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    Bir Sempozyuma Katılan Aile Hekimlerinin Aşı Uygulamaları Konusundaki Bilgilerinin Değerlendirilmesi
    (2021) Kalkan, İrem Akdemir; Taşova, Yeşim; Ören, Merve; Karaşahin, Ömer; Aktar, Fesih; Ayhan, Merve; Akgül, Fethiye
    GİRİŞ ve AMAÇ: Koruyucu hekimliğin oldukça önemli bir parçası olan bağışıklama uygulamalarında en temel görevler aile hekimlerine düşmektedir.Batman ilinde aile hekimlerinin bağışıklama konusundaki eğitim ve güncelleme ihtiyaçlarına yönelik Aralık 2019’da bir sempozyum düzenlenmiştir. Bu çalışmanın amacı gerçekleştirilen sempozyuma katılan birinci basamak hekimlerinin aşı uygulamaları konusundaki bilgi düzeylerini değerlendirmektir. YÖNTEM ve GEREÇLER: Çalışma tanımlayıcı nitelikte bir gözlem çalışması olarak planlanmıştır. Aile hekimi olarak görev yapmakta olan 155 hekim bu sempozyuma katılmış olup 48 hekim anketi doldurmuştur. Sempozyum öncesinde aile hekimlerine demografik sorular ile birlikte aşı uygulamaları konusunda bilgi düzeyini etkileyebileceği düşünülen sorular ve bilgi tespitine yönelik 34 sorudan oluşan bir anket uygulanmıştır. Bilgi sorularının yanıtları doğru, yanlış veya bilmiyorum olarak seçeneklendirilmiştir. BULGULAR: Anket sorularını cevaplayanların 40’ı erkek, meslekte ortalama çalışma süreleri 8±7,3 yıldır.Kişilerin yarısı bilgi ölçümüne yönelik sorulan 34 sorudan 23 ve üzerinde soruyu doğru cevaplamıştır, en az 9 soru (soruların %26,5’i) doğru cevaplanmıştır. Bir kişi ise soruların tamamını doğru cevaplamıştır.Meslekte çalışma süresi ile doğru cevap verilen soru sayısı arasında herhangi bir korelasyon saptanmamıştır (r=-0,142 p=0,337). TARTIŞMA ve SONUÇ: Aşılar konusunda son dönemde giderek artan tereddütleri gidermede en etkin yollardan biri hekim ve diğer sağlık çalışanlarının, aşı uygulanacak bireyler ve ebeveynler ile iyi bir iletişim kurması ve güven sağlamasıdır. Etkin bir iletişimi sağlayabilmek için özellikle birinci basamak sağlık hizmeti veren aile hekimlerimizin bu konudaki bilgilerinin yeterli olması gerekmektedir. Bu nedenle aile hekimlerine yönelik bilgilendirici nitelikte toplantıların düzenlenmesi güncel bilgi erişimi konusunda kolaylık sağlayacaktır.
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    Comparison of tenofovir alafenamide and entecavir therapy in patients with chronic Hepatitis B initially treated with tenofovir disoproxil: A retrospective observational survey
    (Kowsar Publication, 2021) Kalkan, İrem Akdemir; Karaşahin, Ömer; Sarıgül, Figen; Toplu, Sibel Altunışık; Aladağ, Murat; Akgül, Fethiye; Demir, Yakup; Çelen, Mustafa Kemal
    Background: In chronic hepatitis B patients with or exposed to the risk of osteoporosis or renal dysfunction, switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide fumarate (TAF) or entecavir (ETV) maybe the right choice. Objectives: This study aimed to present real-life data in terms of the efficacy and safety of a TAF/ETV treatment change while receiving TDF. Methods: This retrospective study was conducted on 344 adult patients from 10 centers. The data of patients who had changed to ETV (n = 107) and TAF (n = 237) while receiving TDF were analyzed. The data collected at 0 and 6 months of treatment were analyzed. The virological response was assessed based on undetected hepatitis B virus (HBV) DNA. Serum alanine aminotransferase (ALT) values were used to evaluate the biochemical response. For renal function, serum creatinine and phosphorus, as well as estimated glomerular filtration rate (eGFR), were recorded. Moreover, lumbar spine and hip T-scores along with the serum lipid profile were evaluated. Results: The mean age of patients was 41.14 +/- 13.46 years, and 224 (65.1%) of the participants were male. The treatment arms were not significantly different in terms of demographic characteristics, comorbid diseases, infection duration, family history of HBV infection, blood platelet count, serum biomarkers, such as ALT, phosphorus, creatinine, total bilirubin, albumin, lipid profile, and HBV DNA levels at the beginning. No statistically significant difference was found between the proportion of undetectable HBV DNA of the two treatment groups after 6 months (P = 0.221). The ALT normalization in the ETV and TAF groups at the sixth month compared to the baseline levels was not significantly different (P = 0.853, P = 0.330, respectively). There was no statistically significant difference between the two treatment arms regarding changes in eGFR, creatinine, phosphorus, hip, and spine T-scores from baseline to 6 months (P = 0.296, P = 0.78, P = 0.141, P = 0.832, P = 0.947, respectively). In those who switched to TAF or ETV, low-density lipoproteins cholesterol were observed to be significantly higher after 6 months compared to baseline values (P = 0.002, P = 0.049, respectively). The TC increased significantly in the TAF group (P = 0.035). Conclusions: Our study showed that switching to ETV and TAF sustained the viral suppression and biochemical response achieved by TDF therapy. The treatment switch to TAF of ETV can control renal dysfunction and reduce bone mineral density caused by TDF.
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    Healthcare professionals' beliefs regarding influenza vaccination: What has COVID-19 changed?
    (Wolters Kluwer Medknow Publications, 2023) Akgül, Fethiye; Çelik, Sercan Bulut; Atabey, Pınar; Bucaktepe, Pakize Gamze Erten
    Background: Influenza poses a potential public health threat among healthcare professionals since an infected healthcare professional can spread the virus to patients at higher risk as well as his/her own family members and colleagues. Annual influenza vaccination is the most effective way to protect HCPs. Aim: This study was conducted to determine whether demand for and beliefs about influenza vaccination have changed among healthcare professionals in the COVID-19 era and the factors that might have influenced them in the early phase of the pandemic when COVID-19 vaccines were eagerly awaited. Patients and Methods: This observational descriptive study was conducted between November 16, and December 15, 2020. A total of 317 healthcare professionals completed an online survey. Bivariate analysis and binary logistic regression analysis were performed. Results: Nineteen (6.0%) healthcare professionals were regularly vaccinated against influenza every year, and 199 (62.8%) had never been vaccinated. During the 2019-2020 season, 30 (9.5%) participants had been vaccinated and the proportion desiring to be vaccinated against influenza during the 2020-2021 season was 49.8% (n = 158). The results revealed that those with chronic diseases, those who believed they had adequate information about influenza vaccination and those who believed healthcare professionals should be vaccinated against influenza regularly every year, respectively, had 3.5 times, 4.7 times, and 11 times higher vaccination rates. Conclusion: Although the proportion of healthcare professionals with the intention to be vaccinated for influenza increased with the COVID-19 pandemic, it is still not high enough. Influenza vaccination rates should be promoted by in-service training programs.
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    Measuring the knowledge and attitudes of physicians towards patients with HIV/AIDS: study of Anatolian group
    (Emerald Group Publishing, 2021) Kaya, Şafak; Araç, Eşref; Akgül, Fethiye; Çomoğlu, Şenol; Kaya, Şehmuz; Araç, Songül; Yıldız, Yeşim; Büyüktuna, Seyit Ali; Kayaaslan, Bircan; Parlak, Emine; Baysal, Birol; Karakeçili, Faruk; Balık, Elif Zelal; Akkoç, Ali; Özdemir, Kevser; Kavak, Şeyhmus; Doğan, Suat Ali; Günay, Emrah; Karabela, Şemsi Nur; Cabalak, Mehmet; Çağ, Yasemin; Avcı, Veli; Durdu, Yasemin; Kaya, Zehra; Kılıç, Damla; Yerlikaya, Halis; Tarakçı, Hüseyin; Menteş, Osman; Tartar, Ayşe Sağmak; Köse, Adem; Alakuş, Ömer Faruk; Aktaş, Ulaş; Kömek, Halil; Aksöz, Selçuk
    This paper aims to determine the knowledge and attitudes of the physicians regarding human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), to emphasize that these patients exist and they will exist in the future and to raise awareness so as to prevent that their rights to treatment are revoked. Design/methodology/approach The survey was conducted via a link sent through an online system. Random physicians from 81 cities of the country were invited to the survey. The survey has 41 questions regarding knowledge and attitudes in total, including epidemiological information such as age, gender and title. Findings A total of 3,107 physicians has voluntarily participated in the study. In total, 2,195 (70.7%) are internal physicians and 912 (29.3%) are surgical physicians among the participant physicians. In total, 1,452 (46.7%) of the participants are specialist physicians, 608 (19.6%) of the participants are practising physician and the rest of it is physician assistants, academicians and dentists, respectively. Originality/value In this study, it has been found out that the physicians have a lack of knowledge on HIV/AIDS and they adopt a discriminatory attitude towards HIV-positive persons. HIV-positive patients who are exposed to discrimination and scared of being uncovered refrain from applying to hospitals for treatment, which puts public health into jeopardy due to the high viral load and these patients are faced with difficulties in coping with both medical and emotional load of the disease.
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    Pandemi döneminde COVID-19 kliniği ile başvuran ve tesadüfen tespit edilen AIDS olgusu
    (Dicle Üniversitesi Tıp Fakültesi, 2020) Akgül, Fethiye; Çelen, Mustafa Kemal
    Pneumocystis pnömonisi (PCP), Pneumocystis jirovecii mantarının neden olduğu ciddi bir fırsatçı enfeksiyondur.Bununla birlikte, 31 Aralık 2019’da Çin’in Wuhan eyaletinde etiyolojisi bilinmeyen pnömoni vakalarının tanınmasınıtakiben, hastalarda şiddetli akut solunum sendromu koronavirüs 2019’un (SARS-CoV-2) saptanması, yeni birkoronavirüs türünü ortaya çıkarmıştır. Bu virüsün neden olduğu hastalık daha sonra Dünya Sağlık Örgütü tarafındanCOVID-19 (Coronavirus hastalığı 2019) olarak adlandırılmıştır. Klinik pratikte, her iki enfeksiyonda (PCP ve COVID-19)da ateş, nefes darlığı ve bilateral akciğer parankiminde pnömonik infiltrasyonla uyumlu radyolojik bulgularlakarşılaşmaktayız. 11 Mayıs 2020 itibariyle, COVID-19 salgını beş kıtada 198 ülkeyi ve yaklaşık 4.239.167 kişiyietkilemiştir. Dünya Sağlık Örgütü 20 Mart 2020 tarihinde pandemi ilan etmiştir.Pandemi döneminde ateş ve solunum sıkıntısı ile gelen her hastada öncelikle COVID-19 düşünülmeli ve daha ileritetkikler yapılmalıdır. 22 yaşında erkek hasta bu dönemde 2 gündür olan ateş ve solunum sıkıntısı şikayeti ile başvurdu.Fizik muayenesinde ateşi 38,3oC idi ve akciğer oskültasyonunda ince bilateral ralleri vardı. Laboratuvar testlerinde isekan glukoz seviyesi 100 mg/dl, serum kreatinin seviyesi 0,59 mg/dl, AST 46 U/L, ALT 17 U/L, LDH 1102 U/L, CRP 62mg/L, D-dimer 954 mg/L, lökosit sayısı 12.410 /mm3 (%87,6 nötrofil; %6,8 lenfosit), hemoglobin 11.9 g/dl ve trombositsayısı 258000 /mm3 idi. Toraks bilgisayarlı tomografisinde (BT) her iki akciğerde, daha belirgin olarak sol tarafta ve altloblarda yamalı buzlu cam dansiteli alanlar izlendi. Hasta COVID-19 ön tanısı ile interne edildi ve sonrasında Anti-HIVtesti pozitif çıktı. Klinik, laboratuvar ve radyolojik incelemelere dayanarak hem COVID-19 h em d e P CP t edavileriniolgumuza uyguladık. Sonunda iyileştikten sonra taburcu edildi. Pandemi sırasında sadece SARS-COV-2 değil, aynızamanda akciğer enfeksiyonlarına neden olabilecek diğer infeksiyöz etkenler de göz ardı edilmemeli ve ayırıcı tanıdahepsi düşünülmelidir.
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    Real-life data for tenofovir alafenamide fumarate treatment of hepatitis B: The pythagoras cohort
    (Kowsar Publication, 2021) Karaşahin, Ömer; Kalkan, İrem Akdemir; Dal, Tuba; Toplu, Sibel Altunışık; Harputoğlu, Murat; Mete, Ayşe Özlem; Kömür, Süheyla; Sarigül, Figen; Yıldız, Yeşim; Esmer, Fatih; Kandemir, Özlem; Nazik, Selçuk; İnan, Dilara; Akgül, Fethiye; Kaya, Şafak; Tunç, Nurettin; Balin, Şafak Özer; Bayındır, Yaşar; Taşova, Yeşim; Aktar, Fesih; Ören, Meryem Merve; Ayhan, Merve; Demir, Yakup; Çelen, Mustafa Kemal
    Background: Chronic hepatitis B (CHB) is a viral infection that can result in life-threatening conditions, such as hepatocellular carcinoma and cirrhosis. Tenofovir, which is used for the treatment of CHB, is a nucleotide analog that inhibits HBV-DNApolymerase and has two formulations: disoproxil and alafenamide. In contrast to tenofovir disoproxil fumarate (TDF), tenofovir alafenamide fumarate (TAF) penetrates the whole hepatocyte without being eliminated due to its longer plasma half-life and greater plasma stability. As a result, side effects such as proximal renal tubulopathy and loss of bone density are less common in the treatment of TAF and have similar efficacy to TDF. Objectives: The purpose of the study was to evaluate the effectiveness and reliability of TAF using real-life data. Methods: This retrospective cohort study was carried out in secondary or tertiary healthcare centers in southern Turkey. A total of 480 patients aged 18 years and older were administered TAF for an appropriate indication by the infectious diseases and gastroenterology clinics of the healthcare centers participating in this study. The data collected at t = 0, t =3, and t = 6 months of treatment were analyzed. The chi-square, Mann-Whitney U, Friedman, Wilcoxon, Cochran's Q, and McNemar's tests were used. Results: The mean age of the patients was 47.40 +/- 14.5, and 327 of them (68.1%) were male. A total of 78.1% of the 480 patients who underwent the TAF treatment had previous antiviral therapy experience (TDF, n =340; 70.8 %), and 21.9% were treatment-naive. The most common reasons for the initiation of TAF treatment were the use of drugs affecting bone mineral density (BMD) (42.9%) and osteoporosis (22.3%). Patients who had taken TDF experienced a significant improvement in glomerular filtration rate (GFR), hip and spine T-scores, and phosphorus levels from t = 0 months tot = 6 months after switching to TAF (P < 0.05). For this group, no statistically significant difference was observed concerning LDL and cholesterol levels from t= 0 months to t = 6 months. Side effects were reported by 5.7% of patients in the third month and 7.1% in the sixth month, with the most common side effect being hair loss (1%). Conclusions: TAF was found to be an effective and safe alternative to TDF with lower incidences of its long-term effects, such as nephrotoxicity and decreased bone density.