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  • Küçük Resim
    Öğe
    Bir Üniversite Hastanesinde yoğun bakım ünitelerinde nozokomiyal pnömoni risk faktörleri
    (2013) Akkoyunlu, Yasemin; Öztoprak, Nefise; Aydemir, Hande; Pişkin, Nihal; Çelebi, Güven; Ankaralı, Handan; Akduman, Deniz
    Amaç: Nozokomiyal pnömoni (NP) yoğun bakım ünitesi (YBÜ)'nde en sık karşılaşılan nozokomiyal enfeksiyondur. NP gelişen hastalardaki risk faktörlerinin değerlendirilmesi YBÜ ihtiyacı olan hastalar için yol gösterici olabilir. Bu çalışmanın amacı YBÜ'de gelişen NP risk faktörlerinin belirlenmesidir. Yöntemler: Altı aylık süre içerisinde, bir üniversite hastanesinin YBÜ'lerinde 48 saatten uzun kalan hastalar çalışmaya alındı. Toplam olarak 304 hasta prospektif izlenirken, bu hastaların NP gelişen 78'i NP grubunu oluşturdu. Herhangi bir enfeksiyon gelişmeyen hastalar ise kontrol grubu olarak tanımlandı. Tek değişkenli analiz ile NP risk faktörü olabileceği düşünülen veya saptanan değişkenler çok değişkenli lojistik regresyon analizi ile incelendi. Bulgular: 304 hastanın 78'inde (% 25,6) NP gelişti. Çok değişkenli analiz ile ileri yaş (odds ratio [OR] 1, %95 güven aralığı [CI] 1,00-1,06), YBÜ'de yatış süresi (OR 1,3, % 95 CI 1,17-1,39), YBÜ öncesi enfeksiyon varlığı (OR 6,7, %95 CI 1,52-29,94), kan ürünü transfüzyonu (OR 4, %95 CI 1,43-11,46) ve YBÜ yatışından önceki 2 hafta içerisinde antibiyotik kullanım öyküsü (OR 3,3, %95 CI 1,28-8,48) NP için bağımsız risk faktörleri olarak tanımlandı. Ayrıca, NP gelişen hastaların ortalama APACHE II skoru (16,76,7) kontrol grubundan anlamlı olarak yüksek bulundu (11,58,1; p
  • Küçük Resim
    Öğe
    The evaluation of exposure to hepatitis A virus in HBsAg-positive persons: A multicentre study from Turkey
    (Journal of Pure and Applied Microbiology, 2014) Çelen, Mustafa Kemal; Türker, Kamuran; Öztoprak, Nefise; Şener, Alper; Tuna, Nazan; İnce, Nevin; Tabak, Fehmi
    Chronic hepatitis B is a major public health problem in our country. Hepatitis A vaccination in HBV carriers who did not encounter with Hepatitis A virus is also significant. We aimed to evaluate the rate of exposure to HAV in HBsAg-positive persons, and the distribution of seronegative individuals according to age groups. Medical records of 4793 patients from 14 centers who were positive for hepatitis B surface antigen (HBsAg). A total 3514 cases (73.3%) were male and 1279 (26.7) were female. The HBsAg positive patients who were previously tested for HAV IgG at the time of firstly admitted to a center. HBsAg positive patients who were previously not tested for HAV IgG were tested and these . patients were confirmed serologically for HAV. The distribution of cases according to age were determined. In this study, 4793 HBsAg-positive patients were evaluated. The ratio of testing of anti-HAV IgG was very low during the first visit (54.2%). Seronegativity was highest in the age group under 19 years of age (26.2%) followed by 20-25 age group (15.5%) and 26-29 age group (12.5%). Testing of HAV serology should not be ignored in especially HBsAg-positive young adults and seronegative young adults should be vaccinated.
  • Küçük Resim
    Öğe
    Piperacillin-tazobactam Versus Carbapenem Therapy With and Without Amikacin as Empirical Treatment of Febrile Neutropenia in Cancer Patients: Results of an Open Randomized Trial at a University Hospital
    (Oxford Univ Press, 2010) Öztoprak, Nefise; Pişkin, Nihal; Aydemir, Hande; Çelebi, Güven; Akduman, Deniz; Keskin, Ayşegül Seremet; Ankaralı, Handan
    Empirical beta-lactam monotherapy has become the standard therapy in febrile neutropenia. The aim of this study was to compare the efficacy and safety of piperacillin-tazobactam versus carbapenem therapy with or without amikacin in adult patients with febrile neutropenia. In this prospective, open, single-center study, 127 episodes were randomized to receive either piperacillin-tazobactam (4 x 4.5 g IV/day) or carbapenem [meropenem (3 x 1 g IV/day) or imipenem (4 x 500 mg IV/day)] with or without amikacin (1 g IV/day). Doses were adjusted according to renal function. Clinical response was determined during and at completion of therapy. One hundred and twenty episodes were assessable for efficacy (59 piperacillin-tazobactam, 61 carbapenem). Mean duration of treatment was 14.8 +/- 9.6 days in the piperacillin-tazobactam group and 14.7 +/- 8.8 days in the carbapenem group (P > 0.05). Mean days of fever resolution were 5.97 and 4.48 days for piperacillin-tazobactam and carbapenem groups, respectively (P > 0.05). Similar rates of success without modification were found in the piperacillin-tazobactam (87.9%) and in the carbapenem groups (75.4%; P > 0.05). Fungal infection occurrence rates were 30.5 and 18% in piperacillin-tazobactam and carbapenem groups, respectively (P = 0.05). Antibiotic modification rates were 30.5 and 13.1% (P = 0.02) and the addition of glycopeptides to empirical antibiotic regimens rates were 15.3 and 44.3% for piperacillin-tazobactam and carbapenem groups, respectively (P = 0.001). The rude mortality rates were 14% (6/43) and 29.3% (12/41) in piperacillin-tazobactam and carbapenem groups, respectively (P = 0.08). The effect of empirical regimen of piperacillin-tazobactam regimen is equivalent to carbapenem in adult febrile neutropenic patients.