Browsing by Author "Kirnap, Nazli Gulsoy"

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The curative treatment of familial hypercholesterolemia: Liver transplantation
(2019) Kirnap, Nazli Gulsoy; Kirnap, Mahir; Tutuncu, Neslihan Bascil; Moray, Gokhan; Haberal, Mehmet; 31626710; AAH-9198-2019
Background Familial hypercholesterolemia (FH) is an autosomal dominant genetic disorder characterized by premature mortal cardiovascular complications. Liver transplantation (LT) is the only curative treatment option. In this study, the long-term clinical follow-up data of 8 patients who underwent LT with a diagnosis of FH in our center are presented. Materials and Methods A total of 638 LT were performed between December 1985 and June 2019 at Baskent University, of which 8 patients underwent LT with a diagnosis of FH and were evaluated retrospectively. Results Of the 8 patients, 4 underwent deceased donor and 4 living donor transplantation. Five patients had preoperative cardiovascular disease and consequent interventional operations. There was significant reduction in postoperative LDL-C and TC levels starting from the first week, and stabilizing at the first month and first year. The median survival time of patients was 5 years (2-12 years). All patients are still alive. None of the complications of patients with preoperative cardiovascular complications had progressed. Conclusion Liver transplantation is the preferred curative treatment for the pathophysiology of FH. In our study, LDL-C levels were brought under control with LT performed on patients with FH. Median 5-year follow-up of patients showed that the progression of cardiac complications was abated.
Increased monocyte to HDL cholesterol ratio in vitamin B12 deficiency: Is it related to cardiometabolic risk?
(2021) Kirnap, Nazli Gulsoy; 32639203
Vitamin B12 deficiency may have indirect cardiovascular effects in addition to hematological and neuropsychiatric symptoms. It was shown that the monocyte count-to-high density lipoprotein cholesterol (HDL-C) ratio (MHR) is a novel cardiovascular marker. In this study, the aim was to evaluate whether MHR was high in patients with vitamin B12 deficiency and its relationship with cardiometabolic risk factors. The study included 128 patients diagnosed with vitamin B12 deficiency and 93 healthy controls. Patients with vitamin B12 deficiency had significantly higher systolic blood pressure (SBP), diastolic blood pressure (DBP), MHR, C-reactive protein (CRP) and uric acid levels compared with the controls (median 139 vs 115 mmHg, p < 0.001; 80 vs 70 mmHg, p < 0.001: 14.2 vs 9.5, p < 0.001: 10.2 vs 4 mg/dl p < 0.001: 6.68 vs 4.8 mg/dl, p < 0.001 respectively). The prevalence of left ventricular hypertrophy was higher in vitamin B12 deficiency group (43.8%) than the control group (8.6%) (p < 0.001). In vitamin B12 deficiency group, a positive correlation was detected between MHR and SBP, CRP and uric acid (p < 0.001 r:0.34, p < 0.001 r:0.30, p < 0.001 r:0.5, respectively) and a significant negative correlation was detected between MHR and T-CHOL, LDL, HDL and B12 (p < 0.001 r: -0.39, p < 0.001 r: -0.34, p < 0.001 r: -0.57, p < 0.04 r: -0.17, respectively). MHR was high in vitamin B12 deficiency group, and correlated with the cardiometabolic risk factors in this group, which were SBP, CRP, uric acid and HDL. In conclusion, MRH, which can be easily calculated in clinical practice, can be a useful marker to assess cardiovascular risk in patients with vitamin B12 deficiency.
POST-TRANSPLANT DIABETES MELLITUS INCIDENCE AND RISK FACTORS IN ADULT LIVER TRANSPLANTATION RECIPIENTS
(2020) Kirnap, Nazli Gulsoy; Sultanov, Pulat; AlShalabi, Omar; Kirnap, Mahir; Tutuncu, Neslihan Bascil; Haberal, Mehmet A.
Risk Factors and Treatment Options for Persistent Hyperparathyroidism After Kidney Transplantation
(2020) Kirnap, Nazli Gulsoy; Kirnap, Mahir; Sayin, Burak; Akdur, Aydincan; Tutuncu, Neslihan Bascil; Haberal, Mehmet; 0000-0002-8726-3369; 0000-0002-3462-7632; 0000-0002-1816-3903; 0000-0001-8287-6572; 31924405; AAA-3068-2021; AAJ-8097-2021; ABG-5027-2020; J-3707-2015
Background. Kidney transplantation (KT) corrects secondary hyperparathyroidism. However, persistent hyperparathyroidism (pHPT) may be observed in some patients post-KT. This study aims to evaluate the risk factors and treatment options for pHPT. Materials and methods. The study population comprises 1054 patients who underwent KT between January 2001 and May 2019. Serum samples were analyzed for calcium (Ca), phosphorus, creatinine, intact parathyroid hormone (iPTH) and estimated glomerular filtration rate. Results. The prevalence of pHPT following KT is 14%. Ninety pHPT patients were compared with 550 non-pHPT patients. The median duration of pre-KT dialysis was longer, and pre-KT serum Ca, P, and iPTH levels were significantly higher in the pHPT group than the non-HPT group. The pHPT of 46 patients (51%) received medical treatment. The remaining 44 patients (49%) had parathyroidectomy (PTx) if symptoms or signs (or both) of pHPT continued. Subtotal PTx was performed in 35 patients, and minimally invasive PTx was performed in 9 patients. Conclusion. Based on our study results, the most important risk factors for post-KT pHPT are long dialysis duration and high pre-KT iPTH levels. In patients who underwent KT, if pHPT lasts longer than 1 year, surgical treatment is the recommended approach. Based on our experience, the treatment method to be performed in pHPT should be 3+1/2 PTx.
Thyroid cancer incidence and clinicopathological differences in patients with end-stage renal failure
(2020) Kirnap, Nazli Gulsoy; Peker, Hakan; Kirnap, Mahir; Akdur, Aydincan; Akcay, Eda Yilmaz; Moray, Gokhan; 0000-0003-2498-7287; 0000-0002-8726-3369; 0000-0001-6831-9585; AAE-1041-2021; AAA-3068-2021; AAK-1960-2021
Aim: In the present study we aimed to determine the prevalence of thyroid cancer and the clinicopathological properties of papillary thyroid cancer (PTC) in a patient population undergoing dialysis for end-stage renal failure (ESRF). MATERIAL AND METHODS: We retrospectively reviewed all thyroid ultrasonography (USG) examinations performed between January 2007 and December 2015 to determine the incidence of nodular thyroid disease in ESRF and normal patient populations. For both patient groups, differences between patient and tumor characteristics were evaluated in patients diagnosed to have PTC. RESULTS: Among 29.381 patients who underwent thyroid USG examination, 3.491 were included in the ESRF group (Group 1) and 25.890 in the control group (Group 2). Tyroid cancer was detected in 77 (2.2%) of 3.491 patients in Group 1 and 338 (1.3%) of 25.890 patients in Group 2. Thyroid cancer was significantly more prevalent in patients with ESRF (p<0.001). DISCUSSION: When only patients with papillary thyroid cancer were considered, no significant difference existed between the two groups with respect to the prevalence of PTC, although PTC cases in the ESRF group had a significantly higher rate of aggressive characteristics such as capsule invasion, multifbcality, and lymph node metastasis. Whereas thyroid cancer is more common in patients with ESRF compared to normal controls, papillary thyroid cancer was not significantly more prevalent in the ESRF group. CONCLUSIONS: PTC in the ESRF group having more aggressive properties than those in the control group suggests that PTC should be diagnosed earlier in their course, treated more aggressively, and followed more closely in ESRF.
THYROID CANCER RECURRENCE RISK AFTER TRANSPLANTATION: SINGLE CENTER EXPERIENCE
(2020) Iyidir, Ozlem Turhan; Altay, Pinar; Kirnap, Mahir; Kirnap, Nazli Gulsoy; Tutuncu, Neslihan Bascil; Haberal, Mehmet A.
Thyroxin And Thyroid-Stimulating Hormone Changes In Patients With Covid-19
(2022) Kayhan, Sanem; Kirnap, Nazli Gulsoy
Objective: Whether COVID-19 has any effect on thyroid function is still up for debate. The aim of this study was to assess thyroid function in COVID-19 patients. Materials and methods: Clinical signs, laboratory results, and computed tomography scans of the chest of patients followed up in our hospital due to COVID-19 infection, who did not have a known history of thyroid disease, were analyzed retrospectively. Prior to the initiation of treatment for COVID-19 infection, a total of 131 patients who underwent thyroid function tests and 70 healthy volunteers were included in the study as the control group. Serum free thyroxine (fT4) and thyroid-stimulating hormone (TSH) levels of COVID-19 and control groups were measured and compared. Results: When compared with the healthy control group, within the normal range, COVID-19 patients had a significantly lower TSH level and significantly higher fT4 level (p=0.001, p < 0.001, respectively). When each group was compared with the control group in terms of clinical severity, it was found that TSH levels were significantly lower in the critical case group (p < 0.001), and fT4 levels were significantly higher in all levels of clinical severity of COVID-19 (mild to critical) (p < 0.001, p < 0.001, p=0.001, and p=0.006, respectively). Conclusion: Although TSH and fT4 levels were within the normal range in COVID-19 infection, they changed significantly. This suggests that the changes in thyroid function tests in COVID-19 did not have any clinical significance, but caution should be exercised for the transition to thyrotoxicosis in patients with borderline thyroid function tests.
Value of shear wave elastography by virtual touch tissue imaging quantification in patients with diffuse thyroid gland pathology
(2018) Haberal, Kemal Murat; Kural Rahatli, Feride; Turnaoglu, Hale; Kirnap, Nazli Gulsoy; Turhan İyidir, Ozlem; Soudmand, Aresh; Uslu, Nihal; 0000-0002-8211-4065; 30384566; R-9398-2019
Background/aim: This study was performed to assess the diagnostic accuracy of shear wave elastography by virtual touch tissue imaging quantification in patients with diffuse thyroid gland pathology and to differentiate Graves' disease from Hashimoto's thyroiditis. Materials and methods: Thirty patients with Hashimoto's thyroiditis and 22 patients with Graves' disease were evaluated with conventional ultrasonography and shear wave elastography by virtual touch tissue imaging quantification. Thirty healthy participants formed the control group. Ten elastographic measurements of each thyroid lobe were performed in all three study groups. The mean shear wave velocity was calculated and compared between the patients and controls. Results: The mean shear wave velocity of the controls (1.92 +/- 0.14 m/s) was significantly lower than that of the patients with Graves' disease (2.71 +/- 0.22 m/s) and Hashimoto's thyroiditis (2.50 +/- 0.20 m/s). Patients with Graves' disease had significantly higher shear wave velocities than those with Hashimoto's thyroiditis (P < 0.001). Conclusion: Shear wave elastography by virtual touch tissue imaging quantification can be used to discriminate a normal thyroid gland from diffuse thyroid gland pathology after conventional sonography and may assist in the diagnosis of Graves' disease and Hashimoto's thyroiditis.