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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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    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.
  • Küçük Resim
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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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    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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    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