Fakülteler / Faculties
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Item The Role of 5α-Reductase Inhibitors on Prevention and Hormonal Treatment of Prostate Cancer(2014) Ozturk, Bulent; Cicek, Tufan; https://orcid.org/0000-0003-1944-1722; AAJ-8576-2021Aim: Although testosterone generates the main part of serum androgens, the main prostatic androgen is dihydrotestosterone. Dihydroestosterone is produced from testosterone by 5 alpha-reductase. Dihydrotestosterone has some roles on different diseases as benign prostate hyperplasia and prostate cancer in human. We evaluated the role of 5a-reductase inhibitors on the treatment and prevention of prostate cancer. New Findings: Recently, pure antiandrogens targeting androgen receptors or medical and surgical castration are used in hormonal treatment of prostate cancer. However, these treatments reduced the tumoral mass and the activity of androgen receptors, prostate cancer reactivated in 18-30 months. New drugs that affect the different levels of androgen-androgen receptor pathway are needed to increase the affectivity of treatment. One of these drugs is 5 alpha-reductase inhibitors. There two wide clinical trials on 5 alpha-reductase inhibitors as dutasteride and finasteride. The lower incidences of prostate cancer in patients with 5 alpha-reductase inhibitors were reported in these trials. On the other hand, it is reported that more aggressive tumors were seen with 5 alpha-reductase inhibitors in comparison with placebo. Conclusion: Clinical trials with finasteride and dutasteride are encouraging. On the other hand, wide clinical trials are needed to show the possible side effects 5 alpha-reductase inhibitors and the role of androgens in both prostate and other systems.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 Pediatric Langerhans Cell Histiocytosis: Single Center Experience Over A 17-Year Period(2016) Ince, Dilek; Demirag, Bengu; Ozek, Gulcihan; Erbay, Ayse; Ortac, Ragip; Oymak, Yesim; Kamer, Serra; Yaman, Yontem; Kundak, Selcen; Vergin, Canan; 28276205This study aimed to analyze children with the diagnosis of Langerhans cell histiocytosis (LCH) who were diagnosed and treated between 1998-2015. Medical records were evaluated retrospectively for clinical and laboratory features, treatment details, and outcome. There were 20 patients, the median age of diagnosis was 37 months, M/F ratio: 1.5. Nine had single system (SS), 11 had multisystem (MS) LCH. Spontaneous regression occurred in three infants with skin limited LCH. Eight patients had risk organ involvement in MS-LCH group. The curettage alone was performed in only one case. Patients received LCH-II/LCH-III based chemotherapy schema. Radiotherapy was performed to vertebral disease and residual craniofacial bone disease in four cases. The regression and relapse rates were 100% and 33% for SS-LCH. The regression and relapse rates were 73%, and 18% for MS-LCH. Two infants with MS-LCH died despite chemotherapy. Pulmonary and liver involvements affected outcome adversely in MS-LCH. Multidisciplinary treatment approaches are needed.Item An Examination of Medicine and Folk Medicine Elements on the Example of a Medical Text in Verse(2022) Aytac, Uyesi AsliPeople have sought cures for the diseases and ailments they have experienced since ancient times. These were sometimes the sorcerers, herbalists, embers, enchanters, atasaguns or shamans of the period, and sometimes the physicians who worked on modern medicine of the period. Anatolia, as the land where civilizations intersect, contains traces of many cultures and has a very deep structure in terms of cultural accumulation. Considering ancient medicine in Anatolia, it can be seen that sometimes modern medical knowledge and traditional folk medicine methods are used together. These methods are frequently mentioned in written texts and many works in the field of health, both in copyright and translation, have been created. The fact that they include easy treatment methods for illnesses and that they contain medical information that the public can use in daily life emphasize the importance of such texts. It is known that the oldest medical texts in Turkish written in Anatolia were created in the 14th century. Since then, many works including field information such as medicine, folk medicine, pharmacology, botany have a special importance in terms of fully revealing the vocabulary and structure of our language. The text, which is our subject of study, is registered in the collection of Ankara National Library Elazig Provincial Public Library with the number 23 Hk 2/3. The title of the work appears to be Manzume-i Tib and its author Ferdi. The text, written in "me fa' i lun me fa' i lun fe' u lun" prosody pattern and consists of 61 couplets. Although the name of the author appears as Ferdi in the manuscript, the note that the author is not known was written at the beginning of the work. Although the year of writing is not known, the text was written in Old Anatolian Turkish. The note to the head of the manuscript contains the information that it contains some information about health protection. In its content, factors affecting health and disease are emphasized. The medical knowledge until the time of writing and some practices from the field of folk medicine have been combined to include behaviors that should be done in the treatment of diseases and avoided for some diseases. Writing a text on the subject of medicine with prosody, besides the purpose of informing, it also ensures the permanence of the information transferred in a certain harmony. In the text, on the subject of diseases; Problems such as indigestion, headache, sore throat or dry throat, weakness, paralysis, sciatica, meningitis, constipation, hemorrhoids, cramps and pain were included. Among the treatments; Methods such as vomiting, laxative, cupping, and consent have been discussed. Although in small numbers, there are herbal preparations that can be used for some ailments such as tooth jaundice and bad breath. In the face of some ailments and conditions, the daily foods recommended for therapeutic purposes have been pointed out. It is seen that information about mood is also included in addition to physical health. In our study, by giving the transcription of the aforementioned manuscript, it will be pointed out the diseases, diseases and the treatment methods recommended for them. These suggestions will be examined under the headings of beneficial and harmful actions. Comparisons will be made by giving examples from other medical texts written in Anatolia. At the end of the review, there will be a glossary of terms used in the fields of medicine and folk medicine. With further examination of such texts, Old Anatolian Turkish vocabulary will be put forward in a healthier way and data that shed light on various fields such as botany, folklore, pharmacology and psychology will be obtained along with medicine.Item Pre-Discharge and Post-Discharge Management and Treatment Optimization in Acute Heart Failure(2022) Cavusoglu, Yuksel; Altay, Hakan; Nalbantgil, Sanem; Temizhan, Ahmet; Yilmaz, Mehmet Birhan; 35860891Acute heart failure is associated with high mortality and rehospitalization rates and required urgent evaluation and early initiation or intensification of therapy. The risk of death and heart failure rehospitalization is greatest in the early post-discharge period, particularly within the first 3-6 months, and declines over time, which is referred as a vulnerable period of acute heart failure hospitalization. Therefore, implementation of guidelines-directed optimal therapy is not only so crucial in the acute phase but also very important in the pre-discharge and early post-discharge period in reducing mortality and rehospitalization rates. The pre-discharge period represents a window of opportunity for treatment optimization which includes to eliminate congestion, to treat comorbidities or precipitating factors, and to initiate or uptitrate oral therapy before discharge. Early assessment in the post-discharge period based on clinical evaluation and laboratory exams, further optimization of disease-modifying therapy is associated with lower 30-day hospitalization for heart failure. In clinical practice, clinicians usually focus on acute phase intravenous medications and short-term device therapies and, in fact, neglect short- and long-term comprehensive approaches. This paper reviews management strategies that may help reduce mortality and heart failure rehospitalizations in pre-discharge and post-discharge periods and include adopting holistic approaches for heart failure, increasing optimization of evidence-based therapies, treating cardiac and noncardiac comorbidities, improving care transitions, monitoring, and disease management.Item An Evaluation Of The Factors Affecting The Clinical And Laboratory Findings, Prognosis, And Treatment Response İn Children With Chronic Urticaria(2021) Sancakli, Ozlem; 34907626Chronic urticaria (CU) is a rare disease in childhood, and studies in children are limited. In this study, the aim was to investigate the clinical and laboratory findings and demographic characteristics of children with CU and to determine the factors affecting prognosis. The study included 141 patients aged 0-18 years who were diagnosed with CU in the pediatric allergy outpatient clinic between January 1, 2013, and December 31, 2018. Risk factors related to prognosis were investigated by comparing the duration of CU and treatment response with clinical and etiological features. IBM SPSS version 24 was used for statistical analyses. In the study group, the female/male ratio was 69/55, and the median age at first visit was 9.5 years (min:1, max:17). Among patients, 63 (44.5%) had an accompanying atopic disease, and 23 (16.3%) had chronic disease. Of the patients, 124 (88%) had chronic spontaneous urticaria, and 17 patients (12%) had chronic inducible urticaria (CIU). Of those with CIU, 72.2% had symptomatic dermographism, 16.7% had cholinergic urticaria, and 11.1% had cold urticaria. After the evaluations, the most common pathological findings in our patients were intestinal parasitosis (n = 14), anemia (n = 10), and urinary tract infection (n = 8). The median total duration of urticaria was 47 weeks (min:8, max:284). The duration of urticaria was longer in patients with atopy (p < 0.05), and the group that went into remission with standard-dose antihistamine was the group with highest eosinophil count (p = 0.022). In most children with CU, the underlying cause/disease cannot be determined. In our study, treatable triggers were found in some of the patients. Therefore, it is appropriate for each patient to be evaluated with selected laboratory tests after detailed history and physical examination.Item Intralesional triamcinolone acetonide in notalgia paresthetica: Treatment outcomes in five patients(2020) Ozcan, Deren; Seckin, Deniz; Kibaroglu, Seda; Bernhard, Jeffrey D.; 0000-0002-7450-6886; 0000-0002-3964-268X; 32338414; AAQ-6649-2021; AAJ-2956-2021Numerous treatment modalities have been tried with diverse results for pruritus due to notalgia paresthetica (NP). Corticosteroids suppress ectopic neural discharges from injured nerve fibers and also have short-lived suppressive effect on transmission in normal C-fibers. Herein, we evaluated the efficacy of intralesional triamcinolone acetonide in the treatment of NP. The medical reports of five patients who had been diagnosed with NP and treated with intralesional triamcinolone acetonide injections were retrospectively evaluated. Triamcinolone acetonide solution was injected intradermally (10 mg/mL; 0.1 mL/cm(2)) every 3 weeks for a maximum of four treatments. The severity of itch was scored by the patients on a combined numerical and visual analogue scale. After treatment, reduction in itch severity scores varied between 33% and 100%.Item A case of elephantiasis nostras verrucosa treated successfully by a new type of compressive garment(2020) Mansur, A. Tulin; Ozker, Emre; Demirci, Gulsen Tukenmez; 32981199Elephantiasis nostras verrucosa (ENV) is a clinical manifestation composed of hyperkeratotic, verrucous, and papillomatous lesions and dermal fibrosis, which complicate chronic lymphedema. There is currently no cure for ENV, however, several measures have been used to reduce lymphedema and the resultant pseudoepidermal hyperplasia. Supportive dressings and compression therapy still constitute an important part of the treatment. In this report, we present a 69-year-old male patient with ENV developed due to chronic lymphedema caused by venous insufficiency. After failure of healing with conventional two- and three-layered bandages, and elastic stockings, he was successfully treated by a new type of compression garment. We recommend this user friendly garment for prevention of frictional trauma, contact dermatitis, and secondary infection, which all may complicate compression treatments.Item Real-world efficacy and safety of Ledipasvir plus Sofosbuvir and Ombitasvir/Paritaprevir/Ritonavir +/- Dasabuvir combination therapies for chronic hepatitis C: A Turkish experience(2020) Gokturk, Huseyin Savas; 33626001Background/Aims: This study aimed to evaluate the real-life efficacy and tolerability of direct-acting antiviral treatments for patients with chronic hepatitis C (CHC) with/without cirrhosis in the Turkish population. Material and Methods: A total of 4,352 patients with CHC from 36 different institutions in Turkey were enrolled. They received ledipasvir (LDV) and sofosbuvir (SOF)+/- ribavirin (RBV) ombitasvir/paritaprevir/ritonavir +/- dasabuvir (PrOD)+/- RBV for 12 or 24 weeks. Sustained virologic response (SVR) rates, factors affecting SVR, safety profile, and hepatocellular cancer (HCC) occurrence were analyzed. Results: SVR12 was achieved in 92.8% of the patients (4,040/4,352) according to intention-to-treat and in 98.3% of the patients (4,040/4,108) according to per-protocol analysis. The SVR12 rates were similar between the treatment regimens (97.2%-100%) and genotypes (95.6%-100%). Patients achieving SVR showed a significant decrease in the mean serum alanine transaminase (ALT) levels (50.90 +/- 54.60 U/L to 17.00 +/- 14.50 U/L) and model for end-stage liver disease (MELD) scores (7.51 +/- 4.54 to 7.32 +/- 3.40) (p<0.05). Of the patients, 2 were diagnosed with HCC during the treatment and 14 were diagnosed with HCC 37.0 +/- 16.0 weeks post-treatment. Higher initial MELD score (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.22-2.38; p=0.023]), higher hepatitis C virus (HCV) RNA levels (OR: 1.44, 95% CI: 1.31-2.28; p=0.038), and higher serum ALT levels (OR: 1.38, 95% CI: 1.21-1.83; p=0.042) were associated with poor SVR12. The most common adverse events were fatigue (12.6%), pruritis (7.3%), increased serum ALT (4.7%) and bilirubin (3.8%) levels, and anemia (3.1%). Conclusion: LDV/SOF or PrOD +/- RBV were effective and tolerable treatments for patients with CHC and with or without advanced liver disease before and after liver transplantation. Although HCV eradication improves the liver function, there is a risk of developing HCC.