{"id":20782,"date":"2024-06-14T08:59:25","date_gmt":"2024-06-14T08:59:25","guid":{"rendered":"https:\/\/www.tuat.org\/?p=20782"},"modified":"2024-10-07T09:55:29","modified_gmt":"2024-10-07T09:55:29","slug":"burhan-burak-kuzucu","status":"publish","type":"post","link":"https:\/\/www.tuat.org\/en\/burhan-burak-kuzucu\/","title":{"rendered":"Oseltamivir Use in Pregnant Women: Safety and Efficacy Evaluation"},"content":{"rendered":"\t\t
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GEBELERDE OSELTAM\u0130V\u0130R<\/h2>

K\u0131\u015f\u0131n gelip ye\u015fil alan\u0131 i\u015fgal eden \u00dcst Solunum Yolu Enfeksiyonu (\u00dcSYE) hastalar\u0131ndan herhalde hepimiz s\u0131k\u0131ld\u0131k. Ger\u00e7i yaz\u0131n da sevmiyoruz bu hastalar\u0131 da neyse. Genel olarak acil ye\u015fil alandaki \u00dcSYE hastalar\u0131 can s\u0131k\u0131c\u0131d\u0131r ancak bir grup var ki beni korkutuyor: Gebe \u00dcSYE. Bir n\u00f6betimizde bir \u00dcSYE(ate\u015f, bo\u011faz a\u011fr\u0131s\u0131) geldi yine. 26 haftal\u0131k gebe, \u00dcSYE ile d\u0131\u015f merkezde 1 g\u00fcn \u00f6nce antibiyoterapi ba\u015flanm\u0131\u015f ancak hasta ger\u00e7ekten d\u00fc\u015fk\u00fcn durumda. Oral al\u0131m\u0131 azalm\u0131\u015f, ate\u015fi d\u00fc\u015fm\u00fcyor. Muayenesinde bakteriyel bir duruma rastlamad\u0131m. Evet evet, antibiyoterapi bo\u015fa verilmi\u015fti yani. Akci\u011fer sesleri de do\u011fal, pn\u00f6monik bir tutulum d\u00fc\u015f\u00fcnmedim. Ben \u00dcSYE’yi sevmem ancak Gebe \u00dcSYE’den bir kez daha diyorum ki korkuyorum. Viral oldu\u011funu d\u00fc\u015f\u00fcnd\u00fc\u011f\u00fcm i\u00e7in hastam\u0131zdan viral panel (bildi\u011fimiz PCR) ald\u0131m. O s\u0131rada Parol tedavisi + hidrasyon veriyordum. Hasta tedavi sonras\u0131 rahatlasa da 30 dakika sonra yine d\u00fc\u015fk\u00fcn hale geliyordu. Viral panel ve kan sonu\u00e7lar\u0131 da bu s\u0131rada \u00e7\u0131kt\u0131 ki 4 saatte \u00e7\u0131kan kan sonucu ve PCR testi mi olur demeyin, hastanelerde de bazen iyi \u015feyler oluyor. \u0130nfluenza A pozitifti. Yani? O an bu olas\u0131l\u0131\u011f\u0131 d\u00fc\u015f\u00fcnmeden alm\u0131\u015ft\u0131m bu testi. Hatta COV\u0130D 19 \u00e7\u0131karsa kad\u0131n do\u011fuma yat\u0131r\u0131r\u0131m falan diyordum kendi kendime. O an ba\u015flad\u0131m influenzaya ufak bir bak\u0131\u015f atmaya. (Asl\u0131nda hepimizin bilmesi gerekti\u011fi bir konuymu\u015f ki zaten hepimiz biliyoruzdur mutlaka)<\/p>

\u0130nfluenza; ortomiksovir\u00fcs ailesine ait bir RNA vir\u00fcs\u00fcd\u00fcr. \u0130nfluenza A, B ve C olmak \u00fczere \u00fc\u00e7 grubu bulunmaktad\u0131r. \u0130nfluenza A i\u00e7erdi\u011fi hemaglutinin ve n\u00f6rominidaz antijen \u00e7e\u015fitlerine g\u00f6re alt gruplara ayr\u0131lmaktad\u0131r. On alt\u0131 tane hemaglutinin ve 9 tane n\u00f6rominidaz \u00e7e\u015fidi bulunmaktad\u0131r. H1N1 (hemaglutinin-1, n\u00f6rominidaz-1) \u015fu anki pandemiden sorumlu spesifik tiptir. S\u00fcre de\u011fi\u015fmekle birlikte, 10-40 y\u0131lda bir antijenik \u015fift ile tamamen yeni bir tip ortaya \u00e7\u0131kar. Ortaya \u00e7\u0131kan bu tipe kar\u015f\u0131 kimse ba\u011f\u0131\u015f\u0131k olmad\u0131\u011f\u0131 i\u00e7in, morbidite ve mortalitesi h\u0131zla artan yayg\u0131n bir salg\u0131n olabilir. \u0130ki \u00fc\u00e7 y\u0131lda bir A ve B tipinde antijenik drift denen min\u00f6r de\u011fi\u015fiklikler olur. Bu de\u011fi\u015fiklikler de toplumda mevsimsel grip salg\u0131nlar\u0131na yol a\u00e7maktad\u0131r. \u0130nfluenza C ise hafif solunum yolu enfeksiyonuna neden olur.<\/p>

\u0130nfluenza, bildi\u011fimiz grip benzeri semptomlar g\u00f6sterir (ki hatta ad\u0131 GR\u0130P). \u0130nfluenza vir\u00fcs\u00fcn\u00fcn direkt olarak teratojenik oldu\u011fu d\u00fc\u015f\u00fcn\u00fclmemektedir. Ancak sebep oldu\u011fu hipertermi nedeni ile indirekt olarak teratojenik oldu\u011fu kabul edilmektedir. Gebelerde t\u00fcm solunum, dola\u015f\u0131m ve imm\u00fcn sistem de\u011fi\u015fikli\u011fe u\u011frad\u0131\u011f\u0131 i\u00e7in gribal enfeksiyon daha a\u011f\u0131r seyredebilir ve ciddi akci\u011fer enfeksiyonuna yol a\u00e7abilir. T\u00fcm gebeler \u00f6zellikle kronik hastal\u0131\u011f\u0131 olan ve k\u0131\u015f aylar\u0131nda gebelik ge\u00e7iren kad\u0131nlar a\u015f\u0131lanmal\u0131d\u0131r. Mesela bizim bu hastam\u0131zda a\u015f\u0131lanmay\u0131 ben sormam\u0131\u015ft\u0131m ilk ba\u015fta. Sonradan sordu\u011fumdaysa kimsenin b\u00f6yle bir \u015fey \u00f6nermedi\u011fini ve a\u015f\u0131lanmad\u0131\u011f\u0131n\u0131 s\u00f6yledi. Gebelerde influenzan\u0131n sonu\u00e7lar\u0131na birka\u00e7 \u00e7al\u0131\u015fma ile bakacak olursak; 2009 influenza (H1N1) pandemisi s\u0131ras\u0131nda \u00f6zelikle 3. trimester s\u0131ras\u0131nda maternal ve fetal komplikasyonlar nedeni ile hospitalizasyon riski y\u00fcksek bulunmu\u015ftur. 2011 H1N1 pandemisi s\u0131ras\u0131nda hospitalize edilen olgular\u0131n %7\u2019si gebe olup bunlar\u0131nda %22\u2019sinde ast\u0131m komorbid olarak bulunmaktayd\u0131.<\/p>

Tedavisi ise olduk\u00e7a basit! \u0130nfluenzadan \u015f\u00fcphelendiysen do\u011frulamaya gerek olmadan erken oseltamivir ba\u015flanabilir (Kategori 2C). Kald\u0131 ki h\u0131zl\u0131 PCR testlerinde negatif sonu\u00e7 \u00e7\u0131ksa dahi influenza tan\u0131s\u0131 d\u0131\u015flanmamaktad\u0131r. Doz oral olarak g\u00fcnde 2 kez 75 mg. kullan\u0131lmas\u0131 yeterlidir. Yatak istirahati, s\u0131v\u0131, asetaminofen gibi destekleyici \u00f6nlemler ve yak\u0131n gerekir (Kategori 2C). Dispne, hipoksi geli\u015fimi veya g\u00f6\u011f\u00fcs muayene bulgular\u0131nda k\u00f6t\u00fcle\u015fme olan durumlarda yak\u0131n g\u00f6zlem amac\u0131yla hastaneye yat\u0131r\u0131lmal\u0131d\u0131rlar. Oseltamivir, “Gebelik Kategorisi C” ila\u00e7lardand\u0131r. Bu durum ila\u00e7lar\u0131n hamile insanlar i\u00e7in g\u00fcvenli\u011fini de\u011ferlendirmek \u00fczere kontroll\u00fc klinik \u00e7al\u0131\u015fmalar\u0131n yap\u0131lmad\u0131\u011f\u0131n\u0131 g\u00f6stermektedir. Bununla birlikte, hamilelik s\u0131ras\u0131nda oral oseltamivir veya zanamivir tedavisine ili\u015fkin \u00e7ok say\u0131da g\u00f6zlemsel \u00e7al\u0131\u015fma, bu ila\u00e7larla antiviral tedavinin hamilelik s\u0131ras\u0131nda g\u00fcvenli oldu\u011funu ve olumsuz olay veya olumsuz gebelik sonu\u00e7lar\u0131 riskini art\u0131rmad\u0131\u011f\u0131n\u0131 g\u00f6stermi\u015ftir (Beau ve ark., 2014; Dunstan ve ark. 2014). 2009 salg\u0131n\u0131ndaki g\u00f6zlemsel \u00e7al\u0131\u015fmalar, antiviral ila\u00e7larla erken tedavi edilen hamilelerin yo\u011fun bak\u0131ma ihtiya\u00e7 duyma ve \u00f6lme olas\u0131l\u0131\u011f\u0131n\u0131n daha d\u00fc\u015f\u00fck oldu\u011funu g\u00f6stermi\u015ftir. (Siston ve di\u011ferleri, 2010; Louie ve di\u011ferleri, 2010).<\/p>

Yani siz siz olun, gebe \u00dcSYE’lere bakmaktan art\u0131k korkmay\u0131n, Oseltamivir’i de unutmay\u0131n!<\/p>

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Kaynak\u00e7a:<\/p>

Tamma, PD, Ault, KA, Del Rio, C, Steinhoff, MC, Halsey, NA, Omer, SB. Safety of influenza vaccination during pregnancy. Am J Obstet Gynecol 2009Am J Obstet Gynecol. 2009 Dec;201(6):547-52.<\/p>

N,\u00a0A,\u00a0Simavl\u0131 SA,\u00a0Duran Erdolu M,\u00a0\u00d6zt\u00fcrk Turhan N.\u00a0H1N1 \u0130nfluenza: Gebelik ve Laktasyon.\u00a0J Clin Obstet Gynecol.\u00a02009;19(6):354-360.<\/p>

Influenza Vaccination During Pregnancy. ACOG Committee Opinion Number 732. Obstet Gynecol 2018;131:109-14.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t\n

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    OSELTAMIVIR IN PREGNANT WOMEN We are all probably tired of patients with Upper Respiratory Tract Infections (URTI) who come and occupy the green area in the emergency department during winter. In fact, we don’t like these patients in the summer either, but let’s leave that aside. Generally, URTI patients in the green area of the […]<\/p>\n","protected":false},"author":3,"featured_media":22164,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[115],"tags":[],"class_list":["post-20782","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/www.tuat.org\/en\/wp-json\/wp\/v2\/posts\/20782","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.tuat.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.tuat.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.tuat.org\/en\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.tuat.org\/en\/wp-json\/wp\/v2\/comments?post=20782"}],"version-history":[{"count":0,"href":"https:\/\/www.tuat.org\/en\/wp-json\/wp\/v2\/posts\/20782\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.tuat.org\/en\/wp-json\/wp\/v2\/media\/22164"}],"wp:attachment":[{"href":"https:\/\/www.tuat.org\/en\/wp-json\/wp\/v2\/media?parent=20782"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.tuat.org\/en\/wp-json\/wp\/v2\/categories?post=20782"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.tuat.org\/en\/wp-json\/wp\/v2\/tags?post=20782"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}