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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 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 `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 Diversity of Leishmania Strains Isolated from Cutaneous Leishmaniasis Patients in Turkey and its Reflection to Clinics in Mice Model(ANKARA MICROBIOLOGY SOC, 2020-01-01) Ozbilgin, Ahmet; Culha, Gulnaz; Guray, Melda Zeynep; Zeyrek, Fadile Yildiz; Akyar, Isin; Toz, Seray; Ural, Ipek Ostan; Kurt, Ozgur; Kocagoz, Tanil; Cavus, Ibrahim; Gunduz, CumhurAlthough asexual reproduction has been attributed to Leishmania species, genetic exchange has recently been demonstrated, which helped emerging of hybrid isolates. Situated on the crossroads between three continents, Leishmania hybrids may be present in Turkey. In Turkey, visceral leishmaniasis caused by Leishmania infantum is less common, while cutaneous leishmaniasis (CL) caused by Leishmania tropica and L.infantum could reach 2500 reported cases a year. Our aim was to investigate genetic variability of local Leishmania species and presence of hybrid Leishmania strains in Turkey. Twenty CL patients from Sanliurfa and Hatay, where only L.tropica and both L.tropica and L.infantum cause CL, respectively, were registered equally. All isolates were assessed with real-time polymerase chain reaction (Rt-PCR), isoenzyme analysis, gene sequencing, two-dimensional gel electrophoresis (2D-PAGE) and MALDI-TOF/TOF-MS followed by in vivo analyses on mouse model. Identification of differentially expressed proteins was performed. These proteins were confirmed by sequence analysis. All isolates from Sanliurfa were found to be L.tropica which caused cutaneous infection in mice. However, one of 10 isolates from Hatay was found as Leishmania major which caused cutaneous infection. Five isolates were found as L.tropica with Rt-PCR and gene sequencing, one of which had one different protein from the reference L.tropica strain and caused cutaneous infection. Four of the five isolates had five different proteins compared to reference strain and caused both cutaneous and visceral infections. Remaining four isolates showed double melting curves in Rt-PCR, which were concordant with L.tropica and L.infantum. Their sequencing and isoenzyme analyses indicated them as L.infantum. They had six different proteins compared to reference L.infantum strain and caused cutaneous and visceral infections. It is concluded that the isolates with different proteins were hybrid Leishmania species. In the present study, outcomes of the proteomics, genomics, clinical manifestations and tissue tropism on animal models were evaluated together for the first time. In addition to L. tropica and L.infantum, L.major was identified as a causative agent for CL and hybrids of Linfantum/tropica were also shown to be present.Item Radiotherapy Equipment and Workforce in Turkey(KARE PUBL, 2021-01-01) BecerIr, Hatice Bilge; Gurdalli, Salih; Yapici, Bulent; Alkaya, Fadime; cakir, Aydin; Yaray, Kadir; Gursoy, Tamer OguzOBJECTIVE Radiotherapy is a costly treatment that requires the proper use of human and financial resources. In any country, the radiation therapy equipment and workforce should be well planned for the appropriate use of resources and radiotherapy treatments. For proper planning, the current situation should be assessed and prepared for the targets to be achieved. This study aims to determine the current status of radiotherapy devices and the workforce in Turkey. METHODS Questions were sent to 141 centers to evaluate the number of devices, technical specifications, date of manufacture and the number of radiation oncologists, medical physicists, and radiotherapy technicians by Turkish Medical Physics Association. The responses from the centers were analyzed by region and compared with the situation in other countries. RESULTS The data collected in the study are from December 2019. The rate of radiotherapy devices in Turkey according to population is estimated to be 3.14 megavoltage (MV) external devices per 1 million people. The distribution is not homogeneous in all regions. The highest value is 4.59 in the Central Anatolia region, and the lowest is 0.78 in the Eastern Anatolia region. For each MV device, on average, there are 1.58 specialists in medical physics. CONCLUSION Our study has shown that Turkey has made significant progress in terms of radiotherapy equipment and workforce in the past decade. Nevertheless, although Turkey did not reach the standards of high-income European countries, it is comparable to middle-income countries.Item The state of ethics education at medical schools in Turkey: taking stock and looking forward(BMC, 2020-01-01) Kavas, Mustafa Volkan; Ulman, Yesim Isil; Demir, Figen; Artvinli, Fatih; Sahiner, Melike; Demiroren, Meral; Senyurek, Gamze; Pakis, Isil; Bakirci, NadiBackground Ethics teaching is globally considered an essential part of medical education fostering professionalism. It does not only provide knowledge for good clinical conduct, but also trains medical students as virtuous practitioners. Although Turkey has had a considerable experience in ethics education of healthcare professionals, the general state of ethics curricula at medical schools in Turkey is unknown. Methods The purpose of this study was to collect comprehensive data about the ethics education programs at medical schools in Turkey. To this aim, we designed a cross-sectional descriptive questionnaire survey which focuses on the content, teaching years, teaching, assessment and evaluation methodologies, workforce and infrastructure. We delivered the questionnaire to all medical schools in Turkey. Seventy-nine medical schools participated in this study (response rate: 78\%). Results Although most institutions had an undergraduate ethics curriculum (91.1\%), the findings suggest deficiency of teaching personnel (34.2\% had no instructors). Furthermore, the distribution and composition of the workforce was imbalanced. The content varies largely among institutions. Medical schools with an ethics department were more likely to diversify teaching topics. However, ethics education was largely based on the four-principle approach. The content was usually conveyed to students theoretically. Around 90\% of schools had classroom lectures. It is the only method used at one-third of them. Clinical ethics education was mostly lacking. Multiple-choice tests were widely used to assess and evaluate student attainments (86.1\%). Conclusions Staff qualified to teach ethics and ethics education integrated into the six-year medical curriculum given by a multidisciplinary team are urgent necessities. Considering teaching, assessment and evaluation methodologies used, most medical schools seem to fall short of fostering students to develop ethical attitudes. Endeavors aiming for modern topics should be encouraged. As the organization ethics education change continuously, we think that a platform for monitoring ethics education at medical schools in Turkey should be established. Such a body would help ethics instructors to network and find solutions to current problems and build shared wisdom.Item A cross-sectional overview of SARS-CoV-2 genome variations in Turkey(WALTER DE GRUYTER GMBH, 2021-01-01) Ergunay, Koray; Kaya, Mucahit; Serdar, Muhittin; Akyon, Yakut; Yilmaz, EnginObjectives: We assessed SARS-CoV-2 genome diversity and probable impact on epidemiology, immune response and clinical disease in Turkey. Materials and methods: Complete genomes and partial Spike (S) sequences were accessed from the Global Initiative on Sharing Avian Influenza Data (GISAID) database. The genomes were analysed for variations and recombinations using appropriate softwares. Results: Four hundred ten complete genomes and 206 S region sequences were included. Overall, 1,200 distinct nucleotide variations were noted. Mean variation count was 14.2 per genome and increased significantly during the course of the pandemic. The most frequent variations were identified as A23403G (D614G