Tıp Fakültesi / Faculty of Medicine
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Item Evaluation of Nutritional Status in Pediatric İntensive Care Unit Patients: The Results of A Multicenter, Prospective Study in Turkey(2023) Ozkale, Murat; 37601138; A-7806-2016IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score.Item Pulmonary Embolism as the First Sign of Hepatocellular Carcinoma in A Patient Who Was Cured After Five Years(2023) Esendagli, Dorina; Rahatli, Samed; Hekimoglu, Koray; Bozbas, Serife Savas; AAJ-3047-2021Pulmonary embolism (PE) is a preventable cause of death associated with high morbidity and mortality rates. Cancer is a significant risk factor for PE. In this case report, we present a patient with PE who was diagnosed with hepatocellular carcinoma (HCC) one month later. The patient had an unresectable tumor in the liver that had invaded both the inferior vena cava and the right atrium. He underwent transarterial chemoembolization (TACE) and sorafenib treatment. After two years, he underwent stereotactic radiosurgery, and he was switched to regorafenib. After five years, he was cured. This case is unique in terms of long survival compared to the literature.Item Determination of Risk Factors for Postoperative Acute Kidney Injury in Patients With Gynecologic Malignancies(2023) Doganci, Melek; Zeyneloglu, Pinar; Kayhan, Zeynep; Ayhan, Ali; 37575800; IVV-1127-2023; C-3736-2018; AAJ-4623-2021BackgroundPostoperative acute kidney injury (AKI) is an important cause of mortality and morbidity among surgical patients. There is little information on the occurrence of AKI after operations for gynecologic malignancies. This study aimed to determine the incidence of AKI in patients who underwent surgery for gynecological malignancies and determine the risk factors in those who developed postoperative AKI. MethodologyA total of 1,000 patients were enrolled retrospectively from January 2007 to March 2013. AKI was defined according to the Kidney Disease Improving Global Outcomes 2012 Clinical Practice Guideline for Acute Kidney Injury. Perioperative variables of patients were collected from medical charts.ResultsThe incidence of postoperative AKI was 8.8%, with stage 1 occurring in 5.9%, stage 2 in 2.4%, and stage 3 in 0.5% of the patients. Patients who had AKI were significantly older, had higher body mass index (BMI) higher preoperative C-reactive protein (CRP) levels, and more frequently had a history of distant organ metastasis when compared with those who did not have AKI. When compared with patients who did not develop AKI postoperatively, longer operation times and intraoperative usage of higher amounts of erythrocyte suspension and fresh frozen plasma were seen in those who developed AKI. ConclusionsPatients who had AKI were older, had higher BMI with higher preoperative CRP levels, more frequent distant organ metastasis, longer operation times, and higher amounts of blood transfused intraoperatively. Defining preoperative, intraoperative, and postoperative risk factors for postoperative AKI and taking necessary precautions are important for the early detection and intervention of AKI.Item Detection of Visual-Auditory Reaction Rates in Individuals with Type 2 Diabetes Mellitus(2023) Bilaloglu, Melisa; Ergun, Ahmet; Altay, Feride P.; Iyidir, Ozlem T.; Kiziltan, Erhan; 0000-0002-9994-9405; 0000-0001-6029-3835; 0000-0001-5305-6807; AAL-7975-2021; AAD-6090-2021; K-7904-2019AIM:The primary purpose of our study was to understand the damage in the peripheral nerves of patients with diabetes and to determine the change in patients' reaction rates and perceptions by the age groups, duration of diabetes, fasting plasma glucose and HbA1c values, and compare these with those of the healthy individuals. METHODS: This study was carried out at the Baskent University Hospital Endocrinology and Metabolic Diseases Outpatient Clinic. A total of 64 patients diagnosed with type 2 diabetes and 64 healthy controls were included in the study. Finger tapping, visual, and auditory reaction time tests were performed on the subjects, respectively. The subjects' fasting plasma glucose and HbA1c levels, and the duration of their diabetes were recorded. Analyses were per -formed using the SPSS version 25. Differences were considered statistically significant when the p-value is <0.05. RESULTS: It was observed that the participants in the control group between the ages of 18-34 showed a faster reaction in all tests (p=0.01), but the difference in reaction rates in both groups decreased as the age increased. There were positive cor-relations between the duration of type 2 diabetes and the visual and auditory examination results (r= 0.69, p<0.05, r=0.52, p<0.05, respectively). There was also a positive correlation between the HbA1c (%) and the visual (r=0.97, p<0.05) examina-tion results. CONCLUSIONS: As the patients' HbA1c levels and the time spent with type 2 diabetes increased, their reaction rate and per-ception skills decreased. Especially in the early stages of the disease, cognitive decline was observed to be rapid. It is thought that diabetic control is significant.Item Does Varicocele Repair Improve Conventional Semen Parameters? A Meta-Analytic Study of Before-After Data(2023) Ceyhan, Erman; 0000-0001-8223-6399; 37382284; ABI-2513-2020Purpose: The purpose of this meta-analysis is to study the impact of varicocele repair in the largest cohort of infertile males with clinical varicocele by including all available studies, with no language restrictions, comparing intra-person conventional semen parameters before and after the repair of varicoceles. Materials and Methods: The meta-analysis was performed according to PRISMA-P and MOOSE guidelines. A systematic search was performed in Scopus, PubMed, Cochrane, and Embase databases. Eligible studies were selected according to the PICOS model (Population: infertile male patients with clinical varicocele; Intervention: varicocele repair; Comparison: intra-person before-after varicocele repair; Outcome: conventional semen parameters; Study type: randomized controlled trials [RCTs], observational and case-control studies). Results: Out of 1,632 screened abstracts, 351 articles (23 RCTs, 292 observational, and 36 case-control studies) were includ-ed in the quantitative analysis. The before-and-after analysis showed significant improvements in all semen parameters after varicocele repair (except sperm vitality); semen volume: standardized mean difference (SMD) 0.203, 95% CI: 0.129-0.278; p<0.001; I2=83.62%, Egger's p=0.3329; sperm concentration: SMD 1.590, 95% CI: 1.474-1.706; p<0.001; I2=97.86%, Egger's p<0.0001; total sperm count: SMD 1.824, 95% CI: 1.526-2.121; p<0.001; I2=97.88%, Egger's p=0.0063; total motile sperm count: SMD 1.643, 95% CI: 1.318-1.968; p<0.001; I2=98.65%, Egger's p=0.0003; progressive sperm motil-ity: SMD 1.845, 95% CI: 1.537%-2.153%; p<0.001; I2=98.97%, Egger's p<0.0001; total sperm motility: SMD 1.613, 95% CI 1.467%-1.759%; p<0.001; l2=97.98%, Egger's p<0.001; sperm morphology: SMD 1.066, 95% CI 0.992%-1.211%; p<0.001; I2=97.87%, Egger's p=0.1864. Conclusions: The current meta-analysis is the largest to date using paired analysis on varicocele patients. In the current meta-analysis, almost all conventional semen parameters improved significantly following varicocele repair in infertile patients with clinical varicocele.Item Comparison of Compressed High-Intensity Radar Pulse and Tone Burst Stimulation in Vestibular Evoked Myogenic Potentials in Acute Peripheral Vestibular System Pathologies(2023) Aydin, Berna Deniz; Erbek, Hatice Seyra; 0000-0002-8453-6069; 0000-0003-0038-8167; 36975085; AAJ-2445-2021BACKGROUND: It is ascertained that the compressed high-intensity radar pulse (CHIRP) is an effective stimulus in auditory electrophysiology. This study aims to investigate whether Narrow Band Level Specific Claus Elberling Compressed High-Intensity Radar Pulse (NB LS CE-CHIRP) stimulus is an effective stimulus in the vestibular evoked myogenic potentials test. METHODS: A case-control study was designed. Fifty-four healthy participants with no vertigo complaints and 50 patients diagnosed with acute peripheral vestibular pathology were enrolled in this study. Cervical and ocular vestibular evoked myogenic potential tests (cervical vestibular evoked myogenic potentials and ocular vestibular evoked myogenic potentials) with 500 Hz tone burst and 500 Hz Narrow Band Level Specific CE-CHIRP stimulations were performed on all participants. In addition, cervical vestibular evoked myogenic potentials and ocular vestibular evoked myogenic potentials tests with 1000 Hz tone burst and 1000 Hz Narrow Band Level Specific CE-CHIRP were performed on 24 Meniere's disease patients. P1 latency, N1 latency, amplitude, threshold, and the asymmetry ratio of responses were recorded. RESULTS: In healthy participants, with CHIRP stimulus, shorter P1 latency (P <.001), shorter N1 latency (P <.001), and lower threshold (P =.003) were obtained in the cervical vestibular evoked myogenic potentials test; shorter P1 latency (P <.001), shorter N1 latency (P <.001), higher amplitude (P <.001), and lower threshold (P <.001) were obtained in ocular vestibular evoked myogenic potentials test. In symptomatic ears of patients, with CHIRP stimulus, shorter P1 latency (P <.001), shorter N1 latency (P <.001), and lower threshold (P =.013 in cervical vestibular evoked myogenic potentials; P =.015 in ocular vestibular evoked myogenic potentials) were obtained in cervical vestibular evoked myogenic potentials and ocular vestibular evoked myogenic potentials tests. In asymptomatic ears of patients, with CHIRP stimulus, shorter P1 latency (P <.001) and shorter N1 latency (P <.001) were obtained in the cervical vestibular evoked myogenic potentials test; shorter P1 latency (P <.001), shorter N1 latency (P <.001), higher amplitude (P <.001), and lower threshold (P =.006) were obtained in ocular vestibular evoked myogenic potentials test. CONCLUSION: Our results suggest that due to higher response rates, shorter latencies, higher amplitude, and lower threshold values, the Narrow Band Level Specific CE-CHIRP stimulus is an effective stimulus for both cervical vestibular evoked myogenic potentials and ocular vestibular evoked myogenic potentials tests.Item Evaluation of Diffusion Tensor Imaging Findings in Clinically Isolated Syndrome and Relapsing-Remitting Multiple Sclerosis Patients(2023) Alatas, Ozkan; Cavusoglu, Berrin; Caylak, Ali; Keskin, Onur; Idiman, Egemen; Idiman, Fethi; Ada, EmelObjective: To compare diffusion tensor imaging (DTI) findings of the normal-appearing white matter (NAWM) and corpus callosum (CC) in patients with clinically isolated syndrome (CIS) and relapsing-remitting multiple sclerosis (RRMS) and a healthy control (HC) group. Materials and Methods: The CIS (n = 10), RRMS (n = 29), and HC (n = 13) groups were evaluated by DTI in this retrospective study. Mean diffusion (MD) and fractional anisotropy (FA) maps as well as MD and FA measurements were made from the corpus callosum genu (CCG), corpus callosum splenium (CCS), and NAWM areas from the frontal, parietal, occipital and temporal lobes. Results: The mean FA values of the NAWM in the temporal lobes were bilaterally lower in both the CIS and RRMS groups than in the HC group. However, no difference was found between the CIS and RRMS groups. In addition, the CIS group had lower FA values in the CCG, whereas the RRMS group had lower FA values in the CCS compared with the HC group. The MD values were significantly different in the CCG between the RRMS and HC groups. Conclusion: DTI contributes to detecting early changes in the NAWM and CC in patients diagnosed with CIS and RRMS. Additionally, DTI can aid in the follow-up care and management of these patients.Item Vaccination in Individuals with Multiple Sclerosis - Part I(2023) Cinar, Bilge Piri; Tuncer, Asli; Bilge, Nuray; Bunul, Sena Destan; Gozubatik Celik, Rabia Gokcen; Ciftci, Eda Derle; Genc, Gencer; Karaman, Bedriye; Kilic, Ahmet Kasim; Sariteke, Alp; Seferoglu, Meral; Tiftikcioglu, Bedile Irem; Tunc, Abdulkadir; Uncu, Gulgun; Yavas, Irfan; Yetkin, Mehmet Fatih; Efendi, Husnu; Siva, Aksel; 0000-0001-6900-4702Multiple sclerosis (MS) is an autoimmune and demyelinating disease of the central nervous system. It is a chronic disease, and in the evaluation of all other health and vital processes, decisions should be made by considering the disease process and the drugs used by the patient. Since vaccination can be performed at every stage of life, from childhood to adulthood, immune system activity, except where it is characteristic of the vaccine, should be reviewed in patients with MS. In this review, the applications of different vaccines in individuals with MS are discussed in two separate sections.Item Major and Minor Salivary Gland Cancers: A Multicenter Retrospective Study(2023) Sumbul, Ahmet Taner; 37084179BackgroundMost of the studies on salivary gland cancers are limited for various reasons such as being single-center, small number of patients, including only major or minor SGCs, or only including epidemiological data. MethodsA total of 37 medical oncology clinics from different regions of Turkey participated in this retrospective-multicenter study. The analyzed data included clinical and demographical features, primary treatment, metastasis localizations, and treatments and includes certain pathologic features. ResultsThe study included data from a total of 443 SGCs. 56.7% was in major salivary glands and 43.3% was in minor salivary glands. Distant metastasis in the major SGCs was statistically significantly more common than in the minor SGCs, locoregional recurrence was statistically significantly more common in the minor SGCs than in the major SGCs (p = 0.003). ConclusionsEpidemiological information, metastasis and recurrence patterns, treatment modalities, and survival analysis of the patients over 20 years of follow-up are presented.Item Epidemiology and Risk Factors of 28-Day Mortality of Hospital-Acquired Bloodstream Infection in Turkish Intensive Care Units: A Prospective Observational Cohort Study(2023) Erol, Cigdem; 37264485; AAJ-1219-2021Synopsis Objectives To uncover clinical epidemiology, microbiological characteristics and outcome determinants of hospital-acquired bloodstream infections (HA-BSIs) in Turkish ICU patients. Methods The EUROBACT II was a prospective observational multicontinental cohort study. We performed a subanalysis of patients from 24 Turkish ICUs included in this study. Risk factors for mortality were identified using multivariable Cox frailty models. Results Of 547 patients, 58.7% were male with a median [IQR] age of 68 [55-78]. Most frequent sources of HA-BSIs were intravascular catheter [182, (33.3%)] and lower respiratory tract [175, (32.0%)]. Among isolated pathogens (n = 599), 67.1% were Gram-negative, 21.5% Gram-positive and 11.2% due to fungi. Carbapenem resistance was present in 90.4% of Acinetobacter spp., 53.1% of Klebsiella spp. and 48.8% of Pseudomonas spp. In monobacterial Gram-negative HA-BSIs (n = 329), SOFA score (aHR 1.20, 95% CI 1.14-1.27), carbapenem resistance (aHR 2.46, 95% CI 1.58-3.84), previous myocardial infarction (aHR 1.86, 95% CI 1.12-3.08), COVID-19 admission diagnosis (aHR 2.95, 95% CI 1.25-6.95) and not achieving source control (aHR 2.02, 95% CI 1.15-3.54) were associated with mortality. However, availability of clinical pharmacists (aHR 0.23, 95% CI 0.06-0.90) and source control (aHR 0.46, 95% CI 0.28-0.77) were associated with survival. In monobacterial Gram-positive HA-BSIs (n = 93), SOFA score (aHR 1.29, 95% CI 1.17-1.43) and age (aHR 1.05, 95% CI 1.03-1.08) were associated with mortality, whereas source control (aHR 0.41, 95% CI 0.20-0.87) was associated with survival. Conclusions Considering high antimicrobial resistance rate, importance of source control and availability of clinical pharmacists, a multifaceted management programme should be adopted in Turkish ICUs.