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Öğe Comparison of pattern electroretinography and optical coherence tomography parameters in patients with primary open-angle glaucoma and ocular hypertension(Turkish Ophthalmology Society, 2015) Demir, Semra Tiryaki; Oba, Mehmet Ersin; Erdo?an, Ezgi Tuna; Odabaşı, Mahmut; Dirim, Ayşe Burcu; Demir, Mehmet; Can, Efe; Kara, Orhan; Şendul, Selam YektaObjectives: To investigate the correlation of visual field (VF), pattern electroretinography (PERG) and Fourier domain optical coherence tomography (FD-OCT) results in patients with ocular hypertension (OHT) and early primary open-angle glaucoma (POAG). Materials and Methods: The study included 72 eyes of 37 patients with early POAG, 76 eyes of 38 patients with OHT, and 60 eyes of 30 controls. All subjects underwent full ophthalmologic examination, VF assessment with 24-2 Humphrey standard automated perimetry (Swedish Interactive Thresholding Algorithm (SITA)-Standard), retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness measurement with FD-OCT, and PERG P50 and N95 wave latency and amplitude measurements with electroretinography (Nihon Kohden). Results: With the exception of the nasal quadrant, all GCC parameters and RNFL results were significantly lower in the POAG group compared to the OHT and control groups. There was no statistically significant difference between the OHT and control group. PERG amplitudes were lower in the POAG and OHT groups than in the control group. Reduction in N95 amplitude was greater than that of P50 amplitude. No difference was detected in PERG latencies among groups. GCC was significantly correlated with VF and RNFL in the POAG group. Conclusion: Significant thinning of the GCC and RNFL occurs in addition to VF pathologies in patients with early POAG, and these examinations should be concomitantly evaluated. During diagnostic assessment of patients with early POAG, GCC and RNFL analysis by FD-OCT are highly effective. GCC is as reliable as RNLF in the early diagnosis of glaucoma and there is a highly significant correlation between them. Dysfunction of ganglion cells in patients with OHT may be detected earlier using PERG amplitude analysis.Öğe 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) Değertekin, Bülent; Demir, Mehmet; Akarca, Ulus S.; Kani, Haluk Tarık; Üçbilek, Enver; Yıldırım, Emre; Güzelbulut, Fatih; Balkan, Ayhan; Vatansever, Sezgin; Danış, Nilay; Demircan, Melek; Soylu, Aliye; Yaraş, Serkan; Kartal, Aysun; Kefeli, Ayşe; Gündüz, Feyza; Yalçın, Kendal; Erarslan, Elife; Aladağ, Murat; Harputluoğlu, Murat; Özakyol, Ayşegül; Temel, Tuncer; Akarsu, Mesut; Sümer, Hale; Akın, Mete; Albayrak, Bülent; Şen, İlker; Alkım, Hüseyin; Uyanıkoğlu, Ahmet; Irak, Kader; Öztaşkın, Sinem; Uğurlu, Çağrı Burak; Güneş, Şevkican; Gürel, Selim; Nuriyev, Kenan; İnci, İsmail; Kaçar, Sabite; Dinçer, Dinç; Doganay, Levent; Göktürk, Hüseyin Savaş; Mert, Ali; Coşar, Arif Mansur; Dursun, Hakan; Atalay, Roni; Akbulut, Sabiye; Balkan, Yasemin; Köklü, Hayrettin; Şimşek, Halis; Özdoğan, Osman; Çoban, Mehmet; Poturoğlu, Şule; Ayyıldız, Talat; Yapalı, Suna; Günşar, Fulya; Akdoğan, Meral; Özenirler, Seren; Akyıldız, Murat; Sezgin, Orhan; Özdoğan, Osman; Kaymakoğlu, Sabahattin; Beşışık, Fatih; Karasu, Zeki; İdilman, RamazanBackground/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]: 1.22-2.38; p=0.023]), higher hepatitis C virus (HCV) RNA levels (OR: 1.44, 95% CI: 1.31-2.28; p=0.038), and higher serum ALT levels (OR: 1.38, 95% CI: 1.21-1.83; p=0.042) were associated with poor SVR12. The most common adverse events were fatigue (12.6%), pruritis (7.3%), increased serum ALT (4.7%) and bilirubin (3.8%) levels, and anemia (3.1%).Conclusion: LDV/SOF or PrOD +/- RBV were effective and tolerable treatments for patients with CHC and with or without advanced liver disease before and after liver transplantation. Although HCV eradication improves the liver function, there is a risk of developing HCC.Öğe Tanı ilişkili gruplama verileri çerçevesinde Türkiye’de ürogenital kanserlere bakış(2013) Aydın, Sabahattin; Yiğit, Pakize; Demir, Mehmet; Güler, HasanÜlkemizde pilot uygulamalarla başlayıp 2011 yılından itibaren Sağlık Bakanlığı hastanelerinde uygulanan Teşhisle İlişkili Gruplar (TİG) önemli bir veri havuzunun oluşmasını sağlayacaktır. Bu çalışmada, bir yıllık TİG verileri içinde üroloji alanına giren hastalar ve özellikle genitoüriner kanserli vakaların nicelik ve nitelik açısından değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışma kapsamında, 2011 yılında Sağlık Bakanlığına bağlı devlet ve eğitim hastanelerinde ayaktan ve yatarak tedavi gören tüm hasta evreni veri kaynağı olarak kullanılmıştır. Bir yıllık TIG verileri içinde ürolojik hastalıklara bağlı olarak tedavi gören vakalar ve özellikle ürogenital kanser tanısı almış olanlar analiz edilmiştir. Bu gruplara yapılan cerrahi ya da dahili yaklaşımlar niceliksel olarak tespit edilmiş, cinsiyet dağılımı, yaşları ve yatış süreleri karşılaştırılmıştır. Ayrıca, TIG frekansları bunlara karşılık gelen bağıl değerlerle çarpılarak kanser vakaların diğer hasta grupları ile ağırlığı kıyaslanmıştır. Bulgular: Devlet ve eğitim hastanelerinde toplam ayaktan başvuru yapan üroloji hastası 6.198.911 (% 2,61), yatarak tedavi gören üroloji hastası ise 397,127 (% 5,27)’dir. Hastaların büyük çoğunluğunu oluşturan frekansı en yüksek ilk 10 TİG içinde kanser vakası bulunmamaktadır. Ürogenital kanserler bütün kanser vakalarının içinde % 9,59 oranında yer tutmaktadır. Toplam 14.154 ürogenital kanser vakasının % 60,07’sini üriner sistem kanserleri, % 39,93’ünü ise genital sistem kanserleri oluşturmaktadır. Bunların % 14,4’ü cerrahi müdahale geçirmiştir. Bağıl değerlerle yapılan karşılaştırmada kanser gruplarına yapılan cerrahi ve dahili müdahaleler eşit ağırlıkta bulunmuştur. Sonuç: TIG verileri; geri ödeme sistemlerinde bir finansman modeli olarak kullanılmasının yanı sıra, hastaların kıyaslanabilir gruplanması, spesifik yatak ihtiyacı, tedavideki kaynak tüketimi ve diğer parametreler açısından analiz edilerek karar destek sistemlerinde kullanılacak önemli bir kaynak oluşturmaktadır. Ürogenital kanserlerin yanında diğer tanı ilişkili grupların da analizi, ulusal poltikaların geliştirilmesine büyük katkı sağlayacaktır.Öğe The COVID-19 pandemic: Clinical practice advice for gastroenterologists, hepatologists, and liver transplant specialists(AVES, 2020) Kabaçam, Gökhan; Dayangaç, Murat; Üçbilek, Enver; Erçin, Cemal Nuri; Günsar, Fulya; Akyıldız, Murat; Akarsu, Mesut; Demir, Mehmet; Kaymakoğlu, Sabahattin; Karasu, Zeki; İdilman, RamazanCoronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a novel acute infectious disease that has rapidly reached staggering pandemic proportions. This review addresses gastroenterologists, hepatologists, liver transplant (LT) specialists, and health-care professionals working in the field of liver diseases and liver transplantation. It has been written based on a limited number of publications, recommendations of national and international liver and organ transplantation societies, and experiences of patients with COVID-19 around the world. The purpose of this review is to provide information addressing questions and concerns about COVID-19, to reveal the effects of the novel disease on patients with chronic liver disease and LT recipients, and to share information about ways in which this pandemic will affect clinical practices. We, the Turkish Association for the Study of the Liver (TASL), would like to remind you that this text is actually not a practical guide. It is imperative to act according to the standards set by health-care institutions and the Ministry of Health, Republic of Turkey.Öğe The use of polypropylene suture as a frontalis suspension material in all age groups of ptosis patients(Informa Healthcare, 2014) Çağatay, Halil Hüseyin; Ekinci, Metin; Apil, Aytekin; Arslan, Banu; Pamukçu, Can; Oba, Mehmet Ersin; Demir, MehmetPurpose/Aim: To evaluate the use of 2-0 polypropylene suture for frontal suspension in ptosis patients with poor levator function. Materials and Methods: This retrospective study included 20 eyelids of 16 patients (5 female, 11 male) with 4 mm or less levator function. The operation was considered successful when the difference between the two upper lids was <= 1 mm, and the upper lid covered the upper limbus by < 3 mm. Results: Median patient age was 22.94 years (2 to 59). Mean follow-up time was 18.06 months (12-29). A successful result was obtained in 14 patients (87.5%). Ptosis recurrence was observed in two patients (12.5%). Lagophthalmos with punctate epithelial keratitis and subsequent spontaneous recovery occurred during the first postoperative week in six patients (37.5%). Two patients with hypocorrection underwent revision surgery in the first postoperative week. Granuloma and material exposition at the forehead incision site observed in one patient at the postoperative fifth month were repaired by excision of the granuloma and suture reposition. Conclusions: Polypropylene suture as a frontalis suspension material in ptosis patients with poor levator function maintained satisfactory results at follow-up. This material allows easy and repeatable eyelid height adjustment and does not obviate future eyelid procedures.
