Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Assessment of the Direct Medical Costs of Type 2 Diabetes Mellitus and its Complications in Turkey(2014) Malhan, Simten; Oksuz, Ergun; Babineaux, Steven M.; Ertekin, Ali; Palmer, James P.; 0000-0002-5723-5965; K-8238-2012Purpose: To estimate the direct annual medical costs of Type 2 diabetes and its complications in diagnosed patients in Turkey. Material and Method: A cost-of-illness model was developed. The prevalence of Type 2 diabetes was derived from the Turkish Diabetes Epidemiology Study, estimated as 13.7% in adults, with one-third of patients previously undiagnosed. Complication costs were extracted from the records of 7095 patients at a Turkish tertiary care hospital in 2009. For each modelled complication, acute phase costs were applied to globally derived incidence rates, and one-year follow-up costs were applied to globally derived prevalence rates. Costs and frequencies of ongoing antihyperglycaemic treatment and disease management were derived from treatment guidelines and Turkish hospital records. Parameter variation was performed. Results: The cost of Type 2 diabetes in diagnosed patients was estimated at between 11.4 to 12.9 billion Turkish Lira, 1% of Gross Domestic Product. Cardiovascular complications comprised the largest share of total medical costs (between 24.3% and 32.6%), followed by renal complicationsrelated costs (between 25% and 28.3%) and concomitant cardiovascular and antihypertensive medication costs (between 14.2% and 16%). Antihyperglycaemic medications and screening costs comprised between 10.9% to 12.3% and between 4.4% to 5% of total costs, respectively. Discussion: Type 2 diabetes is a disease burden and economic burden in Turkey; the complications cost is higher than the cost of disease control. For preventing complications, any activities effect positively limited resources and also quality of life.Item Epidemiology of Colorectal Cancer in Turkey: A Cross-Sectional Disease Registry Study (A Turkish Oncology Group Trial)(2015) Aykan, Nuri Faruk; Yalcin, Suayib; Turhal, N. Serdar; Ozdogan, Mustafa; Demir, Gokhan; Ozkan, Metin; Yaren, Arzu; Camci, Celalettin; Akbulut, Hakan; Artac, Mehmet; Meydan, Nezih; Uygun, Kazim; Isikdogan, Abdurrahman; Unsal, Diclehan; Ozyilkan, Ozgur; Arican, Ali; Seyrek, Ertugrul; Tekin, Salim Basol; Manavoglu, Osman; Ozet, Ahmet; Elkiran, Tamer; Disci, Rian; 0000-0001-8825-4918; 25835113; AAD-2817-2021Background/Aims: This study aimed to determine the epidemiological characteristics of colorectal cancer in Turkey. Materials and Methods: In this multicenter, prospective, and cross-sectional registry study, data for 968 patients with colorectal cancer from 21 centers in 7 geographic regions were analyzed. Results: Diagnosis was colon cancer in 662 (68.4%) and rectum cancer in 306 (31.6%) patients. In total, 60.9% of patients was male; mean age was 58.9 +/- 12.6 years. Among patients, 15.0% was drinking alcohol, 17.5% was smoking, 1.5% had familial history of polyposis, 15.0% had diabetes mellitus, 1.0% had inflammatory bowel disease. Fruit and vegetable consumption was low (<3 times/week) in 35.5% and red meat consumption was high (>= 3 times/week) in 47.4% of the patients. Median time-to diagnosis was 3.0 months and 4.0 months for patients with colon and rectum cancer, respectively. Mean body mass index was >25 in all group of patients. Distal rectum (61.3%) and sigmoid colon (36.8%) were the most common locations of cancer, for rectum and colon respectively. In total, 85.6% of patients were operated; 25.8% had emergency surgery. Low anterior resection rate was 64.2% in rectum cancer. In majority (89.8%) of the patients with rectum cancer who received preoperative treatment, conventional chemo-radiotherapy regimen was given. pTNM staging at diagnosis showed that stage III and IV patients were in majority (35.9% and 29.7%, respectively). Conclusion: Colon cancer is more frequent than rectum cancer in Turkey. Colorectal cancer patients are diagnosed at later stages. Most of the cases were operated. Interregional differences for risk factors are worthwhile for evaluation in future trials.Item Cutaneous Melanoma in Turkey: Analysis of 1157 Patients in the Melanoma Turkish Study(2015) Abali, Huseyin; Celik, Ismail; Karaca, Burcak; Turna, Hande; Saglam, Esra Kaytan; Akman, Tulay; Oztop, Ilhan; Coskun, Hasan Senol; Turhal, Nazim Serdar; Sezer, Ahmet; Nayir, Erdinc; Demir, Gokhan; Budakoglu, Burcin; Issikdogan, Abdurrahman; Engin, Huseyin; Kilickap, Saadettin; Coskun, Ugur; Oyan, Basak; Harputluoglu, Hakan; Er, Ozlem; Kavgaci, Halil; Elkiran, Tamer; 26416068Purpose: To develop a large Turkish National Melanoma registry in order to define demographic and clinicopathologic characteristics of patients with melanoma. Methods: The data was collected from 1635 patients with melanoma through a web-based registry system in 22 centers. Herein we present the results of 1157 patients with cutaneous melanoma. Results: The patient median age was 56.4 years and 646 (55.8%) were males. The commonest subtype was superficial spreading type (357, 30.9%). The commonest primary site was the lower extremities (N=353, 30.5%). The most common Breslow thickness was 1-2 mm (361 patients, 43.5%). Only 104 (12.5%) patients had a thickness <1mm. Among 694 patients with available data, 136 (19.6%) presented with stage 4 disease while the most frequent stage was stage 3, encountered in 393 (56.6% patients). Conclusion: Our melanoma registry is the largest in our country providing a snapshot view of cutaneous melanoma and its care. Our patients presented with more advanced stages and they had worse prognosis compared to SEER database.Item Aflatoxin Levels in Chronic Hepatitis B Patients with Cirrhosis or Hepatocellular Carcinoma in Balkesir, Turkey(2015) Aydin, M.; Aydin, S.; Bacanli, M.; Basaran, N.; 0000-0003-4044-9366; 0000-0001-8581-8933; 0000-0002-6368-2745; 25894298; HLX-0937-2023; J-1104-2013; J-1114-2013Aflatoxins, the secondary metabolites produced by species of naturally occurring Aspergilli, are commonly found in food such as cereals, dried fruits and juice, wine, beer and spices. They are hepatotoxic and are well known human carcinogens based on evidence from human studies. Aflatoxins are an environmental risk factor for the development of hepatocellular carcinoma (HCC). Chronic hepatitis B-infected patients are at increased risk of cirrhosis, hepatic failure and liver cancer. This study was designed to determine the serum aflatoxin B-1 (AFB(1)), aflatoxin B-2 (AFB(2)), aflatoxin G(1) (AFG(1)) and aflatoxin G(2) (AFG(2)) concentrations using high-pressure liquid chromatography (HPLC) in hepatitis B-infected patients with or without cirrhosis and liver cancer, alongside healthy controls in Balkesir, Turkey. The mean AFB(1) and total AF levels in patients without liver cancer and cirrhosis were significantly higher than healthy controls. The mean AFB(1) and total AF levels in patients with chronic hepatitis B and HCC were significantly higher than infected patients with or without cirrhosis. These results suggest that patients with chronic hepatitis B who are exposed to AFs are at increased risk for developing HCC, which might be prevented by reducing consumption of contaminated foods.Item A Multicenter Nationwide Reference Intervals Study For Common Biochemical Analytes in Turkey Using Abbott Analyzers(2014) Sezgin, Nurzen; 25153598Background: A nationwide multicenter study was organized to establish reference intervals (RIs) in the Turkish population for 25 commonly tested biochemical analytes and to explore sources of variation in reference values, including regionality. Methods: Blood samples were collected nationwide in 28 laboratories from the seven regions (>= 400 samples/region, 3066 in all). The sera were collectively analyzed in Uludag University in Bursa using Abbott reagents and analyzer. Reference materials were used for standardization of test results. After secondary exclusion using the latent abnormal values exclusion method, RIs were derived by a parametric method employing the modified Box-Cox formula and compared with the RIs by the non-parametric method. Three-level nested ANOVA was used to evaluate variations among sexes, ages and regions. Associations between test results and age, body mass index (BMI) and region were determined by multiple regression analysis (MRA). Results: By ANOVA, differences of reference values among seven regions were significant in none of the 25 analytes. Significant sex-related and age-related differences were observed for 10 and seven analytes, respectively. MRA revealed BMI-related changes in results for uric acid, glucose, triglycerides, high-density lipoprotein (HDL)-cholesterol, alanine aminotransferase, and.-glutamyltransferase. Their RIs were thus derived by applying stricter criteria excluding individuals with BMI >28 kg/m(2). Ranges of RIs by non-parametric method were wider than those by parametric method especially for those analytes affected by BMI. Conclusions: With the lack of regional differences and the well-standardized status of test results, the RIs derived from this nationwide study can be used for the entire Turkish population.Item Real World Data Estimation: Management and Cost-analysis of Stroke in Tertiary Hospitals in Turkey and the Impact of Co-morbid Malnutrition(2016) Arsava, Ethem Murat; Ozcagli, Tahsin Gokcem; Berktas, Mehmet; Giray, Semih; Guler, Ayse; Gungor, Levent; Ozdemir, Ozcan; Uluc, Kayihan; Yaka, Erdem; Yesilot, Nilufer; https://orcid.org/0000-0002-0722-3181; AAH-1091-2020Objective: To evaluate the management and cost analysis of first-ever stroke patients in Turkey and determine the impact of comorbid malnutrition. Methods: This study was based on expert's view on the management and cost analysis of stroke patients with or without malnutrition via standardized questionnaire forms filled by experts according to their daily clinical practice. Cost items were related to medical treatment, healthcare resources utilization, tests, consultations and complications. Per admission and total annual direct medical costs were calculated with respect to co-morbid malnutrition. Results: Malnutrition was evident in 7.8(3.6)% [mean(standard error of mean; SEM)] of patients at admission; an additional 7.1(4.8)% and 0.9(0.6)% patients developed malnutrition during Neuro-ICU and stroke unit hospitalization, respectively. Length of hospital stay (LOS) was almost 2-fold in patients with malnutrition (P<0.01 for all hospital units). During the 1-year follow-up period a mean(SEM) of 93.8(15.4)% with and 43.3(3.7)% without malnutrition were expected to experience at least 1 complication. The mean (SEM) per patient annual cost of stroke was US$5201(740) in patients with malnutrition and US$3619(614) in patients without malnutrition, while the corresponding figures for per admission were US$3061(513) and US$1958(372), respectively. Conclusions: In conclusion, our findings revealed that management of stroke and its complications have a relatively high burden on the Turkish health reimbursement system. Furthermore, co-morbid malnutrition, being not uncommonly encountered, increased the overall costs and was associated with longer LOS and higher rate of expected complications during 1-year follow up.Item Better Knowledge and Regular Vaccination Practices Correlate Well with Higher Seasonal Influenza Vaccine Uptake in People at Risk: Promising Survey Results from A University Outpatient Clinic(2017) Guvenc, Isil Adadan; Parildar, Hulya; Sahin, Mustafa Kursat; Erbek, Selim Sermed; https://orcid.org/0000-0003-4825-3499; 28449918; S-2103-2016; B-7604-2019Background: The knowledge, beliefs, opinions, and attitudes of patients and their relatives regarding seasonal influenza vaccination were evaluated. Methods: This descriptive study was undertaken in the outpatient clinics of Baskent University Hospital. There were 566 responders who completed a self-administered questionnaire. Results: The mean age of participants was 48.35 years, and 16.8% were >= 65 years. Of the responders, 21.7% were vaccinated this year, whereas 57.8% did not desire to get it. Vaccination rates were significantly higher among responders >= 65 years of age (56.4%), those having at least 1 chronic illness (46.5%), and those who were vaccinated regularly every year (22.2%). Half of the responders did not know that the vaccine was reimbursed for people at risk. The most common reason for refusing the influenza vaccine was not getting the flu frequently (51.2%). Fear of side effects, concerns about vaccine's effectiveness, and belief that vaccine causes the flu were other common reasons for not being vaccinated. Of the responders, 77% believed that getting official information or a recommendation from a physician would influence their decision about seasonal influenza vaccination. Conclusions: People who are at risk or vaccinated regularly display a higher vaccine uptake and better knowledge of influenza and vaccination. The opinions and attitudes of this study population may assist in developing strategies for changing attitudes of the public toward influenza vaccination. (C) 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.Item Clinical Findings and Mutation Analysis of NF1 Patients in Turkey(2018) Terzi, Yunus Kasim; Oguzkan-Balci, Sibel; Anlar, Banu; Varan, Ali; Ersoy-Evanse, Sibel; Sharafif, Parisa; Ayter, Sukriye; https://orcid.org/0000-0001-5612-9696; B-4372-2018Neurofibromatosis type 1 (NF1) is an autosomal dominant disease that is caused by mutations of the NF1 gene. NF1 is clinically characterized by neurofibromas, pigmentation anomalies, and an increased risk of malignant tumors. The mutation rate of NF1 is one of the highest known for human disorders: approximately 50% of all affected individuals are sporadic cases and carry de novo mutations Therefore mutation analysis of NF1 may be an important tool in early diagnosis and genetic counseling. This is the first large NF1 study performed in Turkey. The data collected in this study enabled us to overview the genetic and clinical aspects of NF1 molecular diagnostics. The patients, who were clinically diagnosed for NF1, were included in this study. These patients were clinically evaluated, and subgroup of them genotyped or DNA sequenced for mutations in NF1, either to confirm the clinical diagnosis or to identify pathogenic mutations. The mutation detection rate was 52%, based on analysis of only genomic DNA. We observed that frameshift mutations were the largest proportion of the identified mutations (38.5%). The frequency of microdeletions was 26.9% and the splice site and nonsense mutations were 11.5% in this cohort. Turkish NF1 patients have similar NF1 germline mutations compared to other populations. Considering that some of these detected mutations belonged to the patients who did not fulfill the NIH criteria for NF1 diagnosis, mutation analysis of NF1 is an important tool in early diagnosis and genetic counseling.Item What Have We Learned from Turkish Familial Hypercholesterolemia Registries (A-HIT1 And A-HIT2)?(2018) Yildirir, Aylin; https://orcid.org/0000-0001-8750-5287; 30270069; A-4947-2018Background and aims: Familial hypercholesterolemia (FH) is a common genetic disease of high-level cholesterol leading to premature atherosclerosis. One of the key aspects to overcome FH burden is the generation of largescale reliable data in terms of registries. This manuscript underlines the important results of nation-wide Turkish FH registries (A-HIT1 and A-HIT2). Methods: A-HIT1 is a survey of homozygous FH patients undergoing low density lipoprotein (LDL) apheresis (LA). A-HIT2 is a registry of adult FH patients (homozygous and heterozygous) admitted to outpatient clinics. Both registries used clinical diagnosis of FH. Results: A-HIT1 evaluated 88 patients (27 +/- 11 years, 41 women) in 19 centers. All patients were receiving regular LA. There was a 7.37 +/- 7.1-year delay between diagnosis and initiation of LA. LDL-cholesterol levels reached the target only in 5 cases. Mean frequency of apheresis sessions was 19 +/- 13 days. None of the centers had a standardized approach for LA. Mean frequency of apheresis sessions was every 19 +/- 13 (7-90) days. Only 2 centers were aware of the target LDL levels. A-HIT2 enrolled 1071 FH patients (53 +/- 8 years, 606 women) from 31 outpatients clinics specialized in cardiology (27), internal medicine (1), and endocrinology (3); 96.4% were heterozygous. 459 patients were on statin treatment. LDL targets were attained in 23 patients (2.1% of the whole population, 5% receiving statin) on treatment. However, 66% of statin-receiving patients were on intense doses of statins. Awareness of FH was 9.5% in the whole patient population. Conclusions: The first nationwide FH registries revealed that FH is still undertreated even in specialized centers in Turkey. Additional effective treatment regiments are urgently needed.Item A Bibliometric Analysis of Turkey's Contribution to Bone Health Literature from an Endocrinologist Perspective(2019) Degertekin, Ceyla Konca; İyidir, Ozlem Turhan; Yavuz, Dilek Gogas; 0000-0001-5305-6807; K-7904-2019Objective: To analyze the trend of Turkish publications related to bone health with respect to global publications and to determine the relative contribution of endocrinologists to metabolic bone disease literature. Material and Methods: Publications related to bone health up to and including the year 2017 were retrieved from the "Web of Science" (WoS) and "TUrkiye Atif Dizini" (TAD) database using metabolic bone disease related MeSH terms. Excel (v15.30) and Endnote X8 were used to summarize the bibliometric features, including the number of publications, authors, their affiliations, and contributing countries. Keywords were divided, for a detailed analysis, into three clusters: osteoporosis, parathyroid, and vitamin D-related. Results: A total of 1.880.666 papers were retrieved from WoS globally and, of those, 21.165 (1.13%) were published from Turkey. Of the papers published from Turkey, 3.0% were primarily contributed by endocrinologists. The relative contribution of endocrinology to osteoporosis-related (4.6% vs. 1.5%), parathyroid-related (23.7% vs. 5.3%), and vitamin D-related (23.7% vs. 5.3%) publications was higher for articles originating from Turkey compared to the global data. Endocrinology was among the top five specialties contributing to Turkish metabolic bone disease literature indexed in WoS and TAD. Conclusion: Turkey has a less than expected rate of research output in terms of metabolic bone disease. The relatively higher contribution of endocrinology to that effort is promising. Supporting bone research might accelerate the efforts of Turkish researchers in the field of metabolic bone health.
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