Search

Your search keyword '"DEMIRDAL, Tuna"' showing total 375 results
Start Over Author "DEMIRDAL, Tuna"
375 results on '"DEMIRDAL, Tuna"'

2. The clinical features, treatment and prognosis of neutropenic fever and Coronavirus disease 2019 results of the multicentre teos study

Author

Başkol Elik, Dilşah, Kaya, Şafak, Alkan, Sevil, Demirdal, Tuna, Sener, Alper, Kaya, Selçuk, Güzel Tunçcan, Özlem, Kayaaslan, Bircan, Güner, Rahmet, Eser, Fatma, Kahraman, Hasip, Birengel, Serhat, Sarıcaoğlu, Elif Mukime, Eroğlu, Esma, Çölkesen, Fatma, Öztürk, Erman, Berk Cam, Hande, Mermutluoğlu, Çiğdem, Özer Balin, Şafak, Sincan, Gülden, Altın, Nilgün, Sili, Uluhan, Suntur, Bedia Mutay, Arslan Gülen, Tuğba, Deveci, Burak, Saba, Rabin, İncecik, Şaban, Eser Karlıdağ, Gülden, Hakko, Elif, Akdağ, Damla, Erdem, Hüseyin Aytaç, Sipahi, Hilal, Çicek, Candan, Taşbakan, Mehmet Sezai, Taşbakan, Meltem, Pullukçu, Hüsnü, Yamazhan, Tansu, Arda, Bilgin, Ulusoy, Sercan, and Sipahi, Oguz Resat

Published
2024
Full Text
View/download PDF

9. Evaluation of Pneumonia Risk Factors in Blunt Trauma Patients Followed in Intensive Care.

Author

Balık, Yelda, Balık, Recep, Köse, Işıl, Zincircioğlu, Çiler, Köse, Şükran, Demirdal, Tuna, and Şenoglu, Nimet

Subjects
RISK factors of pneumonia, INJURY complications, BLUNT trauma, RISK assessment, PEARSON correlation (Statistics), PATIENTS, T-test (Statistics), FISHER exact test, EMERGENCY medical services, MANN Whitney U Test, CHI-squared test, MULTIVARIATE analysis, DESCRIPTIVE statistics, VENTILATOR-associated pneumonia, TRACHEA intubation, INTENSIVE care units, STATISTICS, PATIENT monitoring, LENGTH of stay in hospitals, PROPORTIONAL hazards models, REGRESSION analysis, COMORBIDITY, DISEASE complications
Abstract

Introduction: Injuries, leading to significant health and economic burdens globally, have become a prominent concern. Data from the World Health Organization (WHO) in 2012 ranks injuries as the ninth leading cause of death across all age groups, while the Centers for Disease Control and Prevention (CDC) highlights injuries as the primary cause of death among individuals under 45 years of age. Notably, traffic accidents, pedestrian incidents, and falls stand out as the leading causes of these injuries. In 2019, injuries resulted in staggering economic losses in the United States, with substantial portions allocated to hospital expenses, work loss, and the broader societal impact. This study addresses the increased susceptibility to pneumonia in trauma patients and the factors contributing to it, shedding light on its clinical implications. Methods: The study enrolled patients admitted to the Intensive Care Unit (ICU) following blunt trauma. Various statistical analyses were employed, including t-tests, Mann-Whitney U tests, chi-square tests, Fisher's exact tests, and Cox proportional hazards regression analysis, to identify potential risk factors for ventilator-associated pneumonia (VAP). The study examined variables associated with pneumonia in univariable and multivariate analyses, considering patient outcomes over time. Statistical significance was set at a p-value<0.05. Results: Over a five-year period, 32.3% of the patients (n: 42) developed pneumonia among the 130 included in the study. While pneumonia was more common in males and younger patients, no significant relationship was found with age or gender. The SAPS2 score was significantly higher in patients who developed pneumonia, but there was no significant relationship with the ISS score. Patients with pneumonia experienced significantly longer hospital stays, ICU stays, and mechanical ventilation durations. Notably, intubated patients, sedation, and nasogastric tube placement were significantly associated with pneumonia development. Discussion and Conclusion: This study investigates risk factors for pneumonia development in trauma patients in the ICU and confirms the increased susceptibility of these patients to pneumonia. Although the study confirms factors like intubation, sedation, and nasogastric tube placement as risk factors, it provides nuanced insights into their impact on pneumonia development. Furthermore, the study highlights the importance of assessing pneumonia risk over time, emphasizing the critical role of early interventions to mitigate pneumonia rates. In conclusion, this study underscores the significance of identifying and understanding risk factors for pneumonia development in ICU patients after blunt trauma. Recognizing these factors and implementing preventive measures may ultimately reduce mortality and morbidity in this patient population. [ABSTRACT FROM AUTHOR]

Published
2024
Full Text
View/download PDF

11. Tigecycline in the treatment of multidrug-resistant Acinetobacter baumannii meningitis: Results of the Ege study

Author

Sipahi, Oguz Reşat, Mermer, Sinan, Demirdal, Tuna, Ulu, Aslıhan Candevir, Fillatre, Pierre, Ozcem, Selin Bardak, Kaya, Şafak, Şener, Alper, Bulut, Cemal, Tekin, Recep, Kahraman, Hasip, Özgiray, Erkin, Yurtseven, Taşkın, Sipahi, Hilal, Arda, Bilgin, Pullukçu, Hüsnü, Taşbakan, Meltem, Yamazhan, Tansu, Aydemir, Sohret, and Ulusoy, Sercan

Published
2018
Full Text
View/download PDF

12. Influence of multidrug resistant organisms on the outcome of diabetic foot infection

Author

Saltoglu, Nese, Ergonul, Onder, Tulek, Necla, Yemisen, Mucahit, Kadanali, Ayten, Karagoz, Gul, Batirel, Ayse, Ak, Oznur, Sonmezer, Cagla, Eraksoy, Haluk, Cagatay, Atahan, Surme, Serkan, Nemli, Salih A., Demirdal, Tuna, Coskun, Omer, Ozturk, Derya, Ceran, Nurgul, Pehlivanoglu, Filiz, Sengoz, Gonul, Aslan, Turan, Akkoyunlu, Yasemin, Oncul, Oral, Ay, Hakan, Mulazımoglu, Lutfiye, Erturk, Buket, Yilmaz, Fatma, Yoruk, Gulsen, Uzun, Nuray, Simsek, Funda, Yildirmak, Taner, Yaşar, Kadriye Kart, Sonmezoglu, Meral, Küçükardali, Yasar, Tuna, Nazan, Karabay, Oguz, Ozgunes, Nail, and Sargın, Fatma

Published
2018
Full Text
View/download PDF

13. Brucellosis in pregnancy: results of multicenter ID-IRI study

Author

Inan, Asuman, Erdem, Hakan, Elaldi, Nazif, Gulsun, Serda, Karahocagil, Mustafa K., Pekok, Abdullah U., Ulug, Mehmet, Tekin, Recep, Bosilkovski, Mile, Kaya, Safak, Haykir-Solay, Asli, Demirdal, Tuna, Kaya, Selcuk, Sunnetcioglu, Mahmut, Sener, Alper, Tosun, Selma, Aydin, Emsal, Ural, Serap, Yamazhan, Tansu, Muhcu, Murat, Ayaslioglu, Ergin, Bilgic-Atli, Seval, Erbay, Ayse, Ergen, Pinar, Kadanali, Ayten, Sahin, Suzan, Sahin-Horasan, Elif, Avci, Ali, Cag, Yakup, and Beeching, Nicholas J.

Published
2019
Full Text
View/download PDF

14. Daptomycin vs. glycopeptides in the treatment of febrile neutropenia: results of the Izmir matched cohort study

Author

Sipahi, Oguz Resat, Kahraman, Hasip, Erdem, Huseyin Aytac, Yetkin, Funda, Kaya, Selcuk, Demirdal, Tuna, Tunccan, Ozlem Guzel, Karasahin, Omer, Oruc, Ebru, Cag, Yasemin, Kurtaran, Behice, Ulug, Mehmet, Kutlu, Murat, Avci, Meltem, Oztoprak, Nefise, Arda, Bilgin, Pullukcu, Husnu, Tasbakan, Meltem, Yamazhan, Tansu, Kandemir, Ozlem, Dizbay, Murat, Sipahi, Hilal, and Ulusoy, Sercan

Published
2019
Full Text
View/download PDF

15. Causative pathogens and antibiotic resistance in diabetic foot infections: A prospective multi-center study

Author

Hatipoglu, Mustafa, Mutluoglu, Mesut, Turhan, Vedat, Uzun, Gunalp, Lipsky, Benjamin A., Sevim, Erol, Demiraslan, Hayati, Eryilmaz, Esma, Ozuguz, Cem, Memis, Ali, Ay, Hakan, Arda, Bilgin, Uysal, Serhat, Motor, Vicdan Koksaldi, Kader, Cigdem, Erturk, Ayse, Coskun, Omer, Duygu, Fazilet, Guler, Selma, Altay, Fatma Aybala, Ogutlu, Aziz, Bolukcu, Sibel, Yildiz, Senol, Kandemir, Ozlem, Aslaner, Halide, Polat, Arife, Karahocagil, Mustafa K., Yasar, Kadriye Kart, Sehmen, Emine, Kilic, Sirri, Sunbul, Mustafa, Gencer, Serap, Bozkurt, Fatma, Yanik, Tugba, Oztoprak, Nefise, Batirel, Ayse, Sozen, Hamdi, Kilic, Inci, Celik, Ilhami, Ay, Bengisu, Tosun, Selma, Kadanali, Ayten, Çomoglu, Senol, Denk, Affan, Hosoglu, Salih, Aydin, Ozlem, Elaldi, Nazif, Akalin, Serife, Kandemir, Bahar, Akbulut, Ayhan, Demirdal, Tuna, Balik, Recep, Azak, Emel, and Sengoz, Gonul

Published
2016
Full Text
View/download PDF

18. Cranial imaging findings in neurobrucellosis: results of Istanbul-3 study

Author

Erdem, Hakan, Senbayrak, Seniha, Meriç, Kaan, Batirel, Ayşe, Karahocagil, Mustafa Kasım, Hasbun, Rodrigo, Sengoz, Gonul, Karsen, Hasan, Kaya, Selçuk, Inal, Ayşe Seza, Pekok, Abdullah Umut, Celen, Mustafa Kemal, Deniz, Secil, Ulug, Mehmet, Demirdal, Tuna, Namiduru, Mustafa, Tekin, Recep, Guven, Tumer, Parlak, Emine, Bolukcu, Sibel, Avci, Meltem, Sipahi, Oguz Reşat, Ozturk-Engin, Derya, Yaşar, Kadriye, Pehlivanoglu, Filiz, Yilmaz, Emel, Ates-Guler, Selma, Mutlu-Yilmaz, Esmeray, Tosun, Selma, Sirmatel, Fatma, Sahin-Horasan, Elif, Akbulut, Ayhan, Oztoprak, Nefise, Cag, Yasemin, Kadanali, Ayten, Turgut, Huseyin, Baran, Ali Irfan, Gul, Hanefi Cem, Sunnetcioglu, Mahmut, Haykir-Solay, Asli, Denk, Affan, Inan, Asuman, Ayaz, Celal, Ulcay, Asim, Kose, Sukran, Agalar, Canan, and Elaldi, Nazif

Published
2016
Full Text
View/download PDF

20. Miliary tuberculosis: Epidemiologicaland clinical analysis of large-case series from moderate to low tuberculosis endemic Country

Author

Mert, Ali, Arslan, Ferhat, Kuyucu, Tülin, Koç, Emine Nur, Yilmaz, Mesut, Turan, Demet, Altin, Sedat, Pehlivanoglu, Filiz, Sengoz, Gonul, Yildiz, Dilek, Dokmetas, Ilyas, Komur, Suheyla, Kurtaran, Behice, Demirdal, Tuna, Erdem, Hüseyin A., Sipahi, Oguz Resat, Batirel, Ayse, Parlak, Emine, Tekin, Recep, Tunçcan, Özlem Güzel, Balkan, Ilker Inanc, Hayran, Osman, and Ceylan, Bahadir

Published
2017
Full Text
View/download PDF

21. The value of APRI and FIB-4 scores in detection of liver fibrosis of patients with chronic hepatitis C.

Author

Arıkan, Hatice Burcu Açıkalın, Demirdal, Tuna, and Bilir, Neriman

Subjects
*HEPATIC fibrosis, *HEPATITIS C, *CHRONIC hepatitis C, *CIRRHOSIS of the liver
Abstract

Purpose: Infection with hepatitis C virus causes chronic liver damage, fibrosis and in later processes, cirrhosis and liver cancer. Currently, the use of biomarkers, instead of invasive procedures, is recommended to identify liver fibrosis. In this study, we aimed to evaluate the sensitivity and specificity of aspartate aminotransferase (AST) to Platelet Ratio Index (APRI) and Fibrosis-4 Index (FIB-4) scoring for detection of "significant fibrosis" in chronic hepatitis C patients. Materials and Methods: Liver biopsy results and blood test results of 50 patients, infected with chronic hepatitis C, were analyzed. APRI and FIB-4 scores were calculated. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and consistency for APRI and FIB-4 scorings were calculated using a fourfold table. The values of APRI and FIB-4, providing the best specificity and sensitivity in the diagnosis of significant fibrosis, was determined by ROC (receiver operator characteristics curve) analysis. Results: The mean fibrosis stage of 30 patients with significant fibrosis was 2.83±0.74 and the mean patient age was 56.8±13. The sensitivity of APRI ≥ 1.5 to detect significant fibrosis was 16%, the specificity was 90%, PPV was 71% and NPV was 41%. A FIB-4 score of ≥3.25 had a sensitivity of 20%, a specificity of 95%, a PPV of 85% and a NPV of 44%. Conclusion: APRI and FIB-4 have high specificity and PPV in demonstrating significant fibrosis, but have low sensitivity and NPV. The sensitivity of FIB-4 was higher compared to the APRI scoring. More research on this subject is needed, as well as revision of fibrosis scores and development of new fibrosis scores. [ABSTRACT FROM AUTHOR]

Published
2023
Full Text
View/download PDF

23. STAPHLOCOCCUS AUREUS İLE OLUŞTURULAN DENEYSEL İNTRAABDOMİNAL KAYNAKLI BAKTERİYEMİ MODELİNDE BETA GLUKANIN İMMÜNOMODULATÖR ETKİSİNİN ARAŞTIRILMASI

Author

Orhan, Semiha, Demirdal, Tuna, Birdane, Fatih, Kabu, Mustafa, Koca, Halit Buğra, Demirtürk, Neşe, Orhan, Semiha, Koca, Halit Buğra, and Demirtürk, Neşe

Subjects
Staphylococcus aureus, Bakteriyemi, Beta-Glucans, Cytokines, Bacteremia, Sitokinler, Beta glucan
Abstract

OBJECTIVE: The purpose of this study is to investigate the immunomodulatory effect of beta glucan in an experimental model of intraabdominal bacteremia induced by S. aureus. MATERIAL AND METHODS: Thirty Wistar albino rats were randomly divided into four groups. Staphylococcus aureus bacteremia (SAB), treatment with cefazolin, treatment with beta glucan, treatment with both cefazolin and beta glucan groups were constituted respectively. 4 mg/kg beta glucan and 100 mg/kg cefazolin were given after 12x10 8 cfu/ml 1 cc S. aureus was given intraabdominally. After two hours, 0.5 cc blood was drawn and put into blood culture bottles. Levels of Tumor necrosis factor-alpha (TNF-α), interleukin-1 (IL-1), interleukin-6 (IL6), and Interferon gamma (IFN-γ) were evaluated after 4th, 6th and 8th hours. RESULTS: According to the biochemical analyses; At the end of the study it was seen that beta glucan increased the level of IFN-γ at 6th hour, but did not at 4th and 8th hours. This increase became more apparent at 6 th hour when it was given with cefazolin. However IFN-γ levels were found to be higher in the group which cefazolin was given than beta glucan was. As the level of serum TNF-α was evaluated, although there was a supression at 8th hour, it was found to be higher in the group which beta glucan was given than the SAB group. Serum IL-1 levels were higher at 4th, 6th and 8th hours in the group beta glucan was given than the SAB group. Although a decline in IL-1 level was detected in the group which cefazolin was added to beta glucan at 8th hour, this level was found to be higher than the SAB group. When the serum IL-6 level was evaluated, an increase in release of IL-6 was found in the group beta glucan was given in the first 8 hours when it was compared with SAB group. When beta glucan was given with cefazolin, it was observed that IL-6 increased to the highest level at 8th hour. CONCLUSIONS: This experimental intra-abdominal bacteremia model, demonstrated that beta glucan did not supress the production of TNF-α and IL-1, and increased the release of IL- 6 and IFN-γ, especially in the first hours. According to these results, no significant knowledge could be obtained about the benefit of using beta glucan in the treatment of experimental model of intraabdominal bacteremia. AMAÇ: Bu çalışmanın amacı S. aureus ile oluşturulan deneysel intraabdominal kaynaklı bakteriyemi modelinde beta glukanın immünomodulatör etkisini araştırmaktır. GEREÇ VE YÖNTEM: Wistar albina sıçanlardan 30’u rastgele 4 gruba ayrıldı. Sırasıyla Staphylococcus aureus bakteriyemisi (SAB), sefazolin ile tedavi, beta glukan tedavi, beta glukan ve sefazolin tedavi grupları oluşturuldu. İntraabdominal yolla verilen 12x10 8 cfu/ml 1 cc S. aureus verildikten sonra intraabdominal 4 mg/kg beta glukan ve 100 mg/kg sefazolin verildi. 2 saat sonra 0,5 cc kan alınarak kan kültür şişesine ekim yapıldı. 4-6-8. saat sonra Tümör nekroz faktörü alfa (TNF-α), İnterlökin-1( IL-1), İnterlökin-6 (IL-6), İnterferon gama (IFN-γ) düzeyleri araştırıldı. BULGULAR: Biyokimyasal analizlere göre; çalışma sonunda beta glukan 6. saatte IFN-γ’yı arttırdığı, ancak 4. ve 8. saatlerde arttırmadığı görüldü. Sefazolin ile birlikte verildiğinde 6. saatte bu artış daha belirgin olmaktadır. Ancak sefazolin verilen grupta IFN-γ değerleri beta glukandan daha yüksek düzeyde saptandı. Serum TNF-α düzeyleri değerlendirildiğinde, beta glukan verilen grupta 8. saatte TNF-α düzeyinde bir baskılanma saptansa da SAB grubundan daha yüksek olarak bulundu. Serum IL-1 düzeyleri değerlendirildiğinde, beta glukan verilen grupta 4-6 ve 8. saatlerde IL-1 düzeyleri SAB grubuna göre daha yüksekti. Beta glukana sefazolin eklenen grupta 8. saatte IL-1 düzeylerinde azalma tesbit edildiyse de, bu düzeyler SAB grubundan yüksek saptandı. Serum IL-6 seviyesi değerlendirildiğinde, beta glukan verilen grupta SAB grubuna göre ilk 8 saatte IL-6 salınımında artış saptandı. Beta glukan sefazolinle birlikte uygulandığında ise IL-6 artışının ilk 8. saatte en yüksek düzeye ulaştığı görüldü. SONUÇ: Bu deneysel intraabdominal kaynaklı bakteriyemi modeli beta glukanın özellikle ilk saatlerde TNF-α, IL-1 üretimini baskılamadığını, IL-6, IFN-γ salınımını arttırdığını göstermiştir. Bu sonuçlara göre deneysel intraabdominal kaynaklı bakteriyemi tedavisinde beta glukan kullanımının yararı konusunda anlamlı bilgilere ulaşılamadı.

Published
2022

24. İmmünsüpresif hastalarda HBV reaktivasyonunun önlenmesi için tenofovir alafenamid profilaksisi: Çok merkezli bir çalışma

Author

SENOL, Sebnem, SÖNMEZ, Ufuk, DEMİRDAL, Tuna, ŞEN, Pınar, TÜRK, Deniz, ATALAY, Sabri, AKYOL, Deniz, MERMUTLUOĞLU, Çiğdem, ÇELEN, Mustafa Kemal, YAMAZHAN, Tansu, PULLUKÇU, Hüsnü, Dicle Üniversitesi, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Ana Bilim Dalı, Mermutluoğlu, Çiğdem, Çelen, Mustafa Kemal, and Yamazhan, Tansu

Subjects
Tenofovir alafenamid, Medicine, İmmünsüpresif ajanlar, Tenofovir alafenamide, Immunosuppressive agents, tenofovir alafenamide,Hepatitis B / prevention & control,Immunosuppressive Agents, Hepatitis B prevention and control, tenofovir alafenamid,Hepatit B / önlem ve kontrol,immunsüpresif ajanlar, Tıp, Hepatit B önlem ve kontrol
Abstract

Amaç: İmmünsupresif tedavi altındaki yüksek riskli hastalarda hepatit B reaktivasyonu antiviral profilaksi ile önlenebilir. Antiviral seçiminde entekavir (ETC) veya tenofovir disoproksil fumarat (TDF) uzun zamandır kullanılabilmekteyken yakın zamanda kullanıma giren tenofovir alafenamid (TAF) güvenli yan etki profili ile iyi bir alternatif olmuştur. Bu çok merkezli geniş hasta sayılı çalışmada immünsüpresif hasta grubunda tenofovir alafenamidin (TAF) etkinliği ve güvenliği araştırılmıştır. Gereç ve Yöntem: Altı eğitim ve araştırma hastanesinin 1 Ocak 2019- 30 Eylül 2021 arasındaki kayıtları retrospektif olarak incelenerek immünsüpresif tedavi altında iken hepatit B için antiviral profilaksi başlanan ve en az 6 ay süre ile takip edilen hastalar çalışmaya dahil edilmiştir. Aldıkları immünsüpresif tedavi veya kemoterapiye ayrıca hepatit B serolojilerine göre risk grupları belirlenmiş, hepatit B reaktivasyon varlığı ve yan etkileri yönünden incelenmiştir. Bulgular: Yaş ortalaması 62.5±29 yıl olan 148 hastanın 85’i (%57.4) TAF, 63’ü (%42.6) tenofovir disoproksil fumarate (TDF) veya entekavir (ETC) ile profilaksi almaktaydı. %83.1’i HBsAg (-) antiHBc (+) %16.9’u HBsAg (+) olarak bulundu; kronik HBV’li hastaların %36 sının HBV DNA’sı saptanabilir düzeyin üzerindeydi. Çoğu (%69.6) hematolojik bir malinite nedeni ile immünsüpresif alırken %89.2’sinin aldığı tedavi yüksek riskli ilaç grubunda idi. Riskler açısından TAF ve diğer tedavileri alanlar arasında farklılık yoktu. Tedavi gruplarının hiçbirinde reaktivasyon ya da yan etkiye rastlanmadı.Sonuç: Kronik HBV tedavisinde olduğu gibi immünsüpresif tedavi alan bireylerde HBV reaktivasyonunun önlenmesinde de TAF en az TDF ve ETC kadar etkindir. TDF nin böbrek ve kemik yan etkilerinin TAF da görülmemesinin etkin ve güvenli bu tedavi seçeneğini immünsüpresif hastalarda öne çıkaracağını düşünmekteyiz., Purpose: Reactivation of hepatitis B may be prevented by antiviral therapy in immunosuppressed high risk patients. Entecavir (ETC) and tenofovir disoproksil fumarat (TDF) have been used for a long time and recently introduced tenofovir alafenamid (TAF) seems to be a good alternative with rare side effects. This multicentered study with a large patient population aimed to investigate the effectiveness of tenofovir alafenamid (TAF) in immunsuppressed subjects. Materials and Methods: The records of six training and research hospitals between January 1, 2019 and September 30, 2021 were retrospectively reviewed, and patients who were started antiviral prophylaxis for hepatitis B and followed up for at least 6 months while under immunosuppressive therapy were included in the study. Risk groups were determined according to the immunosuppressive treatment or chemotherapy they received, as well as hepatitis B serology, and were examined in terms of the presence of hepatitis B reactivation and its side effects.Results: The mean age of patients was found as 62.5±29. Out of 148 patients, 85 (57.4%) received TAF, 63 (42.6%) received either Entecavir (ETC) or tenofovir disoproksil fumarat (TDF). The majority (83.1%) was found as HBsAg (-) antiHBc (+) and 16.9% was HBsAg (+). HBV DNA was traced in 36% of chronic HBV patients. Most of the patients (69.6%) were receiving immunospuppressives for treatment of a haematologic malignancy and 89.2% was in the high risk treatment group. There was no difference between TAF and the other drugs in terms of risks. Reactivation was not seen in any of the treatment groups. Conclusion: TAF is as effective as TDF and ETC when used for prophylaxis in immunosuppressed HBV patients. Side effects on kidney and bone are not seen in TAF treatment groups which will probably play a role in preferring this new drug.

Published
2022

25. Tenofovir alafenamid prophylaxis for the prevention of HBV reactivation in immunosuppressed subjects: a multicenter study

Author

Akar, Sebnem Senol, Sonmez, Ufuk, Demirdal, Tuna, Sen, Pinar, Ozer, Deniz, Atalay, Sabri, and Akyol, Deniz

Subjects
Risk, B-Virus Reactivation, hepatitis B prevention and control, tenofovir alafenamide, Therapy, immunosuppressive agents, Hepatitis-B, Management
Abstract

Purpose: Reactivation of hepatitis B may be prevented by antiviral therapy in immunosuppressed high risk patients. Entecavir (ETC) and tenofovir disoproksil fumarat (TDF) have been used for a long time and recently introduced tenofovir alafenamid (TAF) seems to be a good alternative with rare side effects. This multicentered study with a large patient population aimed to investigate the effectiveness of tenofovir alafenamid (TAF) in immunsuppressed subjects. Materials and Methods: The records of six training and research hospitals between January 1, 2019 and September 30, 2021 were retrospectively reviewed, and patients who were started antiviral prophylaxis for hepatitis B and followed up for at least 6 months while under immunosuppressive therapy were included in the study. Risk groups were determined according to the immunosuppressive treatment or chemotherapy they received, as well as hepatitis B serology, and were examined in terms of the presence of hepatitis B reactivation and its side effects. Results: The mean age of patients was found as 62.5 +/- 29. Out of 148 patients, 85 (57.4%) received TAF, 63 (42.6%) received either Entecavir (ETC) or tenofovir disoproksil fumarat (TDF). The majority (83.1%) was found as HBsAg (-) antiHBc (+) and 16.9% was HBsAg (+). HBV DNA was traced in 36% of chronic HBV patients. Most of the patients (69.6%) were receiving immunospuppressives for treatment of a haematologic malignancy and 89.2% was in the high risk treatment group. There was no difference between TAF and the other drugs in terms of risks. Reactivation was not seen in any of the treatment groups. Conclusion: TAF is as effective as TDF and ETC when used for prophylaxis in immunosuppressed HBV patients. Side effects on kidney and bone are not seen in TAF treatment groups which will probably play a role in preferring this new drug.

Published
2022

30. The Epidemiology, Clinical Manifestations, Radiology, Microbiology, Treatment, and Prognosis of Echinococcosis: Results of NENEHATUN Study

Author

Parlak, Emine, primary, Kerget, Ferhan, additional, Demirdal, Tuna, additional, Şen, Pınar, additional, Ulaş, Ali Bilal, additional, Öztürk Durmaz, Şenay, additional, Pekok, Umut, additional, Ertürk, Ayşe, additional, Akyol, Deniz, additional, Kepenek Kurt, Esma, additional, Köksal Alay, Handan, additional, Pullukçu, Hüsnü, additional, Taşbakan, Meltem, additional, Erol, Serpil, additional, Laloğlu, Esra, additional, Öztürk Engin, Derya, additional, Ağalar, Canan, additional, and Parlak, Mehmet, additional

Published
2021
Full Text
View/download PDF

31. Diagnostic value of procalcitonin in predicting bacteremia in intensive care unit

Author

Demirdal, Tuna, Sen, Pinar, and Nemli, Salih

Subjects
Bacteremia -- Diagnosis -- Prognosis -- Research, Biological markers -- Research, Health
Abstract

Byline: Tuna. Demirdal, Pinar. Sen, Salih. Nemli Background and Aims: Several biomarkers are used in the diagnosis of bacteremia. Procalcitonin (PCT) is more specific than other biomarkers in differentiating bacterial [...]

Published
2018

32. Surgical site infection rates in 16 cities in Turkey: findings of the International Nosocomial Infection Control Consortium (INICC)

Author

Leblebicioglu, Hakan, Erben, Nurettin, Rosenthal, Victor D., Sener, Alper, Uzun, Cengiz, Senol, Gunes, Ersoz, Gulden, Demirdal, Tuna, Duygu, Fazilet, Willke, Ayse, Sirmatel, Fatma, Oztoprak, Nefise, Koksal, Iftihar, Oncul, Oral, Gurbuz, Yunus, Güçlü, Ertugrul, Turgut, Huseyin, Yalcin, Ata Nevzat, Ozdemir, Davut, Kendirli, Tanil, Aslan, Turan, Esen, Saban, Ulger, Fatma, Dilek, Ahmet, Yilmaz, Hava, Sunbul, Mustafa, Ozgunes, Ilhan, Usluer, Gaye, Otkun, Metin, Kaya, Ali, Kuyucu, Necdet, Kaya, Zeynep, Meric, Meliha, Azak, Emel, Yýlmaz, Gürdal, Kaya, Selçuk, Ulusoy, Hülya, Haznedaroglu, Tuncer, Gorenek, Levent, Acar, Ali, Tutuncu, Ediz, Karabay, Oguz, Kaya, Gulsume, Sacar, Suzan, Sungurtekin, Hülya, Uğurcan, Doğaç, Turhan, Ozge, Kaya, Sehnaz, Gumus, Eylul, Dursun, Oguz, Geyik, Mehmet Faruk, Şahin, Ahmet, Erdogan, Selvi, Ince, Erdal, Karbuz, Adem, Çiftçi, Ergin, Taşyapar, Nevin, and Güneş, Melek

Published
2015
Full Text
View/download PDF

33. Pnömokok İnfeksiyonlarının Klinik Özellikleri ve İnvazif Hastalık Göstergeleri.

Author

Şen, Pınar, Demirdal, Tuna, and Nemli, Salih Atakan

Subjects
*BRAIN abscess, *PERITONITIS, *PYELONEPHRITIS, *PERICARDITIS, *MORTALITY, *WOUND infections, *TIME, *STREPTOCOCCAL diseases, *RETROSPECTIVE studies, *DISEASES, *ENDOCARDITIS, *SEPSIS, *DEMOGRAPHY, *MENINGITIS, *ARTHRITIS, *DISEASE risk factors
Abstract

Clinical Characteristics of Pneumococcal Infections and Predictors of Invasive Pneumococcal Disease [ABSTRACT FROM AUTHOR]

Published
2022
Full Text
View/download PDF

35. COVID-19 İnfeksiyonunda Mayıs-Ağustos 2020 Döneminde Yoğun Bakıma Yatış ve Mortalite ile İlişkili Faktörler.

Author

Şen, Pınar and Demirdal, Tuna

Subjects
*INTENSIVE care units, *COVID-19, *MYALGIA, *PATIENTS, *RETROSPECTIVE studies, *HOSPITAL admission & discharge, *RISK assessment, *DYSPNEA
Abstract

Objective: COVID-19 infection causes severe pneumonia and multi-organ failure in adults, increases morbidity and mortality. Our study aimed to determine the factors affecting intensive care unit admission and mortality in hospitalized COVID-19 patients. Methods: The demographic, clinical, and laboratory data of hospitalized patients due to COVID-19 between May 1, 2020 and August 1, 2020 were evaluated retrospectively. Patients who were admitted to the intensive care unit or died during follow-up were included in the study group, and patients who were followed in the inpatient settings and survived consisted the control group. The data obtained at the time of hospitalization were evaluated statistically. Results: A total of473 patients were included in the study. The median age of the patients was 53 years (40-68 years), and 269 (56.9%) were male. During the follow-up, 93(19.7%) patients were admitted to the intensive care unit (ICU). Of the 468 patients for whom follow-up data were available, 62(13.2%) patients died. Patients with older age and comorbid diseases had higher ICU admission and mortality rates (p<0.001 and p<0.001). ICU admission rate was higher in patients with cough (p=0.002), myalgia (p=0.016), and dyspnea (p<0.001) during hospital admission. At the same time, dyspnea was more common in patients who died (p<0.001), and myalgia was more common in surviving patients (p=0.020). Laboratory values associated with both ICU admission and mortality were glucose (p<0.001, p<0.001), AST (p<0.001, p<0.001), serum creatinine (p<0.001, p<0.001), direct bilirubin (p<0.001, p=0.009), albumin (p<0.001, p<0.001), CRP (C-reactive protein) (p<0.001, p<0.001), procalcitonin (p<0.001, p<0.001), leukocyte count (p<0.001, p<0.001), lymphocyte count (p<0.001, p<0.001), neutrophil count (p=0.007, p<0.001), hemoglobin (p<0.001, p<0.001), troponin (p<0.001, p<0.001), D-dimer (p<0.001, p<0.001), ferritin (p<0.001, p<0.001) prothrombin time (p<0.001, p<0.001) and INR (international normalized ratio) (p<0.001, p<0.001) levels. Conclusions: Determining the parameters that define high-risk COVID-19 infected patients in the early period can contribute to reduce ICU admissions and mortality by improving patient management and resource utilization in hospitals. [ABSTRACT FROM AUTHOR]

Published
2022
Full Text
View/download PDF

40. Withdrawal of Staphylococcus aureus from intensive care units in Turkey

Author

Erdem, Hakan, Dizbay, Murat, Karabey, Selma, Kaya, Selcuk, Demirdal, Tuna, Koksal, Iftihar, Inan, Asuman, Erayman, Ibrahim, Ak, Oznur, Ulu-Kilic, Aysegul, Karasahin, Omer, Akbulut, Ayhan, Elaldi, Nazif, Yilmaz, Gulden, Candevir, Aslihan, Gul, Hanefi Cem, Gonen, Ibak, Oncul, Oral, Aslan, Turan, Azak, Emel, Tekin, Recep, Kocak Tufan, Zeliha, Yenilmez, Ercan, Arda, Bilgin, Gungor, Gokay, Cetin, Birsen, Kose, Sukran, Turan, Hale, Akalin, Halis, Karabay, Oguz, Dogan-Celik, Aygul, Albayrak, Adem, Guven, Tumer, Celebi, Guven, Ozgunes, Nail, Ersoy, Yasemin, Sirmatel, Fatma, Oztoprak, Nefise, Balkan, Ilker Inanc, Bayazit, Fatma Nurhayat, Ucmak, Hasan, Oncu, Serkan, Ozdemir, Davut, Ozturk-Engin, Derya, Bitirgen, Mehmet, Tabak, Fehmi, Akata, Filiz, Willke, Ayşe, Gorenek, Levent, Ahmed, Salman Shaheer, Tasova, Yesim, Ulcay, Asim, Dayan, Saim, Esen, Saban, Leblebicioglu, Hakan, Altun, Begin, and Unal, Serhat

Published
2013
Full Text
View/download PDF

41. Diagnostic and prognostic value of new bioscore in critically ill septic patients.

Author

Sen, Pinar, Demirdal, Tuna, Nemli, Salih Atakan, and Sencan, Atilla

Subjects
*PROGNOSIS, *CRITICALLY ill, *INTENSIVE care patients
Abstract

To evaluate the diagnostic and prognostic value of biomarkers and new bioscore in septic patients in intensive care unit (ICU). A study was conducted on septic and non-septic patients in ICU. Diagnostic and prognostic values of C-reactive protein (CRP), procalcitonin (PCT), Sequential Organ Failure Assessments (SOFA) score and new bioscore were analysed statistically. A total of 226 patients were enrolled in the study. In septic patients, PCT, SOFA and bioscore were found significantly increased (p =.007, p =.001 and p =.001, respectively). The AUC value of bioscore was higher than PCT and SOFA in septic patients. SOFA was found to be more significant prognostic marker than bioscore in predicting 28-day mortality. The prognostic value of bioscore and SOFA was similar for predicting 90-day mortality. The new bioscore formed by combination of CRP, PCT and SOFA score may be useful in early diagnosis of sepsis. [ABSTRACT FROM AUTHOR]

Published
2022
Full Text
View/download PDF

44. İmmünsüpresif hastalarda HBV reaktivasyonunun önlenmesi için tenofovir alafenamid profilaksisi: çok merkezli bir çalışma.

Author

Akar, Şebnem Şenol, Sönmez, Ufuk, Demirdal, Tuna, Şen, Pınar, Özer, Deniz, Atalay, Sabri, Akyol, Deniz, Mermutluoğlu, Çiğdem, Çelen, Mustafa Kemal, Yamazhan, Tansu, and Pullukçu, Hüsnü

Subjects
HEPATITIS B, IMMUNOCOMPROMISED patients, IMMUNOSUPPRESSIVE agents, TENOFOVIR, HEPATITIS B virus
Abstract

Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2022
Full Text
View/download PDF

45. Hastane Kaynaklı Pan Drug Resistant Acinetobacter Baumannii Enfeksiyonlarında Risk Faktörleri

Author

Tunay, Havva, Demirdal, Tuna, Demirtürk, Neşe, Tunay, Havva, Demirtürk, Neşe, and ALKÜ

Subjects
endocrine system diseases, [No Keywords], sense organs, biochemical phenomena, metabolism, and nutrition, eye diseases
Abstract

Aim: Acinetobacter baumannii is an important nosocomial pathogen. The purpose of this study was to identify risk factors and mortality of nosocomial infections caused by pan drug resistant (PDR) Acinetobacter baumannii and to characterize their effects on mortality. Patients and Methods: This study was performed at the Afyon Kocatepe University Faculty of Medicine. Nosocomial infections were defined according to the American Center for Disease Control (CDC). Patients with nosocomial infections caused by Acinetobacter baumannii were included in the study. Patients identified as PDR Acinetobacter baumannii and non-PDR Acinetobacter baumannii infection were compared in terms of risk factors. Results: Two different groups were constructed, one group consisting of 145 PDR and the other of 145 non-PDR Acinetobacter baumannii cases. Stay history in an internal intensive care unit (p=0.001), their duration of hospital stay (p=0.031), renal disease (p=0.003), mechanical ventilation (p=0.001), prior usage history of carbapenem (p=0.001), presence of nosocomial pneumonia (p=0.001), were independent risk factors associated with PDR Acinetobacter baumannii infections. The mortality rate for the PDR group was 61.8% and it was 38.2% in the non-PDR group (p=0.008). Conclusion: PDR Acinetobacter baumannii infections are important nosocomial infections with a high mortality rate. Patients’ carbapenem usage, stay history in an internal intensive care unit, renal comorbid diseases, and a diagnosis of nosocomial pneumonia are important risk factors for PDR Acinetobacter baumannii infections. In nosocomial infections caused by PDR Acinetobacter baumannii, many risk factors were modifiable. Amaç: Acinetobacter baumannii, önemli nozokomiyal bir patojendir. Bu çalışmanın amacı, pan drug resistant (PDR) Acinetobacter baumannii nedenli nosokomiyal enfeksiyonlar için risk faktörlerinin ve mortalite üzerine olan etkinin tanımlanmasıdır. Hastalar ve Yöntemler: Çalışma Afyon Kocatepe Üniversitesi Tıp Fakültesi’nde gerçekleştirilmiştir. Amerikan Hastalık Kontrol Merkezi (CDC) tanı kriterlerine göre tanımlanmıştır. Acinetobacter baumannii nedenli nozokomiyal enfeksiyon tanımlanan hastalar çalışmaya dahil edilmiştir. PDR Acinetobacter baumannii ve non-PDR Acinetobacter baumannii enfeksiyonu saptanan olgular risk faktörleri yönünden karşılaştırılmıştır Bulgular: Biri 145 PDR diğeri 145 PDR olmayan Acinetobacter baumannii vakalarından oluşan iki farklı grup oluşturuldu. Dahili yoğun bakım ünitesinde yatış öyküsü (p=0,001), hastanede kalış süresi PDR grupta ortalama 28,2±23,0 (p=0,031), renal hastalık (p=0,003), mekanik ventilasyon (p=0,001),önceden karbapenem kullanma öyküsü (p=0,001), nozokomiyal pnömoni varlığı, (p=0,001 bağımsız risk faktörü olmuştur. Mortalite oranı PDR grupta % 61,8, non-PDR grupta % 38,2, olarak belirlenmiştir (p=0,008). Sonuç: PDR Acinetobacter baumannii enfeksiyonları mortalite oranı yüksek önemli nozokomiyal infeksiyonlardır. Dahili yoğun bakım ünitesinde yatış öyküsü, hastanede kalış süresi, renal hastalık, mekanik ventilasyon, karbapenem kulanım öyküsü, nozokomiyal pnömoni varlığı, solunum sekresyon örneği PDR Acinetobacter baumannii enfeksiyonu için önemli risk faktörleridir. PDR Acinetobacter baumannii nedenli nozokomiyal enfeksiyonlarda çoğu risk faktörleri düzeltilebilir özelliktedir.

Published
2019

46. DOES LEUKEMOID REACTION AFFECT PROGNOSIS IN PATIENTS WITH SOLID MALIGNANCIES?

Author

Yildiz, Yasar, Taskaynatan, Halil, TARHAN, MUSTAFA OKTAY, KÜÇÜKZEYBEK, YÜKSEL, TOPAL, FATİH ESAD, DEMİRDAL, TUNA, ALACACIOĞLU, AHMET, Ozdemir, Ozlem, Varol, Umut, Oflazoglu, Utku, Salman, Tarik, and Sari, Ummu Sena

Abstract

Introduction: Although extreme leukocytosis is associated with increased mortality in patients with non-hematologic cancer patients, it is not well known. The prognosis of patients with extreme leukocytosis mainly depends on the underlying disease.

Published
2019

47. In-vitro evaluation of different antimicrobial combinations with and without colistin against carbapenem-resistant Acinetobacter baumanniiclinical isolates

Author

Müderris, Tuba, Dursun Manyaslı, Gülden, Sezak, Nurbanu, Kaya, Selçuk, Demirdal, Tuna, and Gül Yurtsever, Süreyya

Abstract

Background: Carbapenem-resistant Acinetobacter baumannii(CRAB) infections are one of the most common causes of nosocomial infections and have high mortality rates due to difficulties in treatment. In this study, the in vitro synergistic interactions of the colistin (CT)–meropenem (MEM) combination and patient clinical outcomes were compared in CRAB-infected patients that receive CT–MEM antimicrobial combination therapy. In addition, in vitro synergistic interactions of MEM–ertapenem (ETP), MEM–fosfomycin (FF) and CT–FF antimicrobial combinations were investigated. Finally, the epsilometer (E) test and checkerboard test results were compared and the compatibility of these two tests was evaluated. Methods: Twenty-one patients were included in the study. Bacterial identification was performed with MALDI–TOF, and antimicrobial susceptibility was assessed with an automated system. Synergy studies were performed using the Etest and checkerboard method. Results: For the checkerboard method, the synergy rates for CT–MEM, MEM–FF, MEM–ETP and CT–FF were 100%, 52.3%, 23.8% and 28.5%, respectively. In the Etest synergy tests, synergistic effects were detected for two isolates each in the CT–MEM and CT–FF combinations. Microbial eradication was achieved in nine (52.9%) of the 17 patients that received CT–MEM combination therapy. The agreement between the Etest and the checkerboard test was 6.5%. Conclusions: A synergistic effect was found with the checkerboard method for the CT–MEM combination in all isolates in our study, and approximately 70% of the patients benefited from treatment with this combination. In addition, more than half of the isolates showed a synergistic effect for the MEM–FF combination. Combinations of CT–MEM and MEM–FF may be options for the treatment of CRAB infections. However, a comprehensive understanding of the potential of the microorganism to develop resistant mutants under applied exposures, as well as factors that directly affect antimicrobial activity, such as pharmacokinetics/pharmacodynamics, is essential for providing treatment advice. We found a low rate of agreement between the Etest method and the checkerboard test method in our study, in contrast to the literature. Comprehensive studies that compare clinical results with methods are needed to determine the ideal synergy test and interpretation method.

Published
2024
Full Text
View/download PDF

48. Tüberküloz Lenfadeniti: Bir Olgu Nedeniyle.

Author

Yavuz, Taha, Demirdal, Tuna, and Aydoğmuş, Figen Kaptan

Abstract

Giriş: Tüberküloz lenfadeniti akciğer dışı tüberkülozların 1/3'ünü, tüm tüberküloz olgularının ise %5'ini oluşturmaktadır. Hastalık en sık servikal lenf nodlarında görülürken bunu mediastinal, aksillar, mezenterik, hepatik ve inguinal lenf nodları izlemektedir. Bu bildiride submandibular ve preauriküler bölgede fistülize tutulum yapan tüberküloz lenfadenit olgusu sunulmaktadır. Olgu: Bilinen Alzheimer öyküsü olan 87 yaş erkek hasta 2 ay öncesinde başlayan boyunda ağrısız şişlik ve pürülan vasıfta akıntı olması üzerine kulak burun boğaz polikliniğine başvurmuştu. Öncesinde oral amoksisilin-klavulonik asit kullanmasına rağmen lenfadenopati boyutunda küçülme olmaması, akıntının azalmaması üzerine kulak burun boğaz kliniğine yatırıldı. Lenfoma ön tanısı olan hastanın toraks bilgisayarlı tomografisinde maligniteyi destekleyen bulgu saptanmamış ve tanısal amaçlı lenf bezi eksizyonu yapıldı. Hastanın lenf bezi biyopsisinin patoloji bakısında granülomatöz reaksiyon saptandı. Biyopsinin mikobakteriyolojik incelemesinde ARB görülmemiş, ancak kültüründe M. tuberculosis üremesi oldu. Bu sonuçlar ile polikliniğimize yönlendirilen hastanın fizik muayenesinde sol servikal bölgede lenfadenopati, pürülan akıntı, sedimentasyon yüksekliği (58 mm/saat), C-reaktif protein: 1,5 mg/dl saptandı. Hastaya dörtlü antitüberküloz tedavi başlandı. Duyarlılık testlerinde ilaçlara direnç saptanmadı. İki ay dörtlü antitüberküloz tedavisi almakta olup, kontrollerine devam etmektedir. Sonuç: Tüberküloz insidansı ve prevalansının yüksek olduğu ülkemiz gibi gelişmekte olan ülkelerde, posterior servikal veya supraklaviküler bölgede tek taraflı tek veya birden fazla ağrısız lenfadenopatisi olan olgularda ilk akla gelen tanılardan biri tüberküloz olmalıdır. Akciğer tüberkülozunda sıkça rastlanan ateş, gece terlemesi, kilo kaybı gibi özgül olmayan belirtiler akciğer dışı tutulumda daha az görülmesine rağmen genellikle sessiz ve yavaş ilerleyen bir seyir gösterirler. Klinik bulguların azlığı ve fizik bakı bulgularının belirsizliği tanının gecikmesine neden olmaktadır. Ampirik antibiyoterapi ile küçülmenin olmadığı lenfadenopatilerde histopatolojik tanı için lenf bezi eksizyonundan kaçınılmamalıdır. [ABSTRACT FROM AUTHOR]

Published
2024

49. Predictors of mortality in invasive pneumococcal disease: a meta-analysis.

Author

Demirdal, Tuna, Sen, Pinar, and Emir, Busra

Subjects
PNEUMONIA-related mortality, BACTEREMIA, META-analysis, AGE distribution, SYSTEMATIC reviews, STREPTOCOCCAL diseases, SEX distribution, DRUG resistance in microorganisms, ANTIBIOTICS, PHARMACODYNAMICS
Abstract

Objectives: To assess risk factors for mortality in invasive pneumococcal disease (IPD).Methods: We conducted a systemic literature search in January 2019. The main outcome measure included death within 30 days after diagnosis of IPD. The study protocol was registered in PROSPERO (CRD42019120189).Results: After reviewing 2514 potentially relevant records, remaining 190 articles were included in the analysis. A total of 228,782 IPD patients were identified and the mortality rate was 17.2% in the included articles. No significant evidence of publication bias was found according to the funnel plot and Egger's test (t = 1.464, p = 0.145). Male sex, older age, alcohol abuse, previous tuberculosis, meningitis, hospital acquired infections, multilobar infiltrate or effusion, Pitt bacteremia score≥4, Pneumonia Severity Index≥4, clinical conditions requiring intensive care, underlying clinical conditions, disease caused by serotypes 3, 6B, 9 N, 10A, 11A, 16 F, 17 F, 19, 19 F, 22 F, 23A, 23 F, 31 and 35 F, previous antibiotic use, inappropriate initial antibiotic therapy, penicillin resistance, and vancomycin use during the course of treatment were predicators of 30-day mortality.Conclusions: This meta-analysis highlights important risk factors for IPD-related mortality, many of which may be targeted through preventive measures. [ABSTRACT FROM AUTHOR]

Published
2021
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results