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Öğe Superiority of pathologic lymph node ratio over positive lymph node count in operated early-stage breast cancer(Edizioni Luigi Pozzi, 2024) Urakçı, Zuhat; Ali Kaplan, Muhammet; Oruç, Zeynep; Gümüş, Mahmut; Uncu, Doğan; Ebinç, Senar; Özkan, Metin; Girgin, SadullahAIM: In early-stage breast cancer, the axillary lymph nodes play a crucial role in determining the prognosis of the disease. The rate of lymph node involvement might be a more valuable prognostic factor than the number of positive lymph nodes. Therefore, we aimed to evaluate whether the lymph node ratio (LNR) is a superior prognostic indicator compared to the pathologic lymph node count in early-stage disease. METHODS: We included 3053 non-metastatic, lymph node-positive breast cancer patients who were treated and followed at 6 medical oncology centers in Türkiye between 2004–2018. Based on LNR, patients were classified into three risk groups: high (>0.65), intermediate (0.21–0.65), and low (≤0.20). RESULTS: Classification of patients according to the TNM8 system based on the number of positive lymph nodes revealed that pathologic lymph node count (pN)1 accounted for 49.0% (n = 1495), pN2 for 30.0% (n = 917), and pN3 for 21.0% (n = 641). Based on the LNR risk group, the low-risk group accounted for 45.4% (n = 1385), intermediate for 36.2% (n = 1105), and high for 18.4% (n = 563) of the total patients. For the entire patient cohort, the 5-and 10-year disease-free survival (DFS) were 93% and 67%, respectively, while overall survival (OS) rates were 95% and 75%, respectively. The median DFS for patients with N1, N2, and N3 disease was 149 months (94.2–203.7), 120.1 months (108.2–132.0), and 81.8 months (68.4–131.1), respectively (p < 0.001). The median DFS for the three LNR risk groups (low, intermediate, and high risk) was 148.9 months (95.3–202.6), 118.7 months (99.9–137.7), and 81.8 months (68.2– 95.3) respectively. Increasing LNR rate was an independent prognostic factor for DFS, according to multivariate analysis (p < 0.001). Furthermore, the median DFS was 133 months for pathologic N1 patients in the LNR intermediate-high risk group, while the median DFS was not reached in patients with LNR and the pN2 low risk group (p = 0.034). CONCLUSIONS: This study confirms the significance of LNR as a prognostic factor for DFS. The results show that in certain specific subgroups, LNR provides more information than pathologic lymph node counts. © 2024 The Author(s).Öğe Evaluation of anemia in children with down syndrome(Edizioni Minerva Medica, 2024) Üzel, Veysiye HülyaBacKGroUNd: anemia is one of the most common and important health problems in childhood. in children with a high neurodevelopmental risk, such as in the case of down Syndrome (dS), the negative effects of anemia (especially iron deficiency) may have a higher incidence. The aim of this study was to evaluate the frequency of anemia in children with dS who applied to our hospital. MethodS: the study retrospectively examined the records of 85 children with dS who were admitted to a pediatric outpatient clinic between January 2018 and december 2020. children without co-morbidities between the ages of 6 months and 18 years were included in the study. complete blood counts of the patients were retrospectively examined, and the incidence of anemia was determined according to age and sex. hemoglobin concentration less than 2 Sd for the norm age was defined as anemia. reSUltS: the mean age of the children was 71.3±50.9 months (range: 10-207); furthermore, 48.2% (N.=41) were female and 51.8% (N.=44) were male. anemia was detected in 22.4% (N.=19) of the cases, while anemia was not detected in 77.6% (N.=66). the mean age of children with anemia was 51.5±42.7 years (10 months-144 months). there was no significant difference between those with and without anemia in terms of age and sex. Anemia was found to be more common in the 6-month-2 age group (36%). coNclUSioNS: in this study, it was seen that most children with anemia had dea. anemia must be promptly diagnosed, especially in 6-month/2-year-old children, in a period in which neuromotor development largely occurs. in conclusion, children with dS who are admitted to the hospital for any reason should be evaluated for anemia and treated early, especially if they have iron deficiency anemia, and all children under 1 year of age should be given iron prophylaxis. © 2023 edizioNi MiNerVa Medica.Öğe The clinical and demographic characteristics of patients with late-diagnosed cerebrotendinous xanthomatosis in a Turkish population(Elsevier Ltd, 2024) Bilgin, Hüseyin; Yolbaş, İlyas; Tekeş, SelahattinAim: The aim of this study was to examine the clinical, laboratory and demographic characteristics of patients diagnosed with cerebrotendinous xanthomatosis. Materials and methods: This study included 11 patients followed up in the Paediatric Metabolism Polyclinic for a diagnosis of CTX. The diagnosis of CTX was made from high blood cholestanol level and CYP27A1 gene analysis. All the cases diagnosed with CTX for whom clinical and laboratory findings were evaluated were included in the study. Results: Evaluation was made of 11 patients from 5 different families. The diagnosis was established 25 years after the symptoms first appeared. The diagnosis was made because of bilateral cataracts in 2 patients, tendon xanthomas in 2, and as a result of family screening in 7. Tendon xanthomas were present in 36.3 % of the patients, and there was a history of cataract in 54.5 %. In the current study, mental retardation was determined in 72 % of the patients, psychiatric findings in 36 %, epilepsy in 36 %, pyramidal-extrapyramidal findings in 45 %, and postural tremor in 54 %. In addition, neuropsychiatric symptoms were seen at different rates in patients with different gene alleles. No tendon xanthomas were determined in the cases with c.1263 + 4A>T and c.808C>T mutations. Cataract was determined in all the cases with homozygote c.1263 + 4A>T mutation. Conclusion: In this study, it was determined that the cases were diagnosed late despite the onset of symptoms providing clues for diagnosis at an early age. It was determined that the delay in diagnosis was 25 years. © 2024Öğe The effect of digital parental awareness and somatic symptoms on problematic media use in children with attention-deficit/hyperactivity disorder(W.B. Saunders, 2025) Güzel, Yağmur; Öztürk, MasumBackground: Children diagnosed with Attention-deficit/hyperactivity disorder (ADHD) have greater difficulty in regulating their own media usage and are inclined to spend more time engaging in video games compared to neurotypical children. This study aimed to investigate the effects of ADHD severity, digital parenting awareness, and accompanying psychiatric symptoms on children's problematic media (PMU) use in children with ADHD. Methods: The study included 95 ADHD patients aged between 6 and 11 years and 90 age—and gender-matched healthy controls. The Problematic Media Use Measure-Short form (PMUM-SF), Child Behavior Checklist (6–18 years) (CBCL-6/18), Conners Parent Rating Scale-Revised Short (CPRS-RS), and Digital Parental Awareness Scale (DPAS) were administered to all parents. Results: Daily screen time was 183.56 ± 84.77 min in the ADHD group and 117.47 ± 49.08 min in the control group (p < 0.001), and PMUM-SF scores were higher in children with ADHD (p < 0.001). Comorbid internalizing and externalizing problems were positively associated with PMU. The results of the hierarchical regression analysis showed that ADHD severity, somatic complaints in children, negative media role modeling by mothers, and neglect of children's media use were associated with increased PMU in children (p < 0.001, Adjusted R2 = 0.520). Conclusion: PMU in children with ADHD can be better managed by raising parents' awareness of the adverse effects of digital media within prevention and treatment interventions. Moreover, since comorbid ADHD and somatic symptoms may affect PMU, the severity of somatic complaints should be evaluated within the scope of treatment programs. © 2024 Elsevier Inc.Öğe Factors associated with pulmonary function decline of patients in the cystic fibrosis registry of Turkey: A retrospective cohort study(Wiley, 2024) Emiralioğlu, Nagehan; Çakır, Banu; Sertçelik, Ahmet; Yalçın, Ebru; Kiper, Nural; Şen, Velat; Altıntaş, Derya UfukBackground: The decline in pulmonary function is a predictor of disease progression in patients with cystic fibrosis (CF). This study aimed to determine the decline rate of percent predicted forced expiratory volume in 1 s (ppFEV1) based on the data of the CF Registry of Turkey. The secondary aim was to investigate the risk factors related to the decline in ppFEV1. Methods: A retrospective cohort study of CF patients over 6 years old, with pulmonary function data over at least 2 years of follow-up was extracted from the national CF registry for years 2017-2019. Patients were classified according to disease severity and age groups. Multivariate analysis was used to predict the decline in ppFEV1 and to investigate the associated risk factors. Results: A total of 1722 pulmonary function test results were available from 574 patients over the study period. Mean diagnostic age was older and weight for age, height for age, and body mass index z scores were significantly lower in the group of ppFEV1 < 40, while chronic Pseudomonas aeruginosa (p < .001) and mucoid P. aeruginosa colonization (p < .001) were significantly higher in this group (p < .001). Overall mean annual ppFEV1 decline was -0.97% (95% confidence interval [CI] = -0.02 to -1.92%). The mean change of ppFEV1 was significantly higher in the group with ppFEV1 >= 70 compared with the other (ppFEV1 < 40 and ppFEV1: 40-69) two groups (p = .004). Chronic P. aeruginosa colonization (odds ratio [OR] = 1.79 95% CI = 1.26-2.54; p = .01) and initial ppFEV1 >= 70 (OR = 2.98 95% CI = 1.06-8.36), p = .038) were associated with significant ppFEV1 decline in the whole cohort. Conclusions: This data analysis recommends close follow-up of patients with normal initial ppFEV1 levels at baseline; advocates for early interventions for P. aeruginosa; and underlines the importance of nutritional interventions to slow down lung disease progression.Öğe Clinical and molecular spectrum along with genotype-phenotype correlation of 25 patients diagnosed with 3 M syndrome: a study from Turkey(Springer, 2024) Akalın, Akçahan; Özalkak, Şervan; Yıldırım, Ruken; Karakaya, Amine Aktar; Kolbaşı, Barış; Durmuşalioğlu, Enise Avcı; Kökali, Funda3 M syndrome is a well-known autosomal recessive skeletal genetic disorder caused by biallelic pathogenic variants in the CUL7, OBSL1, and CCDC8 genes. Affected individuals exhibit profound pre- and postnatal growth retardation, distinctive facial features with normal intelligence. This study aims to provide insight into the comprehensive evaluation of clinical, laboratory, and radiological findings, expand the mutational spectrum of the disease, and establish a genotype-phenotype correlation in the present cases. A total of 25 patients from 19 unrelated families were included in the study. Genetic etiology was determined in probands through the utilization of Sanger sequencing and/or targeted gene panel analysis. The clinical, laboratory, and genetic features of all patients at admission and during follow-up were documented. Genotype-phenotype correlation was carried out in the CUL7 and OBSL1 groups. The genetic etiology was established in all patients (n = 25/25, 100%). We identified 15 distinct variants in CUL7, OBSL1, and CCDC8 genes, with eleven being novel. CUL7 variants were present in 13 patients (n = 13/25, 52%), while OBSL1 variants were found in 11 patients (n = 11/25, 44%). No notable distinctions were found in mean birth weight, height, and standard deviation scores between the CUL7 and OBSL1 mutation groups (p > 0.05). Patients with CUL7 variants exhibited significantly lower height standard deviation scores both at admission and at the last examination, as well as lower weight standard deviation scores at the last examination, compared to those with OBSL1 variants (p < 0.05). Conclusion: To date, genotype-phenotype correlations have been identified in a limited number of studies. Further research involving larger cohorts is necessary to solidify these correlations.Öğe Role of Superb Microvascular Imaging (SMI) vascularity index values and vascularity patterns in the differential diagnosis of malignant liver lesions(Springer, 2024) Aslan, Halil Serdar; Arslan, Muhammet; Alver, Kadir Han; Vurgun, Sercan; Demirci, Mahmut; Tekinhatun, MuhammedPurposeTo evaluate the Superb Microvascular Imaging (SMI) vascular patterns and vascularity index (VI) values of malignant focal liver lesions (FLLs), assess their role in differential diagnosis, and examine interobserver agreement.Materials and methodsA total of 107 patients (52 males, 55 females; mean age 62 +/- 12.8 years, range 25-87) referred to the interventional radiology clinic for FLL biopsy between April 2022 and April 2023 were analyzed. Two radiologists independently assessed the SMI vascular patterns and calculated VI values. Differences among three lesion groups - hepatocellular carcinoma (HCC, n = 16), non-HCC primary liver malignancies (n = 16), and metastases (n = 75) - were evaluated, and interobserver agreement was assessed.ResultsMost metastases (88%) demonstrated hypovascular patterns, while HCCs predominantly exhibited hypervascular patterns (68.7-81.3%). Non-HCC primary malignancies showed no dominant vascular pattern. Significant differences in SMI patterns were observed among lesion types (p = 0.001-0.035). VI values for HCCs (7.53-7.73) were significantly higher than those for non-HCC malignancies (2.73-2.93) and metastases (1.35-1.36) (p = 0.0001). ROC analysis based on VI values yielded AUCs of 0.886-0.887, with a cutoff of 2.92 providing 81.3% sensitivity and 79.1-80.2% specificity for HCC diagnosis. The inter-reader agreement for SMI patterns had a kappa score of 0.634, while the intraclass correlation coefficient (ICC) for VI values was 0.959.ConclusionHCCs displayed more hypervascular SMI patterns and significantly higher VI values compared to other malignant FLLs, emphasizing the diagnostic potential of VI in distinguishing HCC from non-HCC tumors. Although metastases primarily exhibited hypovascular patterns and low VI values, no dominant vascular pattern was identified in non-HCC primary liver malignancies. Assessing VI values provided higher interobserver agreement compared to SMI patterns, enhancing objectivity and reproducibility.Öğe Visual art-based training improves medical students’ radiologic labeling skills by improving their contrast sensitivity: A prospective, controlled study(Springernature, 2024) Yücel, Semra; Cevahir, Taylan Tugay; Elek, Alperen; Acar, Selin; Sucubulak, Cemre; Yıldız, Hatice Sude; Dindar, Gülfem Nur; Karagöz, SidarBackgroundObservational skills, including radiologic perceptual abilities, are critical for medical professionals. Numerous studies have shown the positive impact of various visual art courses on observational skills. Some institutions have even incorporated art courses into their curriculum for this purpose. However, the underlying reason for this improvement remains unclear.AimThis prospective, controlled study aims to determine the positive impact of a virtual art evaluation course on medical students' radiologic labeling skills and to uncover the underlying reason.Materials and MethodsThis study examines whether a 12-week art evaluation course with monitored attendance enhances medical students' ability to detect brain abnormalities in MRI scans. Medical students participated in pre- and post-tests identifying abnormalities, while a control group received no intervention. The art course focused on elements such as composition and balance. MRI characteristics, such as the contrast-to-noise ratio (CNR), were measured to assess image quality. To evaluate test difficulty and student performance, the Discrimination Index (DI) was calculated.ResultsNo significant difference was found in pre-test scores between the study and control groups (p = 0.35). A significant increase in post-test scores was observed in the study group (9.52 +/- 3.11 vs. 10.69 +/- 2.72, p = 0.04), compared to controls (8.69 +/- 3.03 vs. 9.30 +/- 2.88, p = 0.19). A moderate positive correlation was found between score improvement and course attendance in the art group (r = 0.42, p = 0.0407). Strong positive correlations were calculated between the DI and CNR in the art group (r = 0.511, p = 0.0205; r = 0.513, p = 0.0212).ConclusionVirtual art courses, which are easy to organize and enjoyable educational activities, improve medical students' radiologic labeling skills and are associated with an increase in their contrast sensitivity.Öğe Comparison of serum USP9x and TGF-β levels in children with autism spectrum disorders with healthy controls(Turkish Neuropsychiatry Assoc-Turk Noropsikiyatri Dernegi, 2024) Karadağ, Mehmet; Turgut, Fatma Subaşı; Ciftçi, Zehra; Hangül, Zehra; Taysi, SeyithanIntroduction: USP9X has been associated with neurodevelopmental disorders due to its role in synaptic development and neural function. This study aimed to compare USP9X and TGF-(3 levels in children with autism and healthy controls, and explore their relationship with autism severity. Methods: Serum USP9X and TGF-(3 levels were measured in 41 healthy control children (aged 3-12 years) and 41 children with autism. Results: Our study revealed a significant increase in USP9X levels (p=0.001) among children with autism compared to controls. However, TGF-(3 levels showed no significant difference between the two groups. Furthermore, we observed a positive correlation between difficulty in making eye contact subscale and blood levels of both USP9X and TGF-(3. Conclusions: This study is the first to compare serum USP9X levels in children with autism to healthy controls. Our findings suggest USP9X's potential role in autism development, emphasizing the need for further research on its involvement in neurodevelopmental processes.Öğe Enhancing treatment decisions for advanced non-small cell lung cancer with epidermal growth factor receptor mutations: A Reinforcement learning approach(Mdpi, 2025) Bozcuk, Hakan Sat; Sert, Leyla; Kaplan, Muhammet Ali; Tatlı, Ali Murat; Karaca, Mustafa; Muğlu, Harun; Bilici, AhmetBackground: Although higher-generation TKIs are associated with improved progression-free survival in advanced NSCLC patients with EGFR mutations, the optimal selection of TKI treatment remains uncertain. To address this gap, we developed a web application powered by a reinforcement learning (RL) algorithm to assist in guiding initial TKI treatment decisions. Methods: Clinical and mutational data from advanced NSCLC patients were retrospectively collected from 14 medical centers. Only patients with complete data and sufficient follow-up were included. Multiple supervised machine learning models were tested, with the Extra Trees Classifier (ETC) identified as the most effective for predicting progression-free survival. Feature importance scores were calculated by the ETC, and features were then integrated into a Deep Q-Network (DQN) RL algorithm. The RL model was designed to select optimal TKI generation and a treatment line for each patient and was embedded into an open-source web application for experimental clinical use. Results: In total, 318 cases of EGFR-mutant advanced NSCLC were analyzed, with a median patient age of 63. A total of 52.2% of patients were female, and 83.3% had ECOG scores of 0 or 1. The top three most influential features identified were neutrophil-to-lymphocyte ratio (log-transformed), age (log-transformed), and the treatment line of TKI administration, as tested by the ETC algorithm, with an area under curve (AUC) value of 0.73, whereas the DQN RL algorithm achieved a higher AUC value of 0.80, assigning distinct Q-values across four TKI treatment categories. This supports the decision-making process in the web-based 'EGFR Mutant NSCLC Treatment Advisory System', where clinicians can input patient-specific data to receive tailored recommendations. Conclusions: The RL-based web application shows promise in assisting TKI treatment selection for EGFR-mutant advanced NSCLC patients, underscoring the potential for reinforcement learning to enhance decision-making in oncology care.Öğe Impact of neutrophil-to-lymphocyte ratio on stroke severity and clinical outcome in anterior circulation large vessel occlusion stroke(Mdpi, 2024) Memiş, Zülfikar; Gürkaş, Erdem; Özdemir, Atilla Özcan; Acar, Bilgehan Atılgan; Öğün, Muhammed Nur; Aytaç, Emrah; Akpınar, Çetin Kürşad; Akıl, EşrefBackground: The prognostic value of the neutrophil-lymphocyte ratio (NLR) in ischemic stroke remains debated due to cohort variability and treatment heterogeneity across studies. This study evaluates the relationship between admission NLR, stroke severity and 90-day outcomes in patients with anterior circulation large vessel occlusion (LVO) undergoing early, successful revascularization. Methods: A retrospective multicenter study was conducted with 1082 patients treated with mechanical thrombectomy for acute ischemic stroke. The relationship between admission NLR, baseline National Institutes of Health Stroke Scale (NIHSS), 24 h NIHSS and 90-day modified Rankin Scale (mRS) outcomes was analyzed using logistic regression. Results: Admission NLR correlated weakly but significantly with both baseline (p = 0.018) and 24 h (p = 0.005) NIHSS scores, reflecting stroke severity. However, multivariate analysis showed that higher 24 h NIHSS scores (OR 0.831, p = 0.000) and prolonged puncture-to-recanalization times (OR 0.981, p = 0.000) were independent predictors of poor 90-day outcomes, whereas NLR was not (p = 0.557). Conclusions: Admission NLR is associated with stroke severity but does not independently predict clinical outcomes at 90 days in patients achieving early and successful revascularization. These findings underscore the critical role of inflammation in the acute phase of stroke but suggest that its prognostic value for long-term outcomes is limited in this context.Öğe Analysis of factors affecting the diagnostic yield for microbiologic diagnosis from percutaneous abdominal abscess drainage(Journal of Infection in Developing Countries, 2024) Arslan, Muhammet; Aslan, Halil Serdar; Tekinhatun, Muhammed; Özgen, Utku; Sarı, TuğbaIntroduction: This study aimed to investigate the factors influencing the diagnostic yield of microbiologic diagnosis obtained through percutaneous abdominal abscess drainage procedures. We analyzed the influence of diverse clinical, radiological, and pre-procedural factors on the success of microbiologic diagnosis in this context. Methodology: A retrospective analysis of patients who underwent percutaneous abdominal abscess drainage was performed to assess the factors affecting the diagnostic yield for microbiologic diagnosis. Results: A total of 174 patients undergoing percutaneous abdominal abscess drainage was included. The use of antibiotics during the procedure and the spread of the abscess to other organs significantly increased the likelihood of obtaining a positive culture. Specifically, antibiotic use during the procedure raised the risk by up to 3.30-fold (OR = 3.30, 95% CI 1.48-7.65, p = 0.004), while abscess spread to another organ increased the risk by approximately 1.87-fold (OR = 1.87, 95% CI 0.98-3.61, p = 0.057). Additionally, abscesses containing air and abscesses with an air-fluid level were more common in patients with positive culture results. Other factors, such as gender, age, malignancy prevalence, and surgical history, did not significantly impact culture results. Conclusions: This study provides valuable insights into the factors affecting the diagnostic yield of microbiologic diagnosis from percutaneous abdominal abscess drainage. The findings underscore the importance of considering patient-specific variables and procedural aspects when planning and executing abscess drainage procedures. Further research can build upon these insights to develop evidence-based guidelines for optimizing the diagnostic yield of percutaneous abdominal abscess drainage procedures.Öğe Real-world data on the use of glecaprevir/pibrentasvir in the treatment of hepatitis C: Is shorter treatment possible?(Galenos Publ House, 2024) Tüzün, Ahmet Yekta; Mermutluoğlu, Çiğdem; Çelen, Mustafa KemalObjectives: This study aimed to present real-world data on the efficacy of glecaprevir/pibrentasvir (G/P) in chronic hepatitis C (CHC) patients treated at our center. Materials and Methods: Non-cirrhotic, treatment-naive, and treatment-experienced (TN/TE) CHC patients with CHC who started G/P treatment in 2022 were included in this retrospective, cross-sectional, single-center, national study. Sustained virological response (SVR) was defined as undetectable hepatitis C virus- ribonucleic acid (HCV-RNA) for at least 12 weeks following the discontinuation of antiviral therapy. Results: Sixty patients with non-cirrhotic TN/TE CHC who started G/P were included in the study. All patients received G/P treatment for 8 weeks. The median age of the patients was 45 years (interquartile range 22-3) and 44 (73.3%) were males. The most frequently identified risk factor for CHC was substance use (n=7, 11.7%), whereas the most common comorbidities were cardiovascular disease, hypertension (n=8,13.3%), and diabetes mellitus (n=7, 11.7%). HCV genotype was evaluated in all patients. Genotype distribution: Genotype 1b was detected in 53 patients (88.3%) and genotype 1 was detected in 7 patients (11.7%). The median pretreatment HCV-RNA level of the patients was 137,000 IU/mL. HCV-RNA was evaluated in all patients at the 4 th and 8 th weeks of treatment and at the 12th th week after treatment. All patients were HCV-RNA-negative in the 1 st month of treatment. Additionally, HCV-RNA negativity continued in all patients at the end of treatment and at 12 week follow-up. No mild, moderate, or serious adverse events were observed during or after treatment. All patients were successfully treated. Conclusion: All patients extremely well tolerated the drug. The SVR response was found to be 100%. In addition, the fact that the viral load of all patients in our study was negative in the 4 th week of treatment suggested the possibility of shorter-term treatment. More studies on this subject.Öğe Changing trends in the etiology of cirrhosis in Türkiye: A multicenter nationwide study(Aves, 2024) Üçbilek, Enver; Yıldırım, Abdullah Emre; Ellik, Zeynep; Turan, İlker; Haktanıyan, Büşra; Orucu, Berk; Demir, Mehmet; Yolaçan, RamazanBackground/Aims: The aim of our study was to investigate the underlying causes behind the etiology of cirrhosis in T & uuml;rkiye.Materials and Methods: The study was comprised of patients with cirrhosis located in the gastroenterology clinics of 28 centers in T & uuml;rkiye between January 2000 and June 2021. Results: The study group consisted of 4953 cirrhotic patients (median age: 62.2 years, male / female: 58% / 42%). Among the patients, 39% of the patients were compensated, and 61% were decompensated. Furthermore, 47.5% had Child-Pugh class A, 38% had Child-Pugh class B, and 14.5% had Child-Pugh class C. The most frequent complaints were abdominal bloating (28%). Ascites (54.2%) was the most common manifestation of decompensation. The median Child-Pugh and MELD-Na scores were 7.0 and 10.0, respectively. The most common cause of cirrhosis was chronic viral hepatitis (43%), followed by cryptogenic cirrhosis (CC) (19%), metabolic dysfunc-tion-associated steatotic liver disease (MASLD)-related cirrhosis (13%), and alcohol-related cirrhosis (11%). Among the 950 patients with CC, 416 had metabolic abnormalities. If these 416 CC patients with metabolic abnormalities were categorized as having MASLD-related cirrhosis, the proportion of MASLD-related cirrhosis increased to 21%. Thirteen percent of the patients were diagnosed with HCC, while 4% had extrahepatic malignancy. Female breast cancer (18%) and colorectal cancer (18%) were the most frequent extra-hepatic malignancies. Conclusion: Viral hepatitis remains the main cause of cirrhosis in T & uuml;rkiye. However, its prevalence seems to be declining, whereas the prevalence of steatotic liver disease-related cirrhosis is increasingÖğe The involvement of the serotonergic system in ketamine and fluoxetine combination-induced cognitive impairments in mice(Ataturk Univ, 2024) Uyar, Emre; Erdinç, Meral; Kelle, İlker; Erdinç, Levent; Şeker, Uğur; Nergiz, YusufBackground: Gluta mater gic N-methyl-D-aspartate (NMDA) receptors play vital roles in memory formation. Changes in the activity of these receptors influence memory processes. Ketamine is a noncompetitive NMDA receptor antagonist drug with promising mood-altering and pain-reducing effects ff ects in low doses. These effects ff ects are believed to be related to altered serotonergic transmission. Methods: The present study investigated the involvement of the serotonergic system in low-dose ketamine administrations' effects ff ects on memory acquisition, consolidation, and retrieval processes. Sixty-four male BALB/c mice were used in this experiment and separated into 8t groups. Mice were treated subchronically with a selective serotonin reuptake inhibitor, fluoxetine, and a serotonin depletion agent, p-chlorophenylalanine (pCPA). A serotonin antagonist, methiothepin, and ketamine were acutely administered 60 minutes before or after the behavioral tests. A passive avoidance (PA) test measured emotional memory acquisition, consolidation, and retrieval processes. Hippocampi malondialdehyde (MDA) levels were analyzed, and histopathological examinations were performed. Results: Ketamine alone did not significantly affect ff ect memory encoding processes in the PA test, while the ketamine-fluoxetine combination disrupted memory consolidation. Fluoxetine negatively affected ff ected the memory acquisition process, which was normalized during the consolidation and retrieval trials. Drug applications did not significantly alter hippocampal MDA levels. In all ketamine-applied groups, histopathologic alterations were evident. Conclusion: Low-dose ketamine administration induces neurodegeneration, and it also impairs memory functions when combined with fluoxetine, indicating increased serotonergic transmission may be involved in the memory-impairing and neurotoxic effects ff ects of ketamine.Öğe A case report of a new variant associated with vici syndrome in a Turkish infant; EPG5 frameshift variant(Brieflands, 2025) İpek, Rojan; Çavdartepe, Büşra Eser; Hazar, LeylaIntroduction: Vici syndrome is a congenital multisystem disorder characterized primarily by callosal agenesis, cataracts, cardiomyopathy, combined immunodeficiency, and oculocutaneous hypopigmentation, along with additional newly recognized findings. Autosomal recessive variants in the EPG5 gene, which encodes ectopic P-granules autophagy protein 5 (EPG5), a key regulator of autophagy, are known genetic causes of this syndrome. The aim of this case report is to present a novel disease-causing variant identified through EPG5 gene sequence analysis. Case Presentation: We report on a 2-month-old Turkish girl who presented with developmental delay, bilateral congenital cataracts, microcephaly, hypotonia, hypertrophic cardiomyopathy, hypopigmented skin lesions, and agenesis of the corpus callosum. Genetic analysis revealed a homozygous c.7504delC (p.G1n2502Argfs*4) frameshift variant in the EPG5 gene, which has not been previously documented. Conclusions: Adding a new variant to the literature is crucial, as it highlights the feasibility of reaching an accurate diagnosis through well-conducted physical examination findings in patients with early developmental delay. This case also raises awareness about such rare diseases. Moreover, recognizing new mutations is critical for understanding atypical findings, prognosis, treatment responses, and the genetic risks for other family members.Öğe Baseline characteristics and clinical insights from the ARTEMIS registry: A comprehensive study of peripartum cardiomyopathy in Türkiye(Kare Publ, 2024) Kayıkçıoğlu, Meral; Biteker, Murat; Mutluer, Ferit Onur; Güzel, Tuncay; Yılmaz, Emre; Demir, Emre; Nalbantgil, Sanem; Ertaş, FarukObjective: Peripartum Cardiomyopathy (PPCM) is a life-threatening, rare disorder that occurs during the late stages of pregnancy or the early postpartum period. The ARTEMIS (A RegisTry of pEripartuM cardIomyopathy in Turkish patientS) aims to investigate the clinical characteristics and outcomes of PPCM in Turkiye, providing insights into its management within this specific population. Methods: The ARTEMIS registry retrospectively enrolled patients diagnosed with PPCM within the last five years at 44 cardiology centers across Turkiye. Eligible participants were women over 18 years old, diagnosed with PPCM and without other known cardiac pathology. Data collected included demographic information, clinical presentation, diagnostic modalities, treatment regimens, and outcomes. Results: The study included 293 patients, predominantly between 25 and 35 years old. The majority presented with symptoms such as dyspnea and palpitations, diagnosed postpartum via echocardiography. A low use of advanced diagnostic imaging was noted, relying primarily on echocardiography for evaluation. Common treatments included beta blockers (97.8%), angiotensin-converting enzyme (ACE) inhibitors (71.3%), and in severe cases, bromocriptine (6.9%). The study highlighted a mortality rate of 5.1%, with surviving patients often requiring continued management for heart failure. Diagnostic challenges and variations in treatment responses were noted, reflecting the complexity of PPCM diagnosis and care. Conclusion: The ARTEMIS registry provides valuable insights into the management of PPCM in Turkiye, highlighting the need for targeted educational programs for healthcare providers and patients. It also underscores the importance of national registries in understanding and improving outcomes for rare diseases like PPCM.Öğe CT-guided lung biopsy: diagnostic accuracy and complication rates of biopsy techniques(Marmara University, 2022) Deniz, Muhammed Akif; Çakır, Çağlayan; Kılınç, Fatih; Kurt, Osman; Deniz, Zelal TaşObjective: We aimed to evaluate the diagnostic accuracy and complication rates of computed tomography (CT)-guided core needle biopsy and fine needle aspiration biopsy (FNAB). Materials and Methods: Patients who underwent CT-guided lung mass biopsy were included. The patients were evaluated in terms of age, gender, lesion diameter, lesion localization, depth of the mass, type of biopsy procedure (core needle biopsies and FNAB). Results: The accuracy rate of FNAB in diagnostic material was found to be 100% in terms of benign, malignant and all lesions. The specificity and sensitivity of FNAB was found to be 100%. The diagnostic accuracy rate of core needle biopsy was found to be 70% in benign lesions, 100% in malignant lesions. The specificity of core needle biopsy was 90% and sensitivity 100%. There was no statistically significant difference between the two biopsy techniques in terms of complications. Conclusion: In conclusion, we found that the diagnostic rates of FNAB and core needle biopsy were close in malignant lesions, the diagnostic rate of core needle biopsy was higher in benign lesions, and there was no difference in terms of complications in both biopsy techniques.Öğe Türkiye'de Koroner Yoğun Bakım Ünitelerindeki Hastane İçi Mortalite (MORCOR-TURK) Çalışmasında Hasta Temel Karakteristikleri ve Öngördürücüleri(2024) Yılmaz, Ahmet Seyda; Kahraman, Fatih; Ersoy, İbrahim; Taylan, Gökay; Kaya, Emin Erdem; Aydın, Ertan; Özbek, MehmetOBJECTIVE: The MORtality in CORonary Care Units in Türkiye (MORCOR-TURK) trial is a national registry evaluating predictors and rates of in-hospital mortality in coronary care unit (CCU) patients in Türkiye. This report describes the baseline demographic characteristics of patients recruited for the MORCOR-TURK trial. METHODS: The study is a multicenter, cross-sectional, prospective national registry that included 50 centers capable of 24-hour CCU service, selected from all seven geographic regions of Türkiye. All consecutive patients admitted to CCUs with cardiovascular emergencies between September 1-30, 2022, were prospectively enrolled. Baseline demographic characteristics, admission diagnoses, laboratory data, and cardiovascular risk factors were recorded. RESULTS: A total of 3,157 patients with a mean age of 65 years (range: 56-73) and 2,087 (66.1%) males were included in the analysis. Patients with arterial hypertension [1,864 patients (59%)], diabetes mellitus (DM) [1,184 (37.5%)], hyperlipidemia [1,120 (35.5%)], and smoking [1,093 (34.6%)] were noted. Non-ST elevation myocardial infarction (NSTEMI) was the leading cause of admission [1,187 patients (37.6%)], followed by ST elevation myocardial infarction (STEMI) in 742 patients (23.5%). Other frequent diagnoses included decompensated heart failure (HF) [339 patients (10.7%)] and arrhythmia [272 patients (8.6%)], respectively. Atrial fibrillation (AF) was the most common pathological rhythm [442 patients (14%)], and chest pain was the most common primary complaint [2,173 patients (68.8%)]. CONCLUSION: The most common admission diagnosis was acute coronary syndrome (ACS), particularly NSTEMI. Hypertension and DM were found to be the two leading risk factors, and AF was the most commonly seen pathological rhythm in all hospitalized patients. These findings may be useful in understanding the characteristics of patients admitted to CCUs and thus in taking precautions to decrease CCU admissions.Öğe Thiol/Disulfide Homeostasis: A Potential New Peripheral Biomarker in Adolescent Depression(AVES, 2024) Öztürk, Masum; Özkan, Yekta; Sapmaz, Şermin Yalın; Erdal, Serkan; Taneli, Fatma; Kandemir, HasanBackground: Thiol-disulfide homeostasis (TDH), one of the most important antioxidants, is involved in the non-enzymatic removal of reactive oxygen molecules in the body and is one of the many methods to measure the level of oxidative stress (OS). In the present study, TDH is investigated in adolescent depression, and its relationship to clinical variables is examined. Methods: Thirty-two (50.0%) patients diagnosed with major depressive disorder (MDD) and without psychotropic drug use and 32 (50.0%) healthy controls were included in the present study. The subjects MDD and control groups were between 13 and 18 years old. Participants completed the DSM-5 Level-2 scales for depression and irritability. A colorimetric method proposed by Erel and Neselioglu was used to analyze the TDH parameters of serum samples. Results: Biochemical analyses of samples from the MDD and control groups showed significant differences between the groups in native thiol (SH) levels (P =.002), disulfide (SS) levels (P =.021), disulfide/total thiol (SS/ToSH) (P =.009), and disulfide/native thiol (SS/SH) (P =.003) levels. Analysis of receiver operating characteristic showed that the area under the curve values with “acceptable discrimination potential” for the TDH parameters were significantly able to discriminate individuals with MDD from healthy controls. Conclusion: Thiol-disulfide homeostasis, one of the OS parameters, was found to be impaired in adolescents with depression. Our results suggest that TDH may contribute to the etiopathogenesis of adolescent MDD and that TDH may be a novel approach to assess OS in adolescent depression. © 2024, AVES. All rights reserved.
