Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Evaluation of Inflammation-Based Prognostic Risk Scores in Predicting in-Hospital Mortality Risk in Hospitalized COVID-19 Patients: A Cross-Sectional Retrospective Study(2023) Celik, Casit Olgun; Ozer, Nurtac; Ciftci, Orcun; Torun, Serife; Yavuz Colak, Meric; Muderrisoglu, Ibrahim Haldun; 0000-0002-6530-6153; 0000-0002-7190-5443; 0000-0002-0294-6874; 38633908; ABF-1652-2021; AAD-5477-2021; AAA-4360-2021Objective: Systemic inflammatory parameters are predictors of poor prognosis in COVID-19 patients. This study evaluated whether the prognostic nutritional index, which was also related to nutrition risk and other inflammation-based prognostic scores, was predictive of in-hospital mortality in COVID-19 patients.Materials and Methods: This was a retrospective cross-sectional single-center study. Based on the exclusion criteria, 151 patients over 18 years old diagnosed with COVID-19 and hospitalized in the intensive care unit between March 2020 and December 2020 were eligible for this study. Multivariable logistic regression analysis was performed to evaluate the predictive value of the Glasgow Prognostic Score (GPS), Prognostic Index (PI), Prognostic Nutritional Index (PNI), and Systemic Inflammatory Index (SII).Results: In the univariate analyses, age, diabetes mellitus (DM), chronic kidney disease, acute kidney injury, hypothyroidism, hospitalization stay, lactate dehydrogenase (LDH), as-partate aminotransferase (AST), D-dimer, ferritin, C-reactive protein (CRP), albumin, hemoglobin level, platelet count, urea, creatinine level, PNI, GPS were significantly associated with mortality. However, in the multivariable logistic regression analysis of the inflamma-tion-based prognostic scores, only PNI was statistically significant in predicting in-hospital mortality (OR=0.83; [95% CI=0.71-0.97]; p=0.019).Conclusion: PNI is a more useful and powerful tool among these inflammation-based prognostic risk scores in predicting in-hospital mortality in COVID-19 patients.Item An Experimental Case-Based Role Model Study of Mitral NeoChord Implantation with New Tools via Transapical Approach(2023) Doganozu, Ersin; Doganozu, Ayse Ceren; Beyazpinar, Deniz Sarp; Sezgin, Atilla; Muderrisoglu, Ibrahim Haldun; Aydinalp, AlpIncreasing fragility with the aging population compels less invasive procedures. Even if cardiac surgeries are getting minimally invasive with new techniques and technological development in the fi eld, many valve surgery candidates suffer from being qualifi ed as inoperable due to fragility, unstable circulatory system, and to be post-myocardial infarction and their life is in danger every day that they are not operated. The main purpose of this case-based role model study is to invent a new technique for implanting a transapical mitral valve NeoChord implantation with new tools.Item A New Chest Radiography Clue to Predict Saphenous Vein Graft Failure(2022) Akbay, Ertan; Coner, Ali; Akinci, Sinan; Adar, Adem; Demir, Ali Riza; Uygur, Begum; Saba, Tonguc; Budak, Ali Baran; Muderrisoglu, Ibrahim HaldunObjective: Saphenous vein graft failure (VGF) is a measure of the short-and long-term success of coronary artery bypass graft surgery (CABG). Aortic arch calcification (AAC) is a long-term finding of atherosclerosis in large vessels. The aim of this study was to evaluate the relationship between AAC and VGF.Materials and Methods: Patients who underwent CABG surgery and subsequent coronary angiography in a single hospital between January 2010 and January 2021 were included in the study. The presence and stage of AAC was evaluated using preoperative chest X-rays. VGF was defined as >= 75% stenosis and/or total occlusion in the saphenous vein graft. In addition, the effect of AAC on VGF was evaluated based on the time elapsed since the CABG procedure. Results: Of the 594 patients who underwent CABG during the study period, 91 patients (mean age 63.6 +/- 10.0; 71 [78.0%] male) were included in the study. VGF was observed in 49 (53.8%) patients. AAC was found to be an independent predictor of VGF (odds ratio [OR]: 2.788, 95% confidence interval [CI]: 1.068-7.278). The results indicated no association between AAC and VGF in patients whose coronaries were screened within 1 year (OR: 1.143, 95% CI: 0.279-4.683), while there was a strong association between AAC and VGF in patients who were screened 1 year after the surgery (OR: 5.355, 95% CI: 1.618-17.720).Conclusion: AAC evaluation may be a valuable diagnostic method to predict VGF after CABG, and particularly late VGF.Item An epidemiological study to define the recent clinical characteristics and outcomes of infective endocarditis in southern Turkey(2021) Acibuca, Aynur; Yilmaz, Mustafa; Okar, Sefa; Kursun, Ebru; Acilar, Onur; Tekin, Abdullah; Demiroglu, Yusuf Ziya; Muderrisoglu, Ibrahim Haldun; 0000-0002-9866-2197; 0000-0002-5658-870X; 33830167; AAZ-9711-2021; ABD-7304-2021Introduction: The aim of this study was to characterise the recent features of patients with infective endocarditis (IE) at one referral centre in southern Turkey, in order to be able to identify the high-risk subgroup and revise preventative measures and management strategies. Methods: Medical records of patients 18 years and older, who had been diagnosed with IE according to the Duke criteria between January 2009 and October 2019, were retrospectively evaluated in a referral general hospital. Results: The total of 139 IE cases comprised 59.7% males and 40.3% females, with a mean age of 55 +/- 16 years. The most encountered symptom was fever (55.4%) and the mitral valve (54%) was the most frequently involved. The most common causative micro-organisms were coagulase-negative staphylococci (30.2%). The in-hospital mortality rate was 30.2%, with congestive heart failure, chronic renal disease and chronic dialysis found to be significantly associated with in-hospital mortality. Conclusion: The study results demonstrate the recent epidemiological features of IE in southern Turkey that are important for clinicians to manage diagnostic and therapeutic processes successfully. Older age, the predominance of staphylococci and higher surgery rates are consistent with the changing trends of IE in some parts the world.Item Acute Coronary Syndrome In Geriatric Patients In An Intensive Care Unit(2021) Keskin, Suzan; Akgun, Arzu Neslihan; Ciftci, Orcun; Muderrisoglu, Ibrahim HaldunObjective: The advancing age of acute coronary syndrome and the ageing population are leading to an increase in the number of elderly patients with acute coronary syndrome in our clinical practice. In our study, we aimed to investigate the effect of acute coronary syndrome in the geriatric patient group. Materials and Method: We retrospectively included geriatric patients who were in intensive care units because of different diagnoses, who also showed an acute coronary syndrome, and who had been diagnosed using the sequential organ failure assessment score. This score is used to describe the condition of a patient with sepsis and the extent of organ damage during treatment in an intensive care unit. We reviewed patients who were at Baskent University Faculty of Medicine between 25 March 2015 and 12 March 2020. Results: We included 63 patients aged 77.27 +/- 7.65 years. There were 40 (63.5%) males and 23 (36.5%) females. A total of 42 (89.4%) patients died in the first 5 months, one (2.1%) died between the 6th and 10th months, two (4.3%) between the 11th and 20th months, and two (4.3%) between the 21st and 30th months. We found a significant relationship between the sequential organ failure assessment score and mortality rate (p<0.05). The sequential organ failure assessment score was reliable in predicting mortality in geriatric patients with acute coronary syndrome, with 57% sensitivity and 75% specificity. Conclusion: Mortality of geriatric patients with acute coronary syndrome can be significantly determined using the sequential organ failure assessment scores.Item Cardiotoxicity of Trastuzumab Emtansine (T-DM1): A Single-center Experience(2021) Acibuca, Aynur; Sezer, Ahmet; Yilmaz, Mustafa; Sumbul, Ahmet Taner; Demircan, Senol; Muderrisoglu, Ibrahim Haldun; Ozyilkan, Ozgur; 0000-0002-3444-8845; 34898302; ABG-4047-2020Objective New anti-cancer drugs promise to increased survival benefits and reduce adverse events. Trastuzumab emtansine (T-DM1) is a novel anti-human epidermal growth factor receptor 2 agent that has shown minimal cardiotoxicity in clinical trials. However, data on real-life outcomes are required. Methods A retrospective review of our center's medical records was performed, including female patients aged >= 18 years with a diagnosis of metastatic breast cancer who were treated with T-DM1. Descriptive statistics were used to investigate clinical features that could increase the risk of cardiotoxicity. Cardiotoxicity was determined by comparing pre and post-T-DM1 echocardiogram results and was defined as a decrease in the left ventricular ejection fraction (LVEF) >10% to below 55%. Results Data from 41 female patients with a mean age of 52 +/- 11.5 years were evaluated. A significant LVEF decrease (from 59% to 33%) was observed in one patient during T-DM1 treatment. Further investigation showed that this decrease was due to underlying coronary artery disease, and LVEF recovered to the baseline value after coronary revascularization. Conclusion T-DM1 seems to be safe in terms of cardiotoxicity. Real-life data with a larger sample size are still needed to confirm the cardiac safety of T-DM1.Item Markers of coagulation and fibrinolysis do not detect or predict the presence of left atrial appendage thrombus in patients with atrial fibrillation(2020) Doganozu, Ersin; Ciftci, Orcun; Hasirci, Senem; Yilmaz, Kerem Can; Karacaglar, Emir; Sade, Leyla Elif; Muderrisoglu, Ibrahim Haldun; Ozin, Mehmet Bulent; 0000-0002-2538-1642; 0000-0001-8926-9142; 0000-0002-8342-679X; 0000-0003-3737-8595; 32147650; ABI-6723-2020; W-5233-2018; AAK-7805-2021; AAJ-1331-2021; AAQ-7583-2021Objective: This study was designed to evaluate the role of hemostatic variables in arterial blood serum in left atrial thrombosis and to define any hemostatic variables, such as serum biomarkers, that could potentially reduce the need for transesophageal echocardiography. Method: This study included patients with non-valvular asymptomatic atrial fibrillation (AF), either paroxysmal, persistent, or chronic. The presence of an left atrial appendix (LAA) thrombus was used to form 2 groups: thrombus (+) and thrombus (-). The serum levels of the thrombotic/fibrinolytic markers including beta-thromboglobulin, prothrombin fragment 1+2, thrombin/antithrombin complex, human plasminogen activator inhibitor-1/tissue plasminogen activator complex, and D-dimer were compared between 2 groups. Results: The mean age of the study population was 65.6 +/- 12.2 years (range: 30-96 years), and 33 (61.1%) patients were male. Fourteen (25.9%) patients had an LAA thrombus and 40 patients did not. Two groups did not differ significantly with regard to any of the coagulation/fibrinolysis markers. The LAA thrombus (+) group had significantly higher rates of heart failure, peripheral artery disease, coronary artery disease, and chronic obstructive pulmonary disease (p<0.05). Neither the serum levels of the study markers nor demographic and clinical parameters were predictive of an LAA thrombus in binary logistic regression analysis. Conclusion: The arterial blood serum markers did not differ significantly between groups with and without an LAA thrombus and did not predict an LAA thrombus in patients presenting with AF.Item THE OUTCOMES OF USING FIXED-DOSE NOMOGRAM-GUIDED UNFRACTIONATED HEPARIN THERAPY IN ELDERLY PATIENTS IN COMPARISON WITH YOUNGER PATIENTS(2020) Acibuca, Aynur; Muderrisoglu, Ibrahim Haldun; 0000-0002-3444-8845; ABG-4047-2020Introduction: In elderly patients, the dosing of unfractionated heparin is difficult because of changing metabolism, which affects the determination of a therapeutic level. The aim of this study was to evaluate the effects of unfractionated heparin therapy in an older population and to determine whether there was any difference from a younger population in terms of the activated partial thromboplastin time results and complication rates when using a standard nomogram. Materials and Methods: A total of 120 patients aged <80 years (Group 1) and 120 patients aged >= 80 years (Group 2), all of whom had been given unfractionated heparin therapy for selected indications in the coronary care unit, were randomly selected and retrospectively enrolled in the study. Infusion time up to a maximum of 48 hours was included, and activated partial thromboplastin time results in that period were categorised as subtherapeutic, therapeutic, or supratherapeutic. The rates of the patients' subtherapeutic, therapeutic, and supratherapeutic results were compared between groups. Results: The peak activated partial thromboplastin time level was higher in patients aged >= 80 years (58.85 [51.28] vs 76.50 [57.45], p<0.001). The supratherapeutic activated partial thromboplastin time percentage (0 [0.25] vs 0.20 [0.43], p<0.001) and numbers of first activated partial thromboplastin time in the supratherapeutic range (10% vs 24.2%, p=0.004) were significantly higher in the older group. Conclusion: Over-anticoagulation may be a problem in the elderly population when using standard nomograms. It was concluded that improvements should be made for a nomogram specific to an older population.Item The Role of Selvester Score on 12-Lead ECG in Determination of Left Ventricular Systolic Dysfunction Among Patients Receiving Trastuzumab Therapy(2019) Ciftci, Orcun; Yilmaz, Kerem Can; Karacaglar, Emir; Akgun, Arzu Neslihan; Yilmaz, Mustafa; Oguz, Arzu; Muderrisoglu, Ibrahim Haldun; 0000-0001-8926-9142; 0000-0001-6512-6534; W-5233-2018; W-8004-2019; ABI-6723-2020Objective: Breast cancer is the most common cancer in women. Trastuzumab is an effective breast cancer agent. The most significant side effect of trastuzumab is left ventricular systolic dysfunction. Selvester score calculated from 12-lead electrocardiography (ECG) has a proven accuracy in predicting left ventricular infarct area and scar volume. We aimed to determine its role in detection of left ventricular systolic dysfunction among trastuzumab-treated breast cancer patients. Methods: A total of 60 trastuzumab-treated patients were retrospectively included. The patients were grouped into two groups with trastuzumab-induced left ventricular systolic dysfunction (left ventricular ejection fraction (LVEF) <55%) (Group 1) and without (Group 2). The left ventricular systolic dysfunction group was divided into two subgroups: LVEF <50% and (Group 1a) and LVEF 50-54% (Group 1b). The Selvester score was compared between Group 1 and Group 2, and between Group 1a, Group 1b, and Group 2. The predictive role of Selvester score in trastuzumab-induced left ventricular systolic dysfunction was determined with univariate and multivariate analysis. Results: The mean age of the patients was 56.7 +/- 13.7 years. Twenty (21.1%) patients had trastuzumab-induced left ventricular systolic dysfunction. The Selvester score was similar between Group 1 and Group 2. Group 1a had a significantly greater Selvester score compared to Group 1b and Group 2 (p<0.05); however, Group 1b and Group 2 had similar Selvester scores (p>0.05). The Selvester score was significantly correlated with left ventricular systolic dysfunction in univariate analysis (r=0.189, p<0.05) but not in multivariate analysis. Conclusion: Selvester score may be useful especially for detecting severe trastuzumab-induced left ventricular systolic dysfunction.Item Evaluation of Ventricular Repolarization Parameters in Patients Admitted to Emergency Department with Electrical Injury(2020) Celik, Casit Olgun; Ciftci, Orcun; Muratoglu, Murat; Muderrisoglu, Ibrahim HaldunObjective: Prolonged T-peak to T-end (Tp-e), a ventricular repolarization parameter, has been related with ventricular arrhythmias (VAs). Novel electrocardiogram (ECG) parameters of ventricular repolarization have received considerable attention recently. In this study, we sought to investigate ventricular repolarization indexes such as the Tp-e and corrected Tp-e (Tp-ec) intervals, Tp-e/QT, Tp-e/QTc, and Tp-ec/QT ratios in patients with electrical injuries (EIs). Methods: Thirty-six patients diagnosed with EIs and 35 age- and sex-matched healthy control patients were included. Admission ECGs of the EI patients were compared with those of the healthy controls. QT and QTc intervals were measured, and the Tp-e and Tp-ec intervals, Tp-e/QT, Tp-ec/QT, and Tp-e/QTc ratios were then calculated from a 12-lead surface ECG. Results: The QT, Tp-e, Tp-e/QT, Tpe/QTc, Tp-ec/QT were not significantly different between the control group and the EI group (p > 0.05). However, the mean QTc interval was significantly higher in the EI group compared to the control group (412.81 +/- 25.46 vs 396.31 +/- 26.47 ms; p:0.009). Furthermore, the Tp-ec and Tp-ec/QT of the EI subgroup with elevated troponin levels significantly differed from those of the EI patients with normal troponin levels (p:0.033 and p:0.016, respectively). Conclusions: This retrospective study indicated that patients with EIs tend to have a prolonged QTc interval. Additionally, Tp-ec and Tp-ec/QT, which reportedly designate the tendency for VAs, were significantly higher in the EI patients with elevated troponin I levels than the EI patients with normal troponin levels, suggesting that patients with myocardial injury may be prone to VAs.