Person: GÜL, FETHİ
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GÜL
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FETHİ
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Publication Metadata only Terapötik Hipotermi Sonrası Gelişen Enfeksiyonların Öngörülmesinde Hematoloji Parametrelerinin Kullanımı(2017-10-29) HAKLAR, GONCAGÜL; GÜL, FETHİ; KASAPOĞLU, UMUT SABRİ; CİNEL, İSMAİL HAKKI; GÜL F., ÇEVLİK T., ARSLANTAŞ M. K., KASAPOĞLU U. S., HAKLAR G., CİNEL İ. H.Publication Open Access An outbreak investigation of Burkholderia cepacia infections related with contaminated chlorhexidine mouthwash solution in a tertiary care center in Turkey(BMC, 2021-12) GÜL, FETHİ; Bilgin, Huseyin; Gelmez, Gulsen Altinkanat; Bayrakdar, Fatma; Sayin, Elvan; Gul, Fethi; Pazar, Nazli; Culha, Gulcan; Yildiz, Serap Suzuk; Cinel, Ismail; Korten, VolkanBackground: We report a nosocomial outbreak caused by Burkholderia cepacia that occurred among six patients admitted in the medical and surgical intensive care unit between 04 March 2019 and 02 April 2019 in Istanbul, Turkey. Methods: The outbreak investigation was launched on 11 March 2019 five days after the detection of B. cepacia in four different patients. We defined potential reservoirs and started environmental screening. We sampled the liquid solutions used in patient care activities. Pulse-field gel electrophoresis (PFGE) was performed to determine the genetic relatedness of environmental and patient samples. Results: Burkholderia cepacia was isolated in tracheal aspiration cultures of six patients. Three out of six patients developed healthcare-associated pneumoniae due to B. cepacia. Environmental cultures in the ICUs revealed B. cepacia growth in 2% chlorhexidine-gluconate mouthwash solution that been used in the colonized patients as well as in samples obtained from the unused products. PFGE revealed the patient and a specific batch of chlorhexidine mouthwash solution samples had a 96% similarity. Conclusion: Contamination of medical solutions used in critical patient care could cause outbreaks and should be detected early by infection control teams.Publication Metadata only The initial resuscitation of septic shock(W B SAUNDERS CO-ELSEVIER INC, 2020) GÜL, FETHİ; Cinel, Ismail; Kasapoglu, Umut S.; Gul, Fethi; Dellinger, R. PhillipSeptic shock is the most severe form of sepsis, characterized by (a) persistent hypotension despite fluid resuscitation and (b) the presence of tissue hypoperfusion. Delays in the diagnosis and initiation of treatment of septic shock is associated with increasing risk for mortality. Early and effective fluid resuscitation and vasopressor administration play a crucial role in maintaining tissue perfusion in septic shock patients. A low diastolic arterial pressure (DAP) correlates with severity of arteriolar vasodilation, compromises left ventricle oxygen supply and can be used for identifying septic shock patients thatwould potentially benefit fromearlier vasopressor therapy. Controversy currently exists as to the balance of fluids and vasopressors to maintain target mean arterial pressure. The aim of this article is to review the rationale for fluid resuscitation and vasopressor therapy and the importance of both mean and diastolic blood pressure during the initial resuscitation of the septic shock. We relate our personal prescription of balancing fluids and vasopressors in the resuscitation of septic shock. (c) 2020 Elsevier Inc. All rights reserved.Publication Open Access Renal Resistive Index is Unsusceptible to Systemic Hemodynamics in Fluid Responsive Critically III Patients(GALENOS YAYINCILIK, 2019-11-12) BİLGİLİ, BELİZ; Gul, Fethi; Bilgili, Beliz; Arslantas, Mustafa Kemal; Ayhan, Secil Ozcan; Cinel, IsmailObjective: The primary goal of fluid resuscitation in critically ill patients is to improve oxygen delivery to ensure adequate organ perfusion. Little evidence is known about renal response to fluids in the acute phase, so renal monitoring after the fluid challenge is fundamental during critical care stay. This study aimed to evaluate changes in the renal resistive index (RRI) and to compare these changes with hemodynamic parameters after fluid challenge in fluid responsive critically ill patients. Materials and Methods: Thirty patients older than 18 years who underwent sedation and received mechanical ventilation were prospectively studied. Twenty patients were fluid responsive and were included in the study. An increase of cardiac output (CO) by 10% or more after PLR measured by ultrasonic CO monitor suspected fluid responsiveness. 500 mL of isotonic solution was administered intravenously for 30 minutes. CO measurements were performed at 0, 1 and 30 minutes. RRI and mean arterial pressure (MAP) were measured by Doppler ultrasonography at 0 and 30 minutes. Repeated measures ANOVA method was used for statistical analysis and p<0.05 was considered significant. Results: CO increased significantly after fluid challenge when compared to baseline (from 3.48 +/- 1.14 to 4.34 +/- 1.43 L/min, p<0.001). MAP increased significantly after fluid administration when compared to baseline (80 +/- 19 to 86 +/- 17, p=0.002). RRI did not significantly differ from baseline after fluid challenge (62 +/- 9 to 60 +/- 10, p=0.11). There was a negative correlation between RRI and MAP at baseline and after fluid challenge. Conclusion: The effect of hemodynamic changes on renal perfusion after fluid challenge is controversial. In our study, 500 mL of crystalloid treatment for 30 minutes increased MAP and CO, but did not contribute to the improvement of RRI in patients who were fluid responsive. We found that fluid challenge did not improve RRI in the early phase of the fluid resuscitation in fluid responsive critically ill patients and RRI is unsusceptible to systemic hemodynamic changes during this period.Publication Metadata only Treatment approach of cerebral ischemia after revascularization surgery of moyamoya disease: Case report(2019-05-05) GÜL, FETHİ; KASAPOĞLU, UMUT SABRİ; CİNEL, İSMAİL HAKKI; GÜL F., KABADAYI F., KASAPOĞLU U. S., CİNEL İ. H.Publication Metadata only Lazer cerrahisi sırasında gelişen trakeobronşial inhalasyon yanığı- olgu sunumu(2017-10-29) KASAPOĞLU, UMUT SABRİ; GÜL, FETHİ; YUMUŞAKHUYLU, ALİ CEMAL; UMUROĞLU, TÜMAY; CİNEL, İSMAİL HAKKI; KASAPOĞLU U. S., GÜL F., ARSLANTAŞ M. K., YUMUŞAKHUYLU A. C., YAMANSAVCI E., UMUROĞLU T., CİNEL İ. H.Publication Open Access A pilot study for treatment of severe COVID-19 pneumonia by aerosolized formulation of convalescent human immune plasma exosomes (ChipEXO™)(2022-11-01) GÜL, FETHİ; CİNEL, İSMAİL HAKKI; Gül F., Gönen Z. B. , Jones O., Taşlı N. P. , Zararsız G., Ünal E., Özdarendeli A., Şahin F., Eken A., Yılmaz S., et al.This is a single-center prospective, open-label, single arm interventional study to test the safety and efficacy of recently described ChipEXO™ for severe COVID-19 pneumonia. The ChipEXO™ is a natural product derived from convalescent human immune plasma of patients recovered from moderate COVID-19 infection. In September 2021, 13 patients with pending respiratory failure were treated with ChipEXO™ adapted for aerosolized formulation delivered via jet nebulizer. Patients received 1-5x1010 nano vesicle/5 mL in distilled water twice daily for five days as an add-on to ongoing conventional COVID-19 treatment. The primary endpoint was patient safety and survival over a 28-day follow-up. The secondary endpoint was longitudinal assessment of clinical parameters following ChipEXO™ to evaluate treatment response and gain insights into the pharmacodynamics. ChipEXO™ was tolerated well without any allergic reaction or acute toxicity. The survival rate was 84.6% and 11 out of 13 recovered without any sequel to lungs or other organs. ChipEXO™ treatment was effective immediately as shown in arterial blood gas analyses before and two hours after exosome inhalation. During the 5 days of treatment, there was a sustainable and gradual improvement on oxygenation parameters: i.e. respiratory rate (RR) [20.8% (P < 0.05)], oxygen saturation (SpO2) [6,7% (P < 0.05)] and partial pressure of oxygen to the fraction of inspired oxygen (PaO2/FiO2) [127.9% (P < 0.05)] that correlated with steep decrease in the disease activity scores and inflammatory markers, i.e. the sequential organ failure assessment (SOFA) score (75%, p < 0.05), C-reactive protein (46% p < 0.05), ferritin (58% p = 0.53), D-dimer (28% p=0.46). In conclusion, aerosolized ChipEXO™ showed promising safety and efficacy for life-threatening COVID-19 pneumonia. Further studies on larger patient populations are required to confirm our findings and understand the pathophysiology of improvement toward a new therapeutic agent for the treatment of severe COVID-19 pneumonia.Publication Metadata only Yoğun bakım ünitesinde konvelesan plazma kullanımının covid-19 hastalarında mortalite üzerindeki etkisi(2022-03-17) GÜL, FETHİ; BİLGİLİ, BELİZ; CİNEL, İSMAİL HAKKI; Sabah M. S., Gül F., Bilgili B., Kaplan S. T., Oktay B. D., Cinel İ. H.Publication Metadata only Scatter-conductivity (VCS) parametres may predict infections and possible sepsis during therapeutic hypothermia(2017-05-13) GÜL, FETHİ; KASAPOĞLU, UMUT SABRİ; CİNEL, İSMAİL HAKKI; HAKLAR, GONCAGÜL; GÜL F., ARSLANTAŞ M. K., ÇEVİK T., KASAPOĞLU U. S., HAKLAR G., CİNEL İ. H.Publication Metadata only Dental mesenchymal stem cells may have immunoregulatory effect on allorejection(2017-09-27) GÜL, FETHİ; KASAPOĞLU, UMUT SABRİ; AKKOÇ, TUNÇ; CİNEL, İSMAİL HAKKI; GÜL F., DOĞAN D., KASAPOĞLU U. S., AKKOÇ T., CİNEL İ. H.