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Item The phenotypic and molecular genetic spectrum of Alstrom syndrome in 44 Turkish kindreds and a literature review of Alstrom syndrome in Turkey(2015) Erol, Ilknur; 25296579Alstrom syndrome (ALMS) is an autosomal recessive disease characterized by multiple organ involvement, including neurosensory vision and hearing loss, childhood obesity, diabetes mellitus, cardiomyopathy, hypogonadism, and pulmonary, hepatic, renal failure and systemic fibrosis. Alstrom Syndrome is caused by mutations in ALMS1, and ALMS1 protein is thought to have a role in microtubule organization, intraflagellar transport, endosome recycling and cell cycle regulation. Here, we report extensive phenotypic and genetic analysis of a large cohort of Turkish patients with ALMS. We evaluated 61 Turkish patients, including 11 previously reported, for both clinical spectrum and mutations in ALMS1. To reveal the molecular diagnosis of the patients, different approaches were used in combination, a cohort of patients were screened by the gene array to detect the common mutations in ALMS1 gene, then in patients having any of the common ALMS1 mutations were subjected to direct DNA sequencing or next-generation sequencing for the screening of mutations in all coding regions of the gene. In total, 20 distinct disease-causing nucleotide changes in ALMS1 have been identified, eight of which are novel, thereby increasing the reported ALMS1 mutations by 6% (8/120). Five disease-causing variants were identified in more than one kindred, but most of the alleles were unique to each single patient and identified only once (16/20). So far, 16 mutations identified were specific to the Turkish population, and four have also been reported in other ethnicities. In addition, 49 variants of uncertain pathogenicity were noted, and four of these were very rare and probably or likely deleterious according to in silico mutation prediction analyses. ALMS has a relatively high incidence in Turkey and the present study shows that the ALMS1 mutations are largely heterogeneous; thus, these data from a particular population may provide a unique source for the identification of additional mutations underlying Alstrom Syndrome and contribute to genotype-phenotype correlation studies.Item Histologic Evaluation of the Effect of Mecsina Hemostopper on Bone Regeneration for Critical-Size Defects(2022) Aydin, Pelin; Akdeniz, Sidika Sinem; Akcay, Eda Yilmaz; 35904834Purpose: Acceleration of the bone healing period and/or increasing the quality of newly formed bone still have great importance in the field of oral and maxillofacial surgery. The aim of this study was to evaluate the effect of isolated liquid Mecsina (herbal extract) and its combination with xenogeneic graft material (bovine bone graft) on bone regeneration. Materials and Methods: Full-thickness critical-size defects with 10-mm diameter and 2-mm depth were created on the calvarial bone region in 28 Sprague Dawley male rats. Four groups were generated: Mecsina Hemostopper, Mecsina Hemostopper + graft group, only graft group, and empty control group. On the 28th day following surgery, all animals were sacrificed. The calvarial samples were evaluated both histopathologically and histomorphometrically. Results: According to the histopathologic evaluation result, vascular proliferation was significantly higher in the groups in which Mecsina Hemostopper was used as a single material or in combination with graft material (P<.05). Histomorphometric evaluation showed that trabecular and osteoid thickness were significantly higher in all Mecsina application groups (P<.05). Conclusion: Mecsina Hemostopper was found to be an effective agent in increasing cell proliferation and providing more qualified bone formation. The combination of Mecsina and xenogeneic bone graft was found to be one of the most effective augmentation options for critical-size defects in rats. Mecsina Hemostopper could be used to get more qualified bone formation clinically, but more clinical research is needed in the future.Item A holistic look at education of the Syrians under temporary protection in Turkey: policy, leadership and practice(2020) Arar, Khalid; Orucu, Deniz; Kucukcayir, Gulnur AkWe sought to provide a holistic view of education of the Syrians under temporary protection by exploring two schooling models in terms of policy and practice for integration. Relying on social justice (SJ) framework as redistribution, recognition and representation, and on ecological framework, we adopted qualitative phenomenological approach with both interviews with principals and teachers integrating Syrian students and related policy text analysis. Our findings indicated that this is a patchy space although SJ framework is evident in the implementations of the school practitioners. Yet, the existing discrepancy between policy and practice as well as the unsystematic approach in evaluating various implementations leaves the rigor vague. Further conclusions and implications are discussed.Item The prevalence and diagnostic criteria of health-care associated infections in neonatal intensive care units in Turkey: A multicenter point- prevalence study(2021) Demirdag, Tugba Bedir; Koc, Esin; Tezer, Hasan; Oguz, Suna; Satar, Mehme; Saglam, Ozge; Uygun, Saime Sunduz; Onal, Esra; Hirfanoglu, Ibrahim Murat; Tekgunduz, Kadir; Oygur, Nihal; Bulbul, Ali; Zubarioglu, Adil Umut; Ustun, Nuran; Unal, Sezin; Aygun, Canan; Karagol, Belma Saygili; Zenciroglu, Aysegul; Oncel, M. Yekta; Saglik, Adviye Cakil; Okulu, Emel; Terek, Demet; Narli, Nejat; Aliefendioglu, Didem; Gursoy, Tugba; Unal, Sevim; Turkmen, Munevver Kaynak; Narter, Fatma Kaya; Ciftdemir, Nukhet Aladag; Beken, Serdar; Cakir, Salih Cagri; Yigit, Sule; Coban, Asuman; Ecevit, Ayse; Celik, Yalcin; Kulali, Ferit; 0000-0002-2232-8117; 33546932; AAJ-4616-2021Background: Healthcare-acquired infections (HAIs) in the neonatal period cause substantial morbidity, mortality, and healthcare costs. Our purpose was to determine the prevalence of HAIs, antimicrobial susceptibility of causative agents, and the adaptivity of the Centres for Disease Control and Prevention (CDC) criteria in neonatal HAI diagnosis. Methods: A HAI point prevalence survey was conducted in the neonatal intensive care units (NICUs) of 31 hospitals from different geographic regions in Turkey. Results: The Point HAI prevalence was 7.6%. Ventilator-associated pneumonia (VAP) and central line-associated bloodstream infections (CLABSI) and late onset sepsis were predominant. The point prevalence of VAP was 2.1%, and the point prevalence of CLABSI was 1.2% in our study. The most common causative agents in HAIs were Gram-negative rods (43.0%), and the most common agent was Klebsiella spp (24.6%); 81.2% of these species were extended spectrum beta-lactamase (ESBL) (& thorn;). Blood culture positivity was seen in 33.3% of samples taken from the umbilical venous catheter, whereas 0.9% of samples of peripherally inserted central catheters (PICCs) were positive. In our study, 60% of patients who had culture positivity in endotracheal aspirate or who had purulent endotracheal secretions did not have any daily FiO2 change (p = 0.67) and also 80% did not have any increase in positive end-expiratory pressure (PEEP) (p = 0.7). On the other hand, 18.1% of patients who had clinical deterioration compatible with VAP did not have endotracheal culture positivity (p = 0.005). Conclusions: Neonatal HAIs are frequent adverse events in district and regional hospitals. This at-risk population should be prioritized for HAI surveillance and prevention programs through improved infection prevention practices, and hand hygiene compliance should be conducted. CDC diagnostic criteria are not sufficient for NICUs. Future studies are warranted for the diagnosis of HAIs in NICUs.Item Postprandial Hypoglycemia: An Unusual Presentation for Insulinoma(2016) Haydardedeoglu, Filiz Eksi; Torun, Ayse Nur Izol; Andic, Cagatay; Bakiner, Okan; Bozkirli, Emre; kayaselcuk, Fazilet; Ertorer, Melek EdaInsulinoma is the most common type of islet cell tumor of the pancreas and its incidence is estimated at four per one million persons per year. Although fasting hypoglycemia is the typical presentation, cases with postprandial hypoglycemia have rarely been reported. A 48-year-old woman was admitted to our department for evaluation of hypoglycemia. Laboratory data suggested a state of postprandial endogenous hyperinsulinemic hypoglycemia. Abdominal computed tomography revealed a mass lesion measuring 20 mm at the distal pancreas. A decision was made to perform an arterial calcium-stimulated venous sampling for excluding nesidioblastosis coexisting with a pancreatic incidental mass. After that the patient was referred to surgery. Pathological examination revealed a low-grade well-differentiated neuroendocrine tumor with regional lymph node metastasis. Herein, we report a case of malignant insulinoma presenting with postprandial hypoglycemia and discuss the differential diagnosis and possible mechanisms of postprandial hypoglycemia in insulinoma cases.Item Addition of gonadotropin releasing hormone agonist for luteal phase support in in-vitro fertilization: an analysis of 2739 cycles(2015) Simsek, Erhan; Kilicdag, Esra Bulgan; Aytac, Pinar Caglar; Coban, Gonca; Simsek, Seda Yüksel; Cok, Tayfun; Haydardedeoglu, Bulent; 26097392Objective: Luteal phase is defective in in vitro fertilization (IVF) cycles, and many regimens were tried for the very best luteal phase support (LPS). Gonadotropin releasing hormone (GnRH) agonist use, which was administered as an adjunct to the luteal phase support in IVF cycles, was suggested to improve pregnancy outcome measures in certain randomized studies. We analyzed the effects of addition of GnRH agonist to standard progesterone luteal support on pregnancy outcome measures, particularly the live birth rates. Material and Methods: This is a retrospective cohort study, including 2739 IVF cycles. Long GnRH agonist and antagonist stimulation IVF cycles with cleavage-stage embryo transfer were included. Cycles were divided into two groups: Group A included cycles with single-dose GnRH agonist plus progesterone LPS and Group B included progesterone only LPS. Live birth rates were the primary outcome measures of the analysis. Miscarriage rates and multiple pregnancy rates were the secondary outcome measures. Results: Live birth rates were not statistically different in GnRH agonist plus progesterone (Group A) and progesterone only (Group B) groups in both the long agonist and antagonist stimulation arms (40.8%/41.2% and 32.8%/34.4%, p<0.05 respectively). Moreover, pregnancy rates, implantation rates, and miscarriage rates were found to be similar between groups. Multiple pregnancy rates in antagonist cycles were significantly higher in Group A than those in Group B (12.0% and 6.9%, respectively). Conclusion: A beneficial effect of a single dose of GnRH agonist administration as a luteal phase supporting agent is yet to be determined because of the wide heterogeneity of data present in literature. Well-designed randomized clinical studies are required to clarify any effect of luteal GnRH agonist addition on pregnancy outcome measures with different doses, timing, and administration routes of GnRH agonists.Item Motivations and Barriers in Promoting Preschool Education(2017) Altun, Sadegul Akbaba; Kucukturan, A. Guler; AAC-5447-2020This study is designed to explore the reasons for sending and not sending preschool age children to preschools at an early age by exploring the motivations for and barriers towards promoting preschool education in Turkey. It aimed to determine various stakeholders' perceptions, attitudes, and knowledge related to preschool education in order to promote high-quality and comprehensive preschool education. The research was conducted with 224 participants in five cities in Turkey. Qualitative data was collected through individual and focus group interviews and interpreted by content analysis and descriptive analysis. The findings indicated that families put forward the following reasons for sending their children to preschool: preschool education prepares children for school and helps form the habit of attending school, teachers' efforts in convincing parents to send their children to preschool, providing the care for the children of working mothers with preschool teachers, and preschool helps children develop social behavior. The following factors were reasons families did not send their children to preschool: economic conditions, perceiving the child as too young, concerns over practices at school, perceptions about the mother's role, and distrust of the transportation system. The results will help decision makers develop policies and strategies to heighten the general public's awareness of the need for early education, as well as better provide early education opportunities.Item Survival outcome of pulmonary metastasectomy among the patients with colorectal cancers(2021) Yildizi, Oya; Daez, Shute Ailia; Findikcioglu, Alper; Kos, Fatih; 0000-0002-0156-5973; 0000-0002-1051-3470; 0000-0002-3532-8394; 34817516; AFT-2303-2022; G-4827-2016OBJECTIVE: Pulmonary metastasectomy for the treatment of metastatic colorectal cancer is essential, but high ranked evidence of survival benefit is lacking. Here, we aimed to examine the prognostic factors after pulmonary metastasectomy in patients with colorectal cancer. METHODS: This is a single-center, retrospective hospital-based observational case series study. We reviewed data for 607 patients with metastatic colorectal cancer (mCRC) who were treated and observed from 2012 to 2019. Of the 607 patients with mCRC, 87 were with solitary lung metastases. Of the 87 patients, 39 were not appropriate for metastasectomy, while 15 patients recognized as suitable candidates by the multidisciplinary thoracic tumor board rejected metastasectomy. Consequently, only 33 patients were included in the final analysis. RESULTS: Rectum was detected as the primary site in 16 (48.5%) patients. Over 80% of patients had metachronous lung metastases, with a median of 29.0 months from initial diagnosis. Video-assisted thoracic surgery with wedge resection was performed in 20 (60.6%) patients. Over 90% of patients had solitary metastasis resected, with 97% of R0 resection. Median tumor size was 23.0 mm (min: 10; max: 90). Adjuvant treatment was given to 31 (93.9%) patients, while neoadjuvant treatment was given only to 8 (25%) patients. Of the 33 patients, there were 25 (75.7%) relapses. The most frequent site of relapse was lung in 15 (45.5%) patients. Interestingly, there were only 4 (12.2%) patients who had a relapse in the liver after lung metastasectomy. We found that median disease-free survival (DFS) and overall survival (OS) were 43.0 (13.0-73.0) and 55.0 (31.6-78.4) months, respectively. CONCLUSIONS: Pulmonary metastasectomy was associated with significantly long-time survival rates in mCRC (43 months of DFS and 55 months of OS). The second relapse occurred in 25 (75.7%) patients, with isolated lung metastases in nearly half of the patients (45.5%). Therefore, lung metastases in mCRC were unique and a multidisciplinary team including a thoracic surgeon should manage these patients.Item The Evaluation of Clinical Signs in Patients with Suspected Renovascular Hypertension(2018) Tekkarismaz, Nihan; Torun, Dilek; Ozkan, Ugur; Zumrutdal, Aysegul; Acar, Fatma Nurhan Ozdemir; 0000-0001-7631-7395; 0000-0002-5682-0943; 0000-0002-6267-3695; AAD-9088-2021; AAK-1697-2021; AAD-9111-2021OBJECTIVE: Renovascular hypertension (RVH) is the most common yet correctable cause of secondary hypertension if diagnosed early. There are many clinical signs that can suggest RVH. The aim of this study was to find which clinical or laboratory signs are more indicative in diagnosing RVH and in determining which patients should go through renal angiography. MATERIAL and METHODS: The study included 184 patients who presented to our clinic due to hypertension and were under risk of RVH. All patients underwent three-dimensional time-of-flight Magnetic Resonance Angiography with phase-contrast. The patients were divided into two groups as with and without renal artery stenosis, supported by MRA. RESULTS: Advanced age, low body mass index, high serum creatinine level, presence of proteinuria, and patients with diabetes mellitus and coronary artery disease were found to be significant risk factors for RVH. Only the presence of renal asymmetry and the history of coronary artery disease were found to be independent risk factors. CONCLUSION: In conclusion, detailed patient history and the evaluation of renal size are very important for patients with hypertension. Coronary artery disease and a difference in renal size of more than 1.5 cm could be strong indicators of RVH.Item The effect of extracorporeal shock wave lithotripsy on distribution of interstitial cells of Cajal in rabbit renal pelvis and proximal ureter(2015) Boybeyi, Ozlem; Fedakar Senyucel, Mine; Ayva, Ebru Sebnem; Soyer, Tutku; Aslan, Mustafa Kemal; Basar, Mehmet Murad; Cakmak, Ahmet Murat; 25790556Background/aim: An experimental study was performed to evaluate the effect of extracorporeal shock wave lithotripsy (ESWL) on the distribution of interstitial cells of Cajal (ICC) in rabbit renal pelvis and proximal ureter. Materials and methods: Six New Zealand rabbits were included. Right kidneys were exposed to a total of 3000 shock waves (14 kV) by using an electrohydraulic-type ESWL device. Right sides were allocated as the ESWL group (EG, n = 6) and left sides as the control group (CG, n = 6). Tissues were harvested on day 7. Tissues were examined histopathologically for the presence of edema, inflammation, congestion, hemorrhage, fibrosis, and vascularization. Mast cell tryptase and CD117 (c-kit) staining was performed for ICC distribution. Results: Although increased tissue edema in renal pelvises and increased inflammation in ureters were observed in EG, no statistical difference was detected between groups (P > 0.05). In CG, positive CD117 staining was detected in 2 renal pelvises and ureters. None of the EG samples showed CD117 staining and no statistical difference was detected between groups (P > 0.05). Conclusion: Rabbit does not appear to be a good model for investigating ICCs. ESWL may cause histopathological alterations in the renal pelvis and ureter. Since it has not been statistically proven, reduced contractility of the ureter after ESWL may not be attributed to altered distribution of ICCs in the renal pelvis and ureter.