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https://hdl.handle.net/20.500.14034/45

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Greater Socioeconomic Disadvantage as Measured by the Area Deprivation Index Is Associated With Failure of Healing Following Arthroscopic Repair of Massive Rotator Cuff Tears but Not With Clinical Outcomes
(W.B. Saunders, 2024) Ardebol J.; Kılıç, Ali İhsan; Pak T.; Menendez M.E.; Denard P.J.
Purpose: To analyze the relationship between Area Deprivation Index (ADI) and preoperative status and short-term postoperative clinical outcomes among patients who underwent arthroscopic rotator cuff repair (ARCR) of massive rotator cuff tears (MRCTs). Methods: A retrospective review was conducted on prospectively maintained data on patients who underwent ARCR of MRCTs defined as tear size ?5 cm or complete tear of at least 2 tendons, with a minimum 2-year follow-up and a valid home address between January 2015 and December 2018. Each patient's home address was mapped to the ADI to determine neighborhood disadvantage. This composite index is composed of 17 census-based indicators, including income, education, employment, and housing quality to quantify the level of socioeconomic deprivation. Ratings were recorded and categorized based on the sample's percentile. Patients were then divided into 2 groups: upper quartile (ie, most disadvantaged [?75th percentile]) and lower 3 quartiles (ie, least disadvantaged [<75th percentile]). Bivariate analysis was performed to associate ADI with patient-reported outcomes (PROs) and range of motion pre- and postoperatively, as well as complications, healing rate, satisfaction, and return to work. Patients reaching or exceeding the minimal clinically important difference for visual analog scale (VAS), American Shoulder and Elbow Surgeons, Veterans Rand 12-Item questionnaire, and subjective shoulder value were recorded for both cohorts. Results: Ninety-nine patients were eligible for study analysis. Preoperative PROs and range of motion were similar, except for a greater VAS for pain (6.3 vs 4.3; P < .01) and lower American Shoulder and Elbow Surgeons score (32.2 vs 45.1; P = .01) in the most disadvantaged group. Both groups showed similar postoperative PROs scores, but greater VAS improvement was seen in the upper quartile group (? 4.2 vs ? 3.0; P = .04). In contrast, only the least-disadvantaged group significantly improved in internal rotation (P = .01) and forward flexion (18°; P < .01) from baseline. Although satisfaction, complications, and return to work were comparable (P > .05), failure of healing occurred more frequently in the most disadvantaged group (21% vs 6%; P = .03). Conclusions: Patients with MRCTs residing in the most disadvantaged neighborhoods as measured by the ADI have more pain and functional limitations before undergoing ARCR but demonstrate similar postoperative functional improvements to patients from other socioeconomic backgrounds. Failure of healing of MRCTs may be more common in disadvantaged groups. Furthermore, both groups reported similar rates of clinically important functional improvement. Level of Evidence: Level III, retrospective cohort comparison. © 2023 Arthroscopy Association of North America
Serum nitric oxide levels are depleted in depressed patients treated with electroconvulsive therapy
(Wolters Kluwer Medknow Publications, 2021) Atagün, Murat İlhan; Atay, Özge Canbek; Balaban, Özlem D.; İpekçioğlu, Derya; Alpugan, Barış; Yalçın, Suat; Senat, Almila
Background: Nitric oxide (NO) is an endogenous substance which has several endocrine functions and may act as neurotransmitter in the brain. High levels of NO may provoke nitrosative stress. Aim: It was aimed to examine serum levels of NO in patients with depressive episodes who were treated with electroconvulsive therapy (ECT) in this study. Methods: The design was a case-control, follow-up study. Patients with depressive episodes (n = 23) and a healthy control group (n = 21) were enrolled. Three serum samples were obtained from the patient group (before ECT, after first and seventh sessions). NO, nitrite, and nitrate levels were examined. Statistical Analysis: Differences between groups were examined with t-test or Mann-Whitney U-test. Longitudinal data were evaluated with Panel Regression Analysis and Kruskal-Wallis Test. Results: Serum levels of NO and nitrite decreased significantly after the seventh session of ECT administration compared to the baseline and first session. Nitrate levels did not differ between the assessments. Conclusions: Reduction of the serum NO and nitrite levels might be a contributing factor for hypertension during the sessions. These findings are reflect the circulating NO levels. Further studies may dissect NO physiology in the brain in mental disorders and potential external effects.
Depression and anxiety in people with hemophilia A and B
(Sage Publications Inc, 2024) Köseoğlu, Fatoş D.; Zuhal, Demirci; Onen-Sertoz, Ozen; Fahri, Sahin
Objective This study described the prevalence of and correlates of depression and anxiety in adult patients with hemophilia A and B. Methods In this cross-sectional study, we investigated patients with hemophilia who were being seen at an adult hemophilia center. Participants were screened for depression and anxiety during their annual clinic visit, which included administration of the Beck Depression Inventory and State-Trait Anxiety Scale. Results Of the 90 patients, 22 (24.4%) met criteria for significant depressive symptoms and and 67 (74.4%) met criteria for significant anxiety symptoms. There were no significant associations between depression and any psychosocial or clinical characteristics or adherence to hemophilia prophylaxis, except for educational status. No association was found between state and trait anxiety scores and psychosocial and clinical characteristics other than hemophilia type. After adjusting for confounding factors, multivariable analysis showed that high school education level was associated with depression (OR: 1.872, CI: 1.312-2.356, P = .010) and type B hemophilia was associated with anxiety (OR: 1.319, CI: 1.089-1.745, P = .042). Conclusion Depression and anxiety are major psychiatric comorbidities in patients with hemophilia in Turkey. Routine evaluation for mood and anxiety disorders are crucial in the care of patients with haemophilia.
Üroloji alanıyla ilgili tıbbi uygulama hatası
(2022) Kaplan, Gazel; Çağlayan, Alper; Meral, Orhan
Hekimlerin tıbbi, idari adli ve etik sorumlulukları bulunmaktadır. Bünyesinde çok sayıda risk barındıran hekimlik mesleğinde istenmeyen olumsuz durumların meydana gelmesi neticesinde hasta veya hasta yakınları tarafından yargı mercilerine tıbbi hatalar yönünden başvurulabilmektedir. Son yıllarda gerek ülkemizde gerekse de dünyada tıbbi uygulama hatası iddiasıyla yapılan şikâyet başvurusu ve açılan dava sayısında belirgin artışın olduğu bilinmektedir. Özellikle cerrahi branşlarda meydana gelen istenmeyen durumlar neticesinde tıbbi hata bulunduğu yönünde davalar olduğu yapılan birçok çalışmada bildirilmektedir. Uzayan yargılama süreçleri, istenen hapis cezaları, ödenen yüklü tazminatlar vs. defansif tıp uygulamalarının da artışına neden olmaktadır. Bu çalışmada, Üroloji alanına yönelik tıbbi uygulama hatası iddiasıyla başlatılan yargı süreçlerinden Danıştay’a yansıyan davalarının incelenerek, en üst idari yargı merci olan Danıştay’ın yerel mahkeme ve üniversite kararlarına bakış açısı değerlendirilecektir. Bir cerrahi branş olan Üroloji alanında görev yapan hekimler için hasta ve hasta yakınları tarafından tıbbi hata iddiasında bulunulması riski azımsanmayacak düzeydedir. Ülkemizde daha önce benzer nitelikte bir çalışma yapılmamış olduğundan sunulan çalışmanın literatüre katkı sağlayacağı düşüncesindeyiz.
Romatizmal hastalık ndeni ile hidroksiklorokinin kullanımının Covid-19'a yakalanma ve hastalık seyri üzerine etkisi
(2022) Gerdan, Vedat; Şener, Aslı; Kızıloğlu, İlker; Korkmaz, Tanzer
Giriş: COVID-19 virüsü dünya çapında yayılmaya ve öldürmeye devam etmektedir. Hidroksiklorokinin etkinliği ve güvenilirliği kanıtlanmadığı için klinik araştırmalar dışında profilaksi için kullanılmaması gerektiği bildirilmiştir. Ancak yerel bir alanda yaptığımız bu çalışmanın sonuçlarının literatür verilerine katkı sağlayacağını düşünüyoruz. Gereç ve Yöntem: Bu çalışmada romatolojik hastalıkları nedeniyle hidroksiklorokin kullanan ve kullanmayan erişkin hastalar retrospektif değerlendirildi. Hidroksiklorokin kullanmayan hastalar kontrol grubu olarak belirlendi. PCR sonuçları ile hastaların hidroksiklorokinin kullanım özellikleri karşılaştırıldı. Bulgular: Hastaların çoğunluğunu (ortanca yaş: 51.8- 17-89 arası) kadınlar (en sık ev hanımı) oluşturmakta idi. Hidroksiklorokin kullanan hasta grubundaki 22 (%5.72) hastanın COVİD-19 şüphesiyle PCR testi yaptırdığı ve sadece ikisinde (%0.52) PCR pozitifliği saptandığı tespit edilmiştir. Kontrol grubunda ise (n=299) PCR testi yapılan 65 hastanın (%21,73) 24'ünde (%8.02) COVİD-19 tespit edildiği görülmektedir. PCR pozitifliği hidroksiklorokinin kullanan grupta istatistiksel olarak daha düşük tespit edildi (n = 2, %0.52, n = 24, %8.02, p = 0.0001). Sonuç: Çalışmamız, hidroksiklorokinin kullanmayanlara göre düzenli olarak hidroksiklorokinin kullananlarda PCR pozitifliğinin daha düşük olduğunu desteklemektedir.
Plevral sıvı kolesterol düzeyinin eksüda ve transüda ayırımındaki rolü Role of pleural fluid cholesterol level in discrimination of transudates and exudates
(2021) Batum, Özgür; Ermin, Sinem; Yılmaz, Ufuk; Kayıkçı, Hazal
Amaç: Plevral sıvıların tanısında, transüda (T)–eksüda (E) ayrımının yapılması önemlidir. Bu çalışmanın amacı, Light kriterleri ile plevral sıvı kolesterol düzeyini içeren tekli, ikili ve üçlü testlerin, T- E ayırımındaki duyarlılık ve özgüllüğünü belirlemektir. Gereç ve Yöntem: Çalışmaya plevral sıvı nedeniyle başvuran 145 hasta dâhil edildi. Plevral sıvı kolesterol düzeyi (PSKD) ?45 mg/dL (tekli test); PSKD ?45 mg/dL veya plevral sıvı LDH düzeyi >kan normal LDH’sının %45 (ikili test); plevral sıvı protein >2,9 g/dL, PSKD ?45 mg/dL, plevral sıvı LDH düzeyi >kan normal LDH’sının %45 (üçlü test) olarak tanımlandı. Kesin tanıya uygun beklenen plevral sıvı tipi altın standart olarak değerlendirmeye alındı. Bulgular: Çalışmaya alınan 139 hastada, kesin tanıya uygun beklenen plevral sıvı tipi olguların %81’inde eksüda; %19’unda transüda olarak belirlendi. Eksüdatif plevral sıvıyı saptamada, tekli testin kesin tanıya uygun beklenen plevral sıvı tipi ile karşılaştırılmasında iki grup arasında sınırda anlamlılık saptandı (p=0.05). İkili ve üçlü test değerlendirmelerinde ise iki grup arasında istatistiki anlamlı fark saptandı (p<0.001). Tekli testin duyarlılığı %88,5, özgüllüğü %84,6; ikili ve üçlü testin ise duyarlılığı %100 olmasına karşın, özgüllükleri düşüktü (sırasıyla, %46,1 ve %42,3). Sonuç: Hasta grubumuzdaki bulgular, eksüdatif plevral sıvının saptanmasında plevral sıvı kolesterol düzeyini içeren tekli, ikili veya üçlü testlerin, Light kriterlerinin yerine kullanılabilmesini desteklememiştir.
Evaluation of cardiovascular disease risk factors, inflammatory markers and subclinical atherosclerosis in patients with hemophilia
(2022) Bozgül, Şükriye Miray Kılınçer; Türk, Uğur Önsel; Saydam, Güray; Barutcuoğlu, Burcu; Şahin, Fahri; Atilla, Fatoş Dilan; Ak, Güneş
Aim: To assess and compare the risk factors of cardiovascular disease (CVD) between patients with hemophilia (PwH) and healthy controls in a single center cohort in Türkiye. Materials and Methods: Anthropometric parameters including height, weight, and body mass index were recorded. Fasting glucose, HbA1c, high sensitive C-Reactive Protein (hs-CRP), adiponectin, lipid parameters (total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides) were assessed. International Physical Activity Questionnaires (IPAQ) and carotid intima media thickness (CIMT) measurements were performed. The data from PwH (n=80) and healthy controls (n=36) were compared. Independent associates of CIMT value were analyzed. Results: Hypertension, diabetes mellitus, metabolic syndrome and smoking frequencies were remarkable in PwH. Family history of CVD was significantly more frequent ( p=0.005) and when considered with IPAQ scores; PwH was much more sedentary than controls (p<0.001). Total cholesterol, LDL-cholesterol were significantly higher in the control group (p =0.003,=0.003) while hs CRP levels were higher in PwH (p=0.009). Age and IPAQ score were significant independent predictors of CIMT (p=0.004 and 0.003, respectively). Conclusion: As a result of aging; PwH exposure to the same CVD risk factors as the general population. Screening for CVD risk factors in PwH other than hemophilia evaluation will be essential.
Effect of COVİD-19 pandemic and coronavac vaccine on blood pressure regulation in chronic hypertensive patients
(2021) Şenöz, Oktay; Erseçgin, Ahmet; Demir, Yusuf; Yurdam, Ferhat Siyamend; Yapan Emren, Zeynep; Gürses, Ecem
Objective: The most common comorbidity in patients with Covid-19 infection is hypertension. Apart from the direct effects of the virus on hypertensive patients, the pandemic period also negatively affected these patients. In addition, the effect of the newly discovered CoronaVac vaccine, which has been widely used in our country in recent months for the prevention of covid-19 infection, on blood pressure regulation is unknown. In this study, we aimed to investigate the effects of the pandemic period and the CoronaVac vaccine in patients receiving treatment for essential hypertension.Method: One hundred ninety-six patients who applied to the cardiology outpatient clinic between 4 June - 9 July 2021, were treated for essential hypertension and had at least 1 dose of CoronaVac vaccine were included in the study. In the pre-pandemic, pre-vaccine and post-vaccine period, mean home and office blood pressures of the patients were examined separately. Results: While the mean home blood pressures of the patients differed significantly between the pre-pandemic and pre-vaccine pandemic period (systolic: 125.1±12.6 vs 129.1±14.1 mmhg, p<0.001, diastolic: 75.3±9.7 vs 77.1±9.8 mmhg, p=0.004), there was no significant difference between the pre- and post-vaccination period (systolic: 129.1±14.1 vs 129.7±13.7 mmhg, p=0.229, diastolic: 77.1±9.8 vs 77.9±9.9 mmhg, p=0.091). Similarly, while office blood pressures differed significantly between the pre-pandemic and pre-vaccine pandemic period (systolic: 133.5±16.5 vs 136.1±16.4 mmhg, p=0.015, diastolic: 79.4±10.9 vs 81.2±12.1 mmhg, p=0.036), there was no significant difference between the pre- and post-vaccination period (systolic: 136.1±16.4 vs 135.6±16.9 mmhg, p=0.651, diastolic: 81.2±12.1 vs 81.1±11.2mmhg, p=0.914). Conclusion: While the Covid-19 pandemic increased the blood pressure of chronic hypertensive patients, the CoronaVac vaccine did not affect the blood pressure regulation of these patients.
Doctors’ visit dilemma: exploring the reliability of the data in an outpatient department
(2021) Küçük, Suat Hayri; Müslümanoğlu, Ahmet Yaser; Özbek, Hanefi; Özen, Olcay; Aydın, Sabahattin
The aim of the study is to investigate the nature of outpatient-based visits to speciality care physicians in outpatient departments of a teaching hospital. A questionnaire which was in a sense “an after-visit summary” that contained patient age, gender and doctor’s major office contact reason was developed. Physicians from different medical disciplines completed the questionnaire on randomly selected visits. Data was analysed statistically by descriptive analysis and cross tabulation. 1184 adult patients were analysed; 587 [49.6 (%)] of them were visited by medicine specialists, and 597 [50.4 (%)] by surgeons. Among all adult admissions, first patients comprised less than half of the workload, 40.8 (%) in surgery and 43.5 (%) in medicine. There was a significant difference between the number of patient contacts in medical and surgical specialities in terms of major visit categories. Compared to first visit, numbers of established patients, office consultation and reporting were significantly higher, whereas number of prehospitalizations was significantly lower in medicine than surgery. As shown in the study, per capita doctors’ visit data is not very reliable, nor is it uniform in OECD database, disabling the comparison between countries.
COVID-19 Salgını döneminde valvüler olmayan atriyal fibrilasyon nedeniyle yeni nesil oral antikoagülan kullanan hastalarda kanama komplikasyonlarının araştırılması
(2022) Şenöz, Oktay; Emren, Sadık Volkan; Yapan Emren, Zeynep; Yurdam, Ferhat Siyamend
Amaç: COVID?19 pandemisi döneminde hastane başvurularının azalması; yeni oral antikoagülan kullanan hastaların takibini zorlaştır? maktadır. Bu bağlamda COVID?19 pandemisi döneminde yeni oral antikoagülan kullanan hastalarda kanama sıklığının araştırılması amaçlandı. Gereç ve Yöntem: Bu çalışma Mayıs 2020 ve Mayıs 2021 tarihleri arasında yapılmış kesitsel bir çalışmadır. COVID?19 pandemi döne? minde en az bir yıldır yeni oral antikoagülan kullanan 216 hasta dahil edilmiştir. Hastaların majör ve minör kanama oranları ve buna et? ki eden ön gördürücüler araştırılmıştır. Bulgular: Hastaların yaş ortalaması 72±10’du ve 129 (%60) hasta kadındı. 46 (%21) hastada kanama saptandı (%3 majör, %18 minör kanama). Kanama gelişen %12 hastada doz azaltımı yapılırken, %7 hastada ilaç kesilmiştir. Çok değişkenli analizlerde düzensiz ilaç kul? lanımı risk oranı: 14,91 (%95 Güven aralığı: 2,451?90,692, p=0,003), kadın cinsiyet risk oranı: 5,507 (%95 güven aralığı: 2,117?14,327, p<0,001), diyabet risk oranı: 2,319 (%95 güven aralığı: 1,069?5,031, p=0,033), HAS?BLED skoru risk oranı: 1,571 (%95 güven aralığı: 1,035?2,384 p=0,034) kanama ile ilişkili bağımsız değişken olarak bulunmuştur. Sonuç: Yeni oral antikoagülan kullanan hastalarda kanama komplikasyonları COVID?19 döneminde de hala bir sorun olmaya devam et? mektedir
Akut serebrovasküler olay geçiren hastalarda acef risk skoru ile aritmi gelişimi arasındaki ilişki
(2022) Güzel, Tuncay; Kış, Mehmet; Şenöz, Oktay
Giriş: Akut inmeden sonra yüksek riskli hastaların belirlenmesi, uygun kardiyak izlem ve altta yatan aritmilerin tanı ve tedavisi, kardiyak morbidite ve mortaliteyi önlemek için önemlidir. ACEF risk skoru, sadece kısa ve uzun vadeli mortalite açısından değil, aynı zamanda majör advers kardiyovasküler olaylar açısından da tatmin edici prediktif değerler ile ilişkilendirilmiştir. Bu çalışmanın amacı akut iskemik serebrovasküler olay (SVO) geçiren hastalarda ACEF risk skoru ile aritmi gelişimi arasındaki ilişkinin araştırılmasıdır. Gereç ve Yöntem: Çalışmaya, akut iskemik SVO geçiren, bazal elektrokardiyografisinde (EKG) aritmi bulunmayan ve aritmi tespiti için Holter EKG takılan ardışık 158 hasta dahil edilmiştir. Hastalar, Holter EKG’de aritmi saptanmayanlar (Grup 1) ve saptananlar (Grup 2) şeklinde iki gruba ayrılarak incelendi. ACEF skoru aşağıdaki formüle göre hesaplandı; ACEF = yaş/sol ventrikül ejeksiyon fraksiyonu+1 (kreatinin>2.0 mg/dL ise). Bulgular: Hastaların yaş ortalaması 71.6±10.6 yıldı ve grup II'deki yaş ortalaması grup I'e göre istatistiksel olarak anlamlı derecede yüksekti (72.8±10.1'e karşı 68.8±11.2 yıl, p=0.025). Hastaların 110'unda (%69.6) Holter EKG'de aritmi saptandı. En sık görülen aritmi tipi ventriküler ekstrasistoller (%32.7) idi. Ortalama ACEF skoru 1.43±0.49 olarak bulundu. ACEF risk skoru grup II'de grup I'e göre istatistiksel olarak anlamlı derecede daha yüksekti (1.497±0.511'e karşı 1.285±0.407, p=0.012). ACEF risk skoru değeri >1.26, %59 duyarlılık ve %56 özgüllük ile akut iskemik inmeli hastalarda aritmi için bir öngördürücü olarak saptandı (eğri altındaki ROC alanı: 0.642, %95 CI: 0.548-0.737, P =0.004 ). Sonuç: Akut iskemik SVO geçiren hastalarda yüksek ACEF risk skoru, holter EKG ile tespit edilen, altta yatan aritmi varlığı ile ilişkilidir. Bu hastalarda aritmi varlığını öngörmek için basit ve kolay ulaşılabilir ACEF risk skoru kullanılabilir.
Acil geçici kalp pili takılan hastaların klinik özellikleri ve hastane içi mortalite oranları
(2021) Yurdam, Ferhat Siyamed; Erseçgin, Ahmet; Şenöz, Oktay; Yapan Emren, Zeynep
Giriş: Geçici kalp pili(GKP) uygulaması birçok bradiaritminin acil tedavisinde hayat kurtarıcı role sahiptir.Özellikle ilaçların etkisiz olduğu infra nodal atriyoventriküler blokların (AVB) acil tedavisi için tek seçenektir.Bu çalışmada,kliniğimizde acil GKP uygulanan hastaların klinik özelliklerini ve hastane içi mortalite oranlarını tespit etmeyi amaçladık. Gereç ve Yöntem:Ekim 2016-Haziran 2021 tarihleri arasında kliniğimizde acil GKP tak ılan 229 hasta çalışmaya dahiledildi. Hastaların klinik ve laboratuvar özellikleri hastane kayıtları vasıtasıyla geriye dönük olarak incelendi. Bulgular: Hastaların 225’ine bradiaritmi nedeniyle, 4’üne ise taşiaritmi nedeniyle (over-drive pacing amaçlı) GKP implante edildi.GKP gerektiren bradiaritmi nedenleri s ırasıyla; idiopatik (%33.3), ilaçlar (%30.6), iskemi (%30.6), hiperpotasemi (%4.9) ve konjenital at riyoventriküler bloktu (%0.4). En s ık bradikardi türü 2. ve 3. derece atriyoventriküler bloklardı (%77.3). Bradiaritmi nedeniyle GKP tak ılan hastaların 110 (%48.9)’una kalıcı kalp pili implantasyonu gerekti. Hastaların 35 (%15.3)’inde hastane içi mortalite gelişti. Mortalite oranı, iskemi ve hiperpotasemi gruplarında diğerlerine göre anlamlı olarak daha yüksekti (p<0.001). Sonuç: Acil GKP implantasyonu gerektiren en sık neden idiopatik ardından iskemi ve ilaçlardı. Hiperpotasemi ve iskeminin neden olduğu ciddibradikardilerde hastane içimortalite oranı oldukça yüksektir
Clues on electrocardiography to predict the presence of paroxysmal atrial fibrillation in patients with acute ischemic stroke: A propensity score-matched study
(2022) Yurdam, Ferhat Siyamend; Şenöz, Oktay
Objectives: In this study, we aimed to detect surface electrocardiography (ECG) markers that could be predictive of paroxysmal atrial fibrillation (PAF) attacks in patients with ischemic stroke. Patients and methods: Between November 2017 and April 2021, a total of 112 patients (65 males, 47 females; mean age: 70.5±6.8 years; range, 51 to 84 years) hospitalized for acute ischemic stroke with sinus rhythm on surface ECG who underwent Holter ECG monitoring for PAF were retrospectively analyzed. The patients were divided into two groups of 56 patients in each (Group 1: those with PAF on Holter ECG and Group 2: those without PAF). Both groups were matched according to demographic, clinical, and echocardiographic features using the propensity score matching method. Results: Demographic, clinical, and echocardiographic features were similar between groups (p>0.05). The mean maximum P-wave duration (PWD) and P-wave dispersion (PWDis) were longer in Group 1 than Group 2 (108.4±9.9 vs. 102.5±10.2 ms; p=0.002, 49.4±13.6 vs. 36.8±11.7 ms; p<0.001). Similarly, the mean P-wave terminal force in lead V1 (PTFV 1) was higher in Group 1 than Group 2 (4415±909 vs. 3826±568 ?V·ms; p<0.001). Logistic regression analysis revealed high PWDis (odds ratio [OR]: 1.164; 95% confidence interval [CI]: 1.069-1.268; p<0.001) and PTFV 1 (OR: 1.156; 95% CI: 1.065-1.254; p=0.001) as independent predictors of PAF. Conclusion: PWDis and PTFV1 are independent predictors of PAF in patients with acute ischemic stroke. These simple and easily accessible predictors that can be detected via surface ECG may be used as a guide to identify patients who require longer rhythm monitoring to better detect occult PAF, thereby preventing recurrent strokes.
The effect of hemodialysis on left ventricular global longitudinal strain in chronic hemodialysis patients with preserved left ventricular ejection fraction
(2022) Emren, Zeynep Yapan; Yurdam, Ferhat Siyamend; Erseçgin, Ahmet; Atay, Gökhan; Arda, Hayri Üstün; Şenöz, Oktay
Objectives: In the present study, we aimed to evaluate the acute effects of hemodialysis (HD) on left ventricular functions with left ventricular (LV) global longitudinal strain (GLS). Patients and methods: This prospective study included a total of 38 patients (24 males, 14 females; mean age: 60.8±13.8 years; range, 31 to 82 years) who were on chronic HD for at least six months and had a LV ejection fraction of ?50% between December 2021 and January 2022. The clinical and echocardiographic features of the patients were recorded before and after HD. The GLS was calculated using two-dimensional speckle-tracking method. Results: The mean dialysis time of the patients was 6.3±3.9 years. The left atrial volume index was significantly lower after HD than before (30.1±10.0 vs. 27.5±8.2 mL/m 2 , p=0.005). Pulsed Doppler echocardiography showed significantly decreased E and A wave peak velocity after HD (99.3±38.2 vs. 80.4±27.8 cm/s, p=0.001 and 99.4±23.2 vs. 90.4±25.5 cm/s, p=0.022), but no significant change in the E/A ratio (1.1±0.5 vs. 1±0.6, p=0.660). There was no significant change on the LV GLS between before and after HD (-17.3±2.6 vs. -16.9±2.6%, p=0.088). Conclusion: Hemodialysis has no significant effect on LV GLS in the acute phase in patients with end-stage chronic renal disease.
Clinical effects of T790M mutation in EGFR tyrosine kinase inhibitor resistant NSCLC patients
(2021) Anar, Ceyda; Kömürcüoğlu, Berna; Polat, Gülru; Büyükşirin, Melih; Batum, Özgür; Erdoğan, Kadri Murat; Güldaval, Filiz
INTRODUCTION: To compare patient characteristics between the T790M-positive and T790M-negative populations, and to analyze the post-progression survival (PPS) after initial tyrosine kinase inhibitor (TKI) failure in order to investigate the prognosis in patients undergoing rebiopsy. METHODS: We investigated the patient characteristics, including the initial EGFR-TKI response and T790M status at the time of rebiopsy or liquid biopsy, subsequent treatment after resistance to the initial EGFR-TKI (the presence of EGFR-TKI re-challenge), treatment just before biopsy and/or rebiopsy (EGFR-TKIs or chemotherapy), the timing of the rebiopsy (just after the initial EGFR-TKI failure or others). RESULTS: No difference was found between the two groups with T790M mutation positive and negative in terms of age, gender, and metastasis location. Only patients with positive T790M mutation had higher progression after TKI use compared to negative ones (p: 0.000). The progression-free median survival in patients using TKI was 19.33 months in the group with T790M mutation and 22.25 months in the negative group. Overall survival was found to be 75 months and 27.5 months in the T790M positive and negative group, respectively, and this was statistically significant. (p: 0.009). DISCUSSION AND CONCLUSION: Overall survival was significantly longer in the T790M positive group than in the T790M negative group. In addition, liquid biopsy can be performed several times for patients with progression after EGFR-TKI use and who do not want to undergo tissue biopsy
Assessing medication adherence of emergency medicine specialists using the MMAS-8
(2022) Kocataş, Arda; Metin, Damla Anbarlı
Aim: Although doctors in the emergency medicine department report high career and life satisfaction rates, burnout and stress may occur after working many years, resulting in several incompatibilities and risks. The Morisky Medication Adherence Scale (MMAS-8) is a simple, reliable, verified self-report measure to assess medication adherence. In our study, we planned to evaluate the treatment compliance of emergency medicine specialists with the MMAS-8 scale. Material and Method: This study employed a cross-sectional descriptive design. The emergency medical experts were contacted online to self-report their medication-taking behaviors using the MMAS-8. The MMAS-8 was evaluated using factor analysis. The treatment combinations of emergency medicine specialists were assessed in terms of chronic disease, the number of night shifts, and the number of medications used. Results: The MMAS-8 was assessed by KMO and Barlett analyses for structural validity and adequate sampling group evaluation. The average score obtained from the MMAS-8 was found to be 3.99±2.52. When chronic disease and medication adherence were considered, the MMAS-8 scores revealed low adherence in cases of chronic diseases (p=0.025). Conclusion: The treatment of patients with chronic diseases is very difficult. As found in this study, although the patients were doctors, medication adherence was low. It is known that emergency medical professionals have a high incidence of chronic diseases and mortality. Furthermore, low medication adherence with chronic or acute treatment increases risks.
Analysis of the correlation between thyroid hormones and thyroid volume by gender: A volumetric computed tomography study
(2022) Öner, Zülal; Öner, Serkan; Secgin, Yusuf; Toy, Şeyma
The aim of this study was to evaluate the correlation between triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) hormones and thyroid gland volume with volumetric analysis performed by using computed tomography (CT) images. In this retrospective study, IV contrasted thoracic CT images taken for different indications between 2019 January and 2020 January were scanned from the archive system of the hospital. 67 (31F, 36M) individuals chosen randomly among patients whose CT results were reported as normal and who had taken thyroid hormone tests within the past week were included in the study. Images in Digital Imaging and Communications in Medicine format were transferred to the personal work station program (Horos Medical Image Viewer). By using the Region of Interest (ROI) console in the current program, a three dimensional model was obtained by drawing the border of the thyroid gland in sections varying between 15 and 25. Volume values of this three-dimensional model and TSH, T3, T4 values of the individuals were compared. While no correlation was found between thyroid gland volume and T3 and T4 hormones, a negative significant correlation was found with TSH. In terms of gender, thyroid gland volume, T3, T4 values were found to be statistically significantly higher in women when compared with men (p?0.05). TSH value was found to be higher in women when compared with men (p=0.005). No statistically significant difference was found in T4 value (p=0.057). Radio-anatomical volumetric data of the thyroid gland presented in this study and its correlation with thyroid functions will be beneficial to clinicians working in the field in both internal and surgical medicine branches and will also guide future studies.
Examination of patients admitted to the emergency department with blunt chest trauma
(2021) Gönüllü, Hayriye; Tekindal, Mustafa Agah; Erdoğan, Arife
Blunt chest trauma is an important and common cause of morbidity and mortality. It constitutes an important part of the admissions to the emergency department. For this purpose, we evaluated the demographic characteristics, type of trauma, accompanying traumas, trauma scoring systems and results, duration of stay in the emergency department, and hospital outcomes of patients with chest trauma admitted to the emergency department of our hospital. In our study, patients who admitted to the emergency department of our hospital within one year with blunt chest trauma were evaluated retrospectively. Of the 156 patients examined, 114 (73%) were male and the mean age was 52.83±17.9 years. Pneumothorax (35%) and rib fracture (55%) were the most common thoracic injuries. When the duration of hospitalization was examined, the presence of lower extremity and abdomen pathologies, pneumothorax, hemothorax, and (>3) rib fracture prolonged the hospitalization period (p<0.05). Revised Trauma Score (RTS) and Glasgow Coma Score (GCS) were found to be significantly lower in deceased patients (p<0.001). Pneumothorax, hemothorax, (>3) rib fracture and pneumomediastinum increased mortality (p<0.05). Patients with chest trauma can have life-threatening clinics. In the emergency department, it should be evaluated for possible life-threatening pathologies, especially in terms of multi-trauma, and thoracic pathologies and other organ injuries should be managed simultaneously in an efficient and rapid manner. The issues to be considered in the triage, stabilization and follow-up of the patients should be well known.
Evaluation of inflammatory and biochemical markers in COVID-19 patients treated with tocilizumab alone or with the combination of tocilizumab and convalescent plasma transfusion
(2022) Karaarslan, Numan; Doğan, Mustafa; Bilir, Bülent; Yılmaz, İbrahim; Özbek, Hanefi
Abstract Aim: Macrophage activation syndrome (MAS) develops due to increased expression of systemic pro-inflammatory cytokines in patients with the 2019 novel coronavirus disease (COVID-19). Immune modulators have been used in anti-cytokine therapy, with the hypothesis that they can ensure cytokine inhibition and treat cytokine storm. The present study aimed to evaluate inflammatory and prognostic biomarkers in severe COVID-19 cases treated with tocilizumab (TCZ) alone or with the combination of tocilizumab and convalescent plasma transfusion (CPT). Materials and Methods: In this retrospective study, data archives of patients with severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) and who were treated with TCZ alone or the combination of CPT and TCZ were evaluated in line with the literature. The obtained data were statistically evaluated and the alpha significance value was taken as <0.05. Results: Post-treatment C-reactive protein (CRP) (76.19% in TCZ-administered group; 89.32% in TCZ+CPT-administered group) (P<0.05), troponin I (TNI) (25.64% in TCZadministered group; 90.39% in TCZ+CPT-administered group) (P<0.05), and ferritin (FER) (63.63% in the TCZ-administered group; 9.09% in the TCZ+CPT-administered) (P<0.05) levels were decreased compared to pre-treatment stage. The mean length of hospital stay was longer in the patients treated with TCZ alone (21.55±8.89 days) than in the patients treated with the combination of TCZ and CPT (27.09±13.66 days) (P<0.05). Conclusion: There was no significant difference between the groups in terms of demographic characteristics. The combination of TCZ and CPT treatment did not decrease the mortality. A significant decrease in CRP and TNI levels was observed in the patients treated with TCZ alone and with the combination of TCZ and CPT. A decrease in FER levels showed the effectiveness of the treatments.
Evaluation of poisoning cases that admitted to the emergency department for suicidal ideation
(2022) Erdoğan, Arife
Aim: In this study, we aimed to evaluate the effects of gender, age, time of admission to the emergency department, season, drug used, the time patients were admitted to the emergency department following the drugs administration, and psychiatric illness history on the clinical outcome of patients by examining the patients who admitted to our emer- gency department after taking suicidal drugs. Materials and Methods: The data of the study were obtained as a result of the retrospective examination of the cases who took drugs for suicidal purposes, who admitted to the emergency department of our hospital between January 2019-January 2020. We divided those who were discharged and admitted to the ward as good clinical outcome, and those who were admitted to the intensive care unit and those who died had poor clinical outcome. We statistically analyzed the effects of age, gender, the active substance used, the time of admission to the emergency department, the number of hours after which it was presented, a previous suicide attempt, and a history of psychiatric illness on clinical outcomes. Results: 295 patients were included in the study. 64.4% (190) of the cases were female and 35.6% (105) were male. The mean age of the patients is 32.9, and the majority of them are in the 25-34 age group (31.5%). The fact that the patients were male, admitted to the emergency room 4 hours after taking the drug, admitted to the emergency room between 00.00-07.59, committed suicide with psychiatric medication, had a previous sui- cide attempt and diagnosis of psychiatric illness, had a statistically poor clinical outcome (p<0.001). Conclusion: As a result, the history of the patients, the active substances they took, the hours and duration of their arrival to the emergency department can be used to predict the occurrence of serious clinical pictures in suicidal drug intake.

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