Fakülteler / Faculties
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Item Transplanted Kidney Function Evaluation(2014) Aktas, Ayse; https://orcid.org/0000-0003-0149-2265; 24484750; AAI-8772-2021The best option for the treatment of end-stage renal disease is kidney transplantation. Prompt diagnosis and management of early posttransplantation complications is of utmost importance for graft survival. Biochemical markers, allograft biopsies, and imaging modalities are used for the timely recognition and management of graft dysfunction. Among several other factors, improvements in imaging modalities have been regarded as one of the factors contributing to increased short-term graft survival. Each imaging procedure has its own unique contribution to the evaluation of renal transplant dysfunction. In the era of multimodality imaging and emerging clinical considerations for the improvement of graft survival, evaluating an imaging modality in its own right may not be relevant and may fall short of expectation. Recognized as being mainly a functional imaging procedure, radionuclide imaging provides valuable information on renal function that cannot be obtained with other imaging. modalities. For evaluating and establishing the current place, indications, and potential applications of radionuclide renal transplant imaging, a classification of renal allograft complications based on renal allograft dysfunction is essential. The major factor affecting long-term graft loss is chronic allograft nephropathy. Its association with early posttransplantation delayed graft function and repeated acute rejection episodes is well documented. Long-term graft survival rate have not improve significantly over the years. Imaging procedures are most commonly performed during the early period after transplantation. There seems to be a need for performing more frequent late posttransplantation imaging for the evaluation of acute allograft dysfunction, subclinical pathology, and chronic allograft changes; for understanding their contribution to patient management; and for identification of pathophysiological mechanisms leading to proteinuria and hypertension. With its unique advantage of relating perfusion to function, the potential for radionuclide imaging to replace late protocol biopsies needs to be investigated. (C) 2014 Elsevier Inc. All rights reserved.Item MDCT Evaluation of Early Pulmonary Infection Types After Liver Transplantation(2015) Hekimoglu, K.; Tezcan, S.; Coskun, M.; Dogrul, M. I.; Moray, G.; Haberal, M.; 0000-0002-0805-0841; 0000-0003-2498-7287; 0000-0002-3462-7632; 0000-0001-5630-022X; 0000-0001-7204-3008; 25769594; AAD-9097-2021; AAE-1041-2021; AAJ-8097-2021; AAM-4120-2021Introduction. Opportunistic pulmonary infections frequently occur after liver transplantation, and affect mortality and morbidity significantly. The purpose of this study was to define the incidence, types, and imaging characteristics of pulmonary infections in liver transplant recipients with multidetector CT (MD CT) evaluation. Methods. Thirty-five adult transplant recipients diagnosed with a pulmonary infection within the first 45 days posttransplantation were reviewed retrospectively from March 2002 to December 2013. MDCT features were evaluated retrospectively by 2 radiologists in consensus. All diagnoses were made by sputum analysis, cultures, biopsies, and postmortem histopathologic evaluation. Results. Pneumococcus pneumonia was found in 7 patients. Five patients had nonspecific pneumonia, Candidiasis, Klebsiella, and Aspergillosis separately. S aureus pneumonia was detected in 2 patients and the other 2 patients had Escherichia coli pneumonia. Two patients had active tuberculosis and 1 patient had Acinetobacter pneumonia also. Four main MDCT patterns were identified: patchy infiltrations (10%), tree-in-bud pattern (9.5%), ground-glass opacity (8.5%), and nodules with halo sign (6%). One patient had a cavitary lesion owing to tuberculosis. Conclusion. Although the incidence of pulmonary complications in liver recipients was relatively low, mortality from serious infections was high. Care must be taken with pulmonary infectious complications in the posttransplant period. For any suspicious case, MDCT evaluation for specific patterns of early accurate diagnosis is very important.Item High Grade Proteinuria as a Cardiovascular Risk Factor in Renal Transplant Recipients(2015) Guliyev, O.; Sayin, B.; Uyar, M. E.; Genctoy, A.; Sezer, S.; Bal, Z.; Demirci, B. G.; Haberal, M.; 0000-0001-8287-6572; 0000-0002-3462-7632; 0000-0002-5145-2280; 26036546; J-3707-2015; AAJ-8097-2021; AAZ-5795-2021; IAO-2608-2023; AAJ-5551-2021Background. Proteinuria is a marker of graft damage and is closely associated with a higher risk of morbidity, mortality, and cardiovascular disease in kidney transplant recipients (KTRs). Arterial stiffness is a well-known predictor of vascular calcification and systemic arteriosclerosis. In our study, we aimed to investigate. the association between proteinuria and graft/patient survival and to determine whether proteinuria may be a predictor for cardiovascular disease in our KTR population. Methods. Ninety KTRs (31 women; age, 38.7 +/- 11 years, with 45.9 +/- 9.6 months post-transplantation period) with normal graft functions in the 3 to 5 years of the post-transplantation period were enrolled. All patients were evaluated for their standard clinical (age, sex, and duration of hemodialysis) parameters. High-grade proteinuria was defined as proteinuria >500 mg/day in the 24-hour urine collection. All patients were evaluated by means of pulse-wave velocity (PWV) measurement at the initiation of the study. Results. Patients were divided into 2 groups: group 1 (high-grade proteinuria) patients with >= 500 mg/24 hours (n = 30) and group 2 (low-grade proteinuria) patients with <500 mg/24 hours (n = 60). High-grade proteinuria was correlated with higher PWV measurements and lower estimated glomerular filtration levels. Proteinuria appears to precede the elevation of serum creatinine and thus may be a useful marker of renal injury and may also be a contributing factor on deterioration of the graft. Conclusions. High-grade (>500 mg/day) proteinuria in KTRs is strongly associated with poor graft survival and increased risk of cardiovascular events. In our study, we proved the significant difference between high-grade and low-grade proteinuric patients, and we suggest 500 mg/day as the threshold of proteinuria in KTR population.Item Can We Predict the Outcome of Varicocelectomy Based on the Duration of Venous Reflux?(2016) Goren, Mehmet Resit; Erbay, Gurcan; Ozer, Cevahir; Kayra, Mehmet Vehbi; Hasirci, Eray; https://orcid.org/0000-0002-2001-1386; https://orcid.org/0000-0002-1706-8680; https://orcid.org/0000-0001-6037-7991; https://orcid.org/0000-0002-7349-9952; https://orcid.org/0000-0002-4147-2966; 000373464600021; Y-6143-2019; AAK-5370-2021; AAK-8372-2021; AAI-7997-2021OBJECTIVE To investigate the outcome of varicocelectomy based on the duration of venous reflux (DVR) of the pampiniform plexus veins. MATERIALS AND METHODS In total, 138 patients with clinically palpable varicoceles were evaluated for DVR with color Doppler ultrasonography from May 2009 to August 2014. The DVR was defined as the DVR of a varicocele in the supine position during the Valsalva maneuver. Patients with bilateral, recurrent, or subclinical varicoceles; hormonal imbalances involving follicle-stimulating hormone, luteinizing hormone, or total testosterone; azoospermia; and intraoperative or postoperative complications were excluded. Of the 138 patients, 76 met the inclusion criteria. All patients were treated with subinguinal microscopic varicocelectomy. Restoration of all three semen parameters (concentration, motility, and morphology) to normal values 6 months postoperatively was considered to indicate treatment success. The patients were divided into those with a DVR of <4.5 seconds (Group 1) and >= 4.5 seconds (Group 2). RESULTS The mean age of the patients was 29.39 (+/- 6.03) years. No statistically significant relationship was found between the success rate and varicocele grade. The cutoff DVR value was calculated as 4.5 seconds using a receiver operating characteristics curve according to patients who underwent successful treatment. The success rates of Groups 1 and 2 were 40.0% and 88.2%, respectively (P = .0001). CONCLUSION The results of this analysis indicate that a DVR of >= 4.5 seconds predicts better outcomes of varicocelectomy. (C) 2016 Elsevier Inc.Item Association of Clinical Properties and Compatibility of the Quantiferon-TB Gold In-Tube Test with the Tuberculin Skin Test in Patients with Psoriasis(2016) Togral, Arzu Karatas; Koryurek, Ozgul Mustu; Sahin, Muzaffer; Bulut, Cemal; Yagci, Server; Eksioglu, Hatice Meral; 26498894; GPX-6417-2022; GRY-5217-2022BackgroundIndividuals with psoriasis show conflicting responses to the tuberculin skin test (TST), a commonly used screening test for latent tuberculosis infection. An alternative to TST is QuantiFERON-TB Gold In-Tube test (QFT-GIT), an in vitro interferon-gamma release assay. This study aimed to determine the effect of the clinical properties of psoriasis (disease severity and koebnerization status) on TST results and the agreement between the TST and QFT-GIT results in psoriatic patients. MethodsOne hundred patients with mild to severe psoriasis were enrolled in this prospective cross-sectional study. Psoriasis properties, including disease severity (psoriasis area and severity index score and koebnerization status), latent tuberculosis infection risk factors, and bacillus Calmette-Guerin vaccination history, were recorded. All patients underwent a TST and QFT-GIT. TST positivity cut-off point was 10 mm for bacillus Calmette-Guerin-vaccinated patients and 5 mm for non-vaccinated patients. ResultsPsoriasis area and severity index scores and koebnerization status did not correlate with TST diameters. Only one of the 23 koebnerization-positive patients developed koebnerization in response to TST. QFT-GIT positivity was prominently higher in the TST-positive group, and this was the only factor that differed between the TST-positive and TST-negative groups (P < 0.001). ConclusionTuberculin skin test results were not affected by psoriasis severity or koebnerization status. QFT-GIT positivity was prominently higher in the TST-positive group (P < 0.001). Overall agreement between TST and QFT-GIT results was moderate ( = 0.413). Concurrent negativity (44%) was higher than concurrent positivity (27%).Item Antifungal Stewardship(2017) Azap, Ozlem K.; Ergonul, Onder; https://orcid.org/0000-0002-3171-8926; AAK-4089-2021Item Cost-of-disease of Heart Failure in Turkey: A Delphi Panel-based Analysis of Direct and Indirect Costs(2022) Cavusoglu, Yuksel; Altay, Hakan; Aras, Dursun; Celik, Ahmet; Ertas, Fatih Sinan; Kilicaslan, Baris; Nalbantgil, Sanem; Temizhan, Ahmet; Ural, Dilek; Yildirimturk, Ozlem; Yilmaz, Mehmet Birhan; 35872647Background: Heart failure (HF) is considered a significant public health issue with a substantial and growing epidemiologic and economic burden in relation to longer life expectancy and aging global population Aims: To determine cost-of-disease of heart failure (HF) in Turkey from the payer perspective. Study Design: Cross-sectional cost of disease study. Methods: In this cost-of-disease study, annual direct and indirect costs of management of HF were determined based on epidemiological, clinical and lost productivity inputs provided by a Delphi panel consisted of 11 experts in HF with respect to ejection fraction (EF) status (HF patients with reduced EF (HFrEF), mid-range EF (HFmrEF) and preserved EF (HFpEF)) and New York Heart Association (NYHA) classification. Direct medical costs included cost items on outpatient management, inpatient management, medications, and non -pharmaceutical treatments. Indirect cost was calculated based on the lost productivity due to absenteeism and presenteeism. Results: 51.4%, 19.5%, and 29.1% of the patients were estimated to be HFrEF, HFmrEF, and HFpEF patients, respectively. The total annual direct medical cost per patient was $887 and non-pharmaceutical treatments ($373, 42.1%) were the major direct cost driver. Since an estimated nationwide number of HF patients is 1,128,000 in 2021, the total annual national economic burden of HF is estimated to be $1 billion in 2021. The direct medical cost was higher in patients with HFrEF than in those with HFmrEF or HFpEF ($1,147 vs. $555 and $649, respectively). Average indirect cost per patient was calculated to be $3,386 and was similar across HFrEF, HFmrEF and HFpEF groups, but increased with advanced NYHA stage. Conclusion: Our findings confirm the substantial economic burden of HF in terms of both direct and indirect costs and indicate that the non-pharmaceutical cost is the major direct medical cost driver in HF management, regardless of the EF status of HF patients.Item The acromegaly registry of ten different centers in Turkey(2020) Keskin, Caglar; Demir, Ozgur; Karci, Alper Cagri; Berker, Dilek; Canturk, Zeynep; Yaylali, Guzin Fidan; Topsakal, Senay; Ersoy, Reyhan; Bayram, Fahri; Ertorer, Melek Eda; Bozkirli, Emre; Haydardedeoglu, Filiz; Dilekci, Esra Nur Ademoglu; Ay, Seyid Ahmet; Cansu, Guven Baris; Sahin, Mustafa; Emral, Rifat; Corapcioglu, Demet; 0000-0002-0179-9673; 0000-0001-7357-8709; 32417639; AAK-5003-2021; ABI-3705-2020; ABI-3393-2020Objectives: To describe biochemical and clinical features, and therapeutic outcomes of acromegaly patients in Turkey. Methods: Retrospective multicenter epidemiological study of 547 patients followed in 10 centers of the Turkish Acromegaly registry. Results: A total of 547 acromegaly patients (55% female) with a median age of 41 was included in this study. Majority of patients had a macroadenoma (78%). Transsphenoidal surgery was performed as primary treatment in 92% of the patients (n = 503). Surgical remission rate was 39% (197/503) in all operated patients. Overall disease control was achieved in 70% of patients. Remission group were significantly older than non-remission group (p = .002). Patients with microadenomas had significantly higher remission rates than patients with macroadenomas (p < .001). Patients with microadenomas were significantly older at the time of diagnosis when compared to patients with macroadenomas (p < .001). Preoperative growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels were significantly lower in the remission group (p < .001). Initial IGF-1 and GH levels were significantly higher in macroadenomas compared to microadenomas (p < .001). Medical treatment was administered as a second-line treatment (97%) in almost all patients without remission. Radiotherapy was preferred in 21% of the patients mostly as a third line treatment. Conclusions: This is one of the largest real life studies evaluating the epidemiological characteristics and treatment outcomes of patients with acromegaly who were followed in different centers in Turkey. Transsphenoidal surgery in the treatment of acromegaly still remains the most valid method. Medical treatment options may improve long-term disease outcomes in patients who cannot be controlled with surgical treatment (up to 70%).Item Low Advanced Lung Cancer Inflammation Index Predicts Poor Prognosis in Locally Advanced Nasopharyngeal Carcinoma Patients Treated with Definitive Concurrent Chemoradiotherapy(2020) Topkan, Erkan; Ozdemir, Yurday; Kucuk, Ahmet; Guler, Ozan Cem; Sezer, Ahmet; Besen, Ali Ayberk; Mertsoylu, Huseyin; Senyurek, Sukran; Kilic Durankus, Nulifer; Bolukbasi, Yasemin; Selek, Ugur; Pehlivan, Berrin; 0000-0001-8120-7123; 0000-0002-7862-0192; 0000-0002-2218-2074; 0000-0001-6908-3412; 0000-0002-1932-9784; 0000-0002-6445-1439; 0000-0002-5361-364X; 33082783; AAG-2213-2021; AAD-6910-2021; AAG-5629-2021; AAC-5654-2020; M-9530-2014; AAD-2667-2020Purpose. We aimed to retrospectively investigate the prognostic worth of pretreatment advanced lung cancer inflammation index (ALI) in locally advanced nasopharyngeal carcinoma (LA-NPC) patients treated with concurrent chemoradiotherapy (C-CRT).Patients and Methods. A total of 164 LA-NPC patients treated with cisplatinum-based definitive C-CRT were included in this retrospective cohort analysis. The convenience of ideal pre-C-CRT ALI cut-offs affecting survival results was searched by employing the receiver operating characteristic (ROC) curve analyses. The primary endpoint was the link between the ALI groups and overall survival (OS), while cancer-specific survival (CSS), locoregional progression-free survival [LR(PFS)], distant metastasis-free survival (DMFS), and PFS comprised the secondary endpoints.Results. The ROC curve analyses distinguished a rounded ALI cut-off score of 24.2 that arranged the patients into two cohorts [ALI >= 24.2 (N = 94) versus < 24.2 (N = 70)] with significantly distinct CSS, OS, DMFS, and PFS outcomes, except for the LRPFS. At a median follow-up time of 79.2 months (range: 6-141), the comparative analyses showed that ALI < 24.2 cohort had significantly shorter median CSS, OS, DMFS, and PFS time than the ALI >= 24.2 cohort (P<0.001for each), which retained significance at 5- (P<0.001) and 10-year (P<0.001) time points. In multivariate analyses, ALI < 24.2 was asserted to be an independent predictor of the worse prognosis for each endpoint (P<0.001for each) in addition to the tumor stage (T-stage) (P<0.05for all endpoints) and nodal stage (N-stage) (P<0.05for all endpoints).Conclusion. As a novel prognostic index, the pretreatment ALI < 24.2 appeared to be strongly associated with significantly diminished survival outcomes in LA-NPC patients treated with C-CRT independent of the universally recognized T- and N-stages.Item Relapsed acute myeloid leukemia presenting with myocardial hypertrophy and constrictive pericardial physiology(2019) Acibuca, Aynur; Yeral, Mahmut; Kocer, Nazim Emrah; Koc, Zafer; Gullu, Hakan; 0000-0002-3444-8845; 31062759; ABG-4047-2020; ABC-4148-2020