Browsing by Subject "Tertiary Care Centers"

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    Etiology of hypopituitarism in tertiary care institutions in Turkish population: Analysis of 773 patients from pituitary study group database
    (Humana Press Inc., 2014) Tanriverdi F.; Dokmetas H.S.; Kebapci N.; Kilicli F.; Atmaca H.; Yarman S.; Ertorer M.E.; Erturk E.; Bayram F.; Tugrul A.; Culha C.; Cakir M.; Mert M.; Aydin H.; Taskale M.; Ersoz N.; Canturk Z.; Anaforoglu I.; Ozkaya M.; Oruk G.; Hekimsoy Z.; Kelestimur F.; Erbas T.
    Hypopituitarism in adult life is commonly acquired and the main causes are known as pituitary tumors and/or their treatments. Since there are new insights into the etiology of hypopituitarism and presence of differences in various populations, more studies regarding causes of hypopituitarism are needed to be done in different ethnic groups with sufficient number of patients. Therefore, we performed a multi-center database study in Turkish population investigating the etiology of hypopituitarism in 773 patients in tertiary care institutions. The study was designed and coordinated by the Pituitary Study Group of SEMT (The Society of Endocrinology and Metabolism of Turkey). Nineteen tertiary reference centers (14 university hospitals and 5 training hospitals) from the different regions of Turkey participated in the study. It is a cross-sectional database study, and the data were recorded for 18 months. We mainly classified the causes of hypopituitarism as pituitary tumors (due to direct effects of the pituitary tumors and/or their treatments), extra-pituitary tumors and non-tumoral causes. Mean age of 773 patients (49.8 % male, 50.2 % female) was 43.9 ± 16.1 years (range 16-84 years). The most common etiology of pituitary dysfunction was due to non-tumoral causes (49.2 %) among all patients. However, when we analyze the causes according to gender, the most common etiology in males was pituitary tumors, but the most common etiology in females was non-tumoral causes. According to the subgroup analysis of the causes of hypopituitarism in all patients, the most common four causes of hypopituitarism which have frequencies over 10 % were as follows: non-secretory pituitary adenomas, Sheehan's syndrome, lactotroph adenomas and idiopathic. With regard to the type of hormonal deficiencies; FSH/LH deficiency was the most common hormonal deficit (84.9 % of the patients). In 33.8 % of the patients, 4 anterior pituitary hormone deficiencies (FSH/LH, ACTH, TSH, and GH) were present. Among all patients, the most frequent cause of hypopituitarism was non-secretory pituitary adenomas. However, in female patients, present study clearly demonstrates that Sheehan's syndrome is still one of the most important causes of hypopituitarism in Turkish population. Further, population-based prospective studies need to be done to understand the prevalence and incidence of the causes of hypopituitarism in different countries. © 2013 Springer Science+Business Media.
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    Antifungal consumption, indications and selection of antifungal drugs in paediatric tertiary hospitals in Turkey: Results from the first national point prevalence survey
    (Elsevier Ltd, 2018) Çağlar İ.; Devrim İ.; Özdemir H.; Şahbudak Z.; Sönmez G.; Buyukcam A.; Gulhan B.; Kara A.; Aygun D.F.; Bayram N.; Celebi S.; Çetin B.; Nepesov M.İ.; Yilmaz A.T.; Kepenekli E.; Çiftdogan D.Y.; Acar M.K.; Yayla B.C.; Okumuş C.; Ecevit Z.; Hatipoglu N.; Kuyucu N.; Kosker M.; Sen S.; Karbuz A.; Sutcu M.; Duramaz B.B.; Özen M.; Çiftçi E.; Alabaz D.; Kurugol Z.; Kara A.; Kanik S.; Kilic O.; Oncel S.; Somer A.; Tapisiz A.; Belet N.; Akcan Ö.M.; Türel Ö.; Ozkaya A.; Tezer H.; Cengiz A.B.; İnce E.; Camcioglu Y.; Kocabas E.; Arisoy E.S.; Salman N.
    Objectives: The aim of this point prevalence survey was to evaluate the consumption, indications and strategies of antifungal therapy in the paediatric population in Turkey. Methods: A point prevalence study was performed at 25 hospitals. In addition to general data on paediatric units of the institutes, the generic name and indication of antifungal drugs, the presence of fungal isolation and susceptibility patterns, and the presence of galactomannan test and high-resolution computed tomography (HRCT) results were reviewed. Results: A total of 3338 hospitalised patients were evaluated. The number of antifungal drugs prescribed was 314 in 301 patients (9.0%). Antifungal drugs were mostly prescribed in paediatric haematology and oncology (PHO) units (35.2%), followed by neonatal ICUs (NICUs) (19.6%), paediatric services (18.3%), paediatric ICUs (PICUs) (14.6%) and haematopoietic stem cell transplantation (HSCT) units (7.3%). Antifungals were used for prophylaxis in 147 patients (48.8%) and for treatment in 154 patients (50.0%). The antifungal treatment strategy in 154 patients was empirical in 77 (50.0%), diagnostic-driven in 29 (18.8%) and targeted in 48 (31.2%). At the point of decision-making for diagnostic-driven antifungal therapy in 29 patients, HRCT had not been performed in 1 patient (3.4%) and galactomannan test results were not available in 12 patients (41.4%). Thirteen patients (8.4%) were receiving eight different antifungal combination therapies. Conclusion: The majority of antifungal drugs for treatment and prophylaxis were prescribed in PHO and HSCT units (42.5%), followed by ICUs. Thus, antifungal stewardship programmes should mainly focus on these patients within the availability of diagnostic tests of each hospital. © 2018 International Society for Chemotherapy of Infection and Cancer
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    Utilization of statins and LDL-cholesterol target attainment in Turkish patients with type 2 diabetes - a nationwide cross-sectional study (TEMD dyslipidemia study)
    (BioMed Central Ltd, 2020) Bayram F.; Sonmez A.; Haymana C.; Sabuncu T.; Dizdar O.S.; Gurkan E.; Carlioglu A.K.; Agbaht K.; Ozdemir D.; Demirci I.; Barcin C.; Salman S.; Tetiker T.; Balci M.K.; Kebapci N.; Ersoy C.; Yumuk V.; Toth P.P.; Satman I.; Guldiken S.; Ayturk S.; Yilmaz M.; Asik M.; Dinccag N.; Cakmak R.; Turker F.; Idiz C.; Hacisahinogullari H.; Bagdemir E.; Yildiz B.; Haliloglu O.; Sancak S.; Ozsari L.; Cagiltay E.; Deyneli O.; Imre E.; Gonen S.; Boysan S.N.; Altuntas Y.; Ozturk F.Y.; Mert M.; Piskinpasa H.; Aydin H.; Imamoglu S.; Gul O.O.; Kiyici S.K.; Cetinarslan B.; Selek A.; Dogru T.; Kirik A.; Efe B.; Kaya A.; Cordan I.; Baldane S.; Kirac C.O.; Capa Z.; Cesur M.; Yetkin I.; Corapcioglu D.; Canlar S.; Yildiz O.B.; Sendur S.N.; Cakir B.; Corakci A.; Kutlu M.; Tutuncu N.B.; Bozkus Y.; Cakal E.; Demirbas B.; Ertek S.; Altay M.; Dagdeviren M.; Abedi A.H.; Cetinkalp S.; Ozisik H.; Oruk G.G.; Yener S.; Saydam B.O.; Guney E.; Unubol M.; Yaylali G.F.; Topsakal S.; Hekimsoy Z.; Akbaba G.; Aslan I.; Dalkiran S.; Akbay E.; Gul K.; Yilmaz M.O.; Bozkirli E.; Altuntas S.C.; Atmaca A.; Durmuş E.T.; Mete T.; Kutluturk F.; Kucukler F.K.; Dikbas O.; Akin S.; Nuhoglu I.; Ersoz H.O.; Bayraktaroglu T.; Sisman P.; Sahin I.; Cetin S.; Capoglu I.; Akbas E.M.; Ucler R.; Eren M.A.; Tuzcu A.K.; Pekkolay Z.; Ozkaya M.; Araz M.
    Background: Attaining acceptable levels of LDL Cholesterol (LDL-C) significantly improves cardiovascular (CV) outcomes in patients with type 2 diabetes mellitus (T2DM). The LDL-C target attainment and the characteristics of patients attaining these targets were investigated in this study. Furthermore, the reasons for not choosing statins and the physicians’ attitudes on the treatment of diabetic dyslipidemia were also examined. Methods: A nationwide, cross-sectional survey was conducted in tertiary centers for diabetes management. Adult patients with T2DM, who were under follow-up for at least a year in outpatient clinics, were consecutively enrolled for the study. LDL-C goals were defined as below 70 mg/dL for patients with macrovascular complications or diabetic nephropathy, and below 100 mg/dL for other patients. Data about lipid-lowering medications were self-reported. Results: A total of 4504 patients (female: 58.6%) were enrolled for the study. The mean HbA1c and diabetes duration was 7.73 ± 1.74% and 10.9 ± 7.5 years, respectively. The need for statin treatment was 94.9% (n = 4262); however, only 42.4% (n = 1807) of these patients were under treatment, and only 24.8% (n = 448) of these patients achieved LDL-C targets. The main reason for statin discontinuation was negative media coverage (87.5%), while only a minority of patients (12.5%) mentioned side effects. Physicians initiated lipid-lowering therapy in only 20.3% of patients with high LDL-C levels. It was observed that the female gender was a significant independent predictor of not attaining LDL-C goals (OR: 0.70, 95% CI: 0.59–0.83). Conclusions: Less than 50 % of patients with T2DM who need statins were under treatment, and only a quarter of them attained their LDL-C targets. There exists a significant gap between the guideline recommendations and the real-world evidence in the treatment of dyslipidemia in T2DM. © 2020, The Author(s).