Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Evaluation of the COVID-19 Rapid Antigen Test(2023) Sanli, Ozlem Oguc; Kuscu, Ozlem Ozkan; Incekas, Caner; 0000-0001-7899-0233; 0000-0001-9019-423XIntroduction: Coronavirus disease, is an infectious disease caused by the SARS-CoV-2. The gold standard method to diagnose is the reverse transcriptase polymerase chain reaction test. Rapid antigen tests can also be used for diagnosis. This study aims to compare the results of these two methods.Materials and Methods: Between November 2021 and July 2022, the study included 1811 patients who visited the emergency depart-ment with coronavirus-related symptoms and signs. Respiratory samples from these patients were simultaneously evaluated using both reverse transcriptase polymerase chain reaction and rapid antigen tests. The reverse transcriptase polymerase chain reaction tests were conducted using the BioSpeedy SARS-CoV-2 reverse transcriptase polymerase chain reaction kit (Bioeksen-Turkiye), while the rapid antigen tests were performed using the RapidForTM SARS-CoV-2 Ag (Vitrosens-Germany).Results: The comparison of the reverse transcriptase polymerase chain reaction test and rapid antigen test results showed a 90.67% sensitivity, 98.28% specificity, 91.27% positive predictive value, 98.15% negative predictive value, and 97.02% (1757/1811) accuracy. Qualitative results of both tests exhibited a very good agreement (Kappa= 0.892, p< 0.001). According to the reverse transcriptase polymerase chain reaction test, the sensitivity of the rapid antigen test was found to be 100% in 28 samples with a cycle threshold <17, 100% in 78 samples with a cycle threshold <20, 98.33% in 120 samples with a cycle threshold <22, and 96.28% in 215 samples with a cycle threshold <25.Conclusion: When the results of the study are evaluated, it is seen that the use of the rapid antigen test for screening purposes and confirmation of patients with negative test results by Reverse transcriptase polymerase chain reaction will provide advantages in terms of both time and cost. Due to the low sensitivity and high positive predictive value of the vitrosens rapid antigen test, we think that this test can be used in the first stage to accelerate the diagnosis of patients with high viral load, who are more likely to be infectious, to prevent transmission and to start their treatment quickly.Item Evaluation of Colposcopy After the Addition of Human Papillomavirus Testing to the Turkish Cervical Cancer Screening Program(2023) Gunes, Ali Can; Ozgul, Nejat; Turkyilmaz, Murat; Kara, Fatih; Unlu, Fahriye; Ayhan, Ali; Gultekin, Murat; 37994572Objective: To evaluate colposcopy performance following the human papillomavirus (HPV) DNA screening program in Turkey. Methods: Women aged 30-65 years are screened for cervical cancer every 5 years, with individuals positive for HPV 16 and/or 18 or other high-risk HPV types with abnormal cytology referred for colposcopy. Both HPV test and cytology are obtained at the same visit. If HPV is negative, cytology will not be assessed. However, if HPV is positive, both cytology and HPV genotyping will be performed. Colposcopy-require was defined as HPV 16/18 positivity or abnormal smear results with any hrHPV positivity, and the remaining patients (normal smear with hrHPV positivity other than HPV 16/18) were grouped as colposcopy non-required. National data on colposcopy outcomes and unnecessary performance rates in February 2018-2019 were evaluated via a questionnaire. Results: A total of 9808 patients were included, divided based on colposcopy requirement: 5751 (58.6%) patients required colposcopy and 4057 (41.4%) did not. Unnecessary colposcopy was performed on 90.1% of the non-required group (3657 of 4057 patients). In the colposcopy-required group, 4455 patients (79.9%) underwent punch biopsy; 3194 (57.1%), endocervical curettage (ECC); and 421 (7.5%), "see and treat" in the non-required group, the results were 2790 (76.3%), 1957 (53.2%), and 211 (5.7%), respectively. A total of 746 cervical intraepithelial neoplasia (CIN)-3 isolates were detected, including 702 using existing screening and triage with 94.1% sensitivity (702/746). Multiple biopsies were taken in 69.8% (n = 3110) of patients from the colposcopy-required group and 63.7% (n = 1777) from the non-required group. The ECC samples included 19 cervical cancers and 212 >= CIN-3 lesions in the colposcopy-required group, and four cancers and 41 >= CIN-3 lesions in the non-required group. The proportion of >= CIN-3 lesions detected by ECC only was 4.7% (35 of 746 >= CIN-3 lesions). Conclusion: Our results showed high rates of unnecessary colposcopies, and a high percentage of multiple and random punch biopsies and ECC.Item The Effect of Suture Materials with Different Absorption Times on Isthmocele: A Retrospective Study(2023) Yetkinel, Selcuk; Aytac, Pinar Caglar; Kalayci, Hakan; Cok, Tayfun; Durdag, Gulsen Dogan; Yaginc, Didem Alkas; Baran, Safak Yilmaz; Alemdaroglu, Songul; Kilicdag, Esra Bulgan; 0000-0002-2165-9168; 0000-0002-5064-5267; 37306162; AAL-1530-2021; AAC-9940-2020; AAI-9594-2021Objectives: With the increasing rate of cesarean operations, the formation of niches and related early and late complications have been observed more frequently. In this study, we examined the effects of using a suture material that can be absorbed faster than conventional sutures on the formation of niches.Material and methods:This study was designed as a retrospective study and completed with a total of 101 patients. During the cesarean operation, the uterus was closed with Rapide Vicryl center dot in 49 patients and Vicryl center dot in 52 patients. The uterine niche was measured with a sonohysterogram 6 months after the operation. The primary outcome of the study was determined as uterine niche formation and the secondary outcome was the post-menstrual spotting (PMS) rate.Results: Duration of surgery, intraoperative/postoperative blood loss, and hospitalization time were similar between the two groups. Niche formation was significantly lower in the Rapide Vicryl group (22.4%) when compared to the Vicryl group (42.3%) (p = 0.046). Also, PMS was observed significantly lower in the Rapide Vicryl group (16.2% and 52.8% in Rapide Vicryl and Vicryl groups, respectively; p = 0.002).Conclusions:The formation of niches and associated PMS rates were less with suture materials that were absorbed faster.Item The Turkish Clinical Microbiology and Infectious Diseases Society (KLIMIK) Evidence-Based Guideline for the Diagnosis and Treatment of Brucellosis, 2023(2023) Simsek-Yavuz, Serap; Ozger, Selcuk; Benli, Aysun; Ates, Can; Aydin, Mehtap; Aygun, Gokhan; Azap, Alpay; Azap, Ozlem; Basaran, Seniha; Demirturk, Nese; Ergonul, Onder; Kocagul-Celikbas, Aysel; Kuscu, Ferit; Saricaoglu, Elif Mukime; Sayin-Kutlu, Selda; Turker, Nesrin; Turkoglu-Yilmaz, EmineAlthough brucellosis is very common in the world and Turkiye, there are no evidence-based guidelines to guide the diagnosis and treatment of the disease. This guide has been prepared by the Turkish Society of Clinical Microbiology and Infectious Diseases to provide evidence-based recommendations to physicians from different specialties interested in the diagnosis and treatment of brucellosis. The recommendations of the Clinical Practice Guide Development Guide of the Infectious Diseases Society of America (IDSA) were taken as the basis for preparing this guide. The guideline preparation group determined 20 questions considered to be important in the diagnosis and treatment of brucellosis, and the publications that could answer these questions prepared in PICO (Population/Patient [P], Intervention [I], Comparison [C], Outcome [O]) format, were searched in ULAKBIM Tr Dizin, PubMed, Cochrane databases without date restrictions. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group method was used to rank the evidence and determine the strength of the recommendations for each PICO question and for each individual outcome. Meta-analyses of comparative clinical studies were performed to answer the PICO questions. Individual participant data (IPD) meta-analyses with data obtained from case reports and case series were conducted in the absence of comparative clinical studies. It is planned to update the recommendations at regular intervals in line with the results of new studies.Item The Changes with the New Legislations(2023) Bicakcioglu, Murat; Gedik, EnderOrgan transplantation is the most important option for the treatment of end-stage diseases. However, there is a large difference between the number of patients on the waiting list and the number of transplants performed. The gradual increase in this difference creates ethical problems related to organ transplantation. Ethical problems and other limitations require organ transplantation to be controlled by legal regulations. In our country, organ transplantation practice is carried out under the supervision of the state. Organ Transplant Practice Regulation has been updated by being published in the Official Gazette dated 09.12.2022 and numbered 32008. Possible end-of-life decisions in brain death are stated in accordance with the conditions of our country. "In cases where brain death is diagnosed, the organ preservation protocols applied are terminated in the absence of family or legal guardian approval regarding organ donation. In case of organ donation by the family or legal guardian, the organ preservation protocols needed for donor care are continued during the period until the transplantation of the organ to the waiting patient", and a solution has been presented to the intensive care physicians for the prognosis of the cases that donated or could not be donated.In the regulation in which the prerequisites of the brain death diagnostic criteria are specified, it is stated that the central body temperature should be =36 degrees C. With the new regulation, end-of-life decisions on brain death and changes made in relation to central body temperature have brought convenience in the diagnosis and follow- up process.Item Ethics and Clinical Communications(2023) Yesiler, Fatma Irem; Gedik, EnderThe diagnosis of brain death has medical, legal and ethical aspects. While the main determinant is the medical approach of the physician in terms of ethics, legal situations are also effective in the process. Non-harm, beneficence, respect for autonomy and justice are the principles that are widely accepted and form the basis of medical ethics. Understanding these principles is a must in order to talk about the ethics of brain death and organ transplantation. In the process of diagnosis and management of brain death, the physician should convey the process to the relatives of the patients in a clear and understandable language and in accordance with the educational-cultural levels of the relatives of the patients. The fact that the concept of brain death is misunderstood in the society or lack of knowledge creates social ethical problems. Special training should be given to health professionals for brain death awareness and early diagnosis, and their ability to resolve ethical problems should be strengthened. Human resources are of great importance in the diagnosis of brain death and in the process of organ transplantation from a cadaver. Communication skills are the mainstay of interaction within the clinic. Organ transplant coordinators should run the process smoothly by creating a bridge between the physician responsible for the case and the intensive care physicians. Such an approach will reduce ethical issues and ensure a successful diagnosis and donation process.Item Ancillary Tests(2023) Zeyneloglu, Pinar; Bozbay, SuhaAncillary tests are the tests those help to confirm the clinical diagnosis of brain death. These tests are in 2 groups as electrophysiological and tests for the evaluation of cerebral blood circulation. They indicate the absence of cerebral blood circulation and brain electrical activity. They should not replace clinical evaluation.Item Comparison Of Inflammation-Based Parameters And MELD-XI Score With 4C Mortality Score In Predicting In-Hospital Mortality In COVID-19(2022) Celik, Casit Olgun; Ciftci, Orcun; Ozer, Nurtac; Muderrsioglu, Ibrahim Haldun; https://orcid.org/0000-0002-7190-5443; AAD-5477-2021Purpose: In this study, we compared the roles of inflammatory parameters such as neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), C-reactive protein/lymphocyte ratio (CLR), monocyte/lymphocyte ratio (MLR), neutrophil/platelet ratio (NPR), neutrophil/monocyte ratio (NMR), CRP/albumin ratio (CAR), BUN/albumin ratio (BAR), MELD-XI score and 4C mortality score in predicting in-hospital mortality risk in COVID-19. Materials and Methods: A total of 117 patients over 18 years old with a PCR-confirmed diagnosis of COVID-19 between June 2020 and February 2021 were retrospectively included. The roles of parameters for independently predicting in-hospital mortality were determined and compared with each other using appropriate statistical methods. Results: Age, chronic kidney disease, diabetes mellitus, acute kidney injury, and length of hospital stay, urea, creatinine, LDH, AST, ferritin, D-dimer, CRP, albumin, Hb, CLR, BAR, CAR, MELD-XI score, and 4C mortality score were significantly correlated to in-hospital mortality. However, only the 4C mortality score and AST independently predicted in-hospital mortality in COVID-19 [OR 2.08 (%95 CI 1.06-2.36), for 4C mortality score, and OR 1.05 (%95 CI 1.00-1.10), for AST]. Conclusion: Unlike other mortality-related inflammatory parameters, the 4C mortality score and AST were independent and strong predictors of mortality in hospitalized COVID-19 patients.Item Psikososyal Stres Faktorleriyle Tetiklenen Erken Baslangicli Konversiyon Bozuklugu Olarak Astazi-Abazi Olgusu 2(2022) Guler Aksu, Gulen; KAYAR, Ozan; TAN, Muhammet Emin; KUTUK, Meryem ozlem; BOZLU, Gulcin; TOROS, FevziyeConversion disorder is defined as the loss or change of motor, sensory, and autonomic nervous system-related functions that cannot be explained completely with organic causes. The etiology of the disease may be explained by psychoanalytic theory, learning theory, sociocultural factors, and some traumatic life events besides genetic and neurobiological factors. The onset is usually between late childhood and early adulthood. The disorder occurs after a high rate of psychosocial stressors and the symptoms can vary. While astasia, as one of the possible complaints in conversion disorder, is defined as not being able to stand due to loss of motor power or sensory loss; abasia is identified as patients having no apparent motor problem but not being able to walk properly. Both conditions can be of organic as well as the psychogenic origin. In this paper, the clinical signs of a seven-year-old boy who was admitted to emergency service of Mersin University Faculty of Medicine with the complaints of astasia and abasia but was found to have conversion disorder is presented. The results of the medical examinations and the possible psychosocial stress factors behind these symptoms, as well as the treatment process of the case, were shared. With this report, we is aimed to draw attention to the importance of early diagnosis of the disorder, the necessity of an interdisciplinary approach in the treatment process, and the handling of psychosocial factors leading to somatic symptoms.Item Effect Of Tacrolimus In The Inner Ear Of Rats(2022) Uysal, Fatmanur; Erbek, Selim S.; Erbek, Seyra; Culhaoglu, BeldePurpose: Tacrolimus, an immunosuppressive agent, is used especially after organ transplantation. It has been asserted that tacrolimus has protective effects on the auditory system in some studies while it has negative effects in other studies. The purpose of our study is to investigate the effect of tacrolimus on the inner ear of the rats. Materials and Methods: 20 healthy Sprague Downey male rats weighing 250-350 grams were included in our study. The first group of rats were given 1mg/kg tacrolimus (n:7), the second group of rats were given 0.1 mg/kg tacrolimus (n:7), and the third group (n:6) was the non-administered control group. The first measurements of all rats were taken with distortion-product otoacoustic emission before starting the experiment. Then, tacrolimus drug was administered by gavage method to the 1st and 2nd groups along 30 days. The last measurement was repeated on the 30th day. Results: According to the results of the first measurements, emission was obtained in all rats and the responses were found to have similar characteristics. Similarly, the difference between the signal noise rate values in the last measurements taken from the groups not show any statistical significance. Conclusions: Based on the distortion-product otoacoustic emission measurements, it can be said that Tacrolimus does not have ototoxic effects on the auditory system of rats considering the administered dosage and time.