PubMed İndeksli Açık & Kapalı Erişimli Yayınlar
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Item Heart failure with non-reduced ejection fraction: Epidemiology, pathophysiology, phenotypes, diagnosis and treatment approaches(2022) Cavusoglu, Yuksel; Celik, Ahmet; Altay, Hakan; Nalban, Sanem; Ozden, Ozge; Temizhan, Ahmet; Ural, Ditek; Unlu, Serkan; Yilmaz, Mehmet Birhan; Zoghi, Mehdi; 35969235Heart failure (HF) has been classified as reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF) by the recent HF guidelines. In addition, HF with improved ejection fraction has been defined as a subgroup of HFrEF. In HFrEF, diagnostic workup and evidence-based pharmacological and device-based therapies have been well established. However, HFpEF, which comprises almost half of the HF population, represents significant uncertainties regarding its pathophysiology, clinical phenotypes, diagnosis and treatment. Diagnostic criteria of HFpEF have been changed a few times over the years and still remained a matter of debate. New paradigms including a prominent role of co-morbidities. inflammation, endothelial dysfunction have been proposed in its pathophysiology. As a complex, multifactorial syndrome HFpEF consists of many overlapping clinical and hemodynamic phenotypes. In contrast to HFrEF, clinical outcomes of HFpEF have not improved over the last decades due to lack of proven effective therapies. Although HFrEF and HFpEF have different clinical spectrums and proposed pathophysiological mechanisms, there is no clear defining syndrome postulated for HFmrEF. Clinical characteristics and risk factors of HFmrEF overlap with HFrEF and HFpEF. HFmrEF is also referred as a transitional zone for dynamic temporal changes in EF. So. HFpEF and HFmrEF, both namely HF with non-reduced ejection fraction (HF-NEF), have some challenges in the management of HF. The purpose of this paper is to provide a comprehensive review including epidemiology, pathophysiology, clinical presentation and phenotypes of HF-NEF and to guide clinicians for the diagnosis and therapeutic approaches based on the available data in the literature.Item Comparison of placental alpha microglobulin-1 protein assay (Amnisure) with speculum examination for the diagnosis of premature preterm rupture of membranes (PPROM): a clinical evaluation(2021) Esin, Sertac; Tohma, Yusuf Aytac; Alay, Ismail; Guden, Mahmut; Colak, Eser; Demirel, Nihal; Bas, Ahmet Yagmur; Serdar Yalvac, Ethem; Kandemir, Omer; 0000-0001-9577-4946; 32835549; AAI-8810-2021In this study, we aimed to compare the clinical outcomes of Premature Preterm Rupture of Membranes (PPROM) cases diagnosed by classical speculum examination and by placental alpha microglobulin-1 protein (PAMG-1) assay. The medical records of all patients with singleton pregnancies that were diagnosed with PPROM were retrospectively reviewed. Singleton pregnancies with PPROM diagnosis that was confirmed either by direct visualisation of amniotic fluid leaking through the cervix or by placental alpha microglobulin-1 protein (PAMG-1) assay if no amniotic fluid leakage was documented were included in the study. Demographics, prenatal and postnatal characteristics were reviewed from the medical charts and were recorded. The study included 138 pregnancies with PPROM; 111 patients in clinical speculum examination group and 27 in PAMG-1 assay group. There were no significant differences in maternal and pregnancy characteristics between the clinical speculum examination and PAMG-1 assay groups. Foetal outcomes were comparable between clinical speculum examination and PAMG-1 assay groups. In the clinical speculum examination group, there were nine (8.1%) chorioamnionitis cases, however, there were no chorioamnionitis cases in the PAMG-1 assay group during the latency period (p = .21).Impact statement What is already known on this subject?Placental alpha microglobulin-1 protein assay uses immunochromatography method to detect trace amount of placental alpha microglobulin-1 protein in vaginal fluids and has high sensitivity and specificity for ROM diagnosis. However, to the best of our knowledge, the clinical outcome of ROM cases detected by classical speculum examination and by placental alpha microglobulin-1 protein assay has not been compared in the literature previously. What do the results of this study add?Although statistically insignificant, cases diagnosed by PAMG-1 assay had lower risk of chorioamnionitis during latency period. What are the implications of these findings for clinical practice and/or further research?Whether cases diagnosed by PAMG-1 assay represent a milder form of rupture of membranes than cases diagnosed by classical speculum examination group warrants further research.Item Reliability of Real-Time Sonoelastography in the Diagnosis of Supraspinatus Tendinopathy(2021) Aydin, Elcin; Soylev, Gozde Ozcan; Muratli, Sedit Kivanc; Limnili, Bora Bora; Boya, Hakan; Tekindal, Mustafa Agah; Agildere, Muhtesem; 0000-0001-8742-5543; 0000-0001-8742-5543; 31107427; AAI-8276-2021; AAJ-4917-2021The practicality of real-time sonoelastography in the diagnosis of tendinopathy is being discussed since the beginning of its use in musculoskeletal system. The aims of this study were to compare the elasticity of pathologic supraspinatus tendon with the uninvolved side by sonoelastography and to determine the relationship between the sonoelastographic findings and magnetic resonance imaging (MRI) grade of the tendinosis. Eighty-2 patients (50 males, 32 females, mean +/- SD age = 53.61 +/- 16.15 years, range = 20-84 years) with unilateral supraspinatus tendinosis were included in this study. Three grades of tendinosis were identified in MRI (grade 1: mild, grade 2: moderate, and grade 3: severe). The strain ratio (SR) of the tendinosis area to the healthy normal area of the same tendon tissue and SR of the tendinosis area to ipsilateral subcutaneous fat tissue were evaluated with sonoelastography. The SRs of the tendinosis areas were also compared with the control (contralateral) side tendon tissue and subcutaneous fat tissue of the same patients. Between-groups comparisons were also done according to the MRI grading. Statistical analysis was done using paired t test (P < 0.005 was considered statistically significant). There was a statistically significant difference in the comparison of the SRs of the tendinosis areas to subcutaneous fat tissues on ipsilateral shoulders (TA/SFT) and the healthy supraspinatus tendon area (TA/ST) of the same shoulder. There was also statistically significant difference when compared with the control side measurements (P < 0.01). In patients who have grade 1 and grade 3 tendinosis on MRI, there was statistically significant difference between elastrographic evaluation of affected and unaffected sides. Real-time sonoelastography is a reliable diagnostic method in patients with rotator cuff tendinosis and shall be kept in mind as a noninvasive, inexpensive, and practical diagnostic test in suitable cases.Item Influenza viruses and SARS-CoV-2 in adult: 'Similarities and differences'(2021) Torun, Serife; Kesim, Cagri; Suner, Aynur; Botan Yildirim, Berna; Ozen, Ozgur; Akcay, Sule; 0000-0002-8964-291X; 0000-0001-7122-4130; 0000-0001-7730-1379; 34957739; AAD-5996-2021; AAN-1681-2021Introduction: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), causing a global pandemic starting from December 2019, showed a course that resulted in serious mortality in the world. In order to understand SARSCoV-2 better, here we aimed to compare the similar and different characteristics of Influenza viruses occurring in the same season with SARS-CoV-2. Materials and Methods: A total of 144 patients (31 patients with COVID-19, 62 patients with H1N1 influenza, and 51 patients with influenza B) were included in the study. Demographic findings, chronic diseases, laboratory values, chest x-ray, and chest CT findings of the patients were evaluated retrospectively. Results: Median age of the COVID-19 patients and rate of male patients were higher than other patient groups (55 years; p< 0.001) (61% male; p< 0.001). The most common chronic medical conditions were hypertension and diabetes. Platelet numbers and alanine aminotransferase values were significantly higher in COVID-19 patients. Radiologically, bilateral (74.2%) and nonspecific distribution (58.1%), ground-glass opacities with consolidation (51.6%), patchy image (25.8%), ground-glass opacities with interstitial changes (22.6%) and halo sign (22.6%) were quite evident than other groups in COVID-19 patients (p< 0.05). Conclusion: We suggest that due to the higher PLT values observed in COVID-19 patients, initiation of anticoagulant therapy should be considered in the early stage and routine follow-up with d-dimer and fibrinogen should be applied for suspected patients. Moreover, attention should be paid in terms of possible liver toxicity of the drugs to be used in treatment due the higher ALT values observed in COVID-19 patients. Since we did not detect SARS-CoV-2 and influenza viruses concurrently in the same patient, it may be helpful to focus on only one virus in a patient with symptoms, and radiographic differences can be used to differentiate COVID-19 from influenza.Item An Atypical Case of Pustular Psoriasis Presenting With Severe Subungual Abscesses Involving All Fingers(2019) Mansur, A. Tulin; 31106021Item A New Imaging Technique for the Diagnosis of Thyroid Cancer: Thyroidography(2019) Aysan, Erhan; Aydin, Ozan; Ercivan, Merve; Aksoy, Direnc; Yavuz, Alp Erdem; 31387418Background: Microcalcifications are the most important diagnostic parameter for thyroid cancer. We developed a new imaging technique based on low dose X-rays that specifically reveal microcalcifications via a new software algorithm. Method: A prospective clinical trial was planned and 45 cases (37 women, 8 men, women/men: 4.6, age range: 17-68, mean age: 43) were included in the study. After total thyroidectomy with standard technique, the fresh thyroid tissues were integrated into the human neck simulator. Raw (DICOM) images were obtained for each tissue sample with a standard mammography device and transformed into new images (thyroidograms) by a new software algorithm. Preoperative ultrasonography (USG) images, DICOM images, and thyroidograms were evaluated in order to observe micro and macrocalcifications by the same experienced radiologist. Results: Twenty-four cases were malignant and 21 cases were benign after histopathologic evaluation. Microcalcification detection with the thyroidography was statistically significant for sensitivity, positive predictive value, negative predictive value, and accuracy (p < 0.05) but not for specificity (p > 0.05) compared to the USG and DICOM images for the malignant and also benign cases. Conclusion: This new imaging technique is hopeful for diagnosis of thyroid cancer according to microcalcification detection and may complement thyroid USG.Item 2019 Turkish Hypertension Consensus Report(2019) Aydogdu, Sinan; Guler, Kerim; Bayram, Fahri; Altun, Bulent; Derici, Ulver; Abaci, Adnan; Tukek, Tufan; Sabuncu, Tevfik; Arici, Mustafa; Erdem, Yunus; Ozin, Bulent; Sahin, Ibrahim; Erturk, Sehsuvar; Bittigen, Atilla; Tokgozoglu, Lale; 31483311The Turkish Hypertension Consensus Report was prepared for the first time in 2015 to adapt the European and American international guidelines to our clinical practice and to create a practical report that could be a basic reference for all physicians dealing with hypertensive patients. This report, which was prepared by a committee with representation from 5 leading hypertension associations, has been accepted and is widely used. New clinical studies in hypertension literature and updated international guidelines since 2015 have demanded an update of the Turkish Hypertension Consensus Report as well. In this updated 2019 report, blood pressure levels were classified as Normal, Elevated, Stage 1, and Stage 2 hypertension. A new section was added for secondary hypertension. It was specified that drug treatment may be initiated with any 1 or a combination of 4 groups of drugs (diuretics, calcium channel blockers, angiotensin-converting enzyme [ACE] inhibitors, and angiotensin receptor blockers [ARBs]), except a combination of an ACE inhibitor and an ARB. It was emphasized that beta-blockers may be a first choice for hypertension treatment in diseases such as atrial fibrillation, heart failure, and coronary artery disease. The initial recommendation for hypertension treatment is a combination therapy in patients with a blood pressure level >= 150/90 mmHg. Target blood pressure values were redefined according to age and the presence of comorbidities. The hypertension treatment algorithm was renewed; it is proposed that drug therapy can also be initiated with a risk-based approach for the group with an elevated blood pressure (systolic blood pressure: 120-139 mmHg, diastolic blood pressure: 80-89 mmHg). The threshold clinic systolic blood pressure level was reduced from 160 mmHg to >= 150 mmHg for the initiation of drug therapy in individuals 80 years of age or more. The section on the treatment of special groups has now been expanded to include pregnancy and lactation. As in the previous report, in this update, practical recommendations for the most common cases seen in the clinic were the goal, rather than a comprehensive report that addresses all aspects of hypertension. This report has evidence-based recommendations for most patients; however, it should be kept in mind that there may be differences from 1 patient to another and that physicians should take an individualized approach according to a good clinical evaluation.Item The microbiological diagnosis of tuberculous meningitis: results of Haydarpasa-1 study(2014) Kursun, E.; 24849547We aimed to provide data on the diagnosis of tuberculous meningitis (TBM) in this largest case series ever reported. The Haydarpasa-1 study involved patients with microbiologically confirmed TBM in Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria and Turkey between 2000 and 2012. A positive culture, PCR or Ehrlich-Ziehl-Neelsen staining (EZNs) from the cerebrospinal fluid (CSF) was mandatory for inclusion of meningitis patients. A total of 506 TBM patients were included. The sensitivities of the tests were as follows: interferon- release assay (Quantiferon TB gold in tube) 90.2%, automated culture systems (ACS) 81.8%, Lowenstein Jensen medium (L-J) 72.7%, adenosine deaminase (ADA) 29.9% and EZNs 27.3%. CSF-ACS was superior to CSF L-J culture and CSF-PCR (p<0.05 for both). Accordingly, CSF L-J culture was superior to CSF-PCR (p<0.05). Combination of L-J and ACS was superior to using these tests alone (p<0.05). There were poor and inverse agreements between EZNs and L-J culture (=-0.189); ACS and L-J culture (=-0.172) (p<0.05 for both). Fair and inverse agreement was detected for CSF-ADA and CSF-PCR (=-0.299, p<0.05). Diagnostic accuracy of TBM was increased when both ACS and L-J cultures were used together. Non-culture tests contributed to TBM diagnosis to a degree. However, due to the delays in the diagnosis with any of the cultures, combined use of non-culture tests appears to contribute early diagnosis. Hence, the diagnostic approach to TBM should be individualized according to the technical capacities of medical institutions particularly in those with poor resources.Item The value of serum mean platelet volume in testicular torsion(2015) Cicek, Tufan; Togan, Turhan; Akbaba, Kaan; Narci, Huseyin; Aygun, Cem; 25762515Objective To compare the serum mean platelet volume (MPV) in patients with testicular torsion and healthy control subjects. Methods This retrospective study compared clinical and demographic data from patients who underwent surgery for testicular torsion and healthy controls. Testicular torsion was diagnosed with a physical examination and Doppler ultrasonography. Age, leukocyte count, platelet count and MPV were recorded for all participants. Results A total of 50 patients with testicular torsion and 51 healthy control subjects were enrolled. There was no significant difference in age and platelet count between the two groups. Patients with testicular torsion had a significantly higher leukocyte count and MPV, compared with controls. According to receiver operating characteristic curve analysis performed for the prediction of testicular torsion, the best cut-off point for MPV was 7.7fl (sensitivity 62%, specificity 96%), and the best cut-off point for leukocyte count was 9.5x10(9)/l (sensitivity 58%, specificity 80%). Conclusions The MPV may be useful as an ancillary test for the diagnosis of testicular torsion. Further studies are needed in order to confirm these preliminary results.