1
|
Arslan E, Yildiz Y, Karaşahin Ö, Demir Y, Tümbül Mermutluoğlu Ç, Ünlü G, Kuşçu F, Kaya Ş, Akgül F, Damar Çakirca T, Yilmaz Karadağ F, Altunişik Toplu S, Nazik S, Akdemir İ, Özer Balin Ş, Kandemir FÖ, İnan D, Bayindir Y, Taşova Y, Çelen MK. Evaluation of chronic hepatitis B patients who voluntarily discontinued oral antiviral therapy: is there an answer to the controversial topic? Eur J Gastroenterol Hepatol 2024; 36:438-444. [PMID: 38407855 DOI: 10.1097/meg.0000000000002722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
OBJECTIVE The 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. METHODS Data from 138 patients from 11 centers were included in this registry-based study. Factors associated with VR were investigated using multivariate Cox regression analysis. RESULTS Ninety-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. CONCLUSION The findings of this study may provide clinical guidance in terms of determining the most appropriate discontinuation time for NA.
Collapse
Affiliation(s)
- Eyüp Arslan
- Department of Infectious Diseases and Clinical Microbiology, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul
| | - Yeşim Yildiz
- Department of Infectious Diseases and Clinical Microbiology, Gazi University Faculty of Medicine, Ankara
| | - Ömer Karaşahin
- Department of Infectious Diseases and Clinical Microbiology, Erzurum Regional Training and Research Hospital, Erzurum
| | - Yakup Demir
- Department of Infectious Diseases and Clinical Microbiology, Dicle University Faculty of Medicine, Diyarbakir
| | - Çiğdem Tümbül Mermutluoğlu
- Department of Infectious Diseases and Clinical Microbiology, Dicle University Faculty of Medicine, Diyarbakir
| | - Gülten Ünlü
- Department of Infectious Diseases and Clinical Microbiology, Derince Training and Research Hospital, Kocaeli
| | - Ferit Kuşçu
- Department of Infectious Diseases and Clinical Microbiology, Çukurova University Faculty of Medicine, Adana
| | - Şafak Kaya
- Department of Infectious Diseases and Clinical Microbiology, Gazi Yasargil Training and Research Hospital, Diyarbakir
| | - Fethiye Akgül
- Department of Infectious Diseases and Clinical Microbiology, Batman Regional State Hospital, Batman, Turkey
| | - Tuba Damar Çakirca
- Department of Infectious Diseases and Clinical Microbiology, Şanliurfa Training and Research Hospital, Şanliurfa
| | - Fatma Yilmaz Karadağ
- Department of Infectious Diseases and Clinical Microbiology, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul
| | - Sibel Altunişik Toplu
- Department of Infectious Diseases and Clinical Microbiology, Inonu University Faculty of Medicine, Malatya
| | - Selçuk Nazik
- Department of Infectious Diseases and Clinical Microbiology, Sütçü İmam University Faculty of Medicine, Kahramanmaraş
| | - İrem Akdemir
- Department of Infectious Diseases and Clinical Microbiology, Ankara University Faculty of Medicine, Ankara
| | - Şafak Özer Balin
- Department of Infectious Diseases and Clinical Microbiology, Fırat University Faculty of Medicine, Elazığ
| | - Fatma Özlem Kandemir
- Department of Infectious Diseases and Clinical Microbiology, Mersin University Faculty of Medicine, Mersin
| | - Dilara İnan
- Department of Infectious Diseases and Clinical Microbiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Yaşar Bayindir
- Department of Infectious Diseases and Clinical Microbiology, Inonu University Faculty of Medicine, Malatya
| | - Yeşim Taşova
- Department of Infectious Diseases and Clinical Microbiology, Çukurova University Faculty of Medicine, Adana
| | - Mustafa Kemal Çelen
- Department of Infectious Diseases and Clinical Microbiology, Dicle University Faculty of Medicine, Diyarbakir
| |
Collapse
|
2
|
Sürmelioğlu N, Yalçın N, Kuşçu F, Candevir A, İnal AS, Kömür S, Kurtaran B, Demirkan K, Taşova Y. Physicians' knowledge of potential covid-19 drug-drug interactions: An online survey in turkey. Postgrad Med 2020; 133:237-241. [PMID: 32780961 DOI: 10.1080/00325481.2020.1807809] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Given the many medications used to treat novel coronavirus disease (COVID-19) and its comorbidities and complications, the risk of drug-drug interactions (DDIs) and resulting patient harm is concerning. This study aimed to shed light on physicians' knowledge of potential DDIs related to COVID-19 treatment, to determine the effect of an information brief about these DDIs on their correct response rates, and to identify factors associated with higher levels of knowledge about these DDIs. METHODS The knowledge of physicians regarding the clinical significance and intervention of 7 common potential DDIs during COVID-19 treatment was evaluated via an online survey. Using a pretest-posttest design, the physicians completed a multiple-choice questionnaire first using their existing knowledge, then received an information brief about the DDIs and completed the same questionnaire again. Pretest and posttest scores were evaluated and factors affecting correct response rates were determined using correlation, regression, and post-hoc analyzes. RESULTS A total of 244 physicians participated in the survey, 147 (60.2%) of whom were involved in the treatment of COVID-19 patients. After the information brief, there were significant increases in the number of correct responses for both clinical significance and interventions (p < 0.0001). In comparisons of pretest knowledge, physicians involved in the treatment of COVID-19 patients showed significantly higher correct response rate for interventions compared to physicians who had not treated COVID-19 patients (p = 0.003). Post-hoc analysis to compare pretest correct intervention responses among all medical specialties revealed significant differences between infectious diseases and family practice (mean difference: 1.059; p = 0.005) and between internal medicine and family practice (mean difference: 1.771; p < 0.0001). CONCLUSION Physicians involved in the treatment of COVID-19 patients had more knowledge regarding clinical significance and appropriate management of potential DDIs than those not involved. Therefore, it may be beneficial to organize trainings and issue guidelines about potential DDIs for physicians during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Nursel Sürmelioğlu
- Department of Clinical Pharmacy, Faculty of Pharmacy, Çukurova University, Adana, Turkey
| | - Nadir Yalçın
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Ferit Kuşçu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Aslıhan Candevir
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Ayşe Seza İnal
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Süheyla Kömür
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Behice Kurtaran
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Yeşim Taşova
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| |
Collapse
|
3
|
Korkmaz P, Kurtaran B, Özdemir Armağan Ş, Turan Özden H, Kacar F, Ateş S, Durmuş G, Bayındır Bilman F, Uygun Kızmaz Y, Hamidi AA, Özdemir B, Yıkılgan AB, Fırat P, İnan A, Okay G, Işık ME, But A, Uğurlu K, Harman R, Ergüt Sezer B, Doyuk Kartal E, Kuşçu F, Şener A, Mıstanoğlu Özatağ D, Tükenmez Tigen E, Dağlı Ö, Koçak F, Kuşoğlu H, Ertürk Şengel B, Demirel A, Naz H, Agalar C, Öztürk Engin D, Dökmetaş İ, Gürsul NC, Yılmaz Karadağ F, Çayıröz MU, Kürekçi Y, Kadanalı A, Çakar ZŞ, Savaşçı Ü, Erdem İ, Çağan Aktaş S. The factors affecting inadequate empirical antimicrobial therapy and clinical course in upper urinary tract infections of the elderly patients. mjima 2020. [DOI: 10.4274/mjima.galenos.2020.2020.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
4
|
Karaman E, Ilkit M, Kuşçu F. Identification of Cryptococcus antigen in human immunodeficiency virus-positive Turkish patients by using the Dynamiker ® lateral flow assay. Mycoses 2019; 62:961-968. [PMID: 31344286 DOI: 10.1111/myc.12969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/18/2019] [Accepted: 07/20/2019] [Indexed: 12/27/2022]
Abstract
Cryptococcus neoformans causes life-threatening meningoencephalitis, particularly in human immunodeficiency virus (HIV)-positive individuals with low CD4 levels (<100 cells/μL). Although the burden of cryptococcal meningoencephalitis (CM) in Turkey is low (0.13 cases per 100 000 persons), asymptomatic individuals at risk of cryptococcosis should be screened for antigenemia to prevent the disease and/or promote early CM diagnosis. A lateral flow assay (LFA) is used to detect Cryptococcus antigen (CrAg) in cerebrospinal fluid and serum. We determined Cryptococcus antigenemia prevalence in serum samples of HIV-positive and HIV-negative adult patients by using Dynamiker® CrAg-LFA, a point-of-care dipstick test. Patients' demographic data, CD4 count, HIV-RNA levels and anti-retroviral therapy status were recorded. CrAg was detected in 28 (11%) of 254 HIV-positive patients screened but not in 100 HIV-negative control individuals; a significant difference was observed in the CrAg-LFA positivity rate between HIV-positive and HIV-negative groups (x2 = 11.970; P < .05). In CrAg-positive patients, the median CD4 level was 666 cells/μL (115-1344 cells/μL), with a median viral load of 23 copies/mL (0-3.69 × 106 copies/mL). In HIV-positive CrAg-negative patients, the median CD4 level was 633 cells/μL (31-2953 cells/μL) and the median viral load was 12 copies/mL (0-1.95 × 106 copies/mL; P > .05). Results indicate that HIV-positive patients with both low (<200 cells/μL) and high (>200 cells/μL) CD4 counts should be screened for asymptomatic cryptococcal antigenemia. HIV-associated asymptomatic cryptococcosis is not uncommon in Turkey, which warrants systematic screening. Updated strategies for CM prevention among HIV-positive patients should be used even in non-endemic countries.
Collapse
Affiliation(s)
- Evrim Karaman
- Division of Mycology, Department of Microbiology, Faculty of Medicine, University of Çukurova, Adana, Turkey
| | - Macit Ilkit
- Division of Mycology, Department of Microbiology, Faculty of Medicine, University of Çukurova, Adana, Turkey
| | - Ferit Kuşçu
- Department of Infectious Diseases, Faculty of Medicine, University of Çukurova, Adana, Turkey
| |
Collapse
|
5
|
Idilman R, Baykam N, Kaymakoğlu S, Tabak F, Bahçecioğlu HI, Bektaş A, Bulut C, Günşar F, İnan D, Karaosmanoğlu HK, Karasu Z, Kuşçu F, Mete B, Özbakır Ö, Özdoğan OC, Parlak M, Sırmatel F, Topalak Ö, Ünsal B, Guidelines Study Group VH. Turkey 2017 Clinical Practice Guidelines on recommendations for screening diagnosing and managing hepatitis C virus. Turk J Gastroenterol 2018; 28:90-93. [PMID: 29303105 DOI: 10.5152/tjg.2017.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The present guideline updates the Turkish recommendations for the screening, diagnosis and management of Hepatitis
C virus (HCV) infection prepared by the Turkish Association for the Study of the Liver (TASL) and Viral Hepatitis
Society (VHS). The aim of this guidance was to provide updates recommendations to physicians, who are interested
in HCV care on the optimal screening, diagnosis and pre-treatment management for patients with HCV infection
in Turkey. These recommendations, produced by panel experts, were aimed to addresses the management issues
ranging from diagnosis and linkage to care, to the optimal treatment regimen in patients with HCV infection. Recommendations
are based on evidence and opinions of more than 70% of the panelists. This guidance is supported by
the memberships of two societies and not by pharmaceutical companies. This guidance will be updated frequently
as new data become available.
Collapse
Affiliation(s)
- Ramazan Idilman
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Nurcan Baykam
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Sabahattin Kaymakoğlu
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Fehmi Tabak
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Halil I Bahçecioğlu
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ahmet Bektaş
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Cemal Bulut
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Fulya Günşar
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Dilara İnan
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Hayat K Karaosmanoğlu
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Zeki Karasu
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ferit Kuşçu
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Birgül Mete
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ömer Özbakır
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Osman C Özdoğan
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Mehmet Parlak
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Fatma Sırmatel
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ömer Topalak
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Belkis Ünsal
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | | |
Collapse
|
6
|
Abstract
Background/aim:
Tuberculous peritonitis may be difficult to diagnose due to its insidious and variable clinical manifestations as well as
characteristics similar to malignancy. In this study, case reports from Turkey over the last 10 years were reviewed systematically using
pooled analysis.
Materials and methods:
Thirty-four suitable articles were found and 163 tuberculous peritonitis cases were included in the study.
Results:
The mean age was 34.1 years (17–79 years), and 146 (98.6%) of the patients were female and 17 (10.4%) were male. The most
common complaints of these patients were abdominal pain (77.4%) and abdominal distention (73.5%). Ascites in the abdomen (75%),
fever (42%), abdominal tenderness (33%), and abdominal distention (30.7%) were the most common physical examination findings.
The mean adenosine deaminase level was 120.3 IU/L. In the subsets of patients with relevant data, acid-fast bacilli were found in 23.3%,
culture was positive in 22.2%, and
Mycobacterium tuberculosis
polymerase chain reaction was positive in 20%. In abdominal imaging,
ascites was reported in 92%. Elevated serum CA-125 was reported in 96.7% of the patients. Of 105 patients with data available following
the antituberculous therapy prognosis, four (3.8%) died and the other 101 (96.2%) showed good treatment response.
Conclusion:
Tuberculous peritonitis should be kept in mind during the differential diagnosis of patients admitted with the triad of
ascites, fever, and abdominal distention.
Collapse
|
7
|
Candevir Ulu A, Güven Gökmen T, Kibar F, Kurtaran B, Önlen C, Kuşçu F, İnal AS, Kömür S, Yaman A, Aksu HSZ, Taşova Y. Molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae at a Turkish centre: Is the increase of resistance a threat for Europe? J Glob Antimicrob Resist 2017; 11:10-16. [DOI: 10.1016/j.jgar.2017.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/15/2017] [Accepted: 06/21/2017] [Indexed: 12/18/2022] Open
|
8
|
Oğul A, Şahin B, Kuşçu F, Taktakoğlu O, Yetişir AE, Büyükşimşek M, Mirili C, Gökçay S, Gökhan Gök M, Kum P. The Importance of Parameters: MPV, MPV/Thrombocyte Ratio and Neutrophil/Lymphocyte Ratio in Sorafenib Treatment Response of Patients with Hepatocellular Cancer. J Gastrointest Cancer 2017; 48:286-287. [DOI: 10.1007/s12029-017-9970-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
9
|
Kömür S, Ulu A, Kurtaran B, İnal AS, Kuşçu F, Tekin D, Taşova Y. Daptomisin alan hastalarda gelişen ani solunum yetmezliği ve eozinofilik pnömoni: beş olgunun sunumu. Cukurova Med J 2016. [DOI: 10.17826/cutf.208261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
10
|
Kömür S, Kuşçu F, Ulu A, İnal AS, Kurtaran B, Taşova Y, Aksu HSZ. Kronik hepatit C enfeksiyonunda tedavi yaklaşımı. Cukurova Med J 2016. [DOI: 10.17826/cutf.215478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
11
|
Kömür S, Ulu A, Kurtaran B, Türkoğlu BÖ, İnal AS, Kuşçu F, Belgin B, Kılıç F, Çiçekdemir HY, Bozkurt S, Gürel D, Aksu HSZ, Tasova Y. Bir Günlük Nokta Prevalans ile Bakış: Cerrahi Profilaksi Uygun mu? Mustafa Kemal Üniv Tıp Derg 2016. [DOI: 10.17944/mkutfd.67968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
12
|
Kuşçu F, Menemenlioğlu D, Öztürk DB, Korukluoğlu G, Uyar Y. Anti-HIV Pozitif Bir Hastada Saptanan Akut Toskana Virus Enfeksiyonu*. MIKROBIYOL BUL 2014. [DOI: 10.5578/mb.5401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|