Fakülteler / Faculties
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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 Treatments for Female Victims of Intimate Partner Violence: Systematic Review and Meta-Analysis(2022) Karakurt, Guennur; Koc, Esin; Katta, Pranaya; Jones, Nicole; Bolen, Shari D.; 35185725Intimate partner violence (IPV) is an important problem that has significant detrimental effects on the wellbeing of female victims. The chronic physical and psychological effects of intimate partner violence (IPV) are complex, long-lasting, chronic, and require treatments focusing on improving mental health issues, safety, and support. Various psycho-social intervention programs are being implemented to improve survivor wellbeing. However, little is known about the effectiveness of different treatments on IPV survivors' wellbeing. For this purpose, we conducted a systematic review and meta-analysis to assess the effectiveness of interventions on improving outcomes that describe the wellbeing of adult female survivors of IPV. We searched PubMed, PsycINFO, and Cochrane Library. We explored the effectiveness of available interventions on multiple outcomes that are critical for the wellbeing of adult female victims of IPV. To provide a broad and comprehensive view of survivors' wellbeing, we considered outcomes including mental health, physical health, diminishing further violence, social support, safety, self-efficacy, and quality of life. We reviewed 2,770 citations. Among these 25 randomized-controlled-study with a total of 4,683 participants met inclusion criteria. Findings of meta-analyses on interventions indicated promising results in improving anxiety [standardized mean difference (SMD) -7.15, 95% confidence interval (CI) -8.39 to -5.92], depression (SMD -0.26, CI -0.56 to -0.05), safety (SMD = 0.43, CI 0.4 to -0.83), violence prevention (SMD = -0.92, CI -1.66 to -0.17), health (SMD = 0.39, CI 0.12 to 0.66), self-esteem (SMD = 1.33, CI -0.73 to 3.39), social support (SMD =0.40, CI 0.20 to 0.61), and stress management (SMD = -8.94, CI -10.48 to -7.40) at the post-test. We found that empowerment plays a vital role, especially when treating depression and Post-Traumatic Stress Disorder (PTSD), which are difficult to improve across interventions. We found mixed findings on self-efficacy and quality of life. The effects of IPV are long-lasting and require treatments targeting co-morbid issues including improving safety and mental health issues.Item Plasma Exchange in the Treatment of A Child with West Nile Virus Encephalitis: A Case Report(2022) Ozkale, Yasemin; Ozkale, Murat; Ceylan, Ozgur; Erol, IlknurBackground: West Nile virus (WNV) is a member of the Japanese encephalitis antigenic complex of the family Flaviviridae that can cause a wide range of clinical symptoms, from asymptomatic disease to severe meningitis, encephalitis flaccid paralysis, and death. In immunocompetent children, WNV infection is usually benign and self-limiting. However, this virus is also associated with severe neurological disease in some patients, especially those who are older, have a chronic disease, have undergone organ transplantation, or are immunocompromised. Case Report: A 12-year-old boy with selective immunoglobulin A-deficiency (SIgAD) and refractory seizures due to WNV encephalitis (WNE) was successfully treated with therapeutic plasma exchange (TPE) in conjunction with other immunomodulatory therapies. Conclusion: WNV can progress like autoimmune encephalitis. TPE appears to be safe and effective for treating children with WNE. To our knowledge, this report is the first of a child with WNV infection and SIgAD.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 Could Plasma Based Therapies Still Be Considered in Selected Cases with Atypical Hemolytic Uremic Syndrome?(2021) Ozlu, Sare Gulfem; Gulhan, Bora; Aydog, Ozlem; Atayar, Emine; Delibas, Ali; Parmaksiz, Gonul; Ozdogan, Elif Bahat; Comak, Elif; Tasdemir, Mehmet; Acar, Banu; Ozcakar, Zeynep Birsin; Topaloglu, Rezan; Soylemezoglu, Oguz; Ozaltin, Fatih; 35023648Background. Atypical hemolytic uremic syndrome (aHUS) occurs due to defective regulation of the alternative complement pathway (ACP) on vascular endothelial cells. Plasma based therapy (PT) was the mainstay of the treatment for aHUS for many years until the introduction of therapies targeting blockage of the complement system. The aim of this study was to evaluate patients with aHUS who had been treated with plasma based therapies alone. Methods. The outcomes of seven genetically confirmed aHUS patients (2 girls, 5 males) were evaluated by means of clinical presentation, response to plasma therapy, course of the disease during the follow-up period and last status. Results. The median age of the patients at admission was 6.7 years (IQR 0.7-7.8). Three patients received plasma exchange therapy and the other four patients were treated with plasma infusions. One patient was lost to follow-up after one year; the median duration of follow-up for other patients was 3.7 years (IQR 2.7-6.5). During the follow up, two patients from our historical records when complement blocking therapies had not been in clinical use yet in Turkey, underwent kidney transplantation. One transplant patient experienced an acute rejection episode without graft loss. The remaining five patients had a glomerular filtration rate of more than 90 ml/min./1.73 m(2) at the last visit. Conclusion. Although we had a relatively small patient population, our findings indicate that PT might still be considered in selected patients particularly in countries where complement blocking therapies are difficult to reach due to their unavailability or costs that are not covered by the health care systems.Item Treatment of Full-Thickness Cartilage Defects with Pedunculated and Free Synovial Grafts: A Comparative Study in an Animal Model(2020) Haberal, Bahtiyar; Sahin, Orcun; Terzi, Aysen; Simsek, Ekin Kaya; Mahmuti, Ates; Tuncay, Ismail Cengiz; 0000-0002-6035-6258; 0000-0001-5856-8895; 0000-0002-1668-6997; 32850038; AAF-4032-2021; AAF-3988-2021; W-9080-2019Aims and Objectives The purpose of this study was to compare the potential effects of pedunculated and free synovial grafts in the repair of full-thickness articular cartilage defects on an animal model with histological and immunohistochemical analysis. Materials and Methods A comparative study in an animal model was performed with 24 rabbits, divided into two groups. Full-thickness cartilage defects were created bilaterally on the knees of all rabbits. Pedunculated and free synovial grafts were applied to the right knees of Group 1 and Group 2, respectively. Left knees were left as the control group. Six rabbits from each group were randomly selected for euthanasia 4 and 8 weeks postoperatively. All samples were examined histologically with a cartilage scoring system. For immunohistochemical analysis, the degree of collagen 2 staining was determined using a staging system. All data were statistically compared between the study groups with Student's t-test or Mann-Whitney U-test. The correlations between categorical variables were analyzed with Fisher's exact test and Chi-square test. Results In Group 1, the mean defect size had significantly decreased at 8 weeks postsurgery. It was also significantly smaller than that of Group 2. Both pedunculated and free synovial grafts had significantly better histological and immunohistochemical outcomes compared with the controls. Contrastingly, the results of comparison between the study groups (Group 1 vs. 2) at the 4th and 8th week were not statistically significant with regard to histological scores and immunohistochemical staining. Conclusion Synovial tissue, whether pedunculated or free, provided much better cartilage recovery compared with the control. It can be used as a mesenchymal stem cell (MSC) source, and synovium-derived MSCs have the chondrogenic potential for the in vivo treatment of full-thickness cartilage defects.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%.