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    Differences in nephrotoxicity risk and renal effects among anti-viral therapies against hepatitis B
    (2015) Koklu, Seyfettin; Gulsen, Murat Taner; Tuna, Yasar; Koklu, Hayretdin; Yuksel, Osman; Demir, Mehmet; Guner, Rahmet
    Summary Background Results are conflicting with respect to the renal effects of anti-viral agents used for hepatitis B virus infection. Aim To compare short and long-term renal effects in real-life settings and to determine risk factors for renal impairment during treatment. Methods 2221 treatment-naïve patients were enrolled. Among these, 895 (302 lamivudine, 27 telbivudine, 282 entecavir, 273 tenofovir and 11 adefovir initiated patients) had 'repeated measures' of creatinine (baseline, 1st, 6th, 12th and 24th month of treatment). Telbivudine and adefovir groups were excluded from further analysis because of the low number of patients. We calculated the glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) formula at each time point. Hypophosphataemia was also recorded. Risk factors for renal impairment were analysed. Results Tenofovir caused a decline in GFR at each time point when compared to baseline levels. However, lamivudine and entecavir did not change GFR. GFR-shifting from ?90 to 60-89 mL/min/1.73 m2 was comparable among groups. The proportion of patients whose baseline creatinine increased more than 25% was comparable among all anti-virals. GFR showed a decline in patients who switched from entecavir to tenofovir. One patient with compensated cirrhosis needed to change from tenofovir because of renal safety. Seven and three patients developed transient hypophosphataemia in the tenofovir and lamivudine groups, respectively. Conclusions Although tenofovir caused a decline in GFR, differences between the anti-viral agents do not appear to be so impressive. In patients with and without renal risk factors at baseline, there is no impact of anti-virals, including tenofovir. © 2014 John Wiley & Sons Ltd.
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    THE EFFECTS OF ADDITION MALIC ACID AND WHEY ON THE SOME PARAMETERS OF VETCH-WHEAT SILAGES
    (Parlar Scientific Publications (P S P), 2021) Duru, Asuman Arslan; Elmali, Dilek Aksu; Yuksel, Osman; Kutay, Harun
    In this study, the effects of addition matte acid, whey and the combined of whey-malic acid on the silage quality were investigated. In the study, 0.3%; 0.6% and 0.9(Yo malic acid, whey and combinations were used. There were no significant differences in the odour, colour and structure of silages. The levels of dry matter, organic matter, crude ash, crude fiber, crude protein, neutral detergent fiber and acid detergent fiber did not differ. The pH, flieg score, and water soluble carbohydrate value of silages were significantly different. The lowest pH and highest flieg score were found in 0.9% whey and 0.9% whey+0.9% malic acid groups. Ammonia nitrogen and Listeria spp. were not detected. There was no difference in lactic acid bacteria. Sulfite reducing anaerobes were in one sample, and Enterobacteriaceae were in 4 samples. In concluation, adding 0.9% whey or 0.9% whey+0.9% malic acid may be beneficial in vetch-wheat silages.
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    Lamivudine Treatment Failure Risks in Chronic Hepatitis B Patients with Low Viral Load
    (Karger, 2013) Koklu, Seyfettin; Gulsen, Murat Taner; Tuna, Yasar; Koklu, Hayretdin; Yuksel, Osman; Yilmaz, Bans; Karaca, Cetin
    Aim: To analyze the risk factors of lamivudine treatment failure (LTF) for the long-term use in patients with low viral load (LVL). Material and Methods: In this multicenter study, 548 antiviral nave noncirrhotic adult patients with LVL (for HBeAg+ patients HBV DNA <10(9) copies/ml and for HBeAg patients HBV DNA <10(7) copies/ml) were enrolled. As a control group, 46 lamivudine-initiated patients with high viral load (HVL) were included. Primary outcome was switching to or adding on another antiviral drug as a consequence of primary nonresponse, partial response, viral breakthrough or adverse events. Secondary outcomes included LTF rates at 1, 2, 3, 4 and 5 years and LTF-related viral and host factors. Results: Among 594 patients, 294 had to change lamivudine at the follow-up. Primary nonresponse, partial response, viral breakthrough or adverse events frequencies were 6.8, 1.6, 64.5 and 0.1%, respectively. Five-year LTF rates were 61.3 and 84.2% in patients with LVL and HVL, respectively. Among patients with LVL, patients with <100,000 copies/all and >= 100,000 copies/ml had 54.8 and 67.3% LTF rates at the end of the 5th year, respectively. Logistic regression analysis of risk factors showed HBeAg+, hepatic activity index, HBV DNA, virological response at 6 months and duration of follow-up were independent predictors for LTF (p values were 0.001, 0.008, 0.003, 0.020 and 0.003, respectively). Conclusion: Similar to patients with HVL, first-line lamivudine therapy is not efficient for long-term use in patients with LVL. LTF risk is so high even in the absence of worse predictive factors. (C) 2013 S. Karger AG, Basel