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Non‑cirrhotic portal fbrosis/idiopathic portal hypertension: APASL recommendations for diagnosis and management
(Springer Nature, 2024) Shukla, Akash; Rockey, Don C.; Kamath, Patrick S.; Kleiner, David E.; Singh, Ankita; Vaidya, Arun; Koshy, Abraham; Goel, Ashish; Dökmeci, A. Kadir; Meena, Babulal; Philips, Cyriac Abby; Sharma, Chhagan Bihari; Örmeci, Necati; Sarin, Shiv Kumar
Since the Asian Pacific Association for the Study of the Liver (APASL) published guidelines on non-cirrhotic portal fibrosis/idiopathic portal hypertension in 2007, there has been a surge in new information, especially with the introduction of the term porto-sinusoidal vascular disorder (PSVD). Non-cirrhotic intra-hepatic causes of portal hypertension include disorders with a clearly identifiable etiology, such as schistosomiasis, as well as disorders with an unclear etiology such as non-cirrhotic portal fibrosis (NCPF), also termed idiopathic portal hypertension (IPH). This entity is being increasingly recognized as being associated with systemic disease and drug therapy, especially cancer therapy. An international working group with extensive expertise in portal hypertension was assigned with formulating consensus guidelines to clarify the definition, diagnosis, histological features, natural history, and management of NCPF/IPH, especially in the context of PSVD. The guidelines were prepared based on evidence from existing published literature. Whenever there was paucity of evidence, expert opinion was included after detailed deliberation. The goal of this manuscript, therefore, is to enhance the current understanding and help create global consensus on the issues surrounding NCPF/IPH.
Babaların aşılar hakkında bilgi ve tutumlarını etkileyen faktörler
(Galenos Yayınevi, 2024) İnce, Tolga; Altun, Büşra Bilgeşen; Totur, Gülberat; Baysal, Serpil Uğur
Amaç: Aşılar, çocukluk çağı enfeksiyon hastalıklarını önlemede en etkili araçlardır. Ebeveynlerin aşılar hakkındaki bilgi ve tutumları, aşılanma oranlarını etkileyen temel faktörlerden biridir. Anneler hakkında çok sayıda çalışma olmasına karşın babaların aşılar konusunda bilgi ve tutumlarını inceleyen çalışmalar sınırlıdır. Çalışmamızın amacı, babaların ülkemizde uygulanan aşılar hakkındaki bilgi ve tutumlarını değerlendirerek aşılanmaya yaklaşımlarını belirlemek ve aşı karşıtlığına dair görüşleri öğrenmektir. Yöntem: Mayıs-Temmuz 2022 tarihleri arasında çocuk polikliniğine başvuran babaların aşılarla ilgili bilgi ve tutumlarını değerlendiren kesitsel ve analitik bir çalışmadır. Etik kurul onayı alındıktan sonra babalara sosyo-demografik bilgiler, gelir, eğitim düzeyi, çocuk sayısı, babaların aşı tutumu, bilgi düzeyi ve rutin dışı aşı düşüncelerini içeren anket formu uygulanarak aşılar hakkındaki bilgi ve tutumları değerlendirildi. Bulgular: Çalışmaya katılan babaların %33’ü aşılar hakkındaki bilgi düzeyinin iyi olduğunu düşünse de babaların %14,1’inin çocuklarına uygulanan aşıları, %23’ünün aşıların hangi zamanlarda yapıldığını bilmediği bulundu. Babaların büyük çoğunluğu aşılar hakkında bilgi kaynağı olarak sağlık kuruluşlarını ve hekimleri kullanıyordu. Babaların %17,3’ü bugüne kadar çocuklarına aşı yaptırma konusunda en az bir kez kararsızlık yaşadığını belirtirken, aşı reddeden baba yoktu. Aşı kararsızlığının en sık nedeni (%78,1) aşı yan etkisi korkusu bulundu. Anne babanın eğitim düzeyi arttıkça, babaların çocukluk çağı aşıları konusunda olumlu düşüncelerinin arttığı görülmüştür. Sonuç: Aşılama, toplum sağlığını korumada önemli bir rol oynar. Ailelere doğru bilgi sağlanması, aşı karşıtlığını azaltmak ve aşı oranlarını artırmak için önemlidir. Sağlık çalışanlarının güvenilir bilgi sunması, ailelerin aşılara olumlu yaklaşımını ve aşı oranlarını artırma konusunda etkili bir faktördür
Investigating leptin gene variants and methylation status in relation to breastfeeding and preventing obesity
(Multidisciplinary Digital Publishing Institute (MDPI), 2024) Kılıç, Ayşe; Pehlivan, Sacide; Varkal, Mehmet Ali; Tuncel, Fatima Ceren; Kandemir, İbrahim; Özçetin, Mustafa; Poyrazoğlu, Şükran; Kardelen, Aslı Derya; Özdemir, İrem; Yıldız, İsmail
Objective: We investigated whether the results of leptin gene (LEP) 2548G/A (rs7799039) and leptin receptor gene (LEPR) 668 A/G (rs1137101) variants, as well as the methylation analysis of CpG regions at nucleotides −31 and −51 of the LEP gene, showed any differences between breastfed and non-breastfed children in this study. Materials and Methods: The cross-sectional study included 100 children aged 2–5 years who were attending nursery and kindergarten and had been accepted to the Department of General Paediatrics. Infants who were exclusively breastfed for the first six months after birth constituted the study group, and those who were not only breastfeed constituted the control group. Methylation percentages at CpG islands of the LEP gene were compared between exclusively breastfed and non-exclusively breastfed infants, and the statistical significance was analyzed by looking for changes in LEP −31 and −51 nt methylation and LEP 2548G/A ve LEPR 668 A/G variants. Results: Both groups were compared by feeding, and the association of LEPR and LEP gene polymorphisms and −51 nt and −31 nt methylations were analyzed. There were no significant differences between the groups regarding genotype and allele frequency for the LEPR 668 A/G, LEP 2548 G/A gene variant, −31 nt methylation, and −51 nt methylation status. Similarly, there was no significant difference in genotype and allele frequency for the LEPR 668 A/G gene variant in terms of duration of exclusive breastfeeding, total breastfeeding, body mass index, family obesity, and satiety status. However, maternal support from family elders and physical activity increased the 51 nt methylation, but this methylation was not significantly affected by BMI, age, or satiety status. Conclusions: Maternal support from family elders and physical activity were associated with increased 51 nt methylation, but this methylation was not significantly affected by BMI, age, or satiety status. However, there are not enough studies in this area to reach a definitive conclusion, and further research is needed.
Effect of obesity and NAFLD on leukocyte telomere length and hTERT gene MNS16A VNTR variant
(Springer Nature, 2024) Kandemir, İbrahim; Yetim Şahin, Aylin; Oyacı, Yasemin; Khudiyeva, Shahri; Şahin, Memduh; Aksakal, Melike Tuğrul; Pehlivan, Mustafa; Baş, Firdevs; Pehlivan, Sacide
It is known that telomere length (TL) (evaluated with T/S ratio) is shortened in the presence of obesity. In this study, we aimed to investigate how obesity in adolescents and non-alcoholic liver disease (NAFLD) within the obese group affect TL and the clinical significance of the human telomerase reverse transcriptase (hTERT) gene MNS16A VNTR variant in terms of NAFLD. Adolescents with exogenous obesity and healthy controls (aged 10-19 years) who applied to our adolescent outpatient clinic between May-October 2023 were included in this study. We performed upper abdominal ultrasonography to investigate the presence of NAFLD in adolescents with obesity and divided into two groups: those without hepatosteatosis (obese NAFLD (-)) and those with hepatosteatosis (obese NAFLD (+)). We recorded body weight, height, waist circumference, and blood pressure measurements and measured the T/S ratio (telomere sequence copy number/gene single copy number) by the Quantitative Polymerase Chain Reaction method. The groups were compared using frequentist and Bayesian methods. Eighty-three obese adolescents [63 NAFLD(+) 20 NAFLD(-)] and 69 lean controls were included in the study. Pairwise comparisons revealed that T/S ratio was significantly lower in the obese NAFLD (-) group than the obese NAFLD (+) and the control group (p = 0.025, p = 0.007, respectively). T/S ratio was lower in the LL allele group than in the other alleles (p = 0.022) and slightly higher in the obese group with metabolic syndrome compared to the obese group without metabolic syndrome (p = 0.072). hTERT-MNS16A-VNTR gene variant LL allele had a negative correlation with T/S ratio among the obese adolescent group. Patients with LL alleles had higher ALT, GGT, HOMA-IR, and ALT/AST. Diastolic blood pressure had a significant correlation with the T/S ratio. The T/S ratio was shorter in the obese adolescent group compared to healthy ones but was higher in the NAFLD (+) obese compared to the NAFLD (-) obese. ALT level and ALT/AST ratio were higher, T/S ratio was lower in the hTERT MNS16A VNTR variant LL allele group among obese adolescents. In addition, there was a significant correlation between the T/S ratio and diastolic blood pressure in obese adolescents.
Superficial siderosis: A case report of underdiagnosed disorder
(Springer Nature, 2024) Talibov, Tural; İnci, Meltem; Barburoğlu, Mehmet; Sencer, Altay; Çoban, Oğuzhan
Superficial siderosis (SS) is caused by subpial hemosiderin deposition due to chronic low-grade bleeding into the subarachnoid space. Dural tears are the most common etiology. Slowly progressive gait ataxia and hearing impairment are common clinical manifestations. Brain magnetic resonance imaging (MRI) shows linear superficial hypointensity on the T2 weighted images and gradient echo. The therapeutic approach is surgical repair of the bleeding source. The patient presented with progressive hearing loss and ataxia. Neurological examination revealed bilateral hearing loss, nystagmus, dysarthria, brisk deep tendon reflexes, and severe ataxia. Brain MRI showed linear superficial siderosis in the cerebrum, cerebellum, and brain stem. Spinal MRI showed ventral epidural cerebrospinal fluid (CSF) collection and disc-osteophyte complex. Six months after the surgical repair of the dural defect, the patient's neurological examination demonstrated improvement in ataxia and dysarthria. The patient was able to walk without any assistance. Surgical repair of the underlying bleeding source may be beneficial in preventing the progression and improving the symptoms of superficial siderosis SS. This case suggests that SS symptoms are potentially reversible by surgical treatment of the underlying spinal CSF leak after a long disease course.
Clinical significance of coronary artery tortuosity in chronic coronary syndrome & stable angina: Insights from gensini scores
(Kare Publishing, 2024) Özyaşar, Mehmet; Doğduş, Mustafa; Yılmaz, Ahmet; Altıntaş, Mehmet Sait; Yetkin, Ertan
OBJECTIVE This study investigated the clinical significance of coronary artery tortuosity (CAT) in chronic coronary syndrome (CCS) by using Gensini scores. METHODS The retrospective single-center study involved 388 patients undergoing coronary angiography for chest pain, excluding those with acute coronary syndromes or prior coronary interventions. Demographic, clinical, and angiographic data were collected and categorized based on the presence or absence of CAT. Categorical variables were analyzed using appropriate statistical tests, with significance set at p < 0.05. RESULTS Analysis of 388 patients revealed that CAT was associated with older age (p <0.001), female gender (p <0.001), lower smoking (19.3% vs. 29.6%, p=0.025), and hypertension (53.5% vs. 38.7%, p=0.05). There was a slightly higher, nearly significant, prevalence of diabetes in the CAT group (22.8% vs. 14.5%, p=0.051). Furthermore, CAT correlated with diastolic dysfunction (p=0.04) and inversely with coronary atherosclerosis severity, as indicated by lower Gensini scores correlating with higher CAT scores (p=0.039 and p=0.049, respectively). Univariate analysis confirmed CAT's association with older age (p <0,001), female gender (p <0,001), hypertension (p=0,004), diabetes (p=0,039), diastolic dysfunction (p=0,003), and Gensini score (p=0,012). Multivariate analysis further identified significant correlations with age (p=0,001), female gender (p <0,001), and Gensini score (p=0,049). CONCLUSIONS Our findings indicate that older age and female gender predict CAT development in CCS patients. The lower Gensini scores associated with CAT may possibly be due to a reduced atherosclerotic plaque burden in these patients. Further research into this relationship could inform the development of treatment and management strategies for coronary atherosclerosis.
Managing CDH1 cancer risks in a child: Complex decision making in a family with hereditary diffuse gastric cancer
(Wiley, 2024) Ağaoğlu, Nihat Buğra; Hatırnaz Ng, Özden; Zemheri, İtir Ebru; Ünal, Büşra; Gerenli, Nelgin; Tosun, İlkay; Yazıcı, Hülya; Özbek, Uğur; Kamihara, Junne; Rana, Huma Q.
Germline pathogenic variants (PVs) in CDH1 cause hereditary diffuse gastric cancer. The management of CDH1 cases with a positive family history includes total prophylactic gastrectomy or intensive surveillance. In this study, we report a 16-year-old boy with intramucosal gastric signet ring cells in the setting of a germline CDH1 PV and a family history of early-onset gastric cancer. The approach to managing both the proband and their 9-year-old sister, who also had the CDH1 PV, presented a challenge to both clinicians and the family. Herein, we present the complexities of managing gastric cancer risk when a CDH1 PV is identified in childhood in the setting of a family history of early-onset gastric cancer.
A global survey on the use of the international classification of diseases codes for metabolic dysfunction‑associated fatty liver disease
(2024) Zhang, Huai; Targher, Giovanni; Byrne, Christopher D.; Kim, Seung Up; Wong, Vincent Wai-Sun; Valenti, Luca; Glickman, Myer; Ponce, Jaime; Mantzoros, Christos S.; Örmeci, Necati; Zou, Zhuo-Lin
Background: With the implementation of the 11th edition of the International Classification of Diseases (ICD-11) and the publication of the metabolic dysfunction-associated fatty liver disease (MAFLD) nomenclature in 2020, it is important to establish consensus for the coding of MAFLD in ICD-11. This will inform subsequent revisions of ICD-11. Methods: Using the Qualtrics XM and WJX platforms, questionnaires were sent online to MAFLD-ICD-11 coding collaborators, authors of papers, and relevant association members. Results: A total of 890 international experts in various fields from 61 countries responded to the survey. We also achieved full coverage of provincial-level administrative regions in China. 77.1% of respondents agreed that MAFLD should be represented in ICD-11 by updating NAFLD, with no significant regional differences (77.3% in Asia and 76.6% in non-Asia, p = 0.819). Over 80% of respondents agreed or somewhat agreed with the need to assign specific codes for progressive stages of MAFLD (i.e. steatohepatitis) (92.2%), MAFLD combined with comorbidities (84.1%), or MAFLD subtypes (i.e., lean, overweight/obese, and diabetic) (86.1%). Conclusions: This global survey by a collaborative panel of clinical, coding, health management and policy experts, indicates agreement that MAFLD should be coded in ICD-11. The data serves as a foundation for corresponding adjustments in the ICD-11 revision.
Role of biomarkers in community-acquired pneumonia management
(Wolters Kluwer, 2024) Onur, Bahaeddin; Demirbas, Hakan Barış; Gülmez, Arif
Community-acquired pneumonia (CAP) poses a significant global health threat, particularly affecting vulnerable populations. Biomarkers and scoring systems play a crucial role in diagnosing, assessing severity, and guiding treatment decisions for CAP patients. Biomarkers like C reactive protein, procalcitonin, and the neutrophil-to-lymphocyte ratio aid in diagnosis and severity assessment, while scoring systems such as CURB-65 and Pneumonia Severity Index classify patients into risk categories. Emerging biomarkers (uremia, elevated respiratory rate, hypotension, and age ≥ 65) like serum amyloid A and S100 proteins show promise in predicting disease severity and prognosis. However, further research is needed to determine their precise roles and clinical utility in CAP management.
Liver stiffness and steatosis measurements with iLivTouch and FibroScan: A comparative study
(Turkish Society of Gastroenterology, 2024) Özercan, Mübin; Melekoğlu Ellik, Zeynep; Parmaksız, Ayhan; Gümüşsoy, Mesut; Duman, Serkan; Örmeci, Necati
Background/Aims: The presence of liver fibrosis is the most important indicator of progression to cirrhosis. Noninvasive measurement of liver stiffness is crucial for detecting fibrosis. Vibration-controlled transient elastography is one of the most useful methods for this pur%02pose. We aimed to compare the liver stiffness and steatosis measurements with iLivTouch© and the FibroScan© elastography devices Materials and Methods: Two hundred thirty-seven consecutive adult patients with chronic hepatitis were included in the study. The liver stiffness and steatosis were measured with iLivTouch and FibroScan on the same day. Thirty-one patients had liver biopsies on the same day with elastography procedures. The diagnostic performances of iLivTouch and FibroScan were compared to aspartate aminotrans%02ferase to platelet ratio index (APRI), Fibrosis-4 (FIB-4), and nonalcoholic fatty liver disease fibrosis score (NFS). Results: The liver stiffness measurements obtained using iLivTouch and FibroScan had median value of 10.3 (ranging from 2.9 to 46.3) and 7.2 (ranging from 2.5 to 75), respectively. The mean steatosis measurements using ultrasound attenuation parameter with iLiv%02Touch were 245.51 ± 45.79, while the mean controlled attenuation parameter measurements using FibroScan were 259.37 ± 75.0. In subgroup analysis, the AUC of iLivTouch on detecting signiicant fibrosis [0.83, (P = .002)] was minimally higher than other noninvasive methods [0.82 for NFS (P = .003), 0.80 for FibroScan (P = .006), 0.68 for FIB-4 (P = .089), and 0.53 for APRI (P = .76)]. Conclusion: The stiffness and steatosis measurements with iLivTouch and FibroScan were not similar. The accuracy of iLivTouch in detecting significant and advanced fibrosis was minimally higher. Large clinical trials are necessary to support these findings.
Unilateral painless vision loss detected incidentally during the driver's health examination at the family medicine polyclinic: Case report
(Ağrı İbrahim Çeçen Üniversitesi, 2024) Sökmen, Nebi; Onur, Bahaeddin; Ekimci Deniz, Funda
Introduction: Family medicine encompasses a unique set of competencies and characteristics aimed at providing primary care with a patient-centered focus. In this paper, we aimed to present a case study demonstrating how family practice competencies were utilized in the management of central retinal vein occlusion (CRVO). Case: A 48-year-old diabetic man, seeking a driving license health report, presented without complaints. Even though he self-reported normal vision, a comprehensive examination revealed a visual loss in his left eye, leading to a diagnosis of CRVO. Despite the absence of typical risk factors such as hypertension or hyperlipidemia, detailed examination and comprehensive evaluation of the patient offered the patient a chance for diagnosis and treatment. Discussion: CRVO often manifests as painless unilateral vision loss. Family physicians play a crucial role in early detection through comprehensive assessments, even in asymptomatic patients. Rapidly diagnosis and prompt referral to ophthalmologists allow for timely intervention, as seen in this case where intravitreal bevacizumab injections led to improved visual acuity. Conclusion: This case highlights the importance of family physicians detecting signs of disease, in patients without obvious symptoms. Family physicians contribute to the early diagnosis and effective management of many diseases with their comprehensive approach and patient-oriented care.
The therapeutic approach to fibrocystic breast disease in the MCF-10A cell culture model: Striking efficacy of polyphenol
(Istanbul University, 2024) Çelik, İncilay; Seyhan, Mehmet Fatih; Ceviz, Ayşe Begüm; Aydoğan, Çağatay; Yılmaz Aydoğan, Hülya; Öztürk, Oğuz
Background and Aims: Standard treatment regimens for fibrocystic breast disease (FBD) do not provide a permanent cure and have undesirable side effects. This study aims to investigate the therapeutic potential of different honey and propolis, as well as some important polyphenols, on breast epithelial cells (MCF-10A). Materials and Methods: The effects of five honey, two propolis extracts and seven polyphenol samples on the cell viability were assessed the WST-1 assay. Content analysis of the propolis samples was performed using high performance liquid chromatography (HPLC). Results: Chestnut and cedar honey had antiproliferative effects on MCF-10A cells at all doses (1-10 μg/mL), as well as pine honey at the highest dose. However, multifloral honey had no similar effect. Chinese propolis had significant antiproliferative effects on MCF-10A cells at doses of 50-250 μg/mL and on the human periodontal ligament (hPDL) control cells at a dose of 5 μg/mL. Türkiye propolis only had an antiproliferative effect on MCF-10A cells at the highest dose (p = 0.0013). Higher levels of ferulic acid, kaempferol, caffeic acid, pinocembrin and quercetin were detected in Türkiye propolis, while Chinese propolis was rich in pinostrobin. Ferulic acid, pinostrobin and galangin showed antiproliferative properties on MCF-10A cells (p < 0.0001), whereas the remaining four polyphenols had no significant effect on cell viability (p > 0.05). Conclusion: The findings of the study highlight the antiproliferative effects of pinostrobin, ferulic acid and galangin on MCF-10A cells and has also confirmed the antiproliferative effects of honey and propolis samples to be due to their polyphenolic properties. Therefore, this study suggests that polyphenolic substances may have both preventive and therapeutic potential in FBD.
Antiepileptik ilaçların etkileşmeleri
(Türkiye Klinikleri, 2022) Karaalp, Atila
Epilepsi tedavisinde monoterapi temel dayanak noktası olmaya devam etse de, tek bir ilaca yanıt vermeyen hastalarda antiepileptik ilaç kombinasyonları sıklıkla kullanılmaktadır. Bu nedenle epilepsi tedavisinde kombine olarak kullanılan ilaçların arasındaki etkileşmeler klinik açıdan önemli olabilmektedir. Öte yandan antiepileptik ilaçlar, eşzamanlı veya ilişkili diğer komorbid durumların tedavisinde kullanılan başka ilaçlarla bir arada kullanılabilir. Çoklu ilaç tedavisinin uygulanıldığı durumlarda hastalarda çeşitli nedenlerle klinik olarak anlamlı ilaç etkileşmelerinin ortaya çıkma olasılığı artmaktadır. Bu nedenler arasında; (i) antiepileptik ilaçlar genellikle uzun süreler boyunca (örn. ömür boyu) uygulanır ve böylece başka ilaçlarla birlikte reçetelenme olasılıkları artar; (ii) çoğu antiepileptik ilacın dar terapötik indeksi vardır ve farmakokinetik özelliklerinde ufak değişiklikler bile etkide ciddi yanıt kaybına veya toksisiteye neden olabilir; (iii) yaygın olarak kullanılan (karbamazepin, valproik asit, fenitoin ve fenobarbital gibi) antiepileptik ilaçların, diğer birçok ilacın metabolizmasında görev alan enzimlerin aktivitesi üzerinde belirgin (inhibitör veya indüktör) etkileri vardır; (iv) eski ve yeni nesil antiepileptik ilaçların çoğu genellikle aynı sitokrom enziminin substratlarıdır.
Validation of FIB-6 score in assessment of liver fibrosis in chronic hepatitis B
(Wolters Kluwer Health, 2024) Alswat, Khalid; Soliman, Riham; Mikhail, Nabiel N. H.; Örmeci, Necati; Dalekos, George N.; Derbala, Moutaz F. M.; Al-Busafi, Said Ahmed; Hamoudi, Waseem; Shiha, Gamal
Background: We recently developed a simple novel index called fibrosis 6 (FIB‑6) using machine learning data analysis. We aimed to evaluate its performance in the diagnosis of liver fibrosis and cirrhosis in chronic hepatitis B (CHB). Methods: A retrospective observational analysis of data was obtained from seven countries(Egypt, Kingdom of Saudi Arabia (KSA), Turkey, Greece, Oman, Qatar, and Jordan) of CHB patients. The inclusion criteria were receiving an adequate liver biopsy and a complete biochemical and hematological data. The diagnostic performance analysis of the FIB‑6 index was conducted and compared with other non‑invasive scores. Results: A total of 603 patients were included for the analysis; the area under the receiver operating characteristic curve (AUROC) of FIB‑6 for the discrimination of patients with cirrhosis (F4), compensated advanced chronic liver disease (cACLD) (F3 and F4), and significant fibrosis (F2–F4) was 0.854, 0.812, and 0.745, respectively. The analysis using the optimal cut‑offs of FIB‑6 showed a sensitivity of 70.9%, specificity of 84.1%, positive predictive value (PPV) of 40.3%, and negative predictive value (NPV) of 95.0% for the diagnosis of cirrhosis. For the diagnosis of cACLD, the results were 71.5%, 69.3%, 40.8%, and 89.2%, respectively, while for the diagnosis of significant fibrosis, the results were 68.3%, 67.5%, 59.9%, and 75.0%, respectively. When compared to those of fibrosis 4 (FIB‑4) index, aspartate aminotransferase (AST)‑to‑platelet ratio index (APRI), and AST‑to‑alanine aminotransferase (ALT) ratio (AAR), the AUROC for the performance of FIB‑6 was higher than that of FIB‑4, APRI, and AAR in all fibrosis stages. FIB‑6 gave the highest sensitivity and NPV (89.1% and 92.4%) in ruling out cACLD and cirrhosis, as compared to FIB‑4 (63.8% and 83.0%), APRI (53.9% and 86.6%), and AAR (47.5% and 82.3%), respectively. Conclusions: The FIB‑6 index could be used in ruling out cACLD, fibrosis, and cirrhosis with good reliability.
Whole genome expression analysis identifies multiple targeted ıntegrative effects of polyphenol-rich propolis on HER-2-Positive breast cancer cell line
(ACG Publications, 2024) Seyhan, Mehmet Fatih; Timirci Kahraman, Özlem; Eronat, Allison Pınar; Yılmaz, Eren; Ceviz, Ayşe Begüm; Kısakesen, Halil İbrahim; Öztürk, Tülin; Yılmaz-Aydoğan, Hülya; Öztürk, Oğuz
Natural products have been focused by researchers due to their important anticarcinogenic characteristics in the treatment of cancer with the slightest side effects possible. Propolis is one of the most prominent candidates among these natural products in terms of its anticancer features. In this study we aim to research the effects of Anatolian propolis on ER/PR-, HER-2/neu+ human breast cancer cell line SK-BR-3 with intent to clarify the molecular mechanism propolis in HER+ breast cancers in overview of whole genomic expression for the first time via a microarray experiment. Afterwards, microarray data was validated via real time PCR with the selected genes. After performing bioinformatic analysis via GeneSpring Software and String analysis, a 50 µg/mL dose of propolis affected several pathways of HER-2 positive breast cancer cells including cell cycle, DNA repair and apoptosis especially at 48th hour exposure. In contrast, after exposure to 50 µg/mL dose of propolis, up-regulated genes were detected at diverse pathways such as immune response, cell migration regulation, organization of cell-cell adhesion, etc. For this reason, we proposed that polyphenol-rich propolis can be used in the treatment of HER-2 positive breast cancer with characteristics of less toxic than the current treatment methods.
Percutaneous treatment of hydatid cysts with the Örmeci technique
(AVES, 2024) Örmeci, Necati; Asiller, Özgün Ömer; Parmaksız, Ayhan; Kalkan, Çağdaş; Üstüner, Evren; Altınel, Ahmet; Erdem, Hakan
Background/Aims: The percutaneous route is accepted as the most convenient course in the management of hydatid cysts (HCs). The aim of this study is to analyze the efficacy of the Örmeci technique used in the treatment of hydatid cysts. Materials and Methods: This is a retrospective cohort study. Patients with HCs who presented to the Ankara University Faculty of Medicine, Department of Gastroenterology since 1991 were included. Patients with World Health Organization cystic echinococcosis (WHO-CE) types 1, 2, 3A-3B live cysts who were treated percutaneously at least once and followed up after a minimum of 6 months were analyzed. Results: A total of 1556 cystic lesions in 1035 patients have been presented to our department since 1991. Five hundred forty-four live HCs in 479 patients were treated with the Örmeci technique. The mean follow-up time was 59.29 months for females and 57.18 for males. The overall clinical success rate of all treated cysts with the Örmeci technique was 94.5%. After the treatment, a statistically significant decrease was found in all WHO-CE cyst types in terms of cyst sizes (P < .001 for all). Mortality, abscess and fistula formation, sclerosing cholangitis, and drug toxicities were not detected. Only 2 patients experienced reversible anaphylaxis during the treatment among 544 cysts (0.36%). Conclusion: Hydatid cysts can be treated percutaneously by the Örmeci technique with a high success rate for WHO-CE type 1, 2, and 3B. The Örmeci technique is an economic, simple, cheap, and repeatable outpatient procedure. It can be chosen as the first-line therapeutic modality in suitable patients with HCs.
Synergistic and dose-dependent effects of pinostrobin, pinocembrin and pinobanksin on different breast cancer cell lines
(Kafkas Üniversitesi, 2024) Melekoğlu, Abdullah; Ceviz, Ayşe Begüm; Eronat, Allison Pınar; Öztürk, Tülin; Pehlevan, Funda; Yılmaz-Aydoğan, Hülya; Öztürk, Oğuz
In this study, the cytotoxic and apoptotic effects of three phenolic compounds highly found in the poplar type propolis; pinostrobin (PS), pinocembrin (PC) and pinobanksin (PB), were investigated individually and in combination on hormon-positive (MCF-7) and triple negative (MDA-MB-231) breast cancer cell lines and fibrocystic breast epithelium (MCF-10A) as control. Assessment of cytotoxicity and apoptosis were performed with WST-1 and Annexin V-7AAD assays, respectively. All statistical analyses including the two-way ANOVA and multiple-t-test were performed using GraphPad Prism software. Individually, PB (P<0.0001), PS (P<0.0001), and PC (P<0.05) demonstrated potent cytotoxic effects at moderate to high doses and late time intervals on MCF-7. PB and PS have been found to have a significant proliferative effect at low doses (P<0.0001), however, this effect disappeared in higher doses in this cell line. Dual combinations of PB+PC and PB+PS were toxic on MCF-10A, however, dual combination of PS+PC and the triple combination (PB+PS+PC) showed no cytotoxicity until high doses at late time intervals (P>0.05). On MCF-7, the triple combination induced cytotoxic/apoptotic effects even with the 25% dose and 50% dose on MDA-MB-231(p<0.0001). Our findings clearly showed that different combinations of these phenolic substances can have synergistic cytotoxic effects and even hormetic effects in non-tumorogenic cells.
The adjusted prevalence of hepatitis delta virus (HDV) in 25 countries and territories
(Elsevier, 2024) Razavi-Shearer, Devin; Child, H.; Razavi-Shearer, K.; Voeller, A.; Razavi, H.; Örmeci, Necati; Wu, J-C.; Yang, H-I.; Yu, M-L.; Yuen, M-F.; Yurdaydın, C.; Zuckerman, E.
Background and aims: Hepatitis delta virus (HDV) is a satellite RNA virus that requires the hepatitis B virus (HBV) for assembly and propagation. Individuals infected with HDV progress to advanced liver disease faster than HBV mono-infected individuals. Recent studies have estimated the global prevalence of anti-HDV antibodies among the HBV-infected population to be 5-15%. This study aimed to better understand HDV prevalence at the population level in 25 countries/territories. Methods: We conducted a literature review for anti-HDV and HDV-RNA-positive prevalence in HBsAg positive individuals in 25 countries/territories. Virtual meetings were held with experts from each setting to discuss the findings and collect unpublished data. Data were weighted for patient segments and regional heterogeneity to estimate the prevalence in the HBV-infected population. The findings were then combined with The Polaris Observatory HBV data to estimate the anti-HDV & HDV-RNA prevalence in each country/territory at the population level. Results: After adjusting for geographical distribution, disease stage and special populations, the anti-HDV prevalence among the HBsAg+ population changed from the literature estimate in 19 countries. The highest anti-HDV prevalence was 60.1% in Mongolia. Once adjusted for the HBsAg+ population and HDV-RNA+, China had the highest absolute number of HDV-RNA+ cases. Conclusions: We found substantially lower HDV prevalence than previously reported, as prior meta-analyses primarily focused on studies conducted in groups/regions that have a higher probability of HBV infection: tertiary care centers, specific risk groups or geographical regions. There is large uncertainty in HDV prevalence. The implementation of reflex testing would improve estimates, while also allowing earlier linkage to care for HDV-RNA-positive individuals. The logistical and economic burden of reflex testing on the health system would be limited, as it would only screen HBsAg+ cases. Impact and implications: There is a great deal of uncertainty surrounding the prevalence of HDV among people living with HBV at the population level. This study aimed to better understand the burden in 25 countries and territories, to refine techniques that can be used in future analyses. We found a lower prevalence in the majority of places studied than had been previously reported. These data can help inform policy makers on the need to screen people living with HBV to find those coinfected with HDV and at high risk for progression, while also highlighting the pitfalls that other researchers have often fallen into.
ROI-based analysis of diffusion indices in healthy subjects and subjects with deficit or non-deficit syndrome schizophrenia
(Elsevier, 2023) Türk, Yaşar; Devecioğlu, İsmail; Küskün, Atakan; Öge, Cem; Beyazyüz, Elmas; Albayrak, Yakup
We analyzed DTI data involving 22 healthy subjects (HC), 15 patients with deficit syndrome schizophrenia (DSZ), and 25 patients with non-deficit syndrome schizophrenia (NDSZ). We used a 1.5-T MRI scanner to collect diffusion-weighted images and T1 images, which were employed to correct distortions and deformations within the diffusion-weighted images. For 156 regions of interest (ROI), we calculated the average fractional anisotropy (FA), mean diffusion (MD), and radial diffusion (RD). Each ROI underwent a group-wise comparison using permutation F-test, followed by post hoc pairwise comparisons with Bonferroni correction. In general, we observed lower FA in both schizophrenia groups compared to HC (i.e., HC>(DSZ=NDSZ)), while MD and RD showed the opposite pattern. Notably, specific ROIs with reduced FA in schizophrenia patients included bilateral nucleus accumbens, left fusiform area, brain stem, anterior corpus callosum, left rostral and caudal anterior cingulate, right posterior cingulate, left thalamus, left hippocampus, left inferior temporal cortex, right superior temporal cortex, left pars triangularis and right lingual gyrus. Significantly, the right cuneus exhibited lower FA in the DSZ group compared to other groups ((HC=NDSZ)>DSZ), without affecting MD and RD. These results indicate that compromised neural integrity in the cuneus may contribute to the pathophysiological distinctions between DSZ and NDSZ.
E-sağlık: Çevrimiçi taramaların önemi
(Türkiye Çocuk ve Genç Psikiyatrisi Derneği, 2023) Poyraz Fındık, Onur Tuğçe
Dünyada yeti kaybı ve erken ölüme yol açan hastalıklar arasında önemli bir grubu psikiyatrik bozukluklar oluştursa da tedavi ihtiyacı duyan bireylerin yarısından azı ruh sağlığı hizmetlerine erişebilmektedir. Erişim engelleri arasında damgalanma, maliyet, mahremiyet endişeleri ve zaman kısıtlılığı gibi birçok neden bulunabilir. Erişimdeki güçlükleri gidermek için, son 25 yılda bir dizi dijital psikiyatrik değerlendirme ve müdahale programı geliştirilmiştir. COVID-19 pandemisi bu müdahalelerin değerini ortaya koymada önemli bir rol oynamış; ülkemizin yakın zamanda yaşadığı deprem sonrası uzaktan ruh sağlığı hizmetlerinin sunulabilmesiyle depremden etkilenen bölgedeki hizmet kapasitesinin arttırılabilmesi, telesağlık uygulamalarının, klinik uygulamaların vazgeçilmez parçası haline geldiğini bir kez daha göstermiştir. Bununla birlikte, dijital araçların gelecekteki sağlık hizmet sistemlerine en iyi şekilde nasıl entegre edileceğine dair sorular devam etmektedir. Klinisyenlerin, teknolojinin uygun bakıma erişimin genişletilmesinde oynayabileceği rolü benimsemesi ve hastalarının ihtiyaçları ile uyumlu çözümleri kullanabilmesi, dijital araçların etkinliklerinin ve erişilebilirliklerinin en üst düzeye çıkarılmasına katkıda bulunacaktır. Özellikle tanı gecikmelerinin ciddi endişe kaynağı olduğu nörogelişimsel bozuklukların erken teşhisinde sınırlı sayıdaki uzmanın, zaman alan bir değerlendirmeyi geniş popülasyonlara uygulamasındaki zorluklar, bu alandaki teknolojik yeniliklerin gelişimini de hızlandırıcı olmaktadır. Bu sunumda, çocukluk çağı nörogelişimsel bozuklukları başta olmak üzere, dijital ruh sağlığı hizmetlerinin kullanımını teşvik eden çevrimiçi tarama araçları hakkında bilgi verilmesi ve farklı popülasyonlar arasında bu uygulamalara erişimde eşitliği sağlamaya yönelik değerlendirmeler sunulması amaçlanmıştır. Çevrimiçi tarama araçlarının ana hatlarının çizilmesi sonrasında, kullanım yolları, hedef yaş grupları ve uygulama yöntemleri açısından nasıl farklılık gösterdiği ele alınacaktır.

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