Fakülteler / Faculties
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Item Prophylactic Red Blood Cell Exchange May Be Beneficial in the Management of Sickle Cell Disease in Pregnancy(2015) Asma, Suheyl; Kozanoglu, Ilknur; Tarim, Ebru; Sariturk, Cagla; Gereklioglu, Cigdem; Akdeniz, Aydan; Kasar, Mutlu; Turgut, Nurhilal H.; Yeral, Mahmut; Kandemir, Fatih; Boga, Can; Ozdogu, Hakan; 0000-0002-5268-1210; 0000-0002-8902-1283; 0000-0003-3856-7005; 0000-0001-5335-7976; 0000-0002-9580-628X; 0000-0002-4130-1059; 0000-0002-9680-1958; 25070465; AAE-1241-2021; AAD-5542-2021; AAL-3906-2021; AAI-7831-2021; ABC-4148-2020; AAD-6222-2021; AAS-7129-2021BackgroundSickle cell disease (SCD) is associated with chronic hemolysis and painful episodes. Pregnancy accelerates sickle cell complications, including prepartum and postpartum vasoocclusive crisis, pulmonary complications, and preeclampsia or eclampsia. Fetal complications include preterm birth and its associated risks, intrauterine growth restriction, and a high rate of perinatal mortality. The purpose of this study was to evaluate pregnancy outcomes in patients with SCD who underwent planned preventive red blood cell exchange (RBCX). Study Design and MethodsWe retrospectively evaluated the complications of SCD in 37 pregnant patients. Patients with SCD who had undergone prophylactic RBCX were compared with a control group who had not undergone RBCX during pregnancy. ResultsForty-three exchange procedures were performed in 24 patients. The control group comprised 13 patients with a mean age of 27.43.3 years who had not undergone RBCX during pregnancy. Four of the five patients who developed a vasoocclusive crisis died. There was a significant difference in maternal mortality between the study and control groups (p=0.011). There was also a significant difference in the incidence of vasoocclusive crisis between the study and control groups. One fetal death occurred in the 20th gestational week in a patient in the control group, although there were no postpartum complications in either the babies or the mothers in the control group. ConclusionThis study has demonstrated that prophylactic RBCX during pregnancy is a feasible and safe procedure for prevention of complications. Given the decrease in the risks of transfusion, RBCX warrants further study.Item Association Between Hypocapnia and Febrile Seizures(2014) Kilicaslan, Buket; Erol, Ilknur; Ozkale, Yasemin; Saygi, Semra; Sariturk, Cagla; https://orcid.org/0000-0002-3530-0463; https://orcid.org/0000-0003-3009-336X; https://orcid.org/0000-0002-8522-5078; https://orcid.org/0000-0002-4130-1059; 24396127; AAW-9958-2021; AAK-4825-2021; AAL-6136-2021; AAB-1203-2021; AAS-7129-2021The purpose of this study is to determine whether hyperthermia-induced hyperventilation with subsequent hypocapnia is relevant to febrile seizures in children. This is only the second study to measure pCO2 and pH values in children with febrile seizures. This prospective case-control study enrolled 18 children who presented with febrile seizures and 18 children who presented with a febrile illness without seizures. Venous blood gas analyses were measured both from the febrile seizure and control group. There was no significant difference in mean blood pH between the febrile seizure and control groups but blood pCO2 was significantly lower in the febrile seizure group. Patients with complex febrile seizures exhibited significantly lower pCO2 levels within 1 hour of seizure onset than patients with simplex febrile seizures. These data indicate that febrile seizures may be associated with hyperventilation and that the ensuing hypocapnia may contribute to the development of febrile seizures.Item Association Between Panel Reactive Antibody and Antiendothelial Cell Antibody Positivity in Kidney Transplant Patients(2015) Basturk, Bilkay; Kantaroglu, Bircan; Noyan, Z. Aytul; Yildirim, Sedat; Sariturk, Cagla; 0000-0002-8784-1974; 0000-0002-5735-4315; 0000-0002-4130-1059; 25894170; AAD-6918-2021; AAF-4610-2019; AAS-7129-2021Objectives: Endothelium is the major tissue for hyperacute and acute rejection. Binding of antibody to endothelium activates several immunologic mechanisms. Antiendothelial cell antibodies are a group of nonhuman leukocyte antigen antibodies that may play a role in the induction of an immunologic reaction that triggers inflammation. The aim of this study was to investigate whether there was an association between antiendothelial cell antibody positivity and panel reactive antibody positivity in renal transplant patients. Materials and Methods: In this study, we investigated the association between antiendothelial cell antibodies and panel reactive antibody Class I class II crossmatch positivity in patients, and compared these results with results from 100 healthy volunteers. All serum samples were analyzed by bead-based technology for calculated panel reactive antibody positivity; in addition, slides were used, each containing human umbilical vein endothelial cells and capillary-rich tissue for antiendothelial cell antibody positivity. Results: Antiendothelial cell antibodies was positive in 48 of 89 patients (panel reactive antibody Class I class II negative), 22 of 35 patients (class l-positive), 25 of 39 patients (class II-positive), 26 of 40 (class I-class II positive), and 37 of 57 serologic and flow cytometry crossmatch-positive patients (P <= .016), and ultimately, in 122 of 205 patients and 25 of 100 volunteers (P <= .001). Antiendothelial cell antibody positivity was more frequent in panel reactive antibody-positive than negative patients and the control group. Conclusions: Binding of antiendothelial cell antibodies to endothelial cells may activate complement by the classical pathway and cause up-regulation of adhesion molecules. This study questioned the antigenic specificity of antiendothelial cell antibodies. Our study results showed that antiendothelial cell antibodies may play an important role for graft destruction, independent of panel reactive antibody and crossmatch positivity.Item Clinical Relevance of Apheretic Graft Composition in Patients With Acute Myeloblastic Leukemia Who Received a Busulfan-Fludarabine-Antithymocyte Globulin Conditioning Regimen for Allogeneic Transplant(2015) Yeral, Mahmut; Kasar, Mutlu; Boga, Can; Kozanoglu, Ilknur; Ozdogu, Hakan; Sariturk, Cagla; 0000-0002-4130-1059; 0000-0002-9580-628X; 0000-0002-9680-1958; 0000-0002-8902-1283; 0000-0003-3856-7005; 0000-0002-5268-1210; 26103468; AAS-7129-2021; ABC-4148-2020; AAD-6222-2021; AAD-5542-2021; AAL-3906-2021; AAE-1241-2021Objectives: Sparse data are available about the effects of apheretic graft composition on the clinical transplant outcome in allotransplanted patients who have hematologic malignant disease. Major obstacles in recent studies have included heterogeneity of patient populations and differences in the conditioning regimens used. Materials and Methods: This prospective study included 50 patients who had acute myeloblastic leukemia and received busulfan-fludarabine-antithymocyte globulin -based conditioning for peripheral allogeneic stem cell transplant. The concentration of CD34+ cells, T-cell subsets, B cells, and natural killer cells in the graft were analyzed by flow cytometry in the donors who were matched for human leukocyte antigen. Results: In univariate analysis, infusion with a higher dose of natural killer cells (> 1.55 x 10(6)/kg) was associated with improved survival (P=.007 for disease-free survival; P=.024 for overall survival) in patients with acute myeloblastic leukemia. Cox regression models revealed that increased concentration of natural killer cells and CD34+ cells positively affected the clinical outcome of allotransplanted patients (P =.005 for both cell types). According to univariate analysis, these findings were dependent on minimal residual disease and acute graft-versus-host disease. Graft versus-host disease (acute and chronic forms) was not affected by graft composition. Conclusions: Our results suggest that increased concentration of natural killer cells and CD34+ cells in the apheretic product may predict better survival. In contrast, busulfan-fludarabine-antithymocyte globulin -based conditioning eliminates the disadvantages that resulted from the high content of T-cell subsets and B cells, and the course of the transplant and clinical parameters were not affected by the amount of T and B cells.Item Can Computed Tomography Aid in Diagnosis of Intramural Hematomas of the Intestinal Wall?(2015) Ulusan, Serife; Pekoz, Burcak; Sariturk, Cagla; 0000-0002-4130-1059; 26712050; AAS-7129-2021Background : We sought to use computed tomography (CT) data to support the correct differential diagnosis of patients with spontaneous intramural hematomas of the gastrointestinal tract, to aid in the clinical management of those using oral anticoagulants. Methods : Patient data were retrospectively analyzed and patients were divided into two groups. The first group contained 10 patients (5 females, 5 males, median age 65 years [range 3579 years]) who had been diagnosed with spontaneous intramural hematomas of the gastrointestinal tract. The second group contained nine patients (5 females, 4 males, median age 41 years [range 24-56 years]) who exhibited intestinal wall thickening on CT, and who had been diagnosed with ulcerative colitis, Crohn's disease, ameboma, and lymphoma. The enhancement patterns in the CT images of the two groups were compared by an experienced and inexperienced radiologist. The differences in values were subjected to ROC analysis. Results : Inter-observer variability was excellent (0.84) when post-contrast CT images were evaluated, as were the subtraction values (0.89). The subtracted values differed significantly between the two groups (p = 0.0001). A cutoff of +31.5 HU was optimal in determining whether a hematoma was or was not present. Conclusions : Contrast enhancement of an intestinal wall hematoma is less than that of other intestinal wall pathologies associated with increased wall thickness. If the post-contrast enhancement of a thickened intestinal wall is less than +31.5 HU, a wall hematoma is possible.Item Serum Vitamin B12, Folic Acid, and Homocysteine Levels in Children with Febrile Seizure(2015) Ozkale, Yasemin; Erol, Ilknur; Kilicarslan, Buket; Ozkale, Murat; Saygi, Semra; Sariturk, Cagla; Sezgin, Nurzen; 0000-0002-3530-0463; 0000-0002-8522-5078; 0000-0003-0625-1057; 0000-0003-3009-336X; 0000-0002-4130-1059; 27186696; AAK-4825-2021; AAB-1203-2021; A-7806-2016; AAL-6136-2021; AAS-7129-2021The aim of this study is to investigate the associations between febrile seizure and serum levels of vitamin B-12, folic acid, and homocysteine. One hundred and four children who presented with febrile seizure and 75 controls who presented with febrile illness unaccompanied by seizure were enrolled into the study. Mean levels of vitamin B-12, folic acid and homocysteine were compared between two groups. Mean vitamin B-12 level in the febrile seizure group was significantly lower than the control group. The febrile seizure patients with 3 or more had significantly lower serum folic acid than the subgroups with two or one episode only. Serum concentrations of folic acid were significantly lower in the febrile seizure subgroup with body temperature 37.5-39.0 degrees C at time of convulsion. Low serum vitamin B-12 may reduce a child's threshold for seizure and may be a risk factor for febrile seizure. Low serum folic acid level may be predisposed to recurrent febrile seizure.Item QTc Prolongation During Peripheral Stem Cell Apheresis in Healthy Volunteers(2017) Korur, Asli; Kozanoglu, Ilknur; Buyukkurt, Nurhilal; Yeral, Mahmut; Kandemir, Fatih; Gereklioglu, Cigdem; Sariturk, Cagla; Asma, Suheyl; Solmaz, Soner; Boga, Can; Ozdogu, Hakan; 0000-0002-5086-5593; 0000-0001-5335-7976; 0000-0002-8902-1283; 0000-0002-5268-1210; 0000-0002-9580-628X; 0000-0002-4130-1059; 0000-0002-0895-4787; 0000-0002-9680-1958; 27543914; AAD-5616-2021; AAI-7831-2021; AAD-5542-2021; AAD-6222-2021; AAE-1241-2021; ABC-4148-2020; AAS-7129-2021; AAE-1457-2021Background and aim: Today, voluntary donation of peripheral blood stem cells by healthy donors for allogeneic hemopoietic cell transplantation is common worldwide. Such donations are associated with small but measurable risks of morbidity and mortality. Most complications are associated with citrate infusion during cell collection. We studied the effects of citrate infusion on the QTc and other vital parameters during and after peripheral stem cell apheresis in volunteers. Method: To ensure that donors were healthy, screening included taking a detailed medical history, physical examination, and laboratory measurements of plasma calcium and magnesium. Corrected QT (QTc) values were assessed using a 12-lead electrocardiographic platform that derived QTc values automatically. Results: In all, 141 apheresis procedures were performed. The mean QTc values at baseline, at 2 and 4 h during the procedure, and at 30 min after the procedure, were 347.6 +/- 59.5, 349.9 +/- 52.8, 391.8 +/- 54.0, and 404.8 +/- 59.2 ms, respectively. The baseline and 2 h QTcs did not differ significantly, but the baseline QTc did differ significantly from the 4 h and 30 min after the procedure values. The plasma levels of calcium and magnesium did not significantly differ before and after the procedure. Conclusion: QTc prolongation may develop during leukopheresis, particularly if the procedure takes more than 2 h. Thus, to enhance donor safety, QTc measurement should be standard for all donors. In addition, any family history of sudden death should be noted, to prevent the development of possible fatal arrhythmia in susceptible donors.Item East Mediterranean Region Sickle Cell Disease Mortality Trial: Retrospective Multicenter Cohort Analysis of 735 Patients(2016) Karacaoglu, Pelin Kardas; Asma, Suheyl; Korur, Asli; Solmaz, Soner; Buyukkurt, Nurhilal Turgut; Gereklioglu, Cigdem; Kasar, Mutlu; Ozbalci, Demircan; Unal, Selma; Kaya, Hasan; Gurkan, Emel; Yeral, Mahmut; Sariturk, Cagla; Boga, Can; Ozdogu, Hakan; https://orcid.org/0000-0002-7459-7167; https://orcid.org/0000-0001-5335-7976; https://orcid.org/0000-0002-0895-4787; https://orcid.org/0000-0003-3856-7005; https://orcid.org/0000-0002-9580-628X; https://orcid.org/0000-0002-4130-1059; https://orcid.org/0000-0002-8902-1283; 27068408; HKF-1250-2023; AAI-7831-2021; AAL-6544-2020; AAE-1457-2021; AAL-3906-2021; ABC-4148-2020; AAS-7129-2021; AAD-6222-2021; AAD-5542-2021Sickle cell disease (SCD), one of the most common genetic disorders worldwide, is characterized by hemolytic anemia and tissue damage from the rigid red blood cells. Although hydroxyurea and transfusion therapy are administered to treat the accompanying tissue injury, whether either one prolongs the lifespan of patients with SCD is unknown. SCD-related mortality data are available, but there are few studies on mortality-related factors based on evaluations of surviving patients. In addition, ethnic variability in patient registries has complicated detailed analyses. The aim of this study was to investigate mortality and mortality-related factors among an ethnically homogeneous population of patients with SCD. The 735 patients (102 children and 633 adults) included in this retrospective cohort study were of Eti-Turk origin and selected from 1367 patients seen at 5 regional hospitals. A central population management system was used to control for records of patient mortality. Data reliability was checked by a data supervision group. Mortality-related factors and predictors were identified in univariate and multivariate analyses using a Cox regression model with stepwise forward selection. The study group included patients with homozygous hemoglobin S (Hgb S) disease (67 %), Hb S-beta(0) thalassemia (17 %), Hgb S-beta(+) thalassemia (15 %), and Hb S-alpha thalassemia (1 %). They were followed for a median of 66 +/- 44 (3-148) months. Overall mortality at 5 years was 6.1 %. Of the 45 patients who died, 44 (6 %) were adults and 1 (0.1 %) was a child. The mean age at death was 34.1 +/- 10 (18-54) years for males, 40.1 +/- 15 (17-64) years for females, and 36.6 +/- 13 (17-64) years overall. Hydroxyurea was found to have a notable positive effect on mortality (p = 0.009). Mortality was also significantly related to hypertension and renal damage in a univariate analysis (p = 0.015 and p = 0.000, respectively). Acute chest syndrome, splenic sequestration, and prolonged painful-crisis-related multiorgan failure were the most common causes of mortality. In a multivariate analysis of laboratory values, only an elevated white blood cell count was related to mortality (p = 0.009). These data show that despite recent progress in the treatment of SCD, disease-related factors continue to result in mortality in young adult patients. Our results highlight the importance of evaluating curative treatment options for patients who have an appropriate stem cell donor in addition to improving patient care and patient education.Item The Most Common HLA Alleles and Anti-HLA Antibodies to Know for Virtual Cross-Match(2016) Basturk, Bilkay; Kantaroglu, Bircan; Kavuzlu, Miray; Kavuzlu, Miray; Sariturk, Cagla; 0000-0002-8784-1974; 0000-0002-9288-942X; 0000-0002-9288-942X; 0000-0002-4130-1059; 27805512; AAD-6918-2021; AAE-2689-2021; AAE-2689-2021; AAS-7129-2021Objectives: Human leukocyte antigens and HLA-specific antibodies are important before and after transplant treatment. The determination of the alloantibodies before transplant is useful for the estimation of risk for antibody-mediated rejection. Virtual crossmatch uses solid-phase assay to detect anti-HLA antibodies and allows exclusion of donors with unacceptable HLA antigens. The aim of our retrospective study was to investigate HLA class I and class II alleles and panel reactive antibody and Luminex Corporation (Austin, TX, USA) single-antigen bead assay positivity frequencies in the Southeastern region of Turkey Material and Methods: Tissue typing results for HLA class I (HLA-A, HLA-B, HLA-C) and class-II (DRB1and DQB1 haplotypes) in 1756 patients and 2951 donors who were at Baskent University Adana Research and Medical Center between 2010 and 2015 for transplant were studied using sequence-specific primers and/or sequence-specific oligonucleotides. Serum samples were analyzed by Luminex bead technology for antibody detection. Results: We found that, for class I, HLA-A*02, HLA-B*35, and HLA-A*24 and, for class II, DRB*11, DRB*01, and DRB*04 were the 4 most common antigens and HLA-A02, B49, A68, B7 were the 3 most common anti-HLA antibodies, with mean fluorescence intensity values >= 2000 in our population group. Human leukocyte antigen alleles and anti-HLA antibodies were compared with each other except HLA-A*02, A2, with no correlations between allele and panel reactive antibody frequencies identified. However, there was a weak correlation between panel reactive anti body-mean fluorescence intensity scores of 5000 and above with Luminex single-antigen bead assay. Conclusions: This study is the first to conduct such a mass screening of a Turkish population. Our study results show that there is no correlation between HLA frequencies and anti-HLA antibody frequencies. However, there was a weak correlation between panel reactive antibody mean fluorescence intensity scores of 5000 and above with Luminex single-antigen bead assay. Of note, this pattern is important to know for virtual cross-match.Item Clinical Features of Untreated Type 2 Macular Telangiectasia and Efficacy of Anti-Vascular Endothelial Growth Factor Therapy in Macular Neovascularization(2022) Karatas, Muge Coban; Yilmaz, Gursel; Sezen, Aslihan Yuce; Sariturk, Cagla; 35196839Objectives: To compare best corrected visual acuity (BCVA), central macular thickness (CMT), and central choroidal thickness (CCT) in patients with type 2 macular telangiectasia (MacTel 2) and a control group and to evaluate the efficacy of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment in MacTel 2 patients with macular neovascularization (MNV). Materials and Methods: We conducted a retrospective chart review of consecutive MacTel 2 patients who underwent a full ophthalmologic examination including BCVA and dilated fundus examination with slit-lamp biomicroscopy, fluorescein angiography, and optical coherence tomography imaging at baseline and follow-up visits. BCVA, CMT, and CCT were compared between all identified patients (n=26) and a control group (n=30). A subgroup analysis was performed among eyes with MNV (n=7) before and after treatment. Results: CMT and CCT were significantly lower in the MacTel 2 group compared to the control group. Forty-one treatment-naive eyes without MNV proliferation showed no significant change in BCVA, CMT, or CCT during follow-up. Eight eyes of 7 MacTel 2 patients developed MNV during follow-up. All of the patients were treated with intravitreal anti-VEGF. Conclusion: It is important to closely follow MacTel 2 patients for MNV development. To avoid adverse effects, we prefer to monitor patients who have not yet developed MNV. Patients with proliferative MacTel 2 with decreasing visual function may benefit from intravitreal anti-VEGF treatment.