Derleme
BibTex RIS Kaynak Göster

Hipertansif Acillerin Yönetimi ve Tedavisi

Yıl 2020, Cilt: 2 Sayı: 1, 58 - 65, 01.03.2020

Öz

“Hipertansif Acil Durum” ani ve hızlı şekilde tansiyonun genelde ≥180/120 mmHg seviyesine yükselmesi yüzünden end-organ hasarı oluşmasıdır. Acil serviste “Hipertansif Acillerin” düzgün yönetimi ölüm ve kalıcı sakatlığı önlemek için çok önemlidir.

Kaynakça

  • 1. Whelton PK, Carey RM, Aronow WS et al. 2017 ACC/AHA/AAPA/ABC/ACPM/ AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. JACC. 2018;71(19):e127-248.
  • 2. Doğaner YÇ, Aydoğan Ü. Hangi hipertansiyon kılavuzu, hangi eşik değerler? Hipertansiyonda yeni eşik değerler. Türk Aile Hek Derg. 2019; 23 (2): 78-84.
  • 3. Williams B, Mancia G, Spiering W et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal. 2018; 00: 1–98.
  • 4. Aydoğdu S, Güler K, Bayram F ve ark. Türk Hipertansiyon Uzlaşı Raporu 2019. Turk Kardiyol Dern Ars. 2019;47(6):535-546 . 5. Sabuncu T, Şahin İ, Özkan Ç ve ark. Hipertansiyon Tanı ve Tedavi Kılavuzu. Türkiye Endokrinoloji ve Metabolizma Derneği. 2018, Miki Matbaacılık. Ankara.
  • 6. Onat A, Can G, Yüksel H ve ark. TEKHARF 2017 Tıp Dünyasının Kronik Hastalıklara Yaklaşımına Öncülük. Ed. Onat A. 2017, Logos Yayıncılık. İstanbul.
  • 7. Akgün FS, Güneysel Ö. Hipertansiyon Acillerinde Tedavi: “Tansiyonum Fırladı”. Actual Medicine. 2018; 26:4.
  • 8. Elliot JW, Varon J. Evaluation and treatment of hypertensive emergencies in adults UpToDate. 2019.
  • 9. Gifford RW Jr. Management of hypertensive crises. JAMA 1991;14:266(6):829-835.
  • 10. Stewart DL, Feinstein SE, Colgan R. Hypertensive Urgencies and Emergencies. Prim Care Clin Office Pract. 2006;33:613-623.
  • 11. Varon J and Marik PE. Diagnosis and Management of Hypertensive Crisis. CHEST 2000;118:214-227.
  • 12. Khatib OMN, El-Guindy MS. Clinical guidelines for the management of hypertension. World Health Organization. Regional Office for the Eastern Mediterranean 2005.
  • 13. Weber MA , Schiffrin EL , White WB, et al. Clinical Practice Guidelines for the Management of Hypertension in the Community A Statement by the American Society of Hypertension and the International Society of Hypertension. J. Clin. Hypertens. 2014;16:14-26.
  • 14. Ramos A P, Varon J. Current and Newer Agents for Hypertensive Emergencies. Curr Hypertens Rep. 2014;16:1-8.
  • 15. Hebert JC, Vidt DG. Hypertensive Crises. Prim. Care. 2008; 35(3):475-487.
  • 16. Varon J and Marik PE .Clinical Review: The Management of Hypertensive Crises. Critical Care 2003;7:374-384.
  • 17. Baumann BM, Cline DM, Pimenta E. Treatment of of hypertension in the emergency department. J Am Soc Hypertens.2011; 5(5): 366-377.
  • 18. Marcaida JA , Schwid SR ,White WB ,et al. Effects of Tyramine Administration in Parkinson’s Disease Patients Treated With Selective MAO-B Inhibitor Rasagiline. J Mov Disord. 2006;21(10):1716-1721.
  • 19. Marik PE, Varon J. Hypertensive crises: challenges and management. Chest 2007;131(6): 1949-1962.
  • 20. Haas AR and Marik PE. Critical Care Issues for Nephrologist: Current Diagnosis and Management of Hypertensive Emergency. Semin Dialysis. 2006;19(6):502–512.
  • 21. Gandhi SK, Powers JC, Nomeir AM, et al. The pathogenesis of acute pulmonary edema associated with hypertension. N Engl J Med. 2001; 344: 17–22.
  • 22. Kessler CS and Joudeh Y. Evaluation and Treatment of Severe Asymptomatic Hypertension . Am. Fam. Physician. 2010; 81(4): 470-476.
  • 23. Fenves AZ and Ram CVS . Drug Treatment of Hypertensive Urgencies and Emergencies. Semin Nephrol. 2005; 25:272-280.
  • 24. Rodriguez MA, Kumar SK , De Caro M. Hypertensive Crises. Curr. Cardiol. Rev. 2010; 18:102-107.
  • 25. Joint National Committee on Detection Evaluation and Treatment of High Blood Pressure, National High Blood Pressure Education Program Coordinating Committee. The seventh report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure, JNC7 (complete report). NIH Publication No. 04-5230. Bethesda (MD): National Heart, Lung, and Blood Institute, Health Information Center, 2004.
  • 26. Brooks TW, Finch CK, Lobo BL, et al. Blood pressure management in acute hypertensive emergency. Am J Health Syst Pharm 2007;64:2579–2582.
  • 27. Kjeldsen SE, Narkiewicz K, Oparil S, Hedner T. 2013 European Society of Hypertension/European Society of Cardiology Hypertension Guidelines. Blood pressure. 2013;22(4):191-192.
  • 28. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014;311(5):507-520.
  • 29. Rosenow DJ, Russell E. Current Concepts in the management of Hypertensive Crisis: Emergencies and Urgencies. Holist Nurs Pract. 2001;15(4):12-21.
  • 30. Van den Born BJ, Beutler JJ, Gaillard CA, De Gooijer A, Van den Meiracker AH, Kroon AA. Dutch guideline for the management of hypertensive crisis–2010 revision. Neth J Med. 2011; 69(5):248-55.
  • 31. Rivara A ,Montaya E , Varon J. IV Clevidipine for management of hypertension. Integr Blood Press Control. 2010;3:105–111. 32. Marik P, Rivera R. Hypertensive emergencies: an update. Curr Opin Chem Biol 2011;17:569-80.
  • 33. Singla N, Warltier DC, Gandhi SD, et al. ESCAPE-2 Study Group. Treatment of acute postoperative hypertension in cardiac surgery patients: an efficacy study of clevidipine assessing its postoperative antihypertensive effect in cardiac surgery-2 (ESCAPE-2), a randomized, double-blind, placebo-controlled trial. Anesth Analg 2008;107(1):59-67.
  • 34. Pollack, CV, Varon J, Garrison NA et al. Clevidipine, an intravenous dihydropyridine calcium channel blocker, is safe and effective for the treatment of patients with acute severe hypertension. Ann Emerg Med. 2009;53(3):329-338.
  • 35. Ericsson H, Schwieler J, Lindmark BO et al. Enantioselective pharmacokinetics of the enantiomers of clevidipine following intravenous infusion of the racemate in essential hypertensive patients.. Chirality 2001; 13(3): 130-4.
  • 36. Aronson S, Dyke CM, Stierer KA, et al. The ECLIPSE trials: comparative studies of clevidipine to nitroglycerin, sodium nitroprusside, and nicardipine for acute hypertension treatment in cardiac surgery patients. Anesth Analg 2008;107(4):1110-21.
  • 37. Sabbatini M, Strocchi P, Amenta F. Nicardipine and treatment of cerebrovascular diseases with particular reference to hypertension-related disorders. Clin Exp Hypertens 1995; 17(5): 719-750.
  • 38. Schillinger D. Nifedipine in hypertensive emergencies: a prospective study. J Emerg Med 1987; 5: 463–473.
  • 39. Efficacy and safety of intravenous nicardipine in thecontrol of postoperative hypertension. IV Nicardipine Study Group. Chest 1991;99(2):393-398.
  • 40. Van Harten J, Burggraaf K, Danhof M,et al. Negligible sublingual absorption of nifedipine. Lancet 1987;12;2(8572):1363-1365.
  • 41. Woodmansey P, Channer KS. Nifedipine and hypotension. The Lancet 1991; 338(8769):763-764.
  • 42. Haft JI, Litterer WE 3rd. Chewing nifedipine to rapidly treat hypertension. Arch Intern Med. 1984;144(12):2357-2359.
  • 43. Komsuoğlu B, Sengün B, Bayram A, Komsuoğlu SS. Treatment of hypertensive urgencies with oral nifedipine, nicardipine, and captopril. Angiology 1991;42(6):447-454.
  • 44. Diker E, Ertürk Ş, Akgün G: Is sublingual nifedipine administration superior to oral administration in the active treatment of hypertension? Angiology 1992;43:477-481.
  • 45. Chobanian AV; Bakris GL; Black HR; et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA 2003;289(19):2560-2571.
  • 46. Strauss R, Gavras I, Vlahakos D, et al. Enalaprilat in hypertensive emergencies. J Clin Pharmacol. 1986;26(1):39-43.
  • 47. Karakilic E, Buyukcam F, Kocalar G, Gedik S, Atalar E. Same effects of sublingual and oral captopril in hypertension. Eur Rev Med Pharmacol Sci 2012;16:1642-1645.
  • 48. Aggarwal M, Khan IA. Hypertensive Crisis: Hypertensive Emergencies and Urgencies. Cardiol Clin. 2006;24:135-146.
  • 49. Lund –Johansen P. Pharmacology of combined a blockade II Hemodynamic effects of labetalol. Drugs 1984, Suppl 2:35-50.
  • 50. Peacock WF, Varon J, Baumann BM, et al. CLUE: A randomized comperative effectiviness trial of IV Nicardipine versus labetalol use in emergency department. Crit Care 2011;15(3):157.
  • 51. K. F. Bodmann, S. Tröster, R. Clemens, et al. Hemodynamic profile of intravenous fenoldopam in patients with hypertensive crisis. Clin Investig 1993;72:60-64.
  • 52. Munger MA, Rutherford WF, Anderson L, et al. Assessment of intravenous fenoldopam mesylate in the management of severe systemic hypertension. Crit Care Med 1990;18:502-504.
  • 53. Shusterman NH, Elliot WJ, White WB. Fenoldopam, but not nitroprusside, improves renal function in severely hypertensive patients with impaired renal function. Am J Med. 1993;95:161-68.
  • 54. Reisin E, Huth MM, Nguyen BP et al. Intravenouses fenoldopam versus nitroprusside in patients with severe hypertension. Hypertension 1990;15:159-162.
  • 55. Fontes ML, Varon J. Perioperative hypertensive crisis: newer concepts. Int Anesthesiol Clin 2012;50:40-58.
  • 56. Missouris CG, Buckenham T, Cappuccio FP et al. Renal artery stenosis: a common and important problem in patients with peripheral vascular disease. Am J Med 1994;96:10-14.
  • 57. Varon J, Marik PE. Perioperative hypertension management. Vasc Health Risk Manag 2008;4:615-627.
  • 58. Lurbe E, Cifkova R, Cruickshank JK et al. Management of high blood pressure in children and adolescents: Recommendations of the European Society of Hypertension. J Hypertens. 2009;27:1719-1742.
  • 59. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114:555–576.
  • 60. Lindheimer MD, Taler SJ, Cunningham FG. Hypertension in pregnancy. J Am Soc Hypertens. 2008;2:484-494.

Management and Treatment of Hypertensive Emergencies

Yıl 2020, Cilt: 2 Sayı: 1, 58 - 65, 01.03.2020

Öz

“Hypertensive emergency” is a life threathing condition that caused by acute increase of blood pressure usually ≥180/120 mmHg leading end-organ damage. In the Emergency Department appropriate management of “Hypertensive Emergencies” is crucial for preventing death or irreversible disability.

Kaynakça

  • 1. Whelton PK, Carey RM, Aronow WS et al. 2017 ACC/AHA/AAPA/ABC/ACPM/ AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. JACC. 2018;71(19):e127-248.
  • 2. Doğaner YÇ, Aydoğan Ü. Hangi hipertansiyon kılavuzu, hangi eşik değerler? Hipertansiyonda yeni eşik değerler. Türk Aile Hek Derg. 2019; 23 (2): 78-84.
  • 3. Williams B, Mancia G, Spiering W et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal. 2018; 00: 1–98.
  • 4. Aydoğdu S, Güler K, Bayram F ve ark. Türk Hipertansiyon Uzlaşı Raporu 2019. Turk Kardiyol Dern Ars. 2019;47(6):535-546 . 5. Sabuncu T, Şahin İ, Özkan Ç ve ark. Hipertansiyon Tanı ve Tedavi Kılavuzu. Türkiye Endokrinoloji ve Metabolizma Derneği. 2018, Miki Matbaacılık. Ankara.
  • 6. Onat A, Can G, Yüksel H ve ark. TEKHARF 2017 Tıp Dünyasının Kronik Hastalıklara Yaklaşımına Öncülük. Ed. Onat A. 2017, Logos Yayıncılık. İstanbul.
  • 7. Akgün FS, Güneysel Ö. Hipertansiyon Acillerinde Tedavi: “Tansiyonum Fırladı”. Actual Medicine. 2018; 26:4.
  • 8. Elliot JW, Varon J. Evaluation and treatment of hypertensive emergencies in adults UpToDate. 2019.
  • 9. Gifford RW Jr. Management of hypertensive crises. JAMA 1991;14:266(6):829-835.
  • 10. Stewart DL, Feinstein SE, Colgan R. Hypertensive Urgencies and Emergencies. Prim Care Clin Office Pract. 2006;33:613-623.
  • 11. Varon J and Marik PE. Diagnosis and Management of Hypertensive Crisis. CHEST 2000;118:214-227.
  • 12. Khatib OMN, El-Guindy MS. Clinical guidelines for the management of hypertension. World Health Organization. Regional Office for the Eastern Mediterranean 2005.
  • 13. Weber MA , Schiffrin EL , White WB, et al. Clinical Practice Guidelines for the Management of Hypertension in the Community A Statement by the American Society of Hypertension and the International Society of Hypertension. J. Clin. Hypertens. 2014;16:14-26.
  • 14. Ramos A P, Varon J. Current and Newer Agents for Hypertensive Emergencies. Curr Hypertens Rep. 2014;16:1-8.
  • 15. Hebert JC, Vidt DG. Hypertensive Crises. Prim. Care. 2008; 35(3):475-487.
  • 16. Varon J and Marik PE .Clinical Review: The Management of Hypertensive Crises. Critical Care 2003;7:374-384.
  • 17. Baumann BM, Cline DM, Pimenta E. Treatment of of hypertension in the emergency department. J Am Soc Hypertens.2011; 5(5): 366-377.
  • 18. Marcaida JA , Schwid SR ,White WB ,et al. Effects of Tyramine Administration in Parkinson’s Disease Patients Treated With Selective MAO-B Inhibitor Rasagiline. J Mov Disord. 2006;21(10):1716-1721.
  • 19. Marik PE, Varon J. Hypertensive crises: challenges and management. Chest 2007;131(6): 1949-1962.
  • 20. Haas AR and Marik PE. Critical Care Issues for Nephrologist: Current Diagnosis and Management of Hypertensive Emergency. Semin Dialysis. 2006;19(6):502–512.
  • 21. Gandhi SK, Powers JC, Nomeir AM, et al. The pathogenesis of acute pulmonary edema associated with hypertension. N Engl J Med. 2001; 344: 17–22.
  • 22. Kessler CS and Joudeh Y. Evaluation and Treatment of Severe Asymptomatic Hypertension . Am. Fam. Physician. 2010; 81(4): 470-476.
  • 23. Fenves AZ and Ram CVS . Drug Treatment of Hypertensive Urgencies and Emergencies. Semin Nephrol. 2005; 25:272-280.
  • 24. Rodriguez MA, Kumar SK , De Caro M. Hypertensive Crises. Curr. Cardiol. Rev. 2010; 18:102-107.
  • 25. Joint National Committee on Detection Evaluation and Treatment of High Blood Pressure, National High Blood Pressure Education Program Coordinating Committee. The seventh report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure, JNC7 (complete report). NIH Publication No. 04-5230. Bethesda (MD): National Heart, Lung, and Blood Institute, Health Information Center, 2004.
  • 26. Brooks TW, Finch CK, Lobo BL, et al. Blood pressure management in acute hypertensive emergency. Am J Health Syst Pharm 2007;64:2579–2582.
  • 27. Kjeldsen SE, Narkiewicz K, Oparil S, Hedner T. 2013 European Society of Hypertension/European Society of Cardiology Hypertension Guidelines. Blood pressure. 2013;22(4):191-192.
  • 28. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014;311(5):507-520.
  • 29. Rosenow DJ, Russell E. Current Concepts in the management of Hypertensive Crisis: Emergencies and Urgencies. Holist Nurs Pract. 2001;15(4):12-21.
  • 30. Van den Born BJ, Beutler JJ, Gaillard CA, De Gooijer A, Van den Meiracker AH, Kroon AA. Dutch guideline for the management of hypertensive crisis–2010 revision. Neth J Med. 2011; 69(5):248-55.
  • 31. Rivara A ,Montaya E , Varon J. IV Clevidipine for management of hypertension. Integr Blood Press Control. 2010;3:105–111. 32. Marik P, Rivera R. Hypertensive emergencies: an update. Curr Opin Chem Biol 2011;17:569-80.
  • 33. Singla N, Warltier DC, Gandhi SD, et al. ESCAPE-2 Study Group. Treatment of acute postoperative hypertension in cardiac surgery patients: an efficacy study of clevidipine assessing its postoperative antihypertensive effect in cardiac surgery-2 (ESCAPE-2), a randomized, double-blind, placebo-controlled trial. Anesth Analg 2008;107(1):59-67.
  • 34. Pollack, CV, Varon J, Garrison NA et al. Clevidipine, an intravenous dihydropyridine calcium channel blocker, is safe and effective for the treatment of patients with acute severe hypertension. Ann Emerg Med. 2009;53(3):329-338.
  • 35. Ericsson H, Schwieler J, Lindmark BO et al. Enantioselective pharmacokinetics of the enantiomers of clevidipine following intravenous infusion of the racemate in essential hypertensive patients.. Chirality 2001; 13(3): 130-4.
  • 36. Aronson S, Dyke CM, Stierer KA, et al. The ECLIPSE trials: comparative studies of clevidipine to nitroglycerin, sodium nitroprusside, and nicardipine for acute hypertension treatment in cardiac surgery patients. Anesth Analg 2008;107(4):1110-21.
  • 37. Sabbatini M, Strocchi P, Amenta F. Nicardipine and treatment of cerebrovascular diseases with particular reference to hypertension-related disorders. Clin Exp Hypertens 1995; 17(5): 719-750.
  • 38. Schillinger D. Nifedipine in hypertensive emergencies: a prospective study. J Emerg Med 1987; 5: 463–473.
  • 39. Efficacy and safety of intravenous nicardipine in thecontrol of postoperative hypertension. IV Nicardipine Study Group. Chest 1991;99(2):393-398.
  • 40. Van Harten J, Burggraaf K, Danhof M,et al. Negligible sublingual absorption of nifedipine. Lancet 1987;12;2(8572):1363-1365.
  • 41. Woodmansey P, Channer KS. Nifedipine and hypotension. The Lancet 1991; 338(8769):763-764.
  • 42. Haft JI, Litterer WE 3rd. Chewing nifedipine to rapidly treat hypertension. Arch Intern Med. 1984;144(12):2357-2359.
  • 43. Komsuoğlu B, Sengün B, Bayram A, Komsuoğlu SS. Treatment of hypertensive urgencies with oral nifedipine, nicardipine, and captopril. Angiology 1991;42(6):447-454.
  • 44. Diker E, Ertürk Ş, Akgün G: Is sublingual nifedipine administration superior to oral administration in the active treatment of hypertension? Angiology 1992;43:477-481.
  • 45. Chobanian AV; Bakris GL; Black HR; et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA 2003;289(19):2560-2571.
  • 46. Strauss R, Gavras I, Vlahakos D, et al. Enalaprilat in hypertensive emergencies. J Clin Pharmacol. 1986;26(1):39-43.
  • 47. Karakilic E, Buyukcam F, Kocalar G, Gedik S, Atalar E. Same effects of sublingual and oral captopril in hypertension. Eur Rev Med Pharmacol Sci 2012;16:1642-1645.
  • 48. Aggarwal M, Khan IA. Hypertensive Crisis: Hypertensive Emergencies and Urgencies. Cardiol Clin. 2006;24:135-146.
  • 49. Lund –Johansen P. Pharmacology of combined a blockade II Hemodynamic effects of labetalol. Drugs 1984, Suppl 2:35-50.
  • 50. Peacock WF, Varon J, Baumann BM, et al. CLUE: A randomized comperative effectiviness trial of IV Nicardipine versus labetalol use in emergency department. Crit Care 2011;15(3):157.
  • 51. K. F. Bodmann, S. Tröster, R. Clemens, et al. Hemodynamic profile of intravenous fenoldopam in patients with hypertensive crisis. Clin Investig 1993;72:60-64.
  • 52. Munger MA, Rutherford WF, Anderson L, et al. Assessment of intravenous fenoldopam mesylate in the management of severe systemic hypertension. Crit Care Med 1990;18:502-504.
  • 53. Shusterman NH, Elliot WJ, White WB. Fenoldopam, but not nitroprusside, improves renal function in severely hypertensive patients with impaired renal function. Am J Med. 1993;95:161-68.
  • 54. Reisin E, Huth MM, Nguyen BP et al. Intravenouses fenoldopam versus nitroprusside in patients with severe hypertension. Hypertension 1990;15:159-162.
  • 55. Fontes ML, Varon J. Perioperative hypertensive crisis: newer concepts. Int Anesthesiol Clin 2012;50:40-58.
  • 56. Missouris CG, Buckenham T, Cappuccio FP et al. Renal artery stenosis: a common and important problem in patients with peripheral vascular disease. Am J Med 1994;96:10-14.
  • 57. Varon J, Marik PE. Perioperative hypertension management. Vasc Health Risk Manag 2008;4:615-627.
  • 58. Lurbe E, Cifkova R, Cruickshank JK et al. Management of high blood pressure in children and adolescents: Recommendations of the European Society of Hypertension. J Hypertens. 2009;27:1719-1742.
  • 59. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114:555–576.
  • 60. Lindheimer MD, Taler SJ, Cunningham FG. Hypertension in pregnancy. J Am Soc Hypertens. 2008;2:484-494.
Toplam 58 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Acil Tıp
Bölüm Derleme
Yazarlar

Tarık Alay 0000-0002-1563-2292

Yonca Senem Akdeniz 0000-0002-4843-1155

Yayımlanma Tarihi 1 Mart 2020
Gönderilme Tarihi 17 Ocak 2020
Kabul Tarihi 21 Ocak 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 2 Sayı: 1

Kaynak Göster

Vancouver Alay T, Akdeniz YS. Management and Treatment of Hypertensive Emergencies. Phnx Med J. 2020;2(1):58-65.

2392_ccby-295.jpg
Anka Tıp Dergisi  Creative Commons Atıf 4.0 Uluslararası Lisansı ile lisanslanmıştır.

2392_boai-189.jpg

Anka Tıp Dergisi Budapeşte Açık Erişim Deklarasyonu’nu imzalamıştır.