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    Cost-effectiveness of rotavirus vaccination in Turkey
    (Elsevier Taiwan, 2017) Koksal, Tulin; Akelma, Ahmet Zulfikar; Koksal, Ali Osman; Kutukoglu, Irem; Ozdemir, Osman; Yuksel, Cigdem Nuket; Bozkaya, Davut
    Background/Purpose: Cost-effectiveness studies about rotavirus (RV) vaccination programs were performed in many countries due to the severe economic burden of RV infections. This study is an economic evaluation performed to assess the potential for introducing the RV vaccine to the Turkish National Immunization Program. Methods: In this retrospective clinical study, the records and laboratory findings of a total of 4126 patients admitted to Turgut Ozal University Hospital, Ankara, Turkey with acute gastroenteritis were analyzed. A model described by Parashar et al. was used to obtain the annual episodes of diarrhea, hospitalization and outpatients visits in Turkey. Monovalent and pentavalent vaccination was assumed to protect in average 85% of RV acute gastroenteritis. All costs are expressed in 2012 United States (US) $, where US$1 equals 1.8 Turkish Liras (TL). Losses of labor costs were not taken into consideration. Results: The vaccination program with 85% coverage was cost effective and cost saving compared to no vaccination. A projected birth cohort of 1.25 million children was followed until 5 years of age; a routine vaccination could potentially avert 210,994 cases of diarrhea treated in outpatient hospital facilities and 42,715 hospitalizations. The RV associated economic burden was obtained as US$17,909 million per year (US$14.33 per birth annually) in medical direct costs by using the national level of RV diarrhea disease burden estimates. For monovalent and pentavalent vaccination, assuming a cost of US$31.5 and US$38 per vaccine course, the cost of the vaccination program was estimated to be approximately US$37,878 million and US$45,475 million, respectively. Conclusion: At a cost per vaccine course of US$31.5 for monovalent and US$38 for pentavalent vaccine, routine RV vaccination could be potentially cost effective and also cost saving in Turkey. National RV vaccinations will play a significant role in preventing RV infections. Copyright (C) 2016, Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC.
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    Evaluation of therapeutic and prophylactic platelet transfusion practices in a neonatal intensive care unit
    (2019) Korkut, Sabriye; Bozkaya, Davut; Tayman, Cuneyt
    Aim: To investigate the causes of thrombocytopenia requiring platelet transfusion (PT), clinical factors influencing the decision to give PT, and the frequency of major hemorrhage post-PT in a neonatal intensive care unit (NICU). Material and Methods: This retrospective cross-sectional study included neonates who underwent PT at least once in the NICU during a 4-month period. Demographic characteristics, postnatal age at time of PT, number of PTs, thrombocytopenia etiology, and occurrence of major hemorrhage were analyzed. PT threshold was <20x103 /µL in group 1; 20x103 /µL – 49x103 /µL in group 2; and >503 /µL in group 3. Results: Thirty-seven (4.9%) of the 751 patients admitted to the NICU during the study period received PT. These 37 patients received a total of 133 PTs. The most common etiology of thrombocytopenia requiring PT was sepsis (83.5%), followed by NEC (9.8%). Of the 133 PTs, 7 were administered for early-onset thrombocytopenia and 126 for late-onset thrombocytopenia. All patients in group 1 (n=56) had severe thrombocytopenia only with no additional morbidity; patients in group 2 (n=72) had thrombocytopenia accompanied by severe morbidity and/or major hemorrhage, coagulopathy, or extremely low birth weight (ELBW); patients in group 3 (n=4) received PT due to thrombocytopenia and preoperative preparation, coagulopathy, or major hemorrhage. Seven of the 133 PTs (5.3%) were therapeutic and the other 126 (94.7%) were prophylactic. Existing major hemorrhage persisted after 6 of the 7 therapeutic PTs. Major hemorrhage occurred after only 1 prophylactic PT. Conclusion: It was identified bacterial sepsis and NEC as the two most common clinical indications for PT. In general, prophylactic PT was not followed by major hemorrhage, whereas recurrent major hemorrhage occurred after therapeutic PT. Therefore, randomized controlled studies are needed to determine a safe PT threshold value based on a scoring system for predicting the risk of major hemorrhage.
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    Is serum irisin level lower in neonates born to mothers with gestational diabetes?
    (2019) Bozkaya, Davut; Celik, Hasan Tolga; Yigit, Sule; Yurdakok, Murat
    Aim: Irisin is a newly identified myokine that is released from skeletal muscles after exercise and has a regulatory role on energy metabolism. Low serum irisin causes glucose metabolism disorder and metabolic syndrome. The aim of this study was to assess neonatal irisin levels in infants born to mothers with and without gestational diabetes mellitus (GDM).Material and Methods: Hundred neonates born at gestational ages of 26-40 weeks were included in the study. Neonates born to mothers with GDM comprised one group; neonates born to mothers without GDM were evaluated in three groups: appropriate for gestational age (AGA), small for gestational age (SGA), and large for gestational age (LGA) infants. Peripheral blood samples were obtained at postnatal 48 hours and analyzed for serum irisin levels by ELISA.Results: Serum irisin levels in infants born to GDM mothers were significantly lower (mean 0.81 ng/ml) than AGA newborns of healthy mothers (mean 1.21 ng/ml) (p=0.017). Serum irisin levels were not correlated with gestational age, birth weight, Z-score, or BMI (p>0.05). Conclusion: This study show that serum irisin levels are lower in infants born to GDM. Lower irisin levels in the neonatal period may increase the risk of obesity, metabolic syndrome, and glucose metabolism disorder later in life.Keywords: Irisin; newborn; gestational diabetes.