Araştırma Makalesi
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Düzce İlinde Koyunlarda Coxiella burnetii ve Chlamydia abortus Etkenlerine karşı Antikorların Araştırılması

Yıl 2019, , 106 - 109, 30.09.2019
https://doi.org/10.33631/duzcesbed.562838

Öz

Amaç: Bu çalışmanın
amacı Düzce ilindeki koyunlarda,
Coxiella
burnetii
ve Chlamydia abortus
etkenine karşı spesifik antikorları araştırmaktır. Q humması ve koyunların
enzootik abortusu hastalıklarının ayrı ayrı nedeni olan söz konusu 2 patojen,
küçük ruminantlarda yavru atmalar ile ilişkilidir. Mikrobiyal etkenlerin neden
olduğu yavru atmalara bağlı ekonomik kayıplar dünyanın birçok ülkesinde kayda
değer seviyededir.

Gereç ve
Yöntemler:

Çalışma kapsamında serolojik testler için koyun kan örnekleri Düzce ilinden
toplandı. Ticari ELISA kitleri,
C.
burnetii
ve C. abortus
etkenlerine karşı spesifik antikorların tespiti için kullanıldı. Düzce ilinin 5
ilçesindeki 12 köy veya mahallede yer alan 14 sürüden alınmış 72 numune
çalışmada kullanıldı. Numuneler, 2-5 yaş aralığında yavru atma geçmişi olmayan
dişi hayvanlardan alındı.

Bulgular: Sırasıyla
koyunların enzootik abortusu ve Q humması hastalıkları için total seroprevalans
%20,83 ve %26,38 olarak bulundu. Fakat seropozitif sürü oranı, total
seroprevalansdan daha yüksek oranda sırasıyla koyunların enzootik abortusu ve Q
humması hastalıkları için %42,8 ve %50 olarak bulundu. 14 sürü içinde 7 sürüde
her iki hastalık için seropozitif hayvanlar tespit edildi.







Sonuç: Çalışma
sonuçları Düzce ilindeki araştırılan koyun sürülerinin
C. burnetii ve C. abortus
etkenlerine maruz kaldığını doğrulamaktadır. Elde edilen verilere göre, Düzce
ilinde koyun yavru atma vakalarında çalışmada araştırılan iki abort etkenin
muhtemel bağlantısının değerlendirilmesi faydalı olacaktır.

Kaynakça

  • 1. Selim A, Elhalg M, Moawed S. A serological survey of four abortifacient infectious agents among small ruminant in Egypt. Asian J Anim Vet Adv. 2018; 13(2): 114-21.
  • 2. Menzies PI. Control of Important Causes of Infectious Abortion in Sheep and Goats. Vet Clin Food Anim. 2011; 27(1): 81-93.
  • 3. Benkirane A, Essamkaoui S, El Idrissi A, Lucchese L, Natale A. A sero-survey of major infectious causes of abortion in small ruminants in Morocco. Vet Ital. 2015; 51(1): 25-30.
  • 4. Bisias G, Burriel A, Boutsini S, Kritas S, Leontides L. A serological investigation of some abortion causes among small ruminant flocks in Greece. The Internet Journal of Veterinary Medicine. 2009; 8(2): 1-7. Available from: https://ispub.com/IJVM/8/2/13510.
  • 5. Heidari S, Derakhshandeh A, Firouzi R, Ansari-Lari M, Masoudian M, Eraghi V. Molecular detection of Chlamydophila abortus, Coxiella burnetii, and Mycoplasma agalactiae in small ruminants’ aborted fetuses in Southern Iran. Trop Anim Health Prod. 2018; 50(4): 779-85.
  • 6. Hazlett MJ, McDowall R, DeLay J, Stalker M, McEwen B, Van Dreumel T, et al. A prospective study of sheep and goat abortion using real-time polymerase chain reaction and cut point estimation shows Coxiella burnetii and Chlamydophila abortus infection concurrently with other major pathogens. J Vet Diagn Invest. 2013; 25(3): 359-68.
  • 7. Jonker HF. Fetal death: Comparative aspects in large domestic animals. Anim Rep Sci. 2004; 82-83: 415-30.
  • 8. Küçükayan U, Dakman A, Ülker U, Müştak K. Koyun kan serumları ve bakteriyel atık etkenleri yönünden incelenmesi. Etlik Vet Mikrobiyol Derg. 2007; 18(1-2): 11-6.
  • 9. Öztürk D, Türütoğlu H, Kaya M. Burdur ilindeki koyunlarda Chlamydophila abortus enfeksiyonunun seroprevalansı. MAE Vet Fak Derg. 2016; 1(2): 17-20.
  • 10. Kilic S, Pasa S, Babur C, Ozlem MB. Investigation of Coxiella burnetii antibodies in sheep in Aydin region, Turkey. Revue Med Vet. 2005; 156(6): 336-40.
  • 11. Özbey G, Kalender H, Muz A.Q humması’nın epidemiyolojisi ve teşhisi. Erciyes Üniv Sağlık Bil Dergisi. 2009; 18(2): 100-10.
  • 12. Bouvery NA, Souriau A, Lechopier P, Rodolakis A. Experimental Coxiella burnetii infection in pregnant goats: Excretion routes. Vet Res. 2003; 34(4): 423-33.
  • 13. Kennerman E, Rousset E, Gölcü E, Dufour P. Seroprevalence of Q fever (coxiellosis) in sheep from the Southern Marmara Region, Turkey. Comp Immunol Microbiol Infect Dis. 2010; 33(1): 37-45.
  • 14. Manual of Diagnostic Tests and Vaccines for Terrestrial Animals. OIE Terrestrial manual. Chapter 2.1.16. Q Fever. 8th ed. Paris: Office International des Epizooties; 2018. p. 1-18.
  • 15. Rodolakis A, Salinas J, Papp J. Recent advances on ovine chlamydial abortion. BMC Vet Res. 1998; 29(3-4): 275-88.
  • 16. Spickler A.R. cfsph.iastate.edu [Internet]. Center for Food Security and Public Health. [Updated: April 2017; Cited: 2019 February 13]. Available from: http://www.cfsph.iastate.edu/Factsheets/pdfs/chlamydiosis.pdf.
  • 17. Aitken ID, Longbottom D. Chlamydial abortion. In: Aitken ID, editor. Diseases of sheep. 4th ed. Oxford, UK: Blackwell Scientific Ltd; 2007. p. 105-12.
  • 18. Essig A, Longbottom D. Chlamydia abortus: New aspects of infectious abortion in sheep and potential risk for pregnant women. Curr Clin Microbiol Reports. 2015; 2(1): 22-34.
  • 19. Manual of Diagnostic Tests and Vaccines for Terrestrial Animals. OIE Terrestrial manual. Chapter 2.7.6. Enzootic abortion of ewes, Ovine chlamydiosis, Infection with Chlamydia abortus. 8th ed. Paris: Office International des Epizooties; 2018. p. 1-10.
  • 20. Emery MP, Ostlund EN, Ait Ichou M, Ballin JD, McFarling D, McGonigle L. Coxiella burnetii serology assays in goat abortion storm. J Vet Diagn Invest. 2014; 26(1): 141-5.
  • 21. Ceylan E, Berktas M, Keles I, Agaoglu Z. Seroprevalence of Q Fever in cattle and sheep in the east of Turkey. Asian J Anim Vet Adv. 2009; 4(3): 114-21.
  • 22. Gazyagci S, Aktas MS, Kilic S, Babur C, Celebi B, Duru SY. Seroprevalence of Q fever in dairy cattle in the Konya province, Turkey. Revue Med Vet. 2011; 162(8-9): 387-90.
  • 23. Kilic A, Kalender H. A study of the correlation between Coxiella burnetii seropositivity and abortions in sheep in Eastern and Southeastern Turkey. Indian J Anim Res. 2016; 50(3): 401-5.
  • 24. Runge M, Binder A, Schotte U, Ganter M. Investigations concerning the prevalence of Coxiella burnetii and Chlamydia abortus in sheep in correlation with management systems and abortion rate in Lower Saxony in 2004. Berl Münch Tierärztl Wochenschr. 2012; 125(3-4): 138-43.
  • 25. Hatchette TF, Hudson RC, Schlech WF, Campbell NA, Hatchette JE, Ratnam S, et al. Goat-associated Q fever: A new disease in Newfoundland. Emerg Infec Dis. 2001; 7(3): 413-9.
  • 26. Maurin M, Raoult D. Q fever. Clin Microbiol Rev. 1999; 12(4): 518-53.
  • 27. Stuen S, Longbottom D. Treatment and control of chlamydial and rickittsial infections in sheep and goats. Vet Clin North Am Food Anim Pract. 2011; 27(1): 213-33.
  • 28. Alaster Samkange A, Katsande TC, Tjipura-Zaire G, Crafford JE. Seroprevalence survey of Chlamydophila abortus infection in breeding goats on commercial farms in the Otavi Veterinary District, northern Namibia. Onderstepoort J Vet Res. 2010; 77(1): 1-5.
  • 29. Esmaeili H, Bolourchi M, Mokhber-Dezfouli MR. Seroprevalence of Chlamydia abortus infection in sheep and goats in Iran. IJVM. 2015; 9(2): 73-7.
  • 30. Duman R, Durak Y. Investigation on Chlamydia psittaci infections causing abortion in sheep in Konya district using complement fixation test. Turk J Vet Anim Sci. 1998; 22(6): 511-5.
  • 31. Çaya H, Aslantaş Ö, İyisan AS, Mirioğlu M, Tunca ŞT. Chlamydophila abortus’a (Chlamydia psittaci serotype 1) karşı oluşan antikorların mikrokomplement fikzasyon (mCFT) ve Enzyme-Linked Immunosorbent Assay (ELISA) ile araştırılması. Etlik Vet Mikrobiyol Derg. 2006; 17(1-2): 7-12.
  • 32. Gokce HI, Kacar C, Genc O, Sozmen M. Seroprevalence of Chlamydophila abortus in aborting ewes and dairy cattle in the north-east part of Turkey. Bull Vet Inst Pulawy. 2007; 51(9): 9-13.
  • 33. Otlu S, Sahin M, Unver A, Celebi O. Detection of Brucella melitensis and Chlamydophila abortus antibodies in aborting sheep in the Kars province of Turkey. Bull Vet Inst Pulawy. 2007; 51(4): 493-5.
  • 34. Kalender H, Kılıç A, Eröksüz H, Muz A, Kılınç Ü, Taşdemir B. Identification of Chlamydophila abortus infection in aborting ewes and goats in Eastern Turkey. Rev Med Vet (Toulouse). 2013; 164 (6): 295-301.
  • 35. Cetinkaya B, Kalender H, Ertas BH, Muz A, Arslan N, Ongor H, et al. Seroprevalence of coxiellosis in cattle, sheep and people in the east of Turkey. Vet Rec. 2000; 146(5): 131-6.
  • 36. Kalender H. The Incidence of Coxiella burnetii Infection in Ewes in Elazig and Neighboring Provinces. Turk J Vet Anim Sci. 2001; 25(1): 51-5.
  • 37. Parin U, Kaya O. Detection of Coxiella burnetii prevalence in bovine, ovine and caprine herds. Ankara Üniv Vet Fak Derg. 2015; 62(3): 177-81.

Investigation of Coxiella burnetii and Chlamydia abortus Antibodies in Sheep in Düzce Region

Yıl 2019, , 106 - 109, 30.09.2019
https://doi.org/10.33631/duzcesbed.562838

Öz

Aim: The aim
of this study is to investigate the
Coxiella
burnetii
and Chlamydia abortus
antibodies in sheep in Düzce province. These two pathogens are causative agents
of Query fever and Enzootic abortion of ewes, respectively which are related to
abortion in small ruminants. Economic loss due to the abortions which are
caused by microbiological agents is considerably high in many countries.

Material and Methods: Blood samples of sheep were collected from Düzce province of Turkey for
serological tests. Commercial enzyme-linked immunosorbent assay (ELISA) was
used for the detection of specific antibodies to
C. burnetii and C. abortus.
A total of 72 samples obtained from 14 herds located in 12 villages/districts
of 5 towns in Düzce province were utilized in this study. Samples were
collected from 2-5-year-old female animals without an abortion history.

Results: Total seroprevalence
of Enzootic abortion of ewes and Query fever was found to be 20.83% and 26.38%,
respectively. However, the proportion of seropositive herds was found to be
42.8% for Enzootic abortion of ewes and 50% for Q fever, which is higher than
total seroprevalence. 6 flocks out of 14 were found to be seropositive for both
of the diseases simultaneously.







Conclusion: This study confirms the exposure of sheep herds in Düzce province to C. burnetii and C. abortus and provides original seroprevalence data about Düzce.
The data gathered are beneficial to evaluate the possible connection of two
investigated abortogenic pathogens in sheep abortion cases in Düzce province.

Kaynakça

  • 1. Selim A, Elhalg M, Moawed S. A serological survey of four abortifacient infectious agents among small ruminant in Egypt. Asian J Anim Vet Adv. 2018; 13(2): 114-21.
  • 2. Menzies PI. Control of Important Causes of Infectious Abortion in Sheep and Goats. Vet Clin Food Anim. 2011; 27(1): 81-93.
  • 3. Benkirane A, Essamkaoui S, El Idrissi A, Lucchese L, Natale A. A sero-survey of major infectious causes of abortion in small ruminants in Morocco. Vet Ital. 2015; 51(1): 25-30.
  • 4. Bisias G, Burriel A, Boutsini S, Kritas S, Leontides L. A serological investigation of some abortion causes among small ruminant flocks in Greece. The Internet Journal of Veterinary Medicine. 2009; 8(2): 1-7. Available from: https://ispub.com/IJVM/8/2/13510.
  • 5. Heidari S, Derakhshandeh A, Firouzi R, Ansari-Lari M, Masoudian M, Eraghi V. Molecular detection of Chlamydophila abortus, Coxiella burnetii, and Mycoplasma agalactiae in small ruminants’ aborted fetuses in Southern Iran. Trop Anim Health Prod. 2018; 50(4): 779-85.
  • 6. Hazlett MJ, McDowall R, DeLay J, Stalker M, McEwen B, Van Dreumel T, et al. A prospective study of sheep and goat abortion using real-time polymerase chain reaction and cut point estimation shows Coxiella burnetii and Chlamydophila abortus infection concurrently with other major pathogens. J Vet Diagn Invest. 2013; 25(3): 359-68.
  • 7. Jonker HF. Fetal death: Comparative aspects in large domestic animals. Anim Rep Sci. 2004; 82-83: 415-30.
  • 8. Küçükayan U, Dakman A, Ülker U, Müştak K. Koyun kan serumları ve bakteriyel atık etkenleri yönünden incelenmesi. Etlik Vet Mikrobiyol Derg. 2007; 18(1-2): 11-6.
  • 9. Öztürk D, Türütoğlu H, Kaya M. Burdur ilindeki koyunlarda Chlamydophila abortus enfeksiyonunun seroprevalansı. MAE Vet Fak Derg. 2016; 1(2): 17-20.
  • 10. Kilic S, Pasa S, Babur C, Ozlem MB. Investigation of Coxiella burnetii antibodies in sheep in Aydin region, Turkey. Revue Med Vet. 2005; 156(6): 336-40.
  • 11. Özbey G, Kalender H, Muz A.Q humması’nın epidemiyolojisi ve teşhisi. Erciyes Üniv Sağlık Bil Dergisi. 2009; 18(2): 100-10.
  • 12. Bouvery NA, Souriau A, Lechopier P, Rodolakis A. Experimental Coxiella burnetii infection in pregnant goats: Excretion routes. Vet Res. 2003; 34(4): 423-33.
  • 13. Kennerman E, Rousset E, Gölcü E, Dufour P. Seroprevalence of Q fever (coxiellosis) in sheep from the Southern Marmara Region, Turkey. Comp Immunol Microbiol Infect Dis. 2010; 33(1): 37-45.
  • 14. Manual of Diagnostic Tests and Vaccines for Terrestrial Animals. OIE Terrestrial manual. Chapter 2.1.16. Q Fever. 8th ed. Paris: Office International des Epizooties; 2018. p. 1-18.
  • 15. Rodolakis A, Salinas J, Papp J. Recent advances on ovine chlamydial abortion. BMC Vet Res. 1998; 29(3-4): 275-88.
  • 16. Spickler A.R. cfsph.iastate.edu [Internet]. Center for Food Security and Public Health. [Updated: April 2017; Cited: 2019 February 13]. Available from: http://www.cfsph.iastate.edu/Factsheets/pdfs/chlamydiosis.pdf.
  • 17. Aitken ID, Longbottom D. Chlamydial abortion. In: Aitken ID, editor. Diseases of sheep. 4th ed. Oxford, UK: Blackwell Scientific Ltd; 2007. p. 105-12.
  • 18. Essig A, Longbottom D. Chlamydia abortus: New aspects of infectious abortion in sheep and potential risk for pregnant women. Curr Clin Microbiol Reports. 2015; 2(1): 22-34.
  • 19. Manual of Diagnostic Tests and Vaccines for Terrestrial Animals. OIE Terrestrial manual. Chapter 2.7.6. Enzootic abortion of ewes, Ovine chlamydiosis, Infection with Chlamydia abortus. 8th ed. Paris: Office International des Epizooties; 2018. p. 1-10.
  • 20. Emery MP, Ostlund EN, Ait Ichou M, Ballin JD, McFarling D, McGonigle L. Coxiella burnetii serology assays in goat abortion storm. J Vet Diagn Invest. 2014; 26(1): 141-5.
  • 21. Ceylan E, Berktas M, Keles I, Agaoglu Z. Seroprevalence of Q Fever in cattle and sheep in the east of Turkey. Asian J Anim Vet Adv. 2009; 4(3): 114-21.
  • 22. Gazyagci S, Aktas MS, Kilic S, Babur C, Celebi B, Duru SY. Seroprevalence of Q fever in dairy cattle in the Konya province, Turkey. Revue Med Vet. 2011; 162(8-9): 387-90.
  • 23. Kilic A, Kalender H. A study of the correlation between Coxiella burnetii seropositivity and abortions in sheep in Eastern and Southeastern Turkey. Indian J Anim Res. 2016; 50(3): 401-5.
  • 24. Runge M, Binder A, Schotte U, Ganter M. Investigations concerning the prevalence of Coxiella burnetii and Chlamydia abortus in sheep in correlation with management systems and abortion rate in Lower Saxony in 2004. Berl Münch Tierärztl Wochenschr. 2012; 125(3-4): 138-43.
  • 25. Hatchette TF, Hudson RC, Schlech WF, Campbell NA, Hatchette JE, Ratnam S, et al. Goat-associated Q fever: A new disease in Newfoundland. Emerg Infec Dis. 2001; 7(3): 413-9.
  • 26. Maurin M, Raoult D. Q fever. Clin Microbiol Rev. 1999; 12(4): 518-53.
  • 27. Stuen S, Longbottom D. Treatment and control of chlamydial and rickittsial infections in sheep and goats. Vet Clin North Am Food Anim Pract. 2011; 27(1): 213-33.
  • 28. Alaster Samkange A, Katsande TC, Tjipura-Zaire G, Crafford JE. Seroprevalence survey of Chlamydophila abortus infection in breeding goats on commercial farms in the Otavi Veterinary District, northern Namibia. Onderstepoort J Vet Res. 2010; 77(1): 1-5.
  • 29. Esmaeili H, Bolourchi M, Mokhber-Dezfouli MR. Seroprevalence of Chlamydia abortus infection in sheep and goats in Iran. IJVM. 2015; 9(2): 73-7.
  • 30. Duman R, Durak Y. Investigation on Chlamydia psittaci infections causing abortion in sheep in Konya district using complement fixation test. Turk J Vet Anim Sci. 1998; 22(6): 511-5.
  • 31. Çaya H, Aslantaş Ö, İyisan AS, Mirioğlu M, Tunca ŞT. Chlamydophila abortus’a (Chlamydia psittaci serotype 1) karşı oluşan antikorların mikrokomplement fikzasyon (mCFT) ve Enzyme-Linked Immunosorbent Assay (ELISA) ile araştırılması. Etlik Vet Mikrobiyol Derg. 2006; 17(1-2): 7-12.
  • 32. Gokce HI, Kacar C, Genc O, Sozmen M. Seroprevalence of Chlamydophila abortus in aborting ewes and dairy cattle in the north-east part of Turkey. Bull Vet Inst Pulawy. 2007; 51(9): 9-13.
  • 33. Otlu S, Sahin M, Unver A, Celebi O. Detection of Brucella melitensis and Chlamydophila abortus antibodies in aborting sheep in the Kars province of Turkey. Bull Vet Inst Pulawy. 2007; 51(4): 493-5.
  • 34. Kalender H, Kılıç A, Eröksüz H, Muz A, Kılınç Ü, Taşdemir B. Identification of Chlamydophila abortus infection in aborting ewes and goats in Eastern Turkey. Rev Med Vet (Toulouse). 2013; 164 (6): 295-301.
  • 35. Cetinkaya B, Kalender H, Ertas BH, Muz A, Arslan N, Ongor H, et al. Seroprevalence of coxiellosis in cattle, sheep and people in the east of Turkey. Vet Rec. 2000; 146(5): 131-6.
  • 36. Kalender H. The Incidence of Coxiella burnetii Infection in Ewes in Elazig and Neighboring Provinces. Turk J Vet Anim Sci. 2001; 25(1): 51-5.
  • 37. Parin U, Kaya O. Detection of Coxiella burnetii prevalence in bovine, ovine and caprine herds. Ankara Üniv Vet Fak Derg. 2015; 62(3): 177-81.
Toplam 37 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makaleleri
Yazarlar

Mustafa Sencer Karagül 0000-0001-7215-5229

Mehmet Engin Malal Bu kişi benim 0000-0001-8656-3354

Kadir Akar 0000-0003-0894-7357

Yayımlanma Tarihi 30 Eylül 2019
Gönderilme Tarihi 10 Mayıs 2019
Yayımlandığı Sayı Yıl 2019

Kaynak Göster

APA Karagül, M. S., Malal, M. E., & Akar, K. (2019). Investigation of Coxiella burnetii and Chlamydia abortus Antibodies in Sheep in Düzce Region. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 9(3), 106-109. https://doi.org/10.33631/duzcesbed.562838
AMA Karagül MS, Malal ME, Akar K. Investigation of Coxiella burnetii and Chlamydia abortus Antibodies in Sheep in Düzce Region. DÜ Sağlık Bil Enst Derg. Eylül 2019;9(3):106-109. doi:10.33631/duzcesbed.562838
Chicago Karagül, Mustafa Sencer, Mehmet Engin Malal, ve Kadir Akar. “Investigation of Coxiella Burnetii and Chlamydia Abortus Antibodies in Sheep in Düzce Region”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 9, sy. 3 (Eylül 2019): 106-9. https://doi.org/10.33631/duzcesbed.562838.
EndNote Karagül MS, Malal ME, Akar K (01 Eylül 2019) Investigation of Coxiella burnetii and Chlamydia abortus Antibodies in Sheep in Düzce Region. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 9 3 106–109.
IEEE M. S. Karagül, M. E. Malal, ve K. Akar, “Investigation of Coxiella burnetii and Chlamydia abortus Antibodies in Sheep in Düzce Region”, DÜ Sağlık Bil Enst Derg, c. 9, sy. 3, ss. 106–109, 2019, doi: 10.33631/duzcesbed.562838.
ISNAD Karagül, Mustafa Sencer vd. “Investigation of Coxiella Burnetii and Chlamydia Abortus Antibodies in Sheep in Düzce Region”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 9/3 (Eylül 2019), 106-109. https://doi.org/10.33631/duzcesbed.562838.
JAMA Karagül MS, Malal ME, Akar K. Investigation of Coxiella burnetii and Chlamydia abortus Antibodies in Sheep in Düzce Region. DÜ Sağlık Bil Enst Derg. 2019;9:106–109.
MLA Karagül, Mustafa Sencer vd. “Investigation of Coxiella Burnetii and Chlamydia Abortus Antibodies in Sheep in Düzce Region”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, c. 9, sy. 3, 2019, ss. 106-9, doi:10.33631/duzcesbed.562838.
Vancouver Karagül MS, Malal ME, Akar K. Investigation of Coxiella burnetii and Chlamydia abortus Antibodies in Sheep in Düzce Region. DÜ Sağlık Bil Enst Derg. 2019;9(3):106-9.