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Öğe Assessment of the Effects of Quince Seed Mucilage and Wheat Germ Oil on Wound Healing in Rats(Marmara Univ, Inst Health Sciences, 2023) Culha, Canan; Gun, Zeynep Ulku; Selcuk, Aysu; Apikoglu, SuleObjective: People have used traditional herbal medicines for wound care since the dawn of time. This study aimed to assess the cutaneous wound healing effects of wheat germ oil (WGO) and quince seed mucilage (QSM) in rats. Methods: Adult female Wistar albino rats were allocated to one of the three groups: rats treated with topical WGO (n=6); topical QSM (n=6); and topical saline (n=6) as the control group. Two circular, full-thickness wounds of 0.6 mm diameter were created on the dorsal thoracic region of each rat. Test and control solutions were applied twice daily for 14 days. Wound healing was assessed by measuring the wound contraction rate and the time needed for complete epithelialization. Results: When compared with the control group, rats in the WGO group had reduced wound closure rates in the first four days, but considerably greater rates in the 8th, 10th, and 12th days, as well as a shorter duration of time needed to complete epithelialization (11 days vs. 13 days). The wound closure rates of the rats in the QSM group were not substantially different from the control rats and the duration of time needed for complete epithelialization was not significantly different from the control group. Conclusion: WGO use has been shown to improve wound healing. It may be used as an alternative or complementary approach for wound treatment depending on the severity of the wounds. On the other hand, QSM was not found to improve wound healing.Öğe Can antibiotics affect the clinical features of patients with candidemia? The retrospective evaluation of 5 years of data in an intensive care unit(Bmj Publishing Group, 2023) Durmus, Mefkure; Kalkan, Serkan; Karahan, Sena Guzel; Bicakcioglu, Murat; Ozdemir, Nesligul; Gun, Zeynep Ulku; Ozer, Ayse BelinBackgroundCandidemia is an opportunistic infection of intensive care units (ICUs) and causes morbidity and mortality. Multiple antibiotic exposure was found to be an independent risk factor for mortality and non-albicans candidemia (NAC) in candidemia patients. AimThe aim of this study was to determine the relationship between antibiotics and clinical features of patients with candidemia, and to determine the independent risk factors for hospital stay >50 days, 30-day mortality in hospital, candidemia types, and septic shock in candidemia patients. MethodsPatients were evaluated retrospectively for 5 years. A total of 148 candidemia cases were detected and included in the study. Characteristics of cases were defined and recorded. The relationship between qualitative data was determined by the chi(2) test. Logistic regression analysis was used to determine the independent risk factors for hospital stay >50 days, 30-day mortality in hospital, candidemia types, and septic shock in candidemia patients. ResultsThe incidence of candidemia for 5 years was 4.5%. Candida parapsilosis was the most reported species with 65% (n=97). Linezolid and central venous catheters (CVC) were found to be independent risk factors for NAC. Carbapenems and cephalosporins were found in association to lower mortality. No antibiotics or characteristics were found to be independent risk factors for mortality. Some broad spectrum antibiotics and antibiotic combinations were found in relationship with hospital stay >50 days; however, none of them were found to be independent risk factors. Metisilin resistant staphylococcus aureus (MRSA) antibiotics, meropenem+linezolid piperacillin-tazobactam+fluoroquinolones and comorbidity were found in association with septic shock, although only piperacillin-tazobactam+fluoroquinolones and comorbidity were found to be independent risk factors for septic shock. ConclusionsThis study concluded that many antibiotics were safe for candidemia patients. However, clinicians should pay attention when prescribing linezolid or piperacillin-tazobactam and flouroquinolons concomitantly or sequentially for patients with candidemia risk factors.Öğe A clinical pharmacist's intervention on interaction between meropenem and valproic acid in paediatric inpatient clinic: A case report(Istanbul Univ, Fac Pharmacy, 2023) Cakir, Ahmet; Memis, Hasan; Ozdemir, Nesligul; Gun, Zeynep UlkuBackground and Aims: Drug-drug interactions cause many complex drug events, especially adverse drug effects. It is known that drug interactions occur when meropenem and valproic acid are used together. It was aimed to back up existing research on the interaction of valproic acid. Methods: After an interaction had been suspected by the ward pharmacists, all of the patient's drugs were assessed via UpToDate (R) and Micromedex (R) databases and the interaction management was shared with the physician in charge. Results: The patient's serum valproic acid through level was in therapeutic range before meropenem administration. After the administration of meropenem, the patient's number of seizures increased and the serum trough level of valproic acid decreased to 4.3 mu g/ml. The valproic acid levels turned back to normal range after switching to a carbapenem antibiotic. Conclusion: Drug interactions are often encountered in paediatric patients and it is of critical importance in terms of seizure control. Because of the drug interaction between valproic acid and meropenem, one should avoid using these medications concomitantly. If that is impossible, daily serum valproic acid levels should be monitored with caution. Clinical pharmacists could increase the clinicians' awareness about drug-drug interactions.Öğe Development of a Liquid Chromatography-Tandem Mass Spectrometry Method for Quantifying Teicoplanin and Its Application in Critically Ill Patients(Doc Design Informatics Co Ltd, 2025) Memis, Hasan; Cakir, Ahmet; Gun, Zeynep Ulku; Saracoglu, Hatice; Karakukcu, Cigdem; Esmaoglu, Aliye; Dogan, ZaferObjective: Teicoplanin, a glycopeptide antibiotic, is used to treat infections caused by Grampositive pathogens. Trough-level monitoring of teicoplanin is recommended in specific patient populations, including critically ill patients. This study aimed to develop and validate a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method to quantify teicoplanin in human plasma and adapt the method to a critically ill patient sample. Materials and Methods: Teicoplanin trough levels were measured using a newly validated LC-MS/MS method. Analysis was conducted using a C18 column with an inner diameter of 2.7 mu m (50.0 x 3.0 mm), and vancomycin hydrochloride was used as the internal standard. The method's run time per sample was 5.5 minutes. Non-parametric tests were used for statistical analysis. Univariate and multivariate logistic regression were performed to identify teicoplanin target attainment factors. A p-value of <0.05 was considered statistically significant. Results: The method demonstrated linearity between 1.56-100 mg/L teicoplanin concentration and had a lower limit of detection and quantification of 0.33 mg/L and 1.00 mg/L, respectively. Precision, accuracy, recovery rate, and carry-over effects were all within acceptable limits, according to the U.S. Food and Drug Administration (FDA) guidance. Twenty patients were included in the study. The target teicoplanin trough level (>= 10 mg/L) attainment rate was 50%. The patient's laboratory values did not significantly change after teicoplanin treatment (p>0.05), except for erythrocyte count, haemoglobin, and haematocrit values, which decreased significantly (p<0.05). Multivariate analysis revealed no significant factors affecting target attainment (p>0.05). Conclusion: The LC-MS/MS assay validated in this study is high-throughput, robust, and quick enough to be implemented in clinical therapeutic drug monitoring (TDM) laboratories. More large-scale studies are needed to understand better the relationship between teicoplanin trough levels and patient-related factors.Öğe The evaluation and classification of drug-related problems by a clinical pharmacist in an internal diseases intensive care unit: A prospective cohort 7-month study(Istanbul Univ, Fac Pharmacy, 2024) Durmus, Mefkuere; Gun, Zeynep Ulku; Berktas, Haci BayramBackground and Aims: Drug -related problems can cause morbidity and mortality as well as increase health-care costs. Clinical pharmacists provide many benefits to healthcare systems by detecting, decreasing, and preventing drug -related problems. It was aimed to determine and classify drug -related problems and determine risk factors for drug -related problems. Methods: Drug -related problems were evaluated prospectively between August 16, 2021, and March 16, 2022, in 257 patients during their hospital stay who were hospitalized in the internal diseases intensive care unit and took at least one drug. Patients who were not administered any drug or who were younger than 18 were excluded from the study. The Pharmacetical Care Network Europe v.9 method was utilized to classify these problems. Clinical and demographic characteristics of patients with and without drug -related problems were compared by statistical analysis. Risk factors of drug -related problems were determined by logistic regression analysis. Results: At least one drug -related problem was detected in 157 of the 257 patients and a total of 399 drug -related problems were recorded. 399 recommendations were made, and 349 (87.5%) of these were accepted and 50 (12.5%) were not accepted. Drug selection (C1) was the most common cause of drug -related problems at 42.2%, and dose selection (C3) followed this by 41.5%. The results of regression analysis showed that atrial fibrillation (OR: 2.985, CI: 1.158-7.692), hematopoietic stem cell transplantation (OR: 3.883, CI: 1.256-11.999), antibacterial drugs (OR: 3.285, CI: 1.563-6.904), or polypharmacy (OR: 3.955, CI:1.207- 11.071) were risk factors of drug -related problems. Conclusion: The most common drug -related problem category was found as treatment safety and the causes of them were found as drug selection and dose selection. Clinicians should pay attention when prescribing new drugs to patients with atrial fibrillation and a history of hematopoietic stem cell transplantation. Furthermore, clinicians and clinical pharmacists should pay attention if polypharmacy and antibacterial drugs are present in medical therapies.Öğe Evaluation of clinical pharmacy services in pediatric nephrology service(Springer, 2021) Gun, Zeynep Ulku; Aksoy, Nilay; Tabel, Yilmaz; Sancar, Mesut[Abstract Not Available]Öğe EVALUATION OF DRUG-DRUG INTERACTIONS IN A LIVER TRANSPLANTATION UNIT(Springer, 2025) Guzel Karahan, Sena; Durmus, Mefkure; Gun, Zeynep Ulku[No abstract available]Öğe Evaluation of Drug-Related Problems of Intensive Care Unit Patients by Clinical Pharmacists: A Retrospective Study(Galenos Publ House, 2024) Cakir, Ahmet; Memisi, Hasan; Gun, Zeynep Ulku; Bicakcioglu, MuratObjectives: The study aimed to identify drug-related problems (DRPs) and risk factors associated with the emergence of DRPs in intensive care unit (ICU) patients. Materials and Methods: This retrospective study included patients in the anesthesiology and reanimation ICU of a university-affiliated tertiary care hospital. DRPs identified by clinical pharmacists were classified using the Pharmaceutical Care Network Europe Classification for DRPs version 9.1. The association between various patient-related factors, and having DRPs were evaluated. Results: In total, 222 patients were included in the study, 128 of which were male (57.7%). The number of DRPs was 388 in 135 patients (1.75 +/- 2.47 DRPs per patient). The group in which at least 1 DRP was identified, the duration of hospitalization was longer than in the group in which no DRP was identified (p < 0.001). In the groups in which there was the presence of mechanical ventilation support at admission or mortality, the mean DRP count was significantly higher than that in the other group (p < 0.05). Age, duration of hospitalization, and the Acute Physiology and Chronic Health Evaluation (APACHE) II score at admission had positive relationships with the DRP count, but the Glasgow Coma Scale (GCS) showed a negative relationship (p < 0.05). According to the binary logistic regression analysis (p < 0.001), in which the age of the patient, GCS score, APACHE II score at admission, duration of hospitalization, and presence of mechanical ventilation support at admission were included, only the APACHE II score at admission and duration of hospitalization significantly affected the emergence of DRPs. The major problem was related to treatment effectiveness (47.9%), followed by treatment safety problems (29.9%). The major causes of these problems were dose selection (44.0%) and drug selection (36.8). Interventions were made at the drug (97.2%) and prescriber level (2.3%). The acceptance rate of interventions and resolution rate of the DRPs were 93.6% and 85.1%, respectively. The top three medications that caused DRPs the most were as follows: meropenem, colistin, and piperacillin/tazobactam. Conclusion: Clinical pharmacists can detect and treat DRPs quickly. Our analysis shows that clinical pharmacy services are needed in high-DRP wards like ICU.Öğe Prospective evaluation of medication-related problems and pharmacist interventions in liver transplant recipients(Frontiers Media Sa, 2026) Guzel Karahan, Sena; Durmus, Mefkure; Cakir, Ahmet; Gun, Zeynep Ulku; Yilmaz, SezaiBackground: Medication-related problems (MRPs) are a common patient safety issue among hospitalized individuals, often associated with reduced quality of life, increased healthcare costs, and higher mortality. Due to the chronic and complex nature of post-transplant care, liver transplant recipients are particularly vulnerable to MRPs. Clinical pharmacists play a critical role in identifying and resolving MRPs, thereby promoting the rational use of medications. The objective of this study was to characterize MRPs among liver transplant recipients and assess the clinical determinants associated with their occurrence. Method: This prospective study was conducted between 5 October 2023 to 31 April 2024 at the Liver Transplantation Institute. A total of 373 hospitalized liver transplant recipients in inpatient wards and intensive care units who were receiving at least one medication were included. Donors and patients not receiving any medication were excluded. The Pharmaceutical Care Network Europe (PCNE) classification system version 9.1 was used to categorize MRPs. Clinical and demographic characteristics of patients with and without MRPs were compared statistically and risk factors were analyzed through logistic regression. Results: Among the 373 patients included in this study, at least one MRP was identified in 311 patients, yielding 620 MRPs in total. A total of 620 interventions were proposed, of which 547 (88.2%) were accepted, while 73 (11.8%) were rejected. The leading causes of MRPs was dose selection (C3) was the most common cause (44.2%), followed by drug selection (C1) at 26.1%. The presence of at least one comorbidity and acute kidney injury were significant risk factors for the occurrence of MRPs (p < 0.05). Conclusion: To our knowledge, this is the first and most comprehensive study applying the PCNE v.9.1 method to liver transplant recipients hospitalized in both ward and intensive care unit settings. The most prevalent MRPs were related to treatment effectiveness, primarily caused by dose selection and drug selection. Clinical pharmacists and physicians should particularly focus on these aspects when reviewing transplant patients' medication regimens. The results achieved in this study suggest that clinicians should exercise caution when prescribing new medications to transplant recipients with at least one comorbidity and a history of acute kidney injury.Öğe The safety profile of favipiravir in COVID-19 patients with severe renal impairment(Wiley-Hindawi, 2021) Gok, Selim; Bahcecioglu, Omer Faruk; Durmus, Mefkure; Gun, Zeynep Ulku; Ersoy, Yasemin; Aytemur, Zeynep Ayfer; Ulutas, OzkanObjective The safety profile of favipiravir in patients with severe renal impairment has not been investigated and available data are insufficient. The study aimed to compare the incidence of favipiravir-associated adverse events amongst patients with varying renal function statuses. Methods Records of 921 patients who were hospitalised for COVID-19 and had received at least 5 days of favipiravir treatment were retrospectively evaluated and 228 patients were included in the study. Patients' age, sex, comorbidities, estimated glomerular filtration rate (eGFR) and haematological and biochemical values were recorded. The incidence of adverse events was compared with the age, sex, comorbidities and eGFR of the patients. Results The mean age of the patients was 59.3 +/- 15.6 years, and 38.2% of the patients were women. One hundred and thirty-one (57.5%) patients had experienced adverse events. These adverse effects consisted of ALT elevation (35.5%), AST elevation (21.5%), anaemia (16.2%), hyperuricaemia (10.5%), hepatocellular injury (9.2%), neutropenia (3.5%) and thrombocytopenia (2.6%). The incidence of adverse events was not significantly different when patients had eGFR >60 mL/min/1.73 m(2) or eGFR 30-60 mL/min/1.73 m(2) (P > .05), but significantly increased when the eGFR dropped to <30 (P < .05). The differences seen with hyperuricaemia and anaemia were significant (P < .05). Conclusion Even though favipiravir appeared to be well tolerated in the individuals with renal failure in this study, its use in this population remains a challenge that requires more research and analysis.
