Yaralı O (August 1, 2019) BÖLGEMİZDEKİ AİLESEL AKDENİZ ATEŞİ HASTALARININ MEFV GEN MUTASYON TİPLERİNİN SIKLIĞI. The Journal of Kırıkkale University Faculty of Medicine 21 2 254–260.
IEEE M. Bayrak, K. Çadırcı, and O. Yaralı, “BÖLGEMİZDEKİ AİLESEL AKDENİZ ATEŞİ HASTALARININ MEFV GEN MUTASYON TİPLERİNİN SIKLIĞI”, Kırıkkale Üni Tıp Derg, vol. 21, no. 2, pp. 254–260, 2019, doi: 10.24938/kutfd.548831.
ISNAD Bayrak, Muharrem et al. “BÖLGEMİZDEKİ AİLESEL AKDENİZ ATEŞİ HASTALARININ MEFV GEN MUTASYON TİPLERİNİN SIKLIĞI”. The Journal of Kırıkkale University Faculty of Medicine 21/2 (August 2019), 254-260. https://doi.org/10.24938/kutfd.548831.
JAMA Bayrak M, Çadırcı K, Yaralı O. BÖLGEMİZDEKİ AİLESEL AKDENİZ ATEŞİ HASTALARININ MEFV GEN MUTASYON TİPLERİNİN SIKLIĞI. Kırıkkale Üni Tıp Derg. 2019;21:254–260.
MLA Bayrak, Muharrem et al. “BÖLGEMİZDEKİ AİLESEL AKDENİZ ATEŞİ HASTALARININ MEFV GEN MUTASYON TİPLERİNİN SIKLIĞI”. The Journal of Kırıkkale University Faculty of Medicine, vol. 21, no. 2, 2019, pp. 254-60, doi:10.24938/kutfd.548831.
Vancouver Bayrak M, Çadırcı K, Yaralı O. BÖLGEMİZDEKİ AİLESEL AKDENİZ ATEŞİ HASTALARININ MEFV GEN MUTASYON TİPLERİNİN SIKLIĞI. Kırıkkale Üni Tıp Derg. 2019;21(2):254-60.

Bu Dergi, Kırıkkale Üniversitesi Tıp Fakültesi Yayınıdır.