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Item Real-world efficacy and safety of Ledipasvir plus Sofosbuvir and Ombitasvir/Paritaprevir/Ritonavir +/- Dasabuvir combination therapies for chronic hepatitis C: A Turkish experience(AVES, 2020-01-01) Degertekin, Bulent; Demir, Mehmet; Akarca, Ulus S.; Kani, Haluk Tarik; Ucbilek, Enver; Yildirim, Emre; Guzelbulut, Fatih; Balkan, Ayhan; Vatansever, Sezgin; Danis, Nilay; Demircan, Melek; Soylu, Aliye; Yaras, Serkan; Kartal, Aysun; Kefeli, Ayse; Gunduz, Feyza; Yalcin, Kendal; Erarslan, Elife; Aladag, Murat; Harputluoglu, Murat; Ozakyol, Aysegul; Temel, Tuncer; Akarsu, Mesut; Sumer, Hale; Akin, Mete; Albayrak, Bulent; Sen, Ilker; Alkim, Huseyin; Uyanikoglu, Ahmet; Irak, Kader; Oztaskin, Sinem; Ugurlu, Cagri Burak; Gunes, Sevkican; Gurel, Selim; Nuriyev, Kenan; Inci, Ismail; Kacar, Sabite; Dincer, Dinc; Doganay, Levent; Gokturk, Huseyin Savas; Mert, Ali; Cosar, Arif Mansur; Dursun, Hakan; Atalay, Roni; Akbulut, Sabiye; Balkan, Yasemin; Koklu, Hayrettin; Simsek, Halis; Ozdogan, Osman; Coban, Mehmet; Poturoglu, Sule; Ayyildiz, Talat; Yapali, Suna; Gunsar, Fulya; Akdogan, Meral; Ozenirler, Seren; Akyildiz, Murat; Sezgin, Orhan; Ozdogan, Osman; Kaymakoglu, Sabahattin; Besisik, Fatih; Karasu, Zeki; Idilman, Ramazan; Inter, T.A.S.L. Viral Hepatitis SpecialBackground/Aims: This study aimed to evaluate the real-life efficacy and tolerability of direct-acting antiviral treatments for patients with chronic hepatitis C (CHC) with/without cirrhosis in the Turkish population. Material and Methods: A total of 4,352 patients with CHC from 36 different institutions in Turkey were enrolled. They received ledipasvir (LDV) and sofosbuvir (SOF)+/- ribavirin (RBV) ombitasvir/paritaprevir/ritonavir +/- dasabuvir (PrOD)+/- RBV for 12 or 24 weeks. Sustained virologic response (SVR) rates, factors affecting SVR, safety profile, and hepatocellular cancer (HCC) occurrence were analyzed. Results: SVR12 was achieved in 92.8\% of the patients (4,040/4,352) according to intention-to-treat and in 98.3\% of the patients (4,040/4,108) according to per-protocol analysis. The SVR12 rates were similar between the treatment regimens (97.2\%-100\%) and genotypes (95.6\%-100\%). Patients achieving SVR showed a significant decrease in the mean serum alanine transaminase (ALT) levels (50.90 +/- 54.60 U/L to 17.00 +/- 14.50 U/L) and model for end-stage liver disease (MELD) scores (7.51 +/- 4.54 to 7.32 +/- 3.40) (p<0.05). Of the patients, 2 were diagnosed with HCC during the treatment and 14 were diagnosed with HCC 37.0 +/- 16.0 weeks post-treatment. Higher initial MELD score (odds ratio {[}OR]: 1.92, 95\% confidence interval {[}CI]: 1.22-2.38Item What does the Data of 354,725 Patients from Turkey Tell Us About Cervical Smear Epithelial Cell Abnormalities? - The Epithelial Cell Abnormality Rate is Increasing - Quality Control Studies and Corrective Activity are Musts(DE GRUYTER OPEN LTD, 2017-01-01) Turkmen, Ilknur Cetinaslan; Usubutun, Alp; Cakir, Asli; Aydin, Ozlem; Bolat, Filiz Aka; Akbulut, Metin; Altinay, Serdar; Arici, Sema; Aslan, Figen; Astarci, Muzeyyen; Bagir, Emine Kilic; Bas, Yilmaz; Bassullu, Nuray; Celik, Betul; Cetiner, Handan; Cobanoglu, Bengu; Aydin, Abdullah; Demir, Hale; Dogan, Hayriye Tatli; Eken, Kamile Gulcin; Erhan, Selma Sengiz; Erdogan, Gulgun; Erdogan, Kivilcim Eren; Eren, Funda; Ersoz, Safak; Firat, Pinar; Gurses, Iclal; Haberal, Nihan; Kahraman, Dudu Solakoglu; Kamali, Gulcin Harman; Karabulut, Yasemin Yuyucu; Kefeli, Mehmet; Koyuncuoglu, Meral; Koseoglu, R. Dogan; Muezzinoglu, Bahar; Onal, Binnur; Onder, Sevgen; Ozcan, Zuhal; Kimiloglu, Elife; Ozer, Hatice; Sonmez, F. Cavide; Sahin, Sevinc; Sahin, Nurhan; Yalta, TulinObjective: There is no other screening program close to the success rate of PAP test. Cervical cytology constitutes a large workload so that quality control in cervical cytology is important for the quality assurance of pathology laboratories. Material and Method: In this study, we collected the cervical cytology results from all over Turkey and discussed the parameters influencing the quality of the PAP test. The study was conducted with Turkish gynaecopathology working group and 38 centers (totally 45 hospitals) agreed to contribute from 24 different cities. The study was designed to cover the cervical cytology results during 2013. The results were evaluated from the data based on an online questionnaire. Results: The total number of Epithelial Cell Abnormality was 18,020 and the global Epithelial Cell Abnormality rate was 5.08\% in the total 354,725 smears and ranging between 0.3\% to 16.64\% among centers. The Atypical squamous cells/Squamous intraepithelial lesion ratios changed within the range of 0.21-13.94 with an average of 2.61. When the centers were asked whether they performed quality assurance studies, only 14 out of 28 centers, which shared the information, had such a control study and some quality parameters were better in these centers. Conclusion: There is an increase in the global Epithelial Cell Abnormality rate and there are great differences among centers. Quality control studies including the Atypical squamous cells/Squamous intraepithelial lesion ratio are important. Corrective and preventive action according to quality control parameters is a must. A cervical cytology subspecialist in every center can be utopic but a dedicated pathologist in the center is certainly needed.Item Six-year distribution pattern of hepatitis C virus in Turkey: a multicentre study(TAYLOR \& FRANCIS LTD, 2016-01-01) Altindis, Mustafa; Dal, Tuba; Akyar, Isin; Karatuna, Onur; Gokahmetoglu, Selma; Ulger, Seda Tezcan; Kulah, Canan; Uzun, Berrin; Sener, Asli Gamze; Ozdemir, Mehmet; Aydogan, Sibel; Kuskucu, Mert Ahmet; Midilli, Kenan; Otlu, Baris; Celen, Mustafa Kemal; Buruk, Kurtulus; Guducuoglu, HuseyinHepatitis C infection is a public health problem. The aim of this retrospective study was to determine the distribution of hepatitis C virus (HCV) genotypes in seven regions of Turkey, by evaluating 7002 patients with chronic HCV in a six-year period. During the 2009-2014 period, serum/plasma samples from 7002 new consecutive HCV RNA positive patients were collected. The female patients were 3867 (55.2\%). The genotype distribution of HCV patiens was evaluated by ages and years. Statistical analysis was performed by using the Mann-Whitney test and the chi(2) analysis. During the six-year period, genotype 1b was the most common genotype (67.7\%) followed by untypeable genotype 1 (7.7\%), genotype 4 (7.3\%) and genotype 3 (6.7\%). In 2014, genotype 3 was the second most common one (11.3\%) and genotype 4 was the third most common one (9.8\%). In the group with <25 years old patients, genotype 1b was most common (78.48\%, 62/79) between the years of 2009 and 2011, whereas genotype 3 (34.8\%, 86/247), between the years of 2012 and 2014. Genotype 1b was the most common in the groups between 26 and 35 years, 36 and 45 years, 46 and 55 years, 56 and 65 years. The rate of genotype 3 was increased from 4.78\% to 10.06\% and the rate of genotype 4 was increased from 1.3\% to 3.84\%, from 2009-2011 to 2012-2014. In recent years, genotypes 3 and 4 have gained importance. New therapeutic strategies and survey studies may be required for the modified HCV genotype pattern.Item A micro-elimination approach to addressing hepatitis C in Turkey(BMC, 2020-01-01) Idilman, Ramazan; Razavi, Homie; Robbins-Scott, Sarah; Akarca, Ulus Salih; Ormeci, Necati; Kaymakoglu, Sabahattin; Aygen, Bilgehan; Tozun, Nurdan; Guner, Rahmet; Bodur, Hurrem; Lazarus, Jeffrey V.Background In 2016, WHO passed the Global Health Sector Strategy on Viral Hepatitis (GHSS), calling for its elimination by 2030. Two years later, Turkey approved a strategy to reach the WHO targets. This study reports new national prevalence data, breaks it down by subpopulation, and models scenarios to reach HCV elimination. Methods Literature was reviewed for estimates of HCV disease burden in Turkey. They were discussed with stakeholders and used as inputs to develop a disease burden model. The infected population was estimated by sequelae for the years 2015-2030. Three scenarios were developed to evaluate the disease burden in Turkey: a Base 2017 scenario, representing the current standard of care in TurkeyItem Recommendations for the selection of techniques and components used in congenital heart surgery in Turkey(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2012-01-01) Undar, Akif; Haydin, Sertac; Erek, Ersin; Yivli, Perihan; Odemis, Ender; Agirbasli, Mehmet; Alkan-Bozkaya, Tijen; Turkoz, Ayda; Turkoz, Riza; Sasmazel, Ahmet; Karaci, Ali Riza; Cicek, Ali Ekber; Yalcinbas, Yusuf; Akcevin, Atif; Sarioglu, Tayyar; Bakir, IhsanThere is no standard for the selection of technical and mechanical components (heart-lung machine system, oxygenator, arterial and venous cannulae, arterial filter and other specifically-designed components and devices) used in cardiopulmonary bypass in Turkey. The cost of the component plays a significant role in the selection, as well as the preference of the facility. Only a limited number of hospitals decide which components to be used based on scientific data. Studies have confirmed that selected novel techniques and components having no basis of scientific justification may pose risk for the life of the patient in the short- and long-term. The objectives of this study are to show how to use quality-control procedures and scientific data for the selection of novel techniques and components and to share, also, recent techniques experienced to minimize the complication risk after surgery.Item `My story is like a magic wand': a qualitative study of personal storytelling and activism to stop violence against women in Turkey(TAYLOR \& FRANCIS LTD, 2021-01-01) Mwaba, Kasonde; Senyurek, Gamze; Ulman, Yesim Isil; Minckas, Nicole; Hughes, Peter; Paphitis, Sharli; Andrabi, Shazana; Ben Salem, Lobna; Ahmad, Lida; Ahmad, Ayesha; Mannell, JenevieveBackground: Telling personal stories of violence has been central to recent advocacy efforts to prevent violence against women around the world. In this paper, we explore the use of personal storytelling as a form of activism to prevent femicide in Turkey. This study is part of a broader storytelling initiative called SHAER (Storytelling for Health: Acknowledgement, Expression and Recovery) to alleviate the psychological and emotional suffering of women who have experienced gender-based violence in high-prevalence settings. Objectives: We conceptually explore personal stories of violence as a form of both distributed agency and activism. This conceptual framework is used to answer the following research question in the Turkish context: How do women use their personal stories of interpersonal violence for their own benefit (support) and that of others (activism)? Methods: Our study is based on 20 in-depth semi-structured interviews with women who have experienced violence and were purposefully recruited by the `We Will End Femicide' Platform in Istanbul. Interviews were conducted between March and August 2019. We used inductive and deductive thematic analysis to identify instances of personal storytelling at three levels: intrapersonal, relational and collective. Results: Our results show how the use of personal storytelling can provide a means of healing from experiences of violence. However, this process is not linear and is often influenced by the surrounding context including: the listener of the story, their reaction, and what social networks the woman has to support her. In supportive social contexts, personal storytelling can be an effective support for activism against violence: personal stories can provide opportunities for individuals to shape broader discourses about violence against women and the right of women to share their stories. Conclusions: Telling one's personal story of violence can both support women's agency and contribute to the collective struggle against violence against women more broadly.Item Pain management practices in the emergency departments in Turkey(WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2021-01-01) Cetin, Murat; Kaya, Bora; Kilic, Turgay Yilmaz; Hanoglu, Nazife Didem; Gokhan, Servan; Eroglu, Serkan Emre; Akar, Sakine Neval; Cekic, Ozgen Gonenc; Polat, Dicle; Ustsoy, Emre; Cinar, Orhan; Yilmaz, SerkanOBJECTIVES: This study aimed to evaluate pain management practices in the emergency departments (EDs) in Turkey and to evaluate the prevalence and etiologies of oligoanalgesia to identify possible improvement strategies.
METHODS: This multicenter cross-sectional observational study was conducted in 10 tertiary care hospitals in Turkey. Patients who were admitted to the ED with pain chief complaints were included in the study. Both patients and physicians were surveyed with two separate forms by the research associates, respectively. The patient survey collected data about the pain and the interventions from the patients' perspective. The pain was evaluated using the Numerical Rating Scale. The physician survey collected data to assess the differences between study centers on pain management strategies and physician attitudes in pain management.
RESULTS: Ten emergency physicians and 740 patients (male/female: 365/375) enrolled in the study. The median pain score at admission at both triage and ED was 7 (interquartile range: 5-8). The most frequent type of pain at admission was headache (n = 184, 24.7\%). The most common analgesics ordered by physicians were nonsteroidal anti-inflammatory drugs (n = 505, 67.9\%), and the most frequent route of administration was intramuscular injection (n = 396, 53.2\%). About half of the patients (n = 366, 49.2\%) received analgesics 10-30 min from ED admission. The posttreatment median pain score decreased to 3 (P < 0.001). About 79.2\% of patients did not need a second analgesic administration (n = 589), and opioid analgesics were the most frequently administered analgesic if the second application was required. Physicians prescribed an analgesic at discharge from the ED in 55.6\% of the patients (n = 414) and acute pain was present in 7.5\% (n = 56) of the patients.
CONCLUSION: Our study on the pain management practices in the EDs in Turkey suggested that high rate of intramuscular analgesic use and long emergency room stay durations are issues that should constitute the focus of our quality improvement efforts in pain management.Item Changes in radiotherapy practice during COVID-19 outbreak in Turkey: A report from the Turkish Society for Radiation Oncology(ELSEVIER IRELAND LTD, 2020-01-01) Anacak, Yavuz; Onal, Cem; Ozyigit, Gokhan; Agaoglu, Fulya; Akboru, Halil; Akyurek, Serap; Gursel, Bilge; Igdem, Sefik; Yalman, Deniz; Yildiz, Ferah; Saglam, Esra KaytanItem Determination of Antimony Resistance Mechanism of Leishmania tropica Causing Cutaneous Leishmaniasis in Turkey(ANKARA MICROBIOLOGY SOC, 2020-01-01) Ozbilgin, Ahmet; Zeyrek, Fadile Yildiz; Guray, Melda Zeynep; Culha, Gulnaz; Akyar, Isin; Harman, Mehmet; Ozbel, Yusuf; Ertabaklar, Hatice; Cavus, Ibrahim; Gunduz, CumhurWorld Health Organization reported that approximately one billion people are at risk in endemic areas, one million cases of cutaneous leishmaniasis (CL) and approximately 300,000 cases of visceral leishmaniasis (VL) were reported per year in the last five years. The number of deaths due to VL is reported to be approximately 20,000 per year. Approximately 2500 cases/year have been reported as CL, caused by Leishmania tropica and Leishmania infantum, in Turkey. The significant increase observed in many cities mainly in the provinces of Mediterranean and Aegean regions in cases and foci in recent years, suggests that there may be an increase in this infections in the following years as well. In Turkey, the causative agent of CL is L.tropica and meglumine antimoniate is used in the treatment of CL. We aimed to determine antimony resistance genes specific for L.tropica by comparing the gene and protein expressions of antimony-resistant and non-resistant L.tropica strains. Ltropica isolates obtained from 3 CL patients without antimonate resistance from Aegean, Mediterranean and Southeastern regions of Turkey were provided to transform into 3 resistant isolates against meglumine antimony in the laboratory conditions. Gene expression alterations by microarray methodItem Seroprevalence of hepatitis B and C virus infections and risk factors in Turkey: a fieldwork TURHEP study(ELSEVIER SCI LTD, 2015-01-01) Tozun, N.; Ozdogan, O.; Cakaloglu, Y.; Idilman, R.; Karasu, Z.; Akarca, U.; Kaymakoglu, S.; Ergonul, O.The present study was designed to determine the seroprevalence of hepatitis B and C virus (HBV, HCV) infections and risk factors in the Turkish general population. Participants were enrolled from urban and rural areas of the predetermined 23 EUROSTAT NUTS 2 region. A two-stage stratified sampling method was used to select participants from these regions (n = 5460
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