Browsing by Author "Orhan, Sibel Oyucu"

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Chemo-immunotherapy with atezolizumab in extensive-stage small-cell lung cancer; single-center experience
(Akad Doktorlar Yayınevi, 2020-01-01) Şahin, Ahmet Bilgehan; Çubukcu, Erdem; Ocak, Birol; Deligönül, Adem; Kaçan, Turgut; Orhan, Sibel Oyucu; Evrensel, Türkkan; ŞAHİN, AHMET BİLGEHAN; ÇUBUKÇU, ERDEM; OCAK, BİROL; DELİGÖNÜL, ADEM; OYUCU ORHAN, SİBEL; EVRENSEL, TÜRKKAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Onkoloji Anabilim Dalı; 0000-0002-7846-0870; 0000-0001-7537-1699; 0000-0001-8217-3471; 0000-0002-9732-5340; AAJ-8314-2021; AAJ-1027-2021; AAM-4927-2020; ETP-1691-2022; HHA-1866-2022; ESM-4544-2022
Chemo-immunotherapy (CIT) with platin, etoposide and monoclonal antibodies targeting the PD-1/PDL-1 pathway has recently improved survival in extensive-stage small-cell lung cancer (SCLC) after decades. We aimed to investigate the efficacy and safety of CIT with atezolizumab in extensive-stage SCLC in chemotherapy naive patients. Eleven patients who were treated and followed in our center were included in this retrospective observational study. All the patients received carboplatin, etoposide and atezolizumab in the induction phase and atezolizumab in the maintenance phase. The Kaplan-Meier test was used to determine progression-free survival (PFS) and overall survival (OS), and the effects of the sites of metastasis were analyzed using the log-rank test. The median age was 69.9 years, and 81.8% were male. The median number of CIT and total atezolizumab cycles was 4 and 7, respectively. 63.6% received maintenance therapy. Median PFS was 5.2 months (95% CI: 3.4-6.9), and median OS was 11.3 months (95% CI: 1.0-21.5). The overall response rate was 63.6%. There was no significant difference between patients with and without liver metastasis in terms of PFS and OS. We observed toxicity higher than grade 2 in more than half of the patients, and hematological toxicities were prominent. CIT with carboplatin, etoposide and atezolizumab is efficient and safe in extensive-stage SCLC considering the PFS, OS, response rates, 12-month survival rate, and side effects. The progression of liver lesions was remarkable. Cranial and thoracic radiation are issues that should be discussed in the future with data from clinical studies.
Efficacy of chemotherapeutics on classic and non-classic kaposi sarcoma: A single-center retrospective real-world study
(Assoc Basic Medical Sci Federation Bosnia & Herzegovina Sarajevo, 2021-01-01) Orhan, Sibel Oyucu; OYUCU ORHAN, SİBEL; Sahin, Ahmet Bilgehan; ŞAHİN, AHMET BİLGEHAN; Çubukcu, Erdem; ÇUBUKÇU, ERDEM; Deligonul, Adem; DELİGÖNÜL, ADEM; Ocak, Birol; OCAK, BİROL; Orhan, Bedrettin; ORHAN, BEDRETTİN; Evrensel, Turkkan; EVRENSEL, TÜRKKAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Onkoloji Anabilim Dalı.; 0000-0002-7846-0870; 0000-0001-7537-1699; ACW-2157-2022; AAJ-8314-2021; AEC-2238-2022; AAM-4927-2020
Kaposi sarcoma (KS) is a rare disease, and especially for classic KS, a gap exists in the literature about which chemotherapeutics should be given. Here we present our institutional data on the demographic characteristics, treatment, and treatment efficacy in 16 patients with KS treated with chemotherapy. We retrospectively analyzed the demographic and clinical characteristics of and the chemotherapeutic agents administered to the 16 patients with KS diagnosed in our center based on the medical records obtained. The median age, gender, KS type, involved site, cytotoxic agents administered, progression-free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR), and safety profiles of the patients were evaluated. The median age at disease onset was 61.07 years (range, 39.4-85.8 years). Among the patients, one had immunosuppression-related KS, four had acquired immune deficiency syndrome-related KS, and 11 had classic KS. Regarding the first-line cytotoxic therapy, seven patients received pegylated liposomal doxorubicin (PLD), six received paclitaxel, two received oral etoposide, and one received the doxorubicin, bleomycin, and vincristine regimen. The Kaplan-Meier analysis showed that the PFS was 39.9 months (95% confidence interval (CI), 7.7-72.0). In the first-line setting, a significant difference in PFS was observed between the PLD-and paclitaxel-treated groups (unreached vs. 12.8 months; p = 0.033). The OS was 66.1 months (95% CI, 30.2-102.0). The ORR and DCR of the 16 patients were 43.8%, and 81.3%, respectively. No grade 3 or 4 toxicity was observed. This retrospective study showed that among the most preferred chemotherapeutic agents, PLD seems better than paclitaxel in terms of PFS and response rates, and it showed a good safety profile in patients with KS.
Low pan-immune-inflammation-value predicts better chemotherapy response and survival in breast cancer patients treated with neoadjuvant chemotherapy
(Nature Portfolio, 2021-06-06) Şahin, Ahmet Bilgehan; Çubukçu, Erdem; Ocak, Birol; Deligönül, Adem; Orhan, Sibel Oyucu; Tolunay, Şahsine; Gökgöz, Mustafa Şehsuvar; Çetintaş, Sibel; Yarbaş, Görkem; Şenol, Kazım; Göktuğ, Mehmet Refik; Yanaşma, Zeki Burak; Hasanzade, Ulviyya; Evrensel, Türkkan; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Onkoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Genel Cerrahi Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyasyon Onkolojisi Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; 0000-0002-7846-0870; 0000-0001-8217-3471; 0000-0002-5771-7649; AAM-4927-2020; ETP-1691-2022; AEC-2238-2022; ESM-4544-2022; AAJ-8314-2021; AAI-1612-2021; EWY-5692-2022; EOI-5652-2022; EHL-6662-2022; FVY-2168-2022; JJM-0407-2023; EHR-1518-2022; EXU-7466-2022; EXZ-0745-2022; 57188809248; 53986153800; 57219124259; 37088030300; 57203459665; 6602604390; 57203870909; 6505881756; 57226145851; 55632701500; 57226148550; 57226155008; 57226159463; 6603942124
Blood-based biomarkers reflect systemic inflammation status and have prognostic and predictive value in solid malignancies. As a recently defined biomarker, Pan-Immune-Inflammation-Value (PIV) integrates different peripheral blood cell subpopulations. This retrospective study of collected data aimed to assess whether PIV may predict the pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) in Turkish women with breast cancer. The study consisted of 743 patients with breast cancer who were scheduled to undergo NAC before attempting cytoreductive surgery. A pre-treatment complete blood count was obtained in the two weeks preceding NAC, and blood-based biomarkers were calculated from absolute counts of relevant cell populations. The pCR was defined as the absence of tumor cells in both the mastectomy specimen and lymph nodes. Secondary outcome measures included disease-free survival (DFS) and overall survival (OS). One hundred seven patients (14.4%) had pCR. In receiver operating characteristic analysis, optimal cut-off values for the neutrophile-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte (PLR), PIV, and Ki-67 index were determined as >= 2.34, >= 0.22, >= 131.8, >= 306.4, and >= 27, respectively. The clinical tumor (T) stage, NLR, MLR, PLR, PIV, estrogen receptor (ER) status, human epidermal growth factor receptor-2 (HER-2) status, and Ki-67 index were significantly associated with NAC response in univariate analyses. However, multivariate analysis revealed that the clinical T stage, PIV, ER status, HER-2 status, and Ki-67 index were independent predictors for pCR. Moreover, the low PIV group patients had significantly better DFS and OS than those in the high PIV group (p=0.034, p=0.028, respectively). Based on our results, pre-treatment PIV seems as a predictor for pCR and survival, outperforming NLR, MLR, PLR in predicting pCR in Turkish women with breast cancer who received NAC. However, further studies are needed to confirm our findings.
The impact of ki-67 index, squamous differentiation, and several clinicopathologic parameters on the recurrence of low and intermediate-risk endometrial cancer
(Assoc Basic Medical Sci Federation Bosnia & Herzegovina Sarajevo, 2021-01-01) Ocak, Birol; Atalay, Fatma Oz; Sahin, Ahmet Bilgehan; Ozsen, Mine; Dakiki, Bahar; Ture, Seray; Mesohorli, Merve; Odman, Hikmet Utku; Tanriverdi, Ozgur; Ocakoglu, Gokhan; Bayrak, Mehmet; Ozan, Hakan; Demiroz, Candan; Sali, Seda; Orhan, Sibel Oyucu; Deligönül, Adem; Çubukcu, Erdem; Evrensel, Turkkan; Ocak, Birol; OCAK, BİROL; Sahin, Ahmet Bilgehan; ŞAHİN, AHMET BİLGEHAN; Atalay, Fatma Oz; ÖZ ATALAY, FATMA; Ozsen, Mine; ÖZŞEN, MİNE; Dakiki, Bahar; DAKİKİ KORUCU, BAHAR; Ture, Seray; TÜRE AYDIN, SERAY; Mesohorli, Merve; Odman, Hikmet Utku; Ocakoglu, Gokhan; OCAKOĞLU, GÖKHAN; Bayrak, Mehmet; Ozan, Hakan; OZAN, HAKAN; Demiroz, Candan; DEMİRÖZ ABAKAY, CANDAN; Sali, Seda; SALİ, SEDA; Orhan, Sibel Oyucu; OYUCU ORHAN, SİBEL; Deligonul, Adem; DELİGÖNÜL, ADEM; Cubukcu, Erdem; ÇUBUKÇU, ERDEM; Evrensel, Turkkan; EVRENSEL, TÜRKKAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Onkoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.; 0000-0001-7537-1699; 0000-0002-7188-6115; 0000-0002-7846-0870; 0000-0002-5771-7649; 0000-0001-9255-2475; 0000-0002-1114-6051; 0000-0003-1600-333X; AEC-2238-2022; ABA-2897-2021; AAH-5180-2021; AAM-4927-2020; AAJ-8314-2021
Endometrial endometrioid carcinoma (EEC) represents approximately 75-80% of endometrial carcinoma cases. Three hundred and thirty-six patients with EEC followed-up in the authors' medical center between 2010 and 2018 were included in our study. Two hundred and seventy-two low and intermediate EEC patients were identified using the European Society for Medical Oncology criteria and confirmed by histopathological examination. Recurrence was reported in 17 of these patients. The study group consisted of patients with relapse. A control group of 51 patients was formed at a ratio of 3:1 according to age, stage, and grade, similar to that in the study group. Of the 17 patients with recurrent disease, 13 patients (76.5%) were Stage 1A, and 4 patients (23.5%) were Stage 1B. No significant difference was found in age, stage, and grade between the case and control groups (p > 0.05). Body mass index, parity, tumor size, lower uterine segment involvement, squamous differentiation (SqD), and Ki-67 index with p<0.25 in the univariate logistic regression analysis were included in the multivariate analysis. Ki-67 was statistically significant in multivariate analysis (p = 0.018); however, there was no statistical significance in SqD and other parameters. Our data suggest that the Ki-67 index rather than SqD needs to be assessed for recurrence in patients with low- and intermediate-risk EEC.
The ki-67 proliferation index predicts recurrence-free survival in patients with dermatofibrosarcoma protuberans
(Assoc Basic Medical Sci Federation Bosnia & Herzegovina Sarajevo, 2021-01-01) Tanriverdi, Ozgur; Ozsen, Mine; ÖZŞEN, MİNE; Deligonul, Adem; DELİGÖNÜL, ADEM; Yazici, Serkan; YAZİCİ, SERKAN; Cetintas, Sibel Kahraman; Yalcinkaya, Ulviye; YALÇINKAYA, ÜLVİYE; Sahin, Ahmet Bilgehan; ŞAHİN, AHMET BİLGEHAN; Orhan, Sibel Oyucu; OYUCU ORHAN, SİBEL; Ocak, Birol; OCAK, BİROL; Evrensel, Turkkan; EVRENSEL, TÜRKKAN; Kahveci, Ramazan; KAHVECİ, RAMAZAN; Cubukcu, Erdem; ÇUBUKÇU, ERDEM; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Onkoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Plastik Cerrahi ve Estetik Anabilim Dalı.; 0000-0001-6407-0962; 0000-0002-5771-7649; 0000-0002-7846-0870; 0000-0002-0598-7284; 0000-0001-7537-1699; AAJ-8314-2021; AEC-2238-2022; AAM-4927-2020; M-2172-2015
Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft tissue sarcoma that originates from the dermis or subcutaneous tissue in the skin. While its prognosis is generally favorable, disease recurrence is relatively frequent. Since morbidity after repeated surgery may be significant, an optimized prediction of recurrence-free survival (RFS) has the potential to improve current management strategies. The purpose of this study was to investigate the prognostic value of the Ki-67 proliferation index with respect to RFS in patients with DFSP We retrospectively analyzed data from 45 patients with DFSP. We calculated the Ki-67 proliferation index as the percentage of immunostained nuclei among the total number of tumor cell nuclei regardless of the intensity of immunostaining. We constructed univariate and multivariate Cox proportional hazards regression models to identify predictors of RFS. Among the 45 patients included in the study, 8 developed local recurrences and 2 had lung metastases (median follow-up: 95.o months; range: 5.2-412.4 months). The RFS rates at 60, 120, and 240 months of follow-up were 83.8%, 76.2%, and 65.3%, respectively. The median Ki-67 proliferation index was 14%. Notably, we identified the Ki-67 proliferation index as the only independent predictor for RFS in multivariate Cox proportional hazards regression analysis (hazard ratio = 1.106, 95% confidence interval = 1.019-1.200, p = 0.016). In summary, our results highlight the potential usefulness of the Ki-67 proliferation index for facilitating the identification of patients with DFSP at a higher risk of developing disease recurrences.
Treatment efficacy of ribociclib or palbociclib plus letrozole in hormone receptor-positive/HER2-negative metastatic breast cancer
(Future Medicine Ltd, 2023-05-03) Kahraman, Seda; Erul, Enes; Seyyar, Mustafa; Gumusay, Ozge; Bayram, Ertugrul; Demirel, Burcin Cakan; Acar, Omer; Aksoy, Sercan; Baytemur, Naziyet Kose; Sahin, Elif; Cabuk, Devrim; Basaran, Gul; Paydas, Semra; Yaren, Arzu; Guven, Deniz Can; Erdogan, Atike Pinar; Demirci, Umut; Yasar, Alper; Bayoglu, Ibrahim Vedat; Hizal, Mutlu; Gulbagci, Burcu; Paksoy, Nail; Davarci, Sena Ece; Yilmaz, Funda; Dogan, Ozlem; Orhan, Sibel Oyucu; Kayikcioglu, Erkan; Aytac, Ali; Keskinkilic, Merve; Mocan, Eda Eylemer; Unal, Olcun Umit; Aydin, Esra; Yucel, Hakan; Isik, Deniz; Eren, Onder; Uluc, Basak Oyan; Ozcelik, Melike; Hacibekiroglu, Ilhan; Aydiner, Adnan; Demir, Hacer; Oksuzoglu, Berna; Cilbir, Ebru; Cubukcu, Erdem; Cetin, Bulent; Oktay, Esin; Erol, Cihan; Okutur, Sadi Kerem; Yildirim, Nilgun; Alkan, Ali; Selcukbiricik, Fatih; Aksoy, Asude; Karakas, Yusuf; Ozkanli, Gulhan; Duman, Berna Bozkurt; Aydin, Dincer; Dulgar, Ozgecan; Er, Muhammed Muhiddin; Teker, Fatih; Yavuzsen, Tugba; Aykan, Musa Baris; Inal, Ali; Iriagac, Yakup; Kalkan, Nurhan Onal; Keser, Murat; Sakalar, Teoman; Menekse, Serkan; Kut, Engin; Bilgin, Burak; Karaoglanoglu, Muge; Sunar, Veli; Ozdemir, Ozlem; Turhal, Nazim Serdar; Karadurmus, Nuri; Yalcin, Bulent; Sendur, Mehmet Ali Nahit; OYUCU ORHAN, SİBEL; ÇUBUKÇU, ERDEM; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Onkoloji Anabilim Dalı.; 0000-0001-8217-3471 ; ETP-1691-2022; AAJ-8314-2021
Background: Ribociclib, palbociclib and abemaciclib are currently approved CDK4/6 inhibitors along with aromatase inhibitors as the first-line standard-of-care for patients with hormone receptor-positive, HER2-negative metastatic breast cancer. Methods: The authors report retrospective real-life data for 600 patients with estrogen receptor- and/or progesterone receptor-positive and HER2-negative metastatic breast cancer who were treated with ribociclib and palbociclib in combination with letrozole. Results & conclusion: The results demonstrated that the combination of palbociclib or ribociclib with letrozole has similar progression-free survival and overall survival benefit in real life for the patient group with similar clinical features. Specifically, endocrine sensitivity may be a factor to be considered in the treatment preference.
Uludağ İç Hastalıkları kitabı, cilt 1: Tanıda temel bilgi
(Bursa Uludağ Üniversitesi, 2022-10) Ersoy, Alparslan; Özkalemkaş, Fahir; Evrensel, Türkkan; Ersoy, Canan Özyardımcı; Özkocaman, Vildan; Kıyıcı, Murat; Dalkılıç, Ediz; Gül, Özen Öz; Cander, Soner; Pehlivan, Yavuz; Çubukçu, Erdem; Yıldız, Abdülmecit; Deligönül, Adem; Coşkun, Belkıs Nihan; Çelikçi, Sedat; Şahin, Ahmet Bilgehan; Ünsal, Yasemin Aydoğan; Aydın, Mehmet Fethullah; Coşkun, Nurettin; Orhan, Sibel Oyucu; Pınar, İbrahim Ethem; Aydemir, Ensar; Bozkurt, Zeynep Yılmaz; Yalçın, Cumali; Orhan, Bedrettin; Lermi, Nihal; Candar, Ömer; Ateş, Coşkun; Sali, Seda; Teker, Tufan; Sezen, Mehmet; Ocak, Tuğba; Sakar, Orkun; Güçlü, Özge Aydın; Karadağ, Mehmet; Sarandöl, Emre; Sağ, Şebnem Özemri; Parlak, Müfit; Hakyemez, Bahattin; Topal, Naile Bolca; Nas, Ömer Fatih; Gürsel, Başak Erdemli; İnecikli, Mehmet Fatih; Kaya, Hasan Emin; Özpar, Rifat; Öngen, Gökhan; Akpınar, Ali Tayyar; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Göğüs Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Biyokimya Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Genetik Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nükleer Tıp Anabilim Dalı.
İç Hastalıkları, hekim adayının kliniğe ilk adım attığı ve hastayla karşılaştığı bölümlerden birisidir ve tıp eğitiminin temel taşlarından birisidir. İyi bir iç hastalıkları bilgisine sahip olan bir hekim, gerek aile hekimi gerekse uzman hekim olarak herhangi bir branşta çalışırken hastalarına daha fazla yardımcı olacaktır. Tıpta, hastalıklara doğru bir teşhis koymak için hekim öncelikle iyi bir anamnez almalıdır. Hasta ile iyi bir iletişim kurulmalıdır. Anamnez teşhisin yarısı olarak kabul edilir. Tıbbi öyküde sadece hastanın yakınmaları ve kronolojik olarak hikayesi değerlendirilmez aynı zamanda ayırt edici tanı yapılmaya çalışılır. Sistem sorgulaması hastanın söyleyemediği ya da unuttuğu şikayetleri saptamamızı sağlar. Sonra sistemik bir fizik muayene yapılarak değerlendirme aşamasına geçilir. İyi bir hekim, daima hastanın klinik yakınma ve bulgularını bir hastalık ile açıklayabilmelidir. Böylece hastaya doğru bir tanı koyarak tedaviye başlayabilir, bazen de tanı için ileri incelemelere ihtiyaç duyar. Laboratuvar ve/veya görüntüleme yöntemlerine başvurur. Bu kitapta iyi bir hekimlik sanatı uygulayabilmeniz için yukarıdaki konularda yeterli düzeyde bilgiye sahip olmanız ve hastalara sistematik olarak yaklaşmanız hedeflenmiştir.
Uludağ İç Hastalıkları kitabı, cilt 3: Tanı ve tedavi
(Bursa Uludağ Üniversitesi, 2022-10) Ersoy, Alparslan; Dilek, Kamil; Ali, Rıdvan; Dolar, M. Enver; Güllülü, Mustafa; Yavuz, Mahmut; Gülten, Macit; Nak, Selim Giray; Ertürk, Erdinç; Özkalemkaş, Fahir; Evrensel, Türkkan; Demircan, Celaleddin; Gürel, Selim; Ersoy, Canan Özyardımcı; Özkocaman, Vildan; Kıyıcı, Murat; Dalkılıç, Ediz; Gül, Özen Öz; Cander, Soner; Pehlivan, Yavuz; Çubukçu, Erdem; Yıldız, Abdülmecit; Oruç, Ayşegül; Deligönül, Adem; Ersal, Tuba; Eren, Fatih; Şahin, Ahmet Bilgehan; Orhan, Sibel Oyucu; Bozkurt, Zeynep Yılmaz; Lermi, Nihal; Cesur, Selcan; Teker, Tufan; Ocak, Tuğba; Keskin, Mehmed Kürşad; Ekin, Ali; Coşkun, Alper; Büyükuysal, Rıfat Levent; Çavun, Sinan; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Farmakoloji Anabilim Dalı.
Tanı koyabilmemiz için en azından toplumda sık karşılaştığımız hastalıklar hakkında yeterli bilgi sahibi olmamız gerekmektedir. Tanıda temel bilgileri uygulayarak semptomdan tanıya doğru bir yönde gitmemiz, aradığımız hastalığı bilmemize bağlıdır. Bilmediğimiz bir hastalığın semptom ve bulgularını tespit etsek bile o hastaya yararımız olmayacaktır. Hastalıklar her hastada her zaman aynı şekilde karşımıza çıkmazlar. Aynı tedavi de her hastada aynı sonucu vermeyebilir. Hekim tecrübe kazandıkça mesleğinde ustalaşır. Tedavi aşamasında hastalığın seyrini göre müdaheleler yapmamız, hasta yararına riskli kararlar almamız gerekebilir. Ayrıca uyguladığımız tedavilerin yan etkilerini iyi bilmemiz, hekimliğin temel ilkesi olan “önce zarar verme” ilkesinin dışına çıkmamızı engeller. Bu kitapta İç Hastalıklarının farklı branşlarında karşılaşacağınız birçok önemli hastalığa ve tedavilerine yer verilmiştir.