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    Antibiotic Resistance Trends in ESKAPE Pathogens Isolated at a Health Practice and Research Hospital: A Five-Year Retrospective Study
    (J Infection Developing Countries, 2024) Orhan, Zerife; Kirisci, Ozlem; Doganer, Adem; Altun, Mehzat; Kucuk, Burak; Aral, Murat
    Introduction: Antimicrobial resistance remains a global threat with increasing morbidity and mortality rates. The aim of this study was to identify the antimicrobial resistance trends among ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) isolated from clinical samples at a Health Practice and Research Hospital over five years. Methodology: Microbiological diagnosis utilized classical culture methods and automated systems. Antimicrobial susceptibility analysis was conducted using BD Phoenix, adhering to European Committee on Antimicrobial Susceptibility Testing (EUCAST) standards. Results: A total of 15,272 clinical strains of ESKAPE pathogens were identified in this study. The most frequently isolated pathogens among ESKAPE were K. pneumoniae (3.938, 27.79%), Acinetobacter baumannii (3,013, 19.73%) and Enterococcus faecium (2,966, 19.24%). Bacterial strains were isolated predominantly from urine (3,263, 21.37%), followed by blood cultures (3,099, 20.29%). ESKAPE pathogens were most commonly found in internal intensive care units (4,758, 31.16%), followed by surgical intensive care units (4,000, 26.19%). Reduced resistance rates were observed for most antibiotics against Enterococcus faecium and Staphylococcus aureus. The vancomycin resistance rate for Enterococcus faecium was 18.48%, and the methicillin resistance rate for Staphylococcus aureus was 44.87%. A concerning trend of increasing antimicrobial resistance was noted in Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. Conclusions: The alarming rise in antimicrobial resistance among Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae is a significant concern. The high rates of antimicrobial resistance observed in ESKAPE pathogens underscore the urgent need for improvement in antimicrobial stewardship and infection prevention and control programs.
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    Assessment of serum hepcidin levels in patients with non-ST elevation myocardial infarction
    (Turkish Soc Cardiology, 2014) Altun, Burak; Altun, Mehzat; Acar, Gurkan; Kilinc, Metin; Tasolar, Hakan; Kucuk, Ahmet; Temiz, Ahmet
    Objective: Hepcidin is an acute-phase reactant produced in the liver displaying intrinsic antimicrobial activity. There are few studies about hepcidin considered to be acute and chronic inflammatory marker in acute coronary syndromes patients. We investigated in our study whether the level of hepcidin has increased in the acute phase of non-ST elevation myocardial infarction patients (NSTEMI) known as acute inflammatory aggravation of chronic atherosclerotic process. Methods: Seventy patients with NSTEMI and twenty healthy people were recruited as controls in this observational cross-sectional study. Serum hepcidin levels were determined by ELISA, and troponin levels were measured by standard laboratory methods. Levels of hepcidin and troponin were measured at admission and 6 hours later. Mean values of continuous variables were compared between groups using the Student t-test or Mann-Whitney U test, according to whether normally distributed or not, as tested by the Kolmogorov-Smirnov test. Serum troponin and hepcidin levels measured at admission and after 6th hours were compared using paired t-test. Results: Hepcidin level was similar between NSTEMI and controls at admission (24.55 +/- 32.13, 23.67 +/- 33.62 ng/mL, p>0.05, respectively). Also, serum hepcidin levels did not change significantly from baseline in blood samples taken after 6 hour from admission in NSTEMI patients (24.55 +/- 32.13 ng/mL, 29.75 +/- 31.48 ng/mL, p=0.62, respectively). However, serum troponin levels were increased significantly compared to baseline (0.29 +/- 3.56, 2.92 +/- 7.2 ng/mL, p<0.01). Conclusion: Our findings suggest that hepcidin could not be use as a marker of myocardial necrosis in acute phase such as troponin in patients with NSTEMI.
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    Assessment of serum hepcidin levels in patients with non-ST elevation myocardial infarction ( Author`s Reply )
    (2015) Altun, Burak; Taşolar, Mehmet Hakan; Altun, Mehzat
    [Abstract Not Available]
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    Assessment of serum hepcidin levels in patients with non-ST elevation myocardial infarction Reply
    (Turkish Soc Cardiology, 2015) Altun, Burak; Tasolar, Hakan; Altun, Mehzat
    [Anstract Not Available]
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    Assessment of serum hepcidin levels in patients with non-st elevation myocardial infarction: Author`s reply
    (AVES Ibrahim Kara, 2015) Altun, Burak; Taşolar, Hakan; Altun, Mehzat
    [No abstract available]
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    Assessment of serum hepcidin levels in patients with non-ST elevationmyocardial infarction
    (2014) Altun, Burak; Altun, Mehzat; Acar, Gürkan; Kılınç, Metin; Taşolar, Mehmet Hakan; Küçük, Ahmet; Temiz, Ahmet
    Objective: Hepcidin is an acute-phase reactant produced in the liver displaying intrinsic antimicrobial activity. There are few studies abouthepcidin considered to be acute and chronic inflammatory marker in acute coronary syndromes patients. We investigated in our study wheth-er the level of hepcidin has increased in the acute phase of non-ST elevation myocardial infarction patients (NSTEMI) known as acute inflam-matory aggravation of chronic atherosclerotic process.Methods: Seventy patients with NSTEMI and twenty healthy people were recruited as controls in this observational cross-sectional study.Serum hepcidin levels were determined by ELISA, and troponin levels were measured by standard laboratory methods. Levels of hepcidin andtroponin were measured at admission and 6 hours later. Mean values of continuous variables were compared between groups using theStudent t-test or Mann-Whitney U test, according to whether normally distributed or not, as tested by the Kolmogorov-Smirnov test. Serumtroponin and hepcidin levels measured at admission and after 6th hours were compared using paired t-test.Results: Hepcidin level was similar between NSTEMI and controls at admission (24.55±32.13, 23.67±33.62 ng/mL, p>0.05, respectively). Also, serum hepcidinlevels did not change significantly from baseline in blood samples taken after 6 hour from admission in NSTEMI patients (24.55±32.13 ng/mL, 29.75±31.48ng/mL, p=0.62, respectively). However, serum troponin levels were increased significantly compared to baseline (0.29±3.56, 2.92±7.2 ng/mL, p<0.01).Conclusion: Our findings suggest that hepcidin could not be use as a marker of myocardial necrosis in acute phase such as troponin in patientswith NSTEMI.
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    Çanakkale’de Tonsillofarenjitli Hastaların Boğaz Kültürlerinden İzole Edilen Beta Hemolitik Streptokokların Grup Dağılımlarının ve Antibiyotik Direnç Profillerinin Belirlenmesi§
    (2021) Altun, Mehzat; Yapıcı, Binnur Meriçli
    Amaç: Tonsillofarenjitin bakteriyel etkenleri olan A, C ve G grubu beta hemolitik streptokoklar (BHS) çeşitli hastalıklara yol açmakta, morbidite ve mortaliteyi artırmaktadır. Bu çalışmada, akut tonsillofarenjit tanılı hastaların boğaz kültürlerinden identifiye edilen BHS’ların grup dağılım yüzdelerinin ve çeşitli antibiyotiklere direnç oranlarının saptanması amaçlanmıştır. Yöntem: Ekim 2017 ve Mayıs 2018 tarihleri arasında, yaşları 1-80 aralığında olan 200 tonsillofarenjitli hastadan boğaz kültürleri toplanmıştır. Bakteriyel izolatlar Gram boyama, basitrasin-trimetoprim sülfametoksazol, katalaz ve L-Pirolidonil ?-Naftilamid gibi konvansiyonel yöntemlerle tanımlanmıştır. BHS’lerin serogruplandırmaları için lateks aglütinasyon testi kullanılmıştır. Kirby Bauer disk difüzyon yöntemi ile antibiyotik duyarlılık profilleri belirlenmiştir. Kontrol olarak Streptococcus pyogenes ATCC 19615 suşu kullanılmıştır. Klinik Laboratuvar Standartları Enstitüsü (CLSI) kriterlerine göre inhibisyon zon çap ölçümleri değerlendirilmiştir. Bulgular: İki yüz boğaz kültüründen 34 (%17) BHS izole edilmiştir. BHS grup dağılım yüzdeleri %44.1 (15) A, %29.4 (10) C, %23.5 (8) G ve %2.9 (1) F olarak bulunmuştur. Penisilin, vankomisin ve levofloksasin antibiyotiklerine izolatların tamamında %100 duyarlılık belirlenmiştir. Yüzde 29.4 ile en yüksek dirençlilik ampisilin antibiyotiğine bulunurken, bunu %26.5 ile klindamisin, %23.5 ile eritromisin %14.7 ile amoksilin-klavulanik asit ve tetrasiklin, %11.8 ile sefotaksim ve seftriakson, %8.8 ile klaritromisin ve %2.9 ile kloramfenikol takip etmiştir. Sonuç: Bu çalışma, C grubu streptokok ve G grubu streptokokların bazı antibiyotiklere AGS’den daha düşük direnç gösterdiğini ortaya koydu. Bu bulgulara dayanarak BHS grup dağılımları ve antibiyotik direnç profilleri belirli periyotlarla tekrarlanmalı ve halk sağlığı sürveyans çalışmaları ile önlemler alınmalıdır.
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    Chemical Characterization, Antibacterial, Antioxidant, and Cytotoxic Activity of Some Essential Oils Against Strains Causing Acne
    (Soc Cosmetic Chemists, 2023) Altun, Mehzat; Yildirim, Nuray; Yapici, Binnur M.
    The potential of essential oils (EOs) as alternatives to antibiotics for the treatment of acne vulgaris is an area of growing interest due to increasing antibacterial resistance. This study aimed to determine antimicrobial efficacy, chemical profile, and the antioxidant and cytotoxic potential of EOs. Antimicrobial activity was assessed using disc diffusion and minimum inhibitory concentration (MIC) assays against Staphylococcus epidermidis ATCC 12228 and Cutibacterium acnes ATCC 6919. The phytochemical content of oils was determined by gas chromatography/mass spectrometry. The 2,2-diphenyl-1-picrylhydrazyl and the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide methods were used to detect antioxidant properties and cell viability, respectively. Limonene, p-cymene, linalool, 1.8-cineole, & beta;-santalol, cinnamaldehyde, carvacrol, and eucalyptol were the major components of lemon, tea tree, lavender, laurel, sandalwood, cinnamon, oregano, and eucalyptus EOs, respectively. The MIC/minimum bactericidal concentration values were between 0.03125% and 32% (v/v). Binary combinations of cinnamon/lavender and cinnamon/sandalwood exhibited synergism against both bacteria. The Cinnamomum verum showed the greatest antioxidant activity (IC50: 35.08 & mu;g/ml). The cytotoxic activity of EOs at concentrations between 2% and 0.0625% was evaluated against a mouse fibroblast (NIH 3T3) cell line. In vitro test results revealed that antibacterial effective EOs may be used in development of topical acne therapy after in vivo and clinical trials are carried out.
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    Detection of Group A Beta Hemolytic Streptococci Species, emm, and Exotoxin Genes Isolated from Patients with Tonsillopharyngitis
    (Springer, 2020) Altun, Mehzat; Mericli Yapici, Binnur
    Group A Beta Hemolytic Streptococci (GAS) is the most critical human pathogen that leads to tonsillopharyngitis. The aims of this study were to identify GAS isolates and to determine emm typing, the coverage rate of available vaccines, and the distribution of superantigen gene profiles. 15 GAS isolates were isolated from throat cultures of 200 patients with tonsillopharyngitis, who were admitted to Canakkale Health Application and Research Hospital between October 2017 and May 2018. Identification of the isolates was performed by conventional methods and 16S rRNA sequence analysis. emm typing and exotoxin profiling of the isolates were performed by polymerase chain reaction. 7.5% GAS was detected in 200 patients. All the GAS isolates were identified as S. pyogenes. emm typing can be carried out in 13 S. pyogenes isolates. emm89 (33.3%), emm44 (20%), emm6 (13.3%), emm84 (6.7%), emm1 (6.7%), and emm18.1 (6.7%) were found to be six emm types. The coverage rate of S. pyogenes strains for 26-valent vaccine was 61.5% and for the 30-valent vaccine 84.6%. The most common exotoxin was speB (86.7%), followed by speC (60%), speF (33.3%), ssa (26.7%), speA (20%), speM (20%), speJ (13.3%), speL (6.7%), and speI (6.7%). As a result of determining the emm types of S. pyogenes species in Canakkale, it was concluded that the potential of 30-valent vaccine should be considered in Turkey and development of vaccines containing exotoxin types may be beneficial.
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    Determination of chemical compositions and antibacterial effects of selected essential oils against human pathogenic strains
    (Acad Brasileira De Ciencias, 2022) Altun, Mehzat; Yapici, Binnur Mericli
    Increasing the rates of drug resistant bacteria, having adverse effects and also high costs of antibiotics lead to essential oils (EOs) with antibacterial properties have gained importance. The present study was predicted to evaluate antibacterial activity of cinnamon, lavender, tea tree, lemon, coconut, oregano, mint, laurel and eucalyptus EOs alone and in combination. Chemical components of effective EOs were examined through gas chromatography/mass spectrometry (GC/MS). Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) assays were used to identify antibacterial effects of EOs against bacterial strains. The Fractional Inhibitory Concentration index (FICI) of the binary combinations of EOs was determined by checkerboard method. Carvacrol, linalool, linalyl acetate, 1,8-cineole, cinnamaldehyde, terpinen-4-ol and p-cymene were found main components of EOs. Oregano, cinnamon and tea tree EOs exhibited the strongest antibacterial activity with the MIC range between 0.03125-1.00% (v/v). Tea tree/lavender and cinnamon/lavender mixtures showed a synergistic effect against Streptococcus pyogenes and Streptococcus agalactiae. Oregano with tea tree and laurel exhibited a synergistic effect against Staphylococcus aureus. Oregano showed a synergistic effect when combined with cinnamon, lavender and tea tree against S.agalactiae. Our findings indicated that EOs either alone or in combination against pathogens should be preferred as potential antibacterial agents.
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    Determination of Phytochemical and Antibacterial Properties of Momordica charantia Seed Extracts
    (2023) Altun, Mehzat; Orhan, Zerife
    In recent years, it has been essential to discover safe and effective antibacterial drugs because of rising antibiotic-resistant bacteria. In traditional medicine, plant extracts including biological active components have been used for therapeutic purposes. We aimed to evaluate the antimicrobial properties of the aqueous seed extract of Momordica charantia (M. charantia) on 9 pathogenic bacteria. The antibacterial activity of the extract was assessed against strains using disc diffusion and broth microdilution tests. A total of 21 constituents were identified from M.charantia seeds. Alcohols, esters, aldehydes, monoterpenes, and monoterpenoids were found as the prevalent groups. The seed extract showed the greatest antimicrobial activity on Bacillus subtilis (B. subtilis) and Staphylococcus aureus (S. aureus) with an inhibition zone diameter (IZD) value of 15.75±0.50 mm and 15.25±0.957 mm, respectively. The minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC) test results ranged from 12.5 to 100 (mg/mL). The seed extract of M.charantia could be used for the cure of bacterial infections as a new natural drug.
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    Epicardial Adipose Tissue Thickness in Hemodialysis Patients
    (Wiley, 2014) Altun, Burak; Tasolar, Hakan; Eren, Necmi; Binnetoglu, Emine; Altun, Mehzat; Temiz, Ahmet; Gazi, Emine
    Aim: Hemodialysis (HD) patients had higher cardiovascular mortality and it is related to atherosclerosis. Epicardial adipose tissue (EAT) thickness is a marker of atherosclerosis and independent predictor of coronary artery disease. The aim of our study was to evaluate the relationship between EAT and carotid intima-media thickness (CIMT) predictors of early atherosclerosis in HD patients. Methods: The study included 62 HD patients and 40 healthy controls. EAT thickness and CIMT were measured by echocardiography in all subjects. Results: Epicardial adipose tissue thickness and CIMT were higher (6.98 +/- 1.67 vs. 3.84 +/- 0.73 mm, P < 0.001, 0.94 +/- 0.17 vs. 0.63 +/- 0.11 mm, P < 0.001, respectively) in HD patients than in control subjects. EAT thickness were correlated with CIMT, HD duration, age, and calcium. In addition, HD duration, CIMT, and age were independent predictors of EAT thickness on HD patients in regression analysis. Conclusion: Epicardial adipose tissue thickness may be a useful indicator of early atherosclerosis in HD patients.
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    IN VITRO EVALUATION OF THE ANTIOXIDANT, ANTIBACTERIAL, ANTIBIOFILM, AND CYTOTOXIC ACTIVITY OF MENTHA PIPERITA ESSENTIAL OIL
    (Slovak University of Agriculture, 2023) Altun, Mehzat
    Nowadays, antibacterial resistance to synthetic antibiotics has become a big issue worldwide. Mentha piperita essential oil (EO) and its bioactive components with antibacterial, antibiofilm, and antioxidant properties are recommended for the treatment of microbial infections in traditional medicine. This study aimed to detect phytochemical components, antioxidant and cytotoxic activity; to evaluate antibacterial and antibiofilm effects of M. piperita EO on strains. Gas chromatography/mass spectrometry (GC-MS), 2,2-diphenyl-1-picrylhydrazyl (DPPH), and the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) tests were used to determine chemical composition, antioxidant and cytotoxic potentials of EO, respectively. Antibacterial activity was carried out through disc diffusion and minimum inhibitory concentration (MIC) assays. The biofilm biomass of bacteria was determined by the crystal violet (CV) staining method. Menthone (27.28%), L-menthol (23.71%), and limonene (7.48%) were the main components. M. piperita EO was found to have strong antibacterial activity with the MIC-MBC values in the range of 0.125-16.00% (v/v) and moderate antioxidant activity. The peppermint EO showed an antibiofilm effect on all strains and a cytotoxic effect on NIH 3T3 cells. M. piperita EO may be used alone or in combination with antibiotics or carrier oils as a therapeutic agent against bacterial infections. Further in vivo experiments should be carried out to detect a safe dosage of EO.
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    Phytochemical Components, Antioxidant, Antibacterial, and Synergistic Effects of Endemic Sideritis trojana Extract in Combination with Antibiotics on Human Pathogens
    (2023) Altun, Mehzat
    In recent years, dramatically rising multidrug-resistant bacteria (MDR) and side effects of antibiotics lead ethnopharmacology to discover novel antimicrobials derived from plants for bacterial infections. Traditionally, decoction or infusion of the species of Sideritis has been used for the treatment of diseases such as cough, stomach, gastrointestinal, and kidney disorders. In this study, we aimed to investigate the antioxidant and antibacterial activity of the ethanolic extract of Sideritis trojana (S.trojana) and its synergistic potential with antibiotics against human pathogens. Gas chromatography-mass spectrometry (GC-MS), Folin- Ciocalteu, 1-diphenyl-2-picrylhydrazyl radical (DPPH), disc diffusion, and minimum inhibitory concentration (MIC) assays were used for identifying phytochemicals, total phenolic content (TPC), antioxidant, and antibacterial activity of ethanolic extract of S.trojana alone and binary combination with selected antibiotics against Gram-positive and Gram-negative bacterial strains, respectively. Furthermore, the combined effects of the extract with classical antibiotics were evaluated by measuring the inhibition zone diameter (IZD). The S.trojana extract showed moderate antibacterial activity with the MIC ranging between 15.625 to 500 µg/mL against human pathogens and the synergistic effect was detected in a dual combination of extract and antibiotics. The extract exhibited high antioxidant activity with a low IC50 value (0.138±0.010 mg/mL). The TPC value was 47.95±0.24 (mg GAE/g extract). After measurements of cytotoxicity were performed, S.trojana can be used alone or combined with antibiotics as an alternative therapy to eliminate pathogens and can be preferred as an antioxidant agent in the pharmaceutical industry.
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    The relationship between high-sensitive troponin T, neutrophil lymphocyte ratio and SYNTAX Score
    (Informa Healthcare, 2014) Altun, Burak; Turkon, Hakan; Tasolar, Hakan; Beggi, Halil; Altun, Mehzat; Temiz, Ahmet; Gazi, Emine
    Aim. Cardiac troponins are the most preferred biomarkers in the evaluation of acute coronary syndromes (ACS). The aim of our study was to examine the association between high sensitive troponin T (hs-TnT), and neutrophil to lymphocyte ratio (NLR) and the complexity of ACS assessed by SYNTAX Score. Methods and results. 287 patients who underwent coronary angiography were studied (215 male, mean age 62.0 +/- 12.7 years). 133 patients were ST elevation myocardial infarction (STEMI), 154 patients were non-ST elevation (NSTE) ACS. The patients are divided to tertiles according to SYNTAX Score; SYNTAX Score <22 (n = 122) 22 < SYNTAX Score < 32 (n = 120), and SYNTAX Score >32 (n = 45). NLR was significantly correlated with SYNTAX Score in both STEMI and NSTE-ACS groups (r = 0.254, p = 0.003, r = 0.419 p < 0.001). Multiple linear regression analysis showed NLR predicted the angiographic severity of ACS assessed by SYNTAX Score in two groups (beta = 0.231, p = 0.004; beta = 0.232, p = 0.003). Hs-TnT was significantly correlated with SYNTAX Score in two groups (r = 0.327, p < 0.001; r = 0.430, p < 0.001). Multiple linear regression analysis showed hs-TnT was independent predictor of SYNTAX Score in STEMI and NSTE-ACS patients (beta = 0.292, p < 0.001; beta = 0.317, p < 0.001). Conclusion. Hs-TnT and NLR were significantly correlated with angiographic severity of ACS assessed by SYNTAX Score.
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    Tonsillofarenjitli hastalardan izole edilen Streptococcus pyogenes suşlarının tanılanması, antibiyotik direnç profilleri ile emm ve ekzotoksin genlerinin tespiti
    (Çanakkale Onsekiz Mart Üniversitesi, 2019) Altun, Mehzat; Yapıcı, Binnur Meriçli
    Tonsillofarenjitin en sık bakteriyel etkeni A grubu streptokoklar olup; C, G ve F grubu Beta Hemolitik Streptokoklar (BHS) nadiren görülmektedir. Çalışmamızda tonsillofarenjitli hastaların boğaz kültürlerinden izole edilen BHS'lerin grup dağılımları ve antibiyotik direnç profillerinin belirlenmesi, moleküler çalışmalar ile A Grubu Streptokok türlerinin, emm ve süperantijen genlerinin tespiti, mevcut aşıların emm tiplerini kapsama oranının belirlenmesi amaçlanmıştır.200 tonsillofarenjit ön tanılı hastadan alınan boğaz kültürlerinin % 5 koyun kanlı agara ekimi ile BHS'lerin izolasyonu, 16S rRNA dizi analizine dayalı olarak tanılanması, Gram boyama, katalaz, L-Pirolidonil ?-Naftilamid, basitrasin-trimetoprim sülfametoksazol antibiyotik duyarlılık testleri ve lateks agglütinasyon testi ile karakterizasyonu belirlenmiştir. BHS'lerin antibiyotik duyarlılıkları, Kirby Bauer disk difüzyon yöntemi ile belirlenmiştir. Polimeraz Zincir Reaksiyonu (PZR) ve sonrasında yapılan dizi analizi ile AGS'lerin tür tanımlaması 16S rRNA, emm ve spe genlerinin tespiti gerçekleştirilmiştir.15 adet AGS izolatının 16S rRNA dizi analiz sonuçlarına göre S. pyogenes türüne ait olduğu bulunmuştur. emm tiplendirmesi yapılan 13 S. pyogenes izolatında emm89 (% 33.3), emm44 (% 20), emm6 (% 13.3), emm84, emm1 ve emm18.1 (% 6.7) olmak üzere 6 çeşit emm tipi bulunmuştur. S. pyogenes suşlarının 26 valanlı aşıyı kapsama oranı % 61.5, 30 valanlı aşıyı kapsama oranı % 84.6 olarak saptanmıştır. Çalışmamızda en yaygın speB (% 86.7) bulunmuştur. Çanakkale ilinde, S. pyogenes türünün emm tiplerinin belirlenmesi neticesinde 30 valanlı aşının ülkemizde kullanılma potansiyelinin dikkate alınması gerektiği ve yararlı olabileceği kanaatine varılmıştır.