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Öğe Combination Therapy of Major Autohemotherapy and Ozonated Bagging in a Case Diagnosed with Buerger's Disease (Thromboangiitis Obliterans)(2023) Unal, Safa; Kaya, Abdulkadir; Ayaslı, Alper Aziz Hudai; Tunca, BekirIt is well known that ozone therapy provides positive results as a complementary method in peripheral obstructive arterial diseases alongside medical treatment. This article presents a case diagnosed with Buerger's disease, where rapid improvement was observed after a combination of major autohemotherapy (AHT) and ozonated bagging.Öğe Düzce İlinde Son Bir Yılda Görülen Yurt Dışı Kaynaklı Dört Sıtma Olgusu(2020) Keskin, Banu Hümeyra; Tunca, Bekir; Ince, Nevin; Öztürk, Cihadiye Elif; Gökçe, Özlem; Dönmez, BetülSıtma, dünyada tropikal ve subtropikal bölgelerde endemik olarak görülmektedir. Son yıllarda seyahatler ve göçlernedeniyle endemik olmayan bölgelerde de dış kaynaklı sıtma olgularıyla karşılaşılmaktadır. Bu olgu sunumundailimizde son bir yılda görülen yurt dışı kaynaklı dört olgu irdelenmiştir. Olguların hepsinin Afrika’ya seyahat öyküsüolup, ikisinin sıtma profilaksisi almadığı öğrenilmiştir. Tüm olgularda tanı; ince yayma ve kalın damla preparatlarınınincelemelerinde plazmodyum görülmesi ile konulmuştur. İki olguda yapılan PCR testinin sadece birinde pozitifliksaptanmıştır. Etken, iki olguda Plasmodium falciparum, diğer iki olguda ise Plasmodium vivax olarak belirlenmiştir. P.falciparum sıtması olan bir olgu derin anemi nedeniyle yoğun bakımda takip edilmiş ve tüm olgular şifa ile taburcuedilmiştir. Bu olgu sunumunda endemik olmayan bir bölgede görülmüş olan yurt dışı kaynaklı sıtma vakalarınınözellikleri toplu olarak incelenmiştir. Hastanelere ateş nedeniyle başvuran hastalarda sıtmanın endemik olduğubölgelere seyahat sorgulanmalı ve anamnezinde seyahat öyküsü olan ateşli hastalarda ayırıcı tanıda sıtmadüşünülmelidir.Anahtar KelimelÖğe Düzce Üniversitesi Hastanesinde immünmodülatör tedavi alan hastaların hepatit B serolojilerinin retrospektif olarak değerlendirilmesi(Düzce Üniversitesi, 2020) Tunca, Bekir; İnce, NevinGiriş ve Amaç: İmmünsüprese tedavi alan kronik hepatit B ve daha önce geçirilmiş HBV enfeksiyonu olan hastalarda hepatit B reaktivasyonu görülebilmektedir. Hepatit B reaktivasyonu açısından enfeksiyon hastaları polikliniğinde takip edilen hastaların serolojik durumları ve HBV reaktivasyonunun retrospektif olarak değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Hastanemiz Fizik tedavi ve rehabilitasyon ile Dermatoloji polikliniklerinde biyolojik ajan tedavisi alan ve Şubat 2017-Şubat 2020 yılları arasında Enfeksiyon hastalıkları polikliniğinde HBVr açısından takip edilen 166 hasta çalışmaya dahil edilmiştir. Hastaların HBV serolojileri, hepatit B reaktivasyon durumları ve antiviral profilaksileri retrospektif olarak değerlendirilmiştir. Bulgular: Çalışmaya dahil edilen 73 (%43,9) hasta romatoid artrit, 62 (%37,3) hasta ankilozan spondilit, 17 (%10,2) hasta psöriatik artrit, 14 (%8,4) hasta psöriazis nedeni ile biyolojik ajan tedavisi almaktaydı. Hastaların almakta olduğu biyolojik ajanlar hepatit B reaktivasyonu açısından orta risk kategorisindeydi. Serolojik olarak 16 hasta HBsAg pozitif/anti-HBcIgG pozitif, 150 hasta HBsAg negatif ve anti-HBcIgG pozitif olduğu görülmüştür. HBsAg pozitif hastaların tamamına antiviral profilaksi aldığı görülmüş olup lamivudin profilaksisi alan bir hastada HBVr saptanmıştır. HBsAg negatif/anti-HBcIgG pozitif hastalar profilaksi başlanan ve profilaksisiz izlem yapılan hastalar olarak iki grupta değerlendirilmiştir. Profilaksisiz izlem yapılan 104 hastanın 18' inde (%17,3) HBVr saptanmış olup, HBVr saptanan hastalarda HBsAg ters serokonversiyonu olmamış ve AST, ALT değerlerinde artış görülmemiştir. Anti-HBs titresi 100 IU/L altında olan hastalarda 2,5 kat fazla HBVr saptanmıştır. Antiviral profilaksi başlanan 46 hastanın dördünde (%8,7) HBVr görülmüş olup HBsAg ters serokonversiyonu ve AST, ALT değerlerinde artış saptanmamıştır. Sonuç: HBsAg negatif/anti-HBcIgG pozitif HBV reaktivasyonu görülen hastalarda yalnızca HBV DNA pozitifliği saptanmış olup biyokimyasal hepatit ve HBsAg ters serokonversiyonu görülmemiştir. HBV reaktivasyonu açısından orta risk kategorisinde immünsüpresif ajan kullanımı olan hastalarda preemptif tedavi yaklaşımının daha uygun olabileceği düşünülmüştür. Anti-HBs titresi 100 IU/L altında olan hastalarda 2,5 fazla görülmesi nedeni ile Anti-HBs yüksek titrede olmasının HBVr' yi önlemede koruyucu olabileceğini düşündürmüştür. HBsAg pozitif lamivudin profilaksisi alan bir hastada HBVr saptanmıştır. Antiviral profilaksi kararı verilirken yüksek direnç bariyeri olan entekavir ve tenofovir gibi antiviral ajanların tercih edilmesinin daha uygun bir seçenek olabileceği düşünülmüştür.Öğe Evaluation of Factors Affecting Antiretroviral Treatment Changes in HIV- Positive Patients in a University Hospital(Bilimsel Tip Yayinevi, 2023) Çakır, Yasemin; İnce, Nevin; Çalışkan, Emel; Tunca, Bekir; Yekenkurul, DilekIntroduction: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is the leading cause of death from infectious diseases in the world. With the antiretroviral treatments developed over the years, viral replication is suppressed even though the disease cannot be cured yet. However, antiretroviral therapy (ART), like all drugs, has brought with it undesirable side effects as well as positive effects. In addition, demographic characteristics, accompanying comorbidities, organ dysfunctions, viral load, CD4 T lymphocyte count, ART resistance status, coinfections, pregnancy are also effective factors in the initial ART decision and change. In this study, we aimed to show the treatment status of HIV-positive patients followed in the infectious diseases outpatient clinic of our hospital and to determine the factors that affect ART change. Materials and Methods: Demographic data of HIV-positive patients followed in the infectious diseases outpatient clinic between January 2016 and May 2021, HIV-RNA and CD4 T lymphocyte results obtained before and after antiretroviral therapy, and the reasons for changing treatment were evaluated retrospectively. Results: The mean age of the patients included in the study was 40.0 +/- 13.9 (min: 20-max: 76), and 16 (18%) were female and 71 (82%) were male. Treatment was changed in 32% of the patients. Changes were made due to drug-related side effects in 43%, patient-related reasons (such as single tablet request, non-compliance with treatment) in 25%, and virological unresponsiveness in 18% of patients who underwent treatment change. The most common cause of drug changes due to side effects was hyperlipidemia. The treatment regimens that changed the initial treatment were most frequently TDF/FTC/LPV/r and TDF/FTC/EFV, respectively. Conclusion: As a result of our study, we found that the most common cause of ART change in HIV-positive patients in our hospital was drug-related side effects, and patient non-compliance was the second most common. It is important to know the factors that cause these changes in advance and to make choices accordingly when starting the treatment, in order to increase patient compliance and facilitate follow-up.Öğe AN EVALUATION OF PATIENTS WITH TULAREMIA IN DUZCE PROVINCE IN THE WESTERN BLACK SEA REGION OF TURKEY(Parlar Scientific Publications (P S P), 2020) Ince, Nevin; Cetinkaya, Ozlem; Tunca, Bekir; Cakir, YaseminTularemia is a zoonotic infectious disease caused by Francisella tularensis. The aim of our study was to examine the epidemiological and demographical characteristics, laboratory findings, treatment methods, and treatment results of 68 tularaemia cases reported from Duzce, Western Black Sea region of Turkey, between 2016-2019. Clinical diagnosis was confirmed by micro-agglutination test (>= 1/160 titres). A total of 68 patients (35 females, 33 males) were diagnosed with tularemia. The most common symptoms among the patients in the study were swelling in the neck in 88.2% patients, sore throat in 73.5% patients and tonsillopharyngitis in 72.8% of the patients. Lymph node surgery was performed on 29.4% of patients despite receipt of antibiotherapy. The rate of ciprofloxacin use among patients not requiring lymph node surgery(46%) was significantly higher than that in patients requiring such surgery (20%) (p=0.046). No difference in lymph node surgery was observed among patients receiving combination antibiotherapy (p>0.05).Öğe Fatal neutropenic enterocolitis following methotrexate overdose: A case report(Duzce University Medical School, 2019) İnce, Nevin; Tunca, Bekir; Yekenkurul, Dilek; Yıldırım, MustafaMethotrexate, a folic acid antagonist, is widely used in the treatment of neoplasms in addition to diseases such as psoriasis and rheumatoid arthritis. Although well tolerated under normal conditions, the use of more than the recommended doses may cause life-threatening toxicities. Toxicity due to high doses of methotrexate is manifested by bone marrow inhibition, gastrointestinal mucosal damage and pancytopenia. Most cases result from overdose. However, serious adverse events that result in mortality, in particular those of mixing medication in elderly patients, are rare. Herein, we present the case of a 72-year-old man who admitted to the emergency department with painful oral ulcers, inability to swallow and a general impaired condition, and died of sepsis after developing neutropenic enterocolitis following a fever and neutropenia. © 2019, Duzce University Medical School. All rights reserved.Öğe HIV/HBV Coinfection with HBsAg Seroconversion: A Case Report(Bilimsel Tip Yayinevi, 2024) Çakır, Yasemin; Tunca, BekirMortality rates associated with human immunodeficiency virus (HIV) infection have declined with antiretroviral therapy, transforming HIV infection into a chronic disease. However, coinfections and opportunistic infections remain significant contributors to mortality and morbidity in individuals living with HIV. Since the transmission routes are similar, the coexistence of HIV and viral hepatitis infections is common. Human immunodeficiency virus infection and hepatitis B virus (HBV) infection affect the course of each other negatively. In this study, a patient with HIV-HBV co -infection who developed HBsAg seroconversion is presented.Öğe A Rare Manifestation of Leptospirosis: Long-Term Elevation in Liver Enzymes(Duzce Univ, Fac Medicine, 2023) Cakir, Yasemin; Yilmaz Gokce, Ozlem; Tunca, BekirLeptospirosis is a bacterial zoonosis that is endemic in many tropical and subtropical regions. The disease is transmitted to humans by contact with the urine or an environment contaminated with the urine of infected animals. The clinical manifestations of leptospirosis vary from subclinical infection to severe illness with multiorgan dysfunction. This case report aimed to present a leptospirosis case diagnosed with detailed anamnesis and progressed with long-term elevation in liver function tests, in a non-endemic region. A 28-year-old male patient was admitted with complaints of weakness, fever, and vomiting. As a result of the detailed anamnesis, it was learned that the patient with hyperbilirubinemia, elevated liver enzymes, and kidney failure had contact with polluted water in a rural area, and the patient was followed up with a preliminary diagnosis of leptospirosis. Leptospirosis may present with different clinical presentations and be confused with many diseases, risk factors should be carefully questioned.