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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 Taş
Objective: 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.
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, Mehmet
OBJECTIVE: 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.
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, Hasan
Background: 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.
Evaluation of false negativity of the Widal test among culture proven typhoid fever cases
(2008) Hoşoğlu, Salih; Boşnak, Vuslat; Akalın, Şerife; Geyik, Mehmet Faruk; Ayaz, Celal
BACKGROUND: The Widal test is the most common, specific and quick diagnostic method available in the world for diagnosis of typhoid fever; however, false negativity is one of the obstructive features of the test. The aim of this study was to evaluate the associated factors with Widal test negativity in an endemic area. METHODS: Widal test negativity was retrospectively analyzed among culture-proven typhoid fever cases. The potential features including age, gender, previous antibiotic usage, duration of symptoms, leucopoenia, hematocrit value, and erythrocyte sedimentation rate (ESR) were evaluated for association with Widal test negativity. RESULTS: A total of 166 culture-proven typhoid fever cases (93 or 56.0% males) were included in the study. The mean age +/- SD was 23.3 +/- 10.6 years. Mean time of interval between first symptom and test performance time was 10.6 +/- 7.8 days. The Widal test (STO and/or STH) was found positive in 75 cases (45.2%). The statistical analyses revealed that none of these variables were significant for false negativity of the Widal test. Age was found to be a possible factor for a false negative Widal test (p=0.06). CONCLUSION: Of existing compatible clinical findings, age should be considered in cases of Widal test negativity.
The prognostic factors in patients with advanced hepatocellular carcinoma: impact of treatment sequencing
(Taylor and Francis Ltd., 2024) Köstek, Osman; Demirel, Ahmet; Hacıoğlu, Muhammet Bekir; Taştekin, Didem; Karabulut, Senem; Gündogdu, Abidin; Sever, Nadiye; Kaplan, Muhammet Ali; 0000-0002-1901-5603; 0000-0003-0882-0524
The prognosis of patients with advanced HCC can vary widely depending on factors such as the stage of the cancer, the patient’s overall health, and treatment regimens. This study aimed to investigate survival outcomes and associated factors in patients with hepatocellular carcinoma (HCC). In this retrospective study, data from 23 medical oncology clinics were analyzed. Progression-free survival (PFS) and overall survival (OS) values were estimated using the Kaplan–Meier method. Prognostic factors associated with survival which were identified in univariate analysis were subsequently evaluated in a multivariate Cox-regression survival analysis was conducted using the backward stepwise (Conditional LR) method to determine the independent predictors of PFS and OS. Of 280 patients, 131 received chemotherapy and 142 received sorafenib, 6 received atezolizumab plus bevacizumab and 1 received nivolumab for first-line setting. The median follow-up time was 30.4 (95%CI 27.1–33.6) months. For-first line, median PFS was 3.1 (95%CI2.7–3.5) months, and it was significantly longer in patients who received sorafenib or atezolizumab-bevacizumab or nivolumab (PFS 5.8 (95%CI 4.2–7.5) than in those received chemotherapy (PFS 2.1 (95%CI 1.9–2.3) in the first-line setting (p < 0.001). Multivariate analysis revealed that male gender (HR: 2.75, 95% CI: 1.53–4.94, p = 0.01), poor ECOG performance score (HR: 1.88, 95% CI: 1.10–3.21, p = 0.02), higher baseline AFP level (HR: 2.38, 95% CI: 1.54–3.67, p < 0.001) and upfront sorafenib treatment (HR,0.38; 95% CI: 0.23–0.62, p < 0.001) were significantly associated with shorter PFS. The median OS was 13.2 (95%CI 11.1–15.2) months. It was significantly longer in patients who received sorafenib or atezolizumab-bevacizumab or nivolumab in the first-line setting followed by TKIs (sorafenib or regorafenib, OS 18.6 (95%CI 13.8–23.5)) compared to those who received chemotherapy (OS 10.3 (95%CI 6.6–14.1)) in the first-line setting. The multivariate analysis revealed that upfront chemotherapy treatment approach, male gender (HR: 1.77, 95% CI: 1.07–2.94, p = 0.02), poor ECOG performance score (HR: 1.96, 95% CI: 1.24–3.09, p = 0.004) and Child-Pugh score, presence of extrahepatic disease (HR: 1.54, 95% CI: 1.09–2.18, p = 0.01), and higher baseline AFP value (HR: 1.50, 95% CI: 1.03–2.19, p = 0.03) were significantly associated with poor prognosis. Additionally, regarding of treatment sequence, upfront sorafenib followed by regorafenib showed a significantly lower risk of mortality (HR: 0.40, 95% CI: 0.25–0.66, p < 0.001). Sorafenib followed by regorafenib treatment was associated with a significantly lower risk of mortality rather than upfront sorafenib followed by BSC group or upfront chemotherapy followed by TKIs. These findings underscore the importance of the optimal treatment sequences to improve survival in patients with advanced HCC.
Clinical and histopathological characteristics of primary focal segmental glomerulosclerosis in Turkish adults
(Nature Research, 2024) Kurultak, İlhan; Güngör, Özkan; Öztürk, Savaş; Dirim, Ahmet Burak; Eren, Necmi; Yenigün, Ezgi; Dal, Elbis Ahbab
The data regarding primary FSGS (pFSGS) from different parts of the world differ. While the prevalence of pFSGS has been increasing in Western countries like the USA, it follows an inconsistent trend in Europe and Asia and a decreasing trend in Far Eastern countries such as China in the last two decades. There are undetermined factors to explain those national and geographic discrepancies. Herein, we aimed to reveal the current prevalence with clinical and histopathological characteristics of pFSGS in Turkish adults. This study includes the biopsy-proven pFSGS patients data recorded between 2009 and 2019, obtained from the national multicenter primary glomerulonephritis registry system of the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) database. 850 of the 3875 primer glomerulonephritis patients(21.9%) have pFSGS. The mean age is 40.5 ± 14.2 and 435 (51.2%) of patients are male. Nephrotic syndrome is the most common biopsy indication (59.2%). 32.6% of patients have hematuria, 15.2% have leukocyturia and 7.8% have both. Serum creatinine, albumin, and proteinuria are 1.0 mg/dL (IQR = 0.7–1.4) mg/dl, 3.4 ± 0.9 g/dl, 3400 mg/day(IQR, 1774–5740), respectively. Females have lower mean arterial pressure (? 2.2 mmHg), higher eGFR (+ 10.0 mL/min/1.73 m2), and BMI (+ 1.6 kg/m2) than males. Thickened basal membrane(76.6%) and mesangial proliferation (53.5%) on light microscopy are the major findings after segmental sclerosis. IgM (32.7%) and C3 (32.9%) depositions are the most common findings on immunofluorescence microscopy. IgM positivity is related to lower eGFR, serum albumin, and higher proteinuria. The prevalence of pFSGS is stable although slightly increasing in Turkish adults. The characteristics of the patients are similar to those seen in Western countries. © The Author(s) 2024.
Biallelic NAA60 variants with impaired n-terminal acetylation capacity cause autosomal recessive primary familial brain calcifications
(2024) Chelban, Viorica; Aksnes, Henriette; Maroofian, Reza; LaMonica, LaurenC.; Seabra, Luis; Siggervåg, Anette; Devic, Perrine; İpek, Rojan
Primary familial brain calcification (PFBC) is characterized by calcium deposition in the brain, causing progressive movement disorders, psychiatric symptoms, and cognitive decline. PFBC is a heterogeneous disorder currently linked to variants in six different genes, but most patients remain genetically undiagnosed. Here, we identify biallelic NAA60 variants in ten individuals from seven families with autosomal recessive PFBC. The NAA60 variants lead to loss-of-function with lack of protein N-terminal (Nt)-acetylation activity. We show that the phosphate importer SLC20A2 is a substrate of NAA60 in vitro. In cells, loss of NAA60 caused reduced surface levels of SLC20A2 and a reduction in extracellular phosphate uptake. This study establishes NAA60 as a causal gene for PFBC, provides a possible biochemical explanation of its disease-causing mechanisms and underscores NAA60-mediated Nt-acetylation of transmembrane proteins as a fundamental process for healthy neurobiological functioning. © 2024. The Author(s).
The relationship between oxidative stress markers and 1H-Magnetic resonance spectroscopy findings in obsessive compulsive disorder
(Elsevier B.V., 2024) Turgut, Fatma Subaşı; Bulut, Mahmut; Hattapoğlu, Salih; Güneş, Mehmet; Kaya, Mehmet Cemal; Ekici, Faysal; Çetinçakmak, Mehmet Guli
Introduction: The purpose of this study was to examine N-acetyl aspartate (NAA)/creatine (Cr) and glutamate, glutamine, and gamma-aminobutyric acid complex (Glx)/Cr levels in patients with obsessive compulsive disorder (OCD) and healthy controls’ orbitofrontal cortex (OFC) and caudate nucleus (CN) by proton magnetic resonance spectroscopy (1H-MRS) method and to investigate their relationship with oxidative stress markers glutathione peroxidase (GPx) and superoxide dismutase (SOD). Methods: This study included patients with OCD (n = 25) and healthy controls (n = 25) ranging in age from 18 to 65. We used the ELISA method to evaluate serum SOD and GPx levels. Levels of NAA/Cr and Glx/Cr in the orbitofrontal cortex and caudate nucleus were measured using the 1H-MRS method. Results: Our study did not detect statistically significant differences in the orbitofrontal cortex Glx/Cr and NAA/Cr levels between the OCD patients and the control group. OCD patients exhibited a decrease in NAA/Cr levels, consistent with impaired neuronal integration, and an increase in Glx/Cr levels, consistent with hyperactivation, in the caudate nucleus compared to the control group. We observed a negative correlation between NAA/Cr levels in the caudate nucleus and the levels of SOD and GPx. Conclusions: Our study is the first to assess CN and OFC together in OCD patients using 3 T MR, investigating the relationship between neurometabolite concentrations and oxidative stress parameters. The negative correlation we observed between NAA/Cr levels and SOD and GPx in the caudate nucleus suggests that increased oxidative stress in this brain region in OCD patients may contribute to impaired neuronal integration and functionality. © 2024 Elsevier B.V.
Dosimetric results of postoperative tomodirect radiotherapy of keloid on ear cartilage
(Kare Publ, 2016) Teke, Fatma; Doğan, Mehmet Hakan; Selçuk, Caferi Tayyar
In radiotherapy following surgical excision of a keloid, radiation has been delivered using various techniques, doses, and fractions. TomoDirect (TD) is a static delivery mode of TomoTherapy (Accuray, Sunnyvale, CA, USA), allowing for the use of a fixed gantry angle in place of rotational beam delivery. Described in the present report is the first instance of TD used for postoperative radiotherapy of keloid scar. A 21-year-old woman presented with keloid scar that had developed and gradually progressed on the left ear cartilage following a piercing 2 years prior. The patient underwent TD radiotherapy with 2 tangential beams 33 hours after excision. Dose to planning target volume (PTV) was 15 Gy in 3 fractions of 5.0 Gy daily, every other day, and V95 was 100%. Mean dose of left parotid was 0.21 Gy, and maximum doses of brain and left lens were 0.34 Gy and 0.02 Gy, respectively. Optimal dose and technique for safe and effective postoperative keloid radiation therapy are unclear and depend upon keloid area and size. Treatment of keloid on ear or other sites with TD radiotherapy may be an optimal strategy.
Serum prolidase activity and oxidant-antioxidant status in children with chronic hepatitis B virus infection
(Bmc, 2014) Sen, Velat; Uluca, Unal; Ece, Aydin; Kaplan, Ibrahim; Bozkurt, Fatma; Aktar, Fesih; Bagli, Sedat
Background: Chronic hepatitis B (CHB) is a global health problem that can result in serious complications associated with collagen degradation. Prolidase is a specific imidodipeptidase that plays an important role in the breakdown of collagen. The aim of this study was to investigate prolidase activity and oxidant-antioxidant status in children with CHB. Methods: This prospective case control study includes 38 patients with CHB, 31 patients with inactive hepatitis B (IHB), and 29 healthy matched control subjects. Serum prolidase enzyme activity (SPEA), total antioxidant capacity (TAC), total oxidative activity (TOA), and malondialdehyde (MDA) level were measured and oxidative stress index (OSI) was calculated for each group. Results: Patients with CHB had significantly higher SPEA levels (207.82 +/- 186.80 IU/L) than did the controls (58.6 +/- 38.1 IU/L) and IHB patients (67.1 +/- 39.9) (p < 0.001). CHB patients also had significantly higher TOA (45.0 +/- 19.9 vs. 29.4 +/- 11.7 (mu molH(2)O(2) Eq./L), p = 0.005), OSI (33.1 +/- 21.4 vs. 17.5 +/- 10.2, p = 0.002) and MDA (13.4 +/- 4.0 vs. 7.8 +/- 2.6 mu m/L, p < 0.001) values compared with the controls. TOA (32.0 +/- 10.0) and OSI (15.4 +/- 11.0) values of IHB patients were significantly lower than those of CHB patients (p < 0.05). SPEA had significant correlations with HBV-DNA and ALT values (r = 0.514 and r = 0.454, p < 0.001). Conclusion: Our results suggest that prolidase activity can be considered as a reliable marker for CHB and increased oxidative stress appears to be related to chronicity of the disease.
Effect of intraperitoneal etanercept on oxidative stress in rats with peritonitis
(Hindawi Ltd, 2016) Yıldırım, Yaşar; Cellad, Esma Gülsüm; Kara, Ali Veysel; Yilmaz, Zülfükar; Kadiroğlu, Ali Kemal; Bahadır, Mehmet Veysi; Gül, Mesut
Our aim was to evaluate effect of etanercept on oxidative stress parameters in rats with experimental peritonitis and investigate the availability of etanercept usage in the treatment of peritonitis in the future. Twenty-eight rats were divided into four groups as control (group 1), peritonitis (group 2), peritonitis + cefazolin sodium (group 3), and peritonitis + cefazolin sodium + etanercept (group 4). Peritoneal tissue and blood samples were taken from all of the rats for histopathological and biochemical examination. The oxidative stress parameters were examined in blood and tissue samples. It was observed that rats with peritonitis benefit from cefazolin sodium treatment. Evaluating the effectiveness of etanercept was our main objective for this study. In this perspective, we compared group 3 and group 4 and found statistically significant decreases in oxidative parameters and statistically significant increases in antioxidants in serum and tissue samples in group 4. It is observed that there was a significant contribution of etanercept on biochemical and also histopathological results. As a result, the TNF-alpha inhibitor, etanercept, in addition to antibiotics given in the early treatment of peritonitis results in more significant improvement of histopathological and oxidative parameters as compared to antibiotics alone.
Push and pull factors of why medical students want to leave Türkiye: A countrywide multicenter study
(Routledge Journals, Taylor & Francis Ltd, 2023) Eser, Erhan; Çil, Elif; Gündoğan, Nesibe Efruz Şen; Çöl, Meltem; Öztürk, Elif Nur Yıldırım; Thomas, David Terence; Sunter, Ahmet Tevfik
Phenomenon: Physician immigration from other countries is increasing as developed countries continue to be desirable destinations for physicians; however, the determinants of Turkish physicians' migration decisions are still unclear. Despite its wide coverage in the media and among physicians in Turkiye, and being the subject of much debate, there is insufficient data to justify this attention. With this study, we aimed to investigate the tendency of senior medical students in Turkiye to pursue their professional careers abroad and its related factors. Approach: This cross-sectional study involved 9881 senior medical students from 39 different medical schools in Turkiye in 2022. Besides participants' migration decision, we evaluated the push and pull factors related to working, social environment and lifestyle in Turkiye and abroad, medical school education inadequacy, and personal insufficiencies, as well as the socioeconomic variables that may affect the decision to migrate abroad. The analyses were carried out with a participation rate of at least 50%. Findings: Of the medical students, 70.7% had emigration intentions. Approximately 60% of those want to stay abroad permanently, and 61.5% of them took initiatives such as learning a foreign language abroad (54.5%) and taking relevant exams (18.9%). Those who wanted to work in the field of Research & Development were 1.37 (95% CI: 1.22-1.54) times more likely to emigrate. The push factor that was related to emigration intention was the working conditions in the country (OR: 1.89, 95% CI: 1.56-2.28) whereas the social environment/lifestyle abroad was the mere pull factor for the tendency of emigration (OR: 1.73, 95% CI: 1.45-2.06). In addition, the quality problem in medical schools also had a significant impact on students' decisions (OR: 2.20, 95% CI: 1.83-2.65). Insights: Although the percentage of those who want to emigrate definitely was at the same level as in the other developing countries, the tendency to migrate permanently was higher in Turkiye. Improving working conditions in the country and increasing the quality of medical faculties seem vital in preventing the migration of physicians.
Causes of liver test abnormalities in newly diagnosed cancer patients and the investigation of etiological factors
(Taylor & Francis Ltd, 2024) Urakçı, Zuhat; Ebinç, Senar; Oruç, Zeynep; Kalkan, Ziya; Kaplan, Muhammet Ali; Küçükköner, Mehmet; Işıkdoğan, Abdurrahman
Objectives: In this study, we aimed to investigate the causes of liver test abnormalities in newly diagnosed patients naive to anti-tumoral therapy. Method: This study included a total of 490 patients with ALT levels > 5X ULN on liver function tests at the initial presentation to our clinic. Data from 247 (50.4%) patients diagnosed with cancer (cohort A) and 243 (49.6%) patients without cancer (cohort B) were compared with regard to the etiology of liver test abnormalities and the risk factors. Results: The most common etiological factor in cohort A was presence of liver metastasis (31.2%, n = 77). In the comparison of the two groups with regard to etiological factors; the rates of liver metastasis [31.2% vs 0%, (p < 0.001)], drug-induced liver toxicity [30/4% vs 19.8%, (p = 0.007)], pancreaticobiliary pathology [21.5% vs 14%, (p = 0.03)] and chronic viral hepatitis [14.2% vs 7.4%, (p = 0.02)] were higher in the cohort A. The rate of NAFLD was higher in the cohort B [6.9% vs 42.2% (p < 0.001). Conclusion: In our study, the most common cause of liver test abnormalities was the presence of liver metastasis in cohort A and NAFLD in cohort B.
Treatment outcomes and prognostic factors in patients with driver mutant non-small cell lung cancer and de novo brain metastases
(Nature Portfolio, 2024) Kahraman, Seda; Karakaya, Serdar; Kaplan, Muhammed Ali; Göksu, Sema Sezgin; Öztürk, Akın; İşleyen, Zehra Sucuoğlu; Hamdard, Jamshid
Central nervous system (CNS) metastases can be seen at a rate of 30% in advanced stages for patients with non-small cell lung cancer (NSCLC). Growing evidence indicates the predictive roles of driver gene mutations in the development of brain metastases (BM) in recent years, meaning that oncogene-driven NSCLC have a high incidence of BM at diagnosis. Today, 3rd generation targeted drugs with high intracranial efficacy, which can cross the blood-brain barrier, have made a positive contribution to survival for these patients with an increased propensity to BM. It is important to update the clinical and pathological factors reflected in the survival with real-life data. A multi-center, retrospective database of 306 patients diagnosed with driver mutant NSCLC and initially presented with BM between between November 2008 and September 2022 were analyzed. The median progression-free survival (mPFS) was 12.25 months (95% CI, 10-14.5). While 254 of the patients received tyrosine kinase inhibitor (TKI), 51 patients received chemotherapy as first line treatment. The median intracranial PFS (iPFS) was 18.5 months (95% CI, 14.8-22.2). The median overall survival (OS) was 29 months (95% CI, 25.2-33.0). It was found that having 3 or less BM and absence of extracranial metastases were significantly associated with better mOS and iPFS. The relationship between the size of BM and survival was found to be non-significant. Among patients with advanced NSCLC with de novo BM carrying a driver mutation, long-term progression-free and overall survival can be achieved with the advent of targeted agents with high CNS efficacy with more conservative and localized radiotherapy modalities.
Comparison of refugee patients with cystic fibrosis and their counterpart children from Turkey during the war
(Springer, 2024) Yılmaz, Aslı İmran; Pekcan, Sevgi; Eyüboğlu, Tuğba Şişmanlar; Hangül, Melih; Arslan, Hüseyin; Kılınç, Ayşe Ayzit; Çokuğraş, Haluk
Since the outbreak of the Syrian civil war in 2011, the population of Arab refugees in Turkey has rapidly increased. While cystic fibrosis (CF) is believed to be rare among Arabs, recent studies suggest it is underdiagnosed. This study aims to present the demographic, clinical, and genetic characteristics of CF patients among Arab refugees in Turkey. Additionally, a comparison is made between the findings in the National CF Registry 2021 in Turkey (NCFRT) and the refugee CF patient group. The study included refugee patients between the ages of 0 and 18 years who were diagnosed with CF and received ongoing care at pediatric pulmonology centers from March 2011 to March 2021. The study examined demographic information, age at diagnosis, age of diagnosis of patients through CF newborn screening (NBS), presenting symptoms, CF transmembrane conductance regulator (CFTR) mutation test results, sputum culture results, weight, height, and body mass index (BMI) z score. Their results were compared with the NCFRT results. The study included 14 pediatric pulmonology centers and 87 patients, consisting of 46 (52.9%) boys and 41 (47.1%) girls. All of the patients were Arab refugees, with 80 (92%) being Syrian. All the patients were diagnosed in Turkey. The median age at diagnosis of patients was 22.33 (interquartile range, 1-258) months. The median age of diagnosis of patients through NBS was 4.2 (interquartile range, 1-12) months. The median age of older patients, who were unable to be included in the NBS program, was 32.3 (interquartile range, 3-258) months. Parental consanguinity was observed in 52 (59.7%) patients. The mutation that was most frequently found was F508del, which accounted for 22.2% of the cases. It was present in 20 patients, constituting 32 out of the total 144 alleles. There was a large number of genetic variations. CFTR genotyping could not be conducted for 12 patients. These patients had high sweat tests, and their genetic mutations could not be determined due to a lack of data. Compared to NCFRT, refugee patients were diagnosed later, and long-term follow-up of refugee CF patients had significantly worse nutritional status and pseudomonas colonization. Conclusion: Although refugee CF patients have equal access to NBS programs and CF medications as well as Turkish patients, the median age at diagnosis of patients, the median age of diagnosis of patients through NBS, their nutritional status, and Pseudomonas colonization were significantly worse than Turkish patients, which may be related to the difficulties of living in another country and poor living conditions. The high genetic heterogeneity and rare mutations detected in the refugee patient group compared to Turkish patients. Well-programmed NBS programs, thorough genetic studies, and the enhancement of living conditions for refugee patients in the countries they relocate to can have several advantages such as early detection and improved prognosis.What is Known:center dot Children who have chronic diseases are the group that is most affected by wars.center dot The outcome gets better with early diagnosis and treatment in patients with Cystic Fibrosis (CF).What is New:center dot Through the implementation of a newborn screening program, which has never been done in Syria previously, refugee patients, the majority of whom are Syrians were diagnosed with cystic fibrosis within a duration of 4 months. center dot Despite equal access to the newborn screening program and CF medications for both Turkish patients and refugee patients, the challenges of living in a foreign country have an impact on refugees.
Familial Mediterranean fever: perspective on female fertility and disease course in pregnancy from a multicenter nationwide network
(Springer Heidelberg, 2023) Yurdakul, Fatma Gül; Bodur, Hatice; Çay, Hasan Fatih; Uçar, Ülkü; Keskin, Yaşar; Sargın, Betül; Gürer, Gülcan
The aim of this study was to analyze the pregnancy process, especially the Familial Mediterranean fever (FMF) disease course and attack types during pregnancy, and to examine the relationship between disease-related factors and female infertility in FMF patients. The study, which was planned in a multicenter national network, included 643 female patients. 435 female patients who had regular sexual intercourse were questioned in terms of infertility. Pregnancy and delivery history, FMF disease severity and course during pregnancy were evaluated. The relationship between demographic and clinical findings, disease severity, genetic analysis results and infertility was investigated. 401 patients had at least 1 pregnancy and 34 patients were diagnosed with infertility. 154 patients had an attack during pregnancy. 61.6% of them reported that attacks during pregnancy were similar to those when they were not pregnant. The most common attack symptoms were fever, fatigue and abdominal pain-peritonitis (96%, 87%, and 83%, respectively) in the pregnancy period. The disease-onset age, disease activity score, gene mutation analyses, and regular colchicine use (> 90%) were similar between the fertile and infertile groups, while the frequency of previous appendectomy and alcohol consumption rates were higher in individuals with infertility. Our results indicated no significant change in the frequency and severity of attacks during pregnancy. The low rate of infertility (7.8%) in our patients was noted. It has been suggested that the risk of FMF-related infertility may not be as high as thought in patients who are followed up regularly and received colchicine.
Persistent trigeminal artery detected on computed tomography angiography
(Springer France, 2022) Deniz, Muhammed Akif; Turmak, Mehmet; Hattapoğlu, Salih; Tekinhatun, Muhammed
Purpose This study aimed to investigate the prevalence of persistent trigeminal arteries (PTAs) using computed tomography (CT) angiography, emphasize its major characteristics, and compare the findings with those reported in the relevant literature. Methods Patients who underwent cerebral CT angiography in our radiology clinic for any preliminary diagnosis between December 2013 and December 2020 were included in this retrospective study. The patients were reviewed in terms of their age, sex, and the presence of PTAs. The localization of the PTA, vascular connection, PTA type (according to Saltzman and Salas classification), and vascular pathology at the level of anastomoses were examined in the patients with PTAs. Results A total of 1150 patients, (632 [55%] males and 518 [45%] females) were included in this study. A total of seven (0.6%) patients had PTAs. PTAs were located on the right and left sides in three (43%) and four (57%) patients, respectively. A total of three (43%), two (28%), and two (28%) cases were classified as types I, II, and III PTA based on the Saltzman classification, respectively. Moreover, four (57%) and three (43%) cases were lateral and medial types based on the Salas classification, respectively. Conclusion In conclusion, understanding the diagnosis and classification of PTAs is crucial for the diagnosis of possible vascular pathologies by neuroradiologists and physicians performing neurovascular interventional procedures or operations. If these vascular pathologies remain undetected, they may cause fatal bleeding or embolism during surgeries and endovascular procedures.
A Zinc sulphate-resistant acrodermatitis enteropathica patient with a novel mutation in SLC39A4 gene
(Springer-Verlag Berlin, 2012) Kılıç, M.; Taşkesen, M.; Coşkun, T.; Gürakan, F.; Tokatlı, A.; Sivri, H. S.; Dursun, A.
Acrodermatitis enteropathica (AE) is a rare autosomal recessive disorder of zinc deficiency due to an abnormal intestinal zinc transporter. It is characterized by the triad of acral dermatitis, alopecia, and diarrhoea. Once AE is correctly diagnosed, patients are treated with orally administered zinc sulphate. En some patients, relapses occur during adolescence, despite the regular treatment. Here, we discuss the clinical and molecular features of a 13-year-old adolescent girl with acrodermatitis enteropathica who was resistant to high-dose zinc sulphate therapy. We successfully treated the patient with zinc gluconate and vitamin C, and we detected a novel homozygous c.541_551dup (p.Leu186fsX38) mutation in the exon 3 of her SLC39A4 gene.
Ultrasound elastography in kidney disease
(Springer, 2016) Özkan, Fuat; Göya, Cemil; Yıldız, Sema; Duymuş, Mahmut; Menzilcioğlu, Mehmet Sait; Avcu, Serhat; İnci, Mehmet Fatih
Ultrasound elastography is a relatively new imaging modality that can measure tissue elasticity quantitatively by using different techniques. With the development of technology, kidney elasticity measurements can be performed accurately and quickly using ultrasound. Nowadays, kidney stiffness is used not only in fibrosis but also in the characterization of focal lesions, staging of metabolic kidney damage including diabetes mellitus, gout disease, etc.., and evaluating renal damage in urinary tract abnormality. However, kidney is a unique tissue and has a complex internal architecture. Therefore intrinsic or extrinsic factors such as perfusion, urinary pressure, anisotropy, depth of kidney, and hydronephrosis may affect the viscoelasticity of the kidney. Elastography is a useful, quick, noninvasive complementary method in the diagnosis of kidney diseases but needs specific training and optimization techniques as well as acknowledging technical and pathological factors whichmay influence it.
Infant feeding beliefs and practices in Islamic societies: Focusing on rural Turkey
(Springer, 2011) Ertem, Melikşah
[Abstract Not Available]

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