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Öğe Antibiotic use and Influencing Factors Among Hospitalized Patients with COVID-19: A Multicenter Point-Prevalence Study from Turkey(Galenos Publ House, 2022) Sencan, Irfan; Cag, Yasemin; Karabay, Oguz; Kurtaran, Behice; Guclu, Ertugrul; Ogutlu, Aziz; Demirbas, ZehraBackground: Broad-spectrum empirical antimicrobials arc frequently prescribed for patients with coronavirus disease 2019 (COVID-19) despite the lack of evidence for bacterial coinfection. Aims: We aimed to cross-sectionally determine the frequency of antibiotics use, type of antibiotics prescribed, and the factors influencing antibiotics use in hospitalized patients with COVID-19 confirmed by polymerase chain reaction. Study Design: The study was a national, multicenter, retrospective. and single-day point prevalence study. Methods: This was a national, multicenter, retrospective, and single-day point-prevalence study, conducted in the 24-h period between 00:00 and 24:00 on November 18, 2020, during the start of the second COVID-19 peak in Turkey. Results: A total of 1500 patients hospitalized with a diagnosis of COVID-19 were included in the study. The mean age +/- standard deviation of the patients was 65.0 +/- 15.5, and 56.2% (n = 843) of these patients were men. Of these hospitalized patients, 11.9% (n = 178) were undergoing invasive mechanical ventilation or ECMO. It was observed that 1118 (74.5%) patients were receiving antibiotics, of which 416 (372%) were prescribed a combination of antibiotics. In total, 71.2% of the patients had neither a clinical diagnosis nor microbiological evidence for prescribing antibiotics. In the multivariate logistic regression analysis, hospitalization in a state hospital (p < 0.001), requiring any supplemental oxygen (p = 0.005). presence of moderate/diffuse lung involvement (p < 0.001), C-reactive protein >10 ULT coefficient (p < 0.001), lymphocyte count < 800 (p = 0.007), and clinical diagnosis and/or confirmation by culture (p <0.001) were found to be independent factors associated with increased antibiotic use. Conclusion: The necessity of empirical antibiotics use in patients with COVID-19 should be reconsidered according to their clinical, imaging, and laboratory findings.Öğe COVID-19-related anxiety in people living with HIV: an online cross-sectional study(Tubitak Scientific & Technical Research Council Turkey, 2020) Kuman Tuncel, Ozlem; Pullukcu, Husnu; Erdem, Huseyin Aytac; Kurtaran, Behice; Tasbakan, Selin Ece; Isikgoz Tasbakan, MeltemBackground/aim: The emergence of the coronavirus disease 2019 (COVID-19) outbreak has had an enormous emotional impact on sonic vulnerable groups, such as people living with human immunodeficiency virus (HIV) (PLHIV). This study was planned with the aim of assessing the anxiety levels of PLHIV and the sources of their anxiety. Materials and methods: A web-based questionnaire was sent to PLHIV using the virtual snowball sampling method. The questionnaire included questions about sociodemographic status, information about HIV infection, and the Beck Anxiety Inventory (BAI). Additionally, some opinions of the participants about COVID-19 were asked. Results: A total of 307 respondents, with a median age of 33 years, from 32 different cities, participated in the study. More than half of the respondents reported the belief that COVID-19 was not sufficiently well-known by the medical community and nearly 45% believed that they would have snore complications if they contracted COVID-19. One-fourth of the participants had anxiety. Having a preexisting psychiatric disorder, perceiving that they were practicing insufficient preventive measures, not being sure about the presence of any individuals with COVID-19 in their environment, and living with a household member with a chronic disease were found to be the risk factors of PLHIV for having anxiety during this pandemic. The BAI scores were correlated with the patient-reported anxiety levels about the spread of COVID-19 in Turkey, acquiring COVID-19, transmitting COVID-19 to another person, and transmitting HIV to another person. Among the stated conditions, the most common concern was the spread of COVID-19 all over the country, while the least common was transmitting HIV to someone else. Conclusion: The results revealed that a significant proportion of the sample had anxiety, and the findings were essential for developing evidence-based strategies for decreasing the anxiety of PLHIV, especially for those who had risk factors and to provide them with better health care during this pandemic or other pandemic-like crises.Öğe COVID-19-related anxiety in people living with HIV: an online cross-sectional study(2020) Tunçel, Özlem Kuman; Erdem, Hüseyin Aytaç; Pullukçu, Hüsnü; Kurtaran, Behice; Taşbakan, Selin EceBackground/aim: The emergence of the coronavirus disease 2019 (COVID-19) outbreak has had an enormous emotional impact on some vulnerable groups, such as people living with human immunodeficiency virus (HIV) (PLHIV). This study was planned with the aim of assessing the anxiety levels of PLHIV and the sources of their anxiety. Materials and methods: A web-based questionnaire was sent to PLHIV using the virtual snowball sampling method. The questionnaire included questions about sociodemographic status, information about HIV infection, and the Beck Anxiety Inventory (BAI). Additionally, some opinions of the participants about COVID-19 were asked. Results: A total of 307 respondents, with a median age of 33 years, from 32 different cities, participated in the study. More than half of the respondents reported the belief that COVID-19 was not sufficiently well-known by the medical community and nearly 45% believed that they would have more complications if they contracted COVID-19. One-fourth of the participants had anxiety. Having a preexisting psychiatric disorder, perceiving that they were practicing insufficient preventive measures, not being sure about the presence of any individuals with COVID-19 in their environment, and living with a household member with a chronic disease were found to be the risk factors of PLHIV for having anxiety during this pandemic. The BAI scores were correlated with the patient-reported anxiety levels about the spread of COVID-19 in Turkey, acquiring COVID-19, transmitting COVID-19 to another person, and transmitting HIV to another person. Among the stated conditions, the most common concern was the spread of COVID-19 all over the country, while the least common was transmitting HIV to someone else. Conclusion: The results revealed that a significant proportion of the sample had anxiety, and the findings were essential for developing evidence-based strategies for decreasing the anxiety of PLHIV, especially for those who had risk factors and to provide them with better health care during this pandemic or other pandemic-like crises.Öğe Daptomycin vs. glycopeptides in the treatment of febrile neutropenia: results of the Izmir matched cohort study(Springer Heidelberg, 2019) Sipahi, Oguz Resat; Kahraman, Hasip; Erdem, Huseyin Aytac; Yetkin, Funda; Kaya, Selcuk; Demirdal, Tuna; Tunccan, Ozlem Guzel; Karasahin, Omer; Oruc, Ebru; Cag, Yasemin; Kurtaran, Behice; Ulug, Mehmet; Kutlu, Murat; Avci, Meltem; Oztoprak, Nefise; Arda, Bilgin; Pullukcu, Husnu; Tasbakan, Meltem; Yamazhan, Tansu; Kandemir, Ozlem; Dizbay, Murat; Sipahi, Hilal; Ulusoy, SercanPurposeIn this multicentre, retrospective, matched cohort study we aimed to evaluate the outcomes of neutropenic fever cases that were treated with daptomycin or a glycopeptide (vancomycin or teicoplanin).MethodsData and outcomes of adult (aged>18-years old) patients with neutropenic fever [(1) without clinical and radiological evidence of pneumonia, (2) who were treated with daptomycin or a glycopeptide (teicoplanin or vancomycin) for any reason and for at least 72 h] were extracted from the hospital databases. Matching was performed with all of the three following criteria: (1) underlying disease, (2) reason for starting daptomycin or glycopeptide (microbiologic evidence vs. microbiologic evidence, clinical infection vs. clinical infection and empirical therapy vs. empirical therapy) and (3) neutropenic status.ResultsOverall 128 patients [(69/123) (56.1%) in the daptomycin cohort (D) and 59/123 (48%) in the glycopeptide cohort (G)] had a resolution of fever at the end of 72h antibiotic treatment (p=0.25). There was no significant difference in cured, improved and (cured+improved) rates between (D) and (G) cohorts as well as fever of unknown origin cases or microbiologically confirmed infections or clinically defined infections subgroups (p>0.05). There was also no significant difference (p>0.05), in terms of persistent response in the (D) versus (G) cohorts,ConclusionsThese findings suggest that although not better, daptomycin efficacy is comparable to vancomycin if used as empiric therapy in the treatment of adult febrile neutropenia. We conclude that daptomycin may be used at least as a salvage therapy alternative to glycopeptides in the treatment of adult febrile neutropenia cases. A large, randomized-controlled trial may further consolidate the evidence related to this question.Öğe Demographic Characteristics and Transmission Risk Factors of Patients with Hepatitis C Virus in Turkey: The EPI-C, A Multicenter and Cross-sectional Trial(Galenos Yayincilik, 2021) Tabak, Fehmi; Sirin, Goktug; Demir, Mehmet; Aladag, Murat; Sumer, Sua; Kurtaran, Behice; Tosun, SelmaObjectives: To describe the prevalence of risk factors in patients infected with hepatitis C virus (HCV). Materials and Methods: Patients who were aged >18 years visiting outpatient clinics and diagnosed as having HCV infection were enrolled in this cross-sectional, multicenter study conducted in 71 cities. Patient data on socio-demographic and clinical characteristics and pre-defined risk factors were collected. Results: Among 1,018 patients, 53.0% were women. The mean age was 57.2 +/- 14.3 years and 34.8% had been diagnosed as having HCV infection >10 years before enrollment. Almost half of the patients (45.5%) were diagnosed during their regular check-up visits, and only 16.8% were diagnosed because of signs or symptoms of HCV. Genotype 1 and sub-genotype 1 b were detected in 87.9% and 73.7% of the patients, respectively. At least one risk factor was present in 94.8% of the patients. The most frequently reported risk factor was major dental procedures (79.2%), followed by major surgical operations (56.9%) and minor surgical interventions (42.3%). Conclusion: Our results revealed that most of the patients with HCV infection underwent major dental procedures.Öğe Miliary tuberculosis Epidemiologicaland clinical analysis of large-case series from moderate to low tuberculosis endemic Country(Lippincott Williams & Wilkins, 2017) Mert, Ali; Arslan, Ferhat; Kuyucu, Tulin; Koc, Emine Nur; Yilmaz, Mesut; Turan, Demet; Altin, Sedat; Pehlivanoglu, Filiz; Sengoz, Gonul; Yildiz, Dilek; Dokmetas, Ilyas; Komur, Suheyla; Kurtaran, Behice; Demirdal, Tuna; Erdem, Huseyin A.; Sipahi, Oguz Resat; Batirel, Ayse; Parlak, Emine; Tekin, Recep; Tunccan, Ozlem Guzel; Balkan, Ilker Inanc; Hayran, Osman; Ceylan, BahadirThe aim of this study was to determine the clinical features, and outcome of the patients with miliary tuberculosis (TB). We retrospectively evaluated 263 patients (142 male, 121 female, mean age: 44 years, range: 16-89 years) with miliary TB. Criteria for the diagnosis of miliary TB were at least one of the followings in the presence of clinical presentation suggestive of miliary TB such as prolonged fever, night sweats, anorexia, weight loss: radiologic criterion and pathological criterion and/or microbiological criterion; pathological criterion and/or microbiological criterion. The miliary pattern was seen in 88% of the patients. Predisposing factors were found in 41% of the patients. Most frequent clinical features and laboratory findings were fever (100%), fatigue (91%), anorexia (85%), weight loss (66%), hepatomegaly (20%), splenomegaly (19%), choroid tubercules (8%), anemia (86%), pancytopenia (12%), and accelerated erythrocyte sedimentation rate (89%). Tuberculin skin test was positive in 29% of cases. Fifty percent of the patients met the criteria for fever of unknown origin. Acid-fast bacilli were demonstrated in 41% of patients (81/195), and cultures for Mycobacterium tuberculosis were positive in 51% (148/292) of tested specimens (predominantly sputum, CSF, and bronchial lavage). Blood cultures were positive in 20% (19/97). Granulomas in tissue samples of liver, lung, and bone marrow were present in 100% (21/21), 95% (18/19), and 82% (23/28), respectively. A total of 223 patients (85%) were given a quadruple anti-TB treatment. Forty-four (17%) patients died within 1 year after diagnosis established. Age, serum albumin, presence of military pattern, presence of mental changes, and hemoglobin concentration were found as independent predictors of mortality. Fever resolved within first 21 days in the majority (90%) of the cases. Miliary infiltrates on chest X-ray should raise the possibility of miliary TB especially in countries where TB is endemic. Although biopsy of the lungs and liver may have higher yield rate of organ involvement histopathologicaly, less invasive procedures including a bone marrow biopsy and blood cultures should be preferred owing to low complication rates.Öğe Pegylated interferon in HBeAg-positive and -negative chronic hepatitis B patients: post-treatment 1-year results of three Turkish centres(Taylor & Francis Ltd, 2014) Yamazhan, Tansu; Kurtaran, Behice; Pullukcu, Husnu; Yuksel, Esma; Ozkaya, Deniz; Tasbakan, Meltem Isikgoz; Sipahi, Oguz Resat; Durusoy, Raika; Aksu, Hasan Salih ZekiIn this study, we aimed to evaluate the 1-year post-treatment follow-up results of 112 patients who received pegylated interferon (PEG-IFN) for 52 weeks. HBeAg negativity/seroconversion and/or negative HBV-DNA at the end of the treatment were considered as response. Patients who had response at the end of treatment but had HBV-DNA breakthrough during 1-year follow-up were considered as relapse. The study group comprised 112 cases (34 HBeAg-positive, 78 HBeAg-negative). In HBeAg-positive and -negative cases, end-of-treatment response rates were 2.9% and 60.2%, whereas 1-year sustained virological response rates were 0 and 33.3%, respectively. When we compared relapse cases versus cases with response at the end of 1-year follow-up, being female and having low viral load were the two parameters associated with higher response rates (Chi-square, P=0.028; Mann-Whitney U test, P=0.023). Overall non-response rates to PEG-IFN were high (57.1%). Results in HBeAg-positive cases were disappointing.Öğe The Perspectives of Infectious Diseases and Clinical Microbiology Specialists on Online Education Applications and Web-based Seminars(Galenos Yayincilik, 2021) Ozturk Kaygusuz, Turkkan; Agalar, Canan; Kurtaran, Behice; Cag, Yasemin; Tasbakan, MeltemIntroduction: in this study, it was aimed to obtain information about the perspectives of infectious diseases and clinical microbiology (IDCM) specialists on online education applications and web-based seminars, and their usage and utilization rates. Materials and Methods: in this descriptive, cross-sectional study, online survey responses of the IDCM specialists in who were members of Infectious Diseases Clinical Microbiology Specialty Society of Turkey (EKMUD) were evaluated. Results: A total of 184 IDCM specialists answered the survey questions. of the participants, 77.2% thought that the pandemic disrupted postgraduate medical education and 84.8% thought that the pandemic disrupted pre-graduate medical education. Medical educators involved in education during the Coronavirus disease-2019 (COVID-19) pandemic reported that they mostly continued online education. of the participants, 84.9% reported that they were able to use the internet in an effective way to gain access to information during the COVID-19 pandemic. of the responders, 58.2% reported that they followed online training programs, such as web-based seminars and lectures, and 51.6% reported that these online programs contributed to their learning. Participants found online training programs such as web-based seminars and lectures useful in terms of learning competence, that online training programs provided people with gain in space and time, and that they found them more instructive because they gave them the chance to receive training in subjects of their interest. Participants reported that these programs provided learning competency in that these programs were more beneficial to the participants in view of place, the subject that they need/they are interested in and saving time for the trainer and the participants. Due to the COVID-19 pandemic, the participants mostly wanted the 2020 EKMUD congress to be held online. A total 92.9% of the participants reported that online congresses and seminars would decrease travel, participation and sponsorship costs. Only 24.5% of the participants considered that online congresses and seminars would be more effective in terms of social interaction and gaining information than face-to-face congresses. Conclusion: The IDCM specialists reported that online educational practices such as webinars were benefical. The rate of participation in webinars and online education practices were high during the COVID-19 pandemic.Öğe Sofosbuvir/Velpatasvir/Voxilaprevir Experience in Treatment-Naive Chronic Hepatitis C Patients: Preliminary Findings of Real World Data(Galenos Publ House, 2023) Damar Çakırca, Tuba; Yamazhan, Tansu; Yüksekkaya, Esra; Akgül, Fethiye; Kurtaran, Behice; Karaşahin, Ömer; Karabay, OğuzObjectives: The aim of this study was to present the preliminary findings of real-world data of sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) in treatment-naive chronic hepatitis C (CHC) patients, which was approved for the first time in treatment-naive patients in Turkey. Materials and Methods: This retrospective, cross-sectional, multicenter and national study comprised treatment-naive CHC patients receiving SOF/VEL/VOX between June-December 2022 in ten centers from Turkey. The sustained virological response (SVR) was defined as undetectable hepatitis C virus (HCV)-RNA after at least 12 weeks or more from the end of antiviral therapy. Results: Forty one patients initiating SOF/VEL/VOX were included in the study; median age 55 [interquartile range (IQR): 34.5-61 years], 63.4% males, and median HCV-RNA 521,644 IU/mL. Genotype distribution ranged from 1 to 4 in 28 patients who underwent genotype analysis, and genotype-1 was detected in 24 (85.7%) patients. The most common risk factor was substance abuse (n=10, 24.4%) and the most common comorbidity was hypertension (n=111, 26.8%). 3 (7.3%) patients had compensated cirrhosis and one (2.4%) had hepatocellular carcinoma. While in the 1st month of treatment, HCV-RNA was negative in all patients except one patient, at the end of treatment all patients' viral load was negative. SVR12 results were available in 23 patients and SVR24 in 10 patients. SVR12 and SVR24 were achieved in all patients who could be evaluated (100%) (SVR12, 23/23; SVR24, 10/10). Adverse events were reported by two patients: Diarrhea (2.4%) and nausea (2.4%), but did not lead to a discontinuation of treatment. Conclusion: The preliminary results of our study corroborated the efficacy and well tolerateability of SOF/VEL/VOX in treatment- naive CHC patients. High SVR rates were also observed across genotypes 1, 2, 3, 4 with the pangenotypic SOF/VEL/VOX.Öğe Telaprevir Experience From Turkey(Kowsar Publ, 2015) Komur, Suheyla; Kurtaran, Behice; Inal, Ayse Seza; Pullukcu, Husnu; Ulu, Aslihan; Kuscu, Ferit; Yamazhan, Tansu; Tasova, Yesim; Aksu, Hasan Salih ZekiBackground: In patients with chronic hepatitis C, triple drug regimens containing a protease inhibitor, peginterferon and ribavirin were found to significantly increase sustained virologic response rates compared to dual drug regimen containing pegylated interferon and ribavirin, especially in genotype 1. Objectives: In Turkey, telaprevir has been used since March 2013. We aimed to evaluate results of patients with chronic hepatitis C treated with telaprevir, peginterferon and ribavirin. Patients and Methods: We evaluated 28 patients with genotype 1 chronic hepatitis C infection treated with triple drug regimen containing telaprevir, in three medical centers in Turkey, retrospectively. Demographic data of patients, treatment indications, adverse events and outcomes were recorded. Results: Of 28 patients intended to treat, 25 (89.2%) patients completed the treatment. Overall, 21 (82.1%) patients had relapse and five patients were non-responder. Regarding the treatment outcomes of Telaprevir based regimen, 20/26 patients achieved sustained virological response. Pruritus, rash, dysgeusia, anorectal discomfort and anemia were main adverse effects. Blood transfusion and ribavirin dose reduction required for 7 and 11 patients, respectively. Due to several adverse effects, 10 patients were hospitalized. Conclusions: Although more frequent and severe adverse effects, telaprevir has been promising for patients with treatment-experienced hepatitis C.
