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    Analysis of Risk Factors Associated with Candidemia Among Patients with or without COVID-19 in Intensive Care Units During the Pandemic Process: A Multicenter Study
    (Bilimsel Tip Yayinevi, 2023) Karakok, Taliha; Gozukara, Melih Gaffar; Uygun Kizmaz, Yesim; Demir, Yakup; Toruyenler Coskunpinar, Melike; Altun Demircan, Serife; Arslan, Yusuf
    Introduction: The objective of this study was to compare the risk factors and mortality rates of candidemia among patients with and without COVID-19 in the intensive care units (ICU).Materials and Methods: This study is a retrospective multicenter observational study, in ICUs of 12 hospitals (eight tertiary and four secondary hospitals) in Tarkiye. All adult patients (>18 years) hospitalized in ICUs and developed candidemia between 01.01.2020-31.12.2021 were included. The following data were collected: age, gender, nasopharyngeal swab SARS-CoV-2 PCR test, species of Candida (Candida albicans or non-albicans Candida), comorbidities, ICU stay, antibiotic use, corticosteroid, and anti-cytokine therapy, central venous catheter (CVC), abdominal surgery, parenteral nutrition, mechanical ventilation (MV), other cultures isolated Candida spp., echocardiography (ECO), mortality. Data from patients with or without COVID-19 were compared.Results: A total of 188 patients, 66 COVID-19 and 122 non-COVID-19, were included in the study. The median age of the patients was 69.5 and there were no differences between the groups. 185 (98.4%) patients had a history of antibiotic use. Sixteen patients, all from the COVID-19 group, had a history of anti-cytokine therapy. Corticosteroid use was higher in COVID-19 patients (p< 0.001). Intraabdominal surgery was higher in the non-COVID-19 group (p< 0.014). C. albicans was isolated from 36.7% of total patients and the remaining were non-albicans Candida species. The overall mortality was higher in COVID-19 patients (p= 0.014). Alzheimer's and malignancies were higher in non-COVID-19 patients. Intraabdominal surgery, MV, and CVC were higher in tertiary care hospitals whereas parenteral nutrition was higher in secondary care hospitals.Conclusion: Immunosuppressive treatments administered to COVID-19 patients pose a risk in terms of candidemia. Risk factors may differ between secondary and tertiary care hospitals. Preventable risk factors should be determined on a hospital basis and appropriate infection control measures should be taken.
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    Bir Üniversite Hastanesindeki Hekim ve Hemşirelerin HIV/AIDS ile İzlenen Hastalara Yönelik Bilgi ve Ön Yargi Düzeyleri
    (2021) Darakci, Savaş Mert; Mut, Ayşe Nur; Kalkan, İrem Akdemir; Aktar, Fesih; Çelen, Mustafa Kemal; Demir, Yakup
    Giriş: HIV ile enfekte hastaların izleminde yer alacak olan sağlık personellerinin ön yargılı olmaları ve bunun getireceği stigma önemli bir sorun olarak hasta takibine yansıyabilir. Bu çalışmanın amacı, bir üniversite hastanesinde çalışan hekim ve hemşirelerin HIV/AIDS hakkındaki bilgi ön yargı düzeylerinin değerlendirmesidir. Gereç ve Yöntem: Bu kesitsel çalışmanın örneklem büyüklüğü iki yönlü %95 güven aralığında, ortalamadan güven aralığına uzaklık 1, standart sapma 7 alınarak 191 olarak hesaplanmıştır. Dicle Üniversitesi Hastanelerinde 23 kliniğin her birinden rastgele örneklem metodu ile 6 hemşire, 4 asistan hekim ve 1 uzman hekim/öğretim görevlisi/üyesi belirlenerek davet edilmiştir. Toplam 218 hekim ve hemşire dahil edilmiştir. Demografik bilgileri ve HIV/AIDS?le ilgili 30 ifadeyi içeren bir anket uygulanmıştır. Hem bilgi hem de ön yargı puanları için maksimum puan 100 olacak şekilde toplam puanlar hesaplanmıştır. Elde edilen veriler R-3.5.1 programı kullanılarak analiz edilmiştir. Bulgular: Yüzde 33,5?i daha önce HIV ile enfekte bir hastanın takiplerinde görev aldığını ifade etmiştir. HIV bilgi puanı ortalaması 76,3±13,7 olup, erkeklerde (78,9±13,5) ve doktorlarda (83,2±11,1) daha yüksektir. HIV ile ilgili ön yargı ortalama puanı 39,0±21,2 olup, hemşirelerde (42,0±22,3) daha yüksek, akraba/arkadaşlarında HIV ile enfekte bir birey bulunanlarda (23,6±14,3) ise daha düşüktür. HIV bilgi puanı ve ön yargı puanları arasında zayıf negatif bir korelasyon vardır. Katılımcıların %40,6?sı HIV/AIDS?in tedavi edilebilen bir hastalık olmadığını düşünmektedir. Yüzde 52,5?i HIV/AIDS?li hastaları takip etmeyi tercih etmeyeceğini belirtmiştir. Sonuç: HIV/AIDS açısından yüksek endemik bir alanda yer alan ülkemiz için sağlık personellerinin bu hastalıkla daha çok karşılaşacağı göz önüne alındığında sonuçlar kaygı vericidir. Ülkemizde HIV/AIDS stigmasını azaltmaya yönelik yapılacak tüm çalışmalarda sağlık personelleri özel bir grup olarak ele alınmalıdır.
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    Clinical, laboratory, and epidemiological characteristics of patients diagnosed with brucellosis: A comprehensive analysis
    (Dicle Üniversitesi Tıp Fakültesi, 2023) Çiçek, Yeliz; Özcan, Nida; Demir, Yakup; Dayan, Saim
    Introduction: This study aims to evaluate the demographic characteristics, clinical manifestations, laboratory findings, radiological features, and the relationship between brucella capture titers and blood culture positivity in patients followed up due to brucellosis. Methods: The medical records of 214 patients diagnosed with brucellosis, who were followed up at the infectious diseases clinic and/or outpatient clinic between January 2017 and December 2018, were retrospectively reviewed. Demographic and clinical characteristics of 118 included patients were recorded. Brucella capture tests and blood cultures were processed at bacteriology department of Dicle University Hospital Laboratory. Results: The mean age of the patients was 39.54±17.123 years. Fifty percent of the patients were male and 58.5% of the patients resided in rural areas. The most common complaints at presentation were fever (89%) and bone-joint pain (73.7%). The most frequent physical examination findings were fever (89%) and tenderness in bones and joints (73.7%). Elevated erythrocyte sedimentation rate was observed in 29.6% of patients, while elevated c-reactive protein levels were seen in 55.9% of the patients. The two most common hematological findings at the time of diagnosis were anemia with 45.8% and lymphomonocytosis with 26.3%. A statistically significant disparity was observed in the incidence of complications among patients displaying hematological manifestations, including anemia, leukopenia, and thrombocytopenia, associated with brucellosis (p<0.05). The most commonly encountered organ involvements were sacroiliitis, with a prevalence of 31.4%, and splenomegaly, noted in 25.4% of cases. Among the patient cohort, disease reporting was documented in 59.3% of instances. The reporting rate was notably higher at the infectious diseases clinic, accounting for 64.7% of cases, whereas non-infectious clinics exhibited a lower reporting rate of 25%. Blood cultures were taken from 56 of 118 patients followed up due to brucellosis and growth was detected in 30 of them. All of the microorganisms grown were determined to be B. Melitensis. Notably, 62.5% of patients with a brucella capture titer ≥1/ 1280 and 31.25% of those with titers <1/ 1280 exhibited growth in blood cultures. There was a statistically significant correlation between the elevation of brucella capture titers among patients, ranging from 1/320 to 1/5120, and an increased likelihood of detecting brucella bacteria through blood culture (p<0.05). Conclusion: This study revealed a correlation between higher brucella capture titers and blood culture positivity. In addition, markers such as anemia, leukopenia, and thrombocytopenia were associated with an increased risk of complications, emphasizing their importance as prognostic indicators.
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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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    Etkin eğitim müdahalesi HIV hastalarında uyumu ilaç pozolojisinden bağımsız olarak etkiler mi?
    (Dicle Üniversitesi Tıp Fakültesi, 2019) Kalkan, İrem Akdemir; Karaşahin, Ömer; Dal, Tuba; Ören, Meryem Merve; Ayhan, Merve; Demir, Yakup; Yıldız, Yeşim; Aktar, Fesih; Çelen, Mustafa Kemal
    Amaç: Ülkemizde 2017 verileriyle 17.000 kişinin HIV (insan immün yetmezlik virüsü) ile enfekte olduğu bilinmektedir. Hastalığın tedavisinde ilaç uyumu en önemli noktalardandır. HIV/AIDS tedavisinde hasta eğitimi çok önemlidir. Bu çalışmanın amacı eğitim müdahalesi yapılan hasta grubunda ilaç uyumunun değerlendirilmesidir.Yöntemler: Çalışma retrospektif verilerin analiz edildiği bir müdahale çalışması olarak gerçekleştirilmiştir. MayısTemmuz 2017 tarihleri arasında Dicle Üniversitesi Tıp Fakültesi Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji bölümünde izlenmekte olan 107 HIV/AIDS hastası çalışmaya dahil edilmiştir. Hastalığa özgü detaylı eğitim almayı kabul eden hastalar 1. Grup olarak değerlendirilmiştir. Eğitim almak istememiş olan 25 hasta ise (2. Grup/Kontrol grubu) standart poliklinik bilgilendirmesi almıştır. Her iki grubun eğitimleri aynı hekim tarafından verilmiştir. Hastaların tedavinin 3. ve 6. aylarındaki ilaç uyumları tablet sayma yöntemiyle değerlendirilmiştir. Bulgular: Tedavi almakta olan 107 hastanın yaş ortalaması 28.6 yıldır. Hastaların 86’sı (%80,4) erkektir. Hastaların eğitim durumları incelendiğinde %8,4’ü (n=9) sadece okuryazar, %67,3’ü (n=72) ilk ve orta öğretim mezunu olarak tespit edilmiştir. Hastaların öğrenim durumları ile 3. ve 6. aydaki ilaç uyumları arasında istatistiksel olarak anlamlı bir fark tespit edilmemiştir (sırasıyla p=0,159 ve p=0,274). Günlük tablet sayısından bağımsız olarak, ilaç uyumu, eğitim verilenlerde istatistiksel olarak anlamlı düzeyde yüksek saptanmıştır ( p<0,001).Tartışma ve Sonuç: HIV enfeksiyonu olan hastalarda, hastalığa özgü eğitim vermek tablet sayısından ve temel öğrenim üzeyinden bağımsız olarak, ilaç uyumunu anlamlı düzeyde arttırmaktadır. Daha az sayıda tablet içeren rejimler kullanmak da ilaç uyumunu arttırmaktadır.
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    Evaluation of chronic hepatitis B patients who voluntarily discontinued oral antiviral therapy: is there an answer to the controversial topic?
    (Lippincott Williams & Wilkins, 2024) Arslan, Eyup; Yildiz, Yesim; Karasahin, Omer; Demir, Yakup; Mermutluoglu, Cigdem Tumbul; Unlu, Gulten; Kuscu, Ferit
    ObjectiveThe uncertain treatment duration for nucleos(t)ide analogues (NA) used in the treatment of chronic hepatitis B (CHB) is an important problem for both patients and physicians. The aim of this study was to evaluate the determinants of virologic relapse (VR) and the optimum time of treatment discontinuation in the follow-up of CHB patients who voluntarily discontinued treatment after virological suppression was achieved under NA use.MethodsData from 138 patients from 11 centers were included in this registry-based study. Factors associated with VR were investigated using multivariate Cox regression analysis.ResultsNinety-nine (71.7%) of the patients were HBeAg (Hepatitis B e antigen) negative. During the 24-month follow-up period after treatment discontinuation, VR occurred in 58.7% (n = 81) of all patients and 57.6% (n = 57) of HBeAg-negative patients. The duration of NA treatment was significantly shorter (cutoff 60 months) in HBeAg-negative patients who later developed VR. In addition, the duration of virologic remission achieved under NA treatment was significantly shorter (cutoff 52 months) in those who later developed VR. In the Cox multivariate regression model of HBeAg-negative patients, having less than 60 months of NA treatment (HR = 2.568; CI:1.280-5.148; P = 0.008) and the levels of alanine aminotransferase being equal to or higher than twice the upper level of normal at the beginning of treatment (HR = 3.753; CI:1.551-9.081; P = 0.003) were found to be statistically significant and independently associated with VR.ConclusionThe findings of this study may provide clinical guidance in terms of determining the most appropriate discontinuation time for NA.
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    Evaluation of kidney function tests in HIV-positive patients receiving combined antiretroviral therapy
    (John Wiley and Sons Inc, 2021) Aydın, Emre E.; Aydın, Fatma Yılmaz; Demir, Yakup; Yıldırım, Yaşar; Çelen, Mustafa Kemal
    Introduction: Human immunodeficiency virus is a chronic infection that attacks the immune system of the human body, particularly CD4 T lymphocytes. Combined antiretroviral therapies are highly effective in virological suppression of human immunodeficiency virus infection. It has been shown that some retroviral therapies have a higher nephrotoxicity potential. As a result of renal injury, serum creatinine increases and the estimated glomerular filtration rate is reduced. The aim of our study was to assess changes in kidney function during a 24-month period in HIV-positive patients who were begun on combined antiretroviral therapy. Material and Methods: A total of 127 HIV-positive patients were enrolled. The patients were divided into five groups; patients who received no therapy were designated as group 1; those who received Dolutegravir/Abacavir/Lamivudine combination as group 2; those who received Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Fumarate combination as group 3; those who received Emtricitabine/Tenofovir Disoproxil Fumarate/Dolutegravir combination as group 4; and those who received Emtricitabine/Tenofovir Disoproxil Fumarate/Raltegravir combination as group 5. We compared the effects of these drugs on estimated glomerular filtration rate during a 24-month follow-up period. Results: At the 24th month of therapy, a significant difference was observed between the estimated glomerular filtration rate (eGFR) levels of the study groups (P <.001). eGFR level was significantly higher in group 4 compared with groups 1, 2 and 3 (P =.009, P <.001, P <.001, respectively), whereas it was significantly lower in group 5 than groups 1, 2 and 3 (P =.005, P <.001, P [removed].05). Serum creatinine level was significantly higher in groups 4 and 5 compared with the other groups (P <.001). Conclusion: The use of TDF-containing regimens causes renal dysfunction. Therefore, we recommend close monitoring of renal function, especially in patients treated with TDF.
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    First year real life experience with tenofovir alafenamide fumarate: The pythagorean cohort
    (Kare Publishing, 2023) Karaşahin, Ömer; Kalkan, İrem Akdemir; Dal, Tuba; Toplu, Sibel Altunışık; Harputluoğlu, Murat; Mete, Ayşe Özlem; Aktar, Fesih; Demir, Yakup; Çelen, Mustafa Kemal
    Background and Aim: In chronic hepatitis B infection, antiviral therapy significantly reduces the incidence of complications. This study aimed to present real-life 12-month effectiveness and safety data for TAF. Materials and Methods: This Pythagoras Retrospective Cohort Study included patients from 14 centers in Turkiye. The study presents 12-month results of 480 patients treated with TAF as initial therapy or after switching from another antiviral drug. Results: The study shows treatment of about 78.1% patients with at least one antiviral agent (90.6% tenofovir disoproxil [TDF]). The rate of unde-tectable HBV DNA increased in both treatment-experienced and naive pa-tients. In TDF-experienced patients, the rate of alanine transaminase (ALT) normalization increased slightly (1.6%) within 12 months, but the change was not statistically significant (p=0.766). Younger age, low albumin, and high body mass index and cholesterol were identified as risk factors for abnormal ALT after 12 months, but no linear relationship was detected. In TDF-experienced patients, renal and bone function indicators showed significant improvement three months after the transition to TAF and remained stable for 12 months. Conclusion: Real-life data demonstrated effective virological and biochemical responses with TAF therapy. After switching to TAF treat-ment, gains in kidney and bone functions were achieved in the early period.
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    HIV ile enfekte hastalarda bağırsak mikrobiyotasıve antiretroviral tedavilerin mikrobiyota üzerindeki etkileri
    (Dicle Üniversitesi, Tıp Fakültesi, 2023) Demir, Yakup; Çelen, Mustafa Kemal
    Amaç: Çalışmamızın amacı yeni tanı HIV/AIDS hastalarında bağırsak mikrobiyatasını incelemek, bu verileri sağlıklı gönüllülerle karşılaştırmak ve hastalara başlanılan antiretroviral tedavi ile bağırsak mikrobiyota değişimini belirlemektir. Materyal ve Metot: Çalışmamıza Dicle Üniversitesi Tıp Fakültesi Enfeksiyon Hastalıkları Klinik Mikrobiyoloji Anabilim Dalı Poliklinik ve Kliniklerine Aralık 2021 ile Mayıs 2022 yılları arasında başvuran ve yeni tanı alan HIV/AIDS hastaları çalışmanın baseline hasta koluna dahil edilmiştir. Tedavi sonrası 3. ay hastalar tekrar incelenmiş olup çalışmanın kontrol hasta grubuna dahil edilmiştir. Çalışmanın 3. kolunu sağlıklı kontrol grubu oluşturmuştur. İntestinal mikrobiyota analizi için tüm katılımcılardan gaita örneği alınarak yeni nesil dizileme yöntemiyle analiz yapılmıştır. Verilerin analizinde, IBM SPSS Statistics 26 (IBM SPSS, Türkiye) programı kullanıldı. Bulgular: Çalışmaya 15 HIV/AIDS tanılı hasta ile 10 sağlıklı gönüllü kişi dahil edilmiştir. Çalışmaya dahil edilen 25 olgunun 21'i (%84) erkek, 4'ü (%16) kadındı. Katılımcıların yaş ortalaması 35.4±9.1 olup, yaşı en küçük olan katılımcı 21, en ileri olan 50 yaşında idi. Baseline hasta kolunda HIV RNA ortalama 568.740 kopya/ml olarak ölçüldü. HIV RNA sayısı en düşük 354 kopya/ml iken; en yüksek 4 430 860 kopya/ml olarak saptandı. Baseline hasta kolunda CD4+ T lenfosit ortalama sayısı 352 hücre/mm3, en düşük 139 hücre/mm3 iken; en yüksek 650 hücre/mm3 olarak saptandı. Hasta kontrol grubunda HIV RNA ortalama 364 kopya/ml olarak ölçüldü. En düşük HIV RNA 0 kopya/ml iken; en yüksek 5 503 kopya/ml olarak saptandı. Hasta kontrol grubunda CD4+ T lenfosit ortalama sayısı 622 hücre/mm3, en düşük 160 hücre/mm3 iken; en yüksek 1 400 hücre/mm3 olarak saptandı. Tedavi rejimleri ile CD4+ T lenfosit değişikliği ve HIV RNA sayısı arasında anlamlı bir ilişki saptanmadı. Hasta baseline grubunda sağlıklı kontrol grubuna göre Actinobacteria şubesinde artış saptanmıştır. Hasta kontrol grubunda hasta baseline grubuna göre Actinobacteria şubesinde azalma saptanmıştır. Hasta baseline grubunda hasta kontrol grubuna göre cins düzeyinde Bacteroides, Oxalobacter, Neisseria, Collinsella, Pseudomonas ve Streptococcus sayısında artış meydana gelmiştir. Hasta kontrol kolunda tedavi karşılaştırmasında Emtrisitabin, TDF, dolutegravir grubunda Spirochaetes şubesinde ve Veillonellaceae ailesinde, cins düzeyinde ise Oxalobacter'de anlamlı artış saptanmıştır. Sonuç: HIV/AIDS hastalığında bağırsak mikrobiyotası etkilenmektedir. Mikroorganizma çeşitliliği hastalıkla beraber azalmaktadır. Mikroorganizmaların farklılaşması inflamasyonda rol oynamaktadır. Başlanılan tedavi, CD4+ T hücre sayısında artma, HIV RNA'nın düşmesi mikroorganizmal çeşitliliği değiştirmektedir. Bu hastalarda tedavinin kontrol altında olması, beslenme ve egzersiz desteği büyük önem arz etmektedir.
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    HIV ile infekte hastalarda fatalite hızı
    (Bilimsel Tıp Yayınevi, 2019) Kalkan, İrem Akdemir; Demir, Yakup; Çelen, Mustafa Kemal
    Hastalığın tam olarak ortaya konmasından sonraki süreçte, kayıt altına alınan bilgiler ışığında milyonlarca insan HIV/AIDS nedeniyle hayatını kaybetmiştir. Ölüm oranları etkin tedavilerle önemli oranda azalmaktadır. Bununla birlikte HIV/AIDS önemli bir bulaşıcı hastalık olup toplum sağlığını da ilgilendirmektedir. Bu nedenle ölüm oranlarının bilinmesi hasta takibinde oldukça önemlidir. Bu çalışmada bir üniversite hastanesinde 11 yıldır izlenen hastalarda fatalite hızı hesaplanması amaçlanmıştır.
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    Occult hepatitis B infection in Turkish HIV-infected patients: A multicentre, retrospective, cross-sectional study, Schindler study
    (Wiley-Hindawi, 2021) Ünlü, Gülten; Yıldız, Yeşim; Ören, Meryem Merve; Çabalak, Mehmet; Mete, Özlem; Kömür, Süheyla; Yıldırım, Figen; İnan, Dilara; Toplu, Sibel Altunışık; Akhan, Sıla; Karaşahin, Ömer; Kalkan, İrem Akdemir; Demir, Yakup; Ayhan, Merve; Karaoğlan, İlkay; Taşova, Yeşim; Bayındır, Yaşar; Dal, Tuba; Çelen, Mustafa Kemal
    Objective Occult hepatitis B infection (OHBI) appears to have a higher prevalence in populations at high risk for hepatitis B virus (HBV) infection with concomitant liver disease. The aim was to assess the prevalence of OHBI in a sample of human immunodeficiency virus -1 positive and HBV surface antigen-negative (HIV-1+/HBsAg-) Turkish patients. Methods Ten centres in Turkey were included in the study. Patients were selected on the basis of a power calculation with a known population size of HIV-positive patients and a reported prevalence of OHBI. Gender, age, occupation, place of residence, treatment and clinical status, and laboratory results, including immunodeficiency panel, antibody tests, hemogram, biochemistry, and coagulation studies were evaluated retrospectively. Results The number of HIV-infected patients followed in these centres was 3172 and the sample population numbered 278. All 278 were HBsAg negative. The mean age of the sample was 37.2 +/- 13.1 years and 235 (84.5%) were male. All but one patient (99.6%) had been treated with antiretroviral therapy. Of the 278 patients, 169 (60.6%) were positive for Anti-HBs and 125 (44.8%) were positive for Anti-HBc IgG. HIV RNA was detected in 203/278 (73%) of the patients. Four HBV DNA (1.4%) were diagnosed with OHBI. There was no significant difference in hemogram, hemoglobin or bilirubin concentrations in those with OHBI compared with the other patients. Conclusion In a representative sample of HIV+ patients from 10 Turkish centres, the prevalence of OHBI was found to be 1.4%. In HIV positive patients, it is important to identify those with OHBI for optimal clinical management and prognosis.
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    Parent attitudes about childhood vaccines scala: Turkish cultural and linguistic validation
    (Pamukkale University, 2021) Kalkan, İrem Akdemir; Ören, Meryem Merve; Karaşahin, Ömer; Yıldız, Yeşim; Demir, Yakup; Dal, Tuba; Aktar, Fesih; Çelen, Mustafa Kemal; 0000-0002-3383-7830
    Purpose: Vaccine hesitation is a public health threat in Turkey and throughout the world. There is no scale validation inTurkish in this topic.This study sought to validate a Turkish version of the scale developed by Opel et al. in 2011 and revised in 2013, the “Parent Attitudes About Childhood Vaccines Survey”. Materials and methods: This was a translation and linguistic validation study conducted using a serial method. Language validation study was carried out using ’Serial method’ for scale developed by Opel DJ and his colleagues.The scale was translated, reviewed, retranslated, and reviewed for clarity and uniformity. Content validity was assessed using a modified Lawshe method. A content validity ratio and content validity index was calculated for each item according to the opinions expressed regarding the suitability of each scale item. Results: The scope validity ratio for all questions was above the critical content validity ratio of 0.455. The content validity index value of the scale was 0.630, and the content validity of the questions was statistically significant. Conclusions: The linguistic validation of the parental attitude scale regarding childhood vaccination and the statistically significant results of the scope validity tests indicate that the Turkish version is valid. Subsequent validity and reliability studies are expected to make the scale measuring parental attitudes about vaccine heed in Turkey.Thus, it is thought that it will contribute to the studies to be carried out on vaccine heed and struggle by working in a wider audience.
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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.
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    Öğe
    Real-life experience of tenofovir alafenamide fumarate: The pythagorean cohort
    (Wiley, 2021) Karaşahin, Ömer; Kalkan, İrem Akdemir; Dal, Tuba; Toplu, Sibel Altunışık; Harputoğlu, Murat; Mete, Ayse Özlem; Aktar, Fesih; Demir, Yakup; Çelen, Mustafa Kemal
    Real-life experience of tenofovir alafenamide fumarate: The pythagorean cohort