Dahili Tıp Bilimleri Bölümü Koleksiyonu

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https://hdl.handle.net/20.500.13055/58

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Diaphragmatic dysfunctions and their treatment: Neural therapy and manual medicine as effective approaches
(Salient Visionary Publications, 2025) Ural Nazlıkul, Fatma Gülçin; Nazlıkul, Hüseyin
Diaphragmatic dysfunctions are a medical issue whose relevance is often underestimated. They manifest in respiratory and systemic symptoms such as dyspnea, sleep disturbances, chronic fatigue, gastroesophageal reflux, and even heart failure. As the primary respiratory muscle, the diaphragm is pivotal in maintaining trunk stability and regulating intra-abdominal pressure, making its dysfunction capable of exerting profound impacts on overall health. Causes and Pathophysiology of Diaphragmatic Dysfunctions: Diaphragmatic dysfunctions can arise from a variety of factors, including: • Chronic stress, which increases tension in the diaphragm and surrounding fascia, • Myofascial trigger points, which impair muscle contraction and mobility, • Scar tissue, which limits fascial mobility, • Trauma, surgeries, or mechanical stress, which may irritate or impair the function of the phrenic nerve. The phrenic nerve, which innervates the diaphragm, plays a crucial role in the functionality of this muscle. Irritation or damage to the phrenic nerve can significantly impair diaphragmatic movement, leading not only to breathing difficulties but also to dysregulation of the autonomic nervous system and organ functions. Treatment Approaches: The combination of neural therapy and manual medicine has proven to be particularly effective in treating diaphragmatic dysfunctions. Injections targeting myofascial trigger points and segmental therapy can support diaphragmatic function. Manual diagnostics play a critical role in identifying segmental dysfunctions and fascial adhesions.
Ergenlik öncesi bir kızda vajinada yabancı cisim
(Türkiye Klinikleri Yayınevi, 2025) Uğur Baysal, Serpil; Totur, Gülberat; Yavuz, Onur
Kız çocuklarında tekrarlayan vajinal akıntı ya da kanama yakınması, özellikle standart tedaviye dirençli ise vajinada yabancı cisim varlığını düşündürmelidir. En sık tuvalet kâğıdı saptanırken, madeni para, boncuk, küçük oyuncaklar ve çengelli iğne gibi farklı objeler de bildirilmiştir. Bu nedenle, benzer semptomlarla başvuran hastalarda ayrıntılı değerlendirme kritik öneme sahiptir. Sekiz yaşında bir kız çocuğu, 4 aydır aralıklı âdet kanaması olduğu ileri sürülerek polikliniğe getirildi. Ağrı, ateş ve travma öyküsü yoktu. Dış merkezde yapılan tetkiklerde erken puberte ve koagülasyon bozukluğu dışlanmış, pelvik görüntüleme normal bulunmuştu. Cinsel istismar açısından çocuk ve aile ile ayrı ayrı görüşüldü, cinsel istismar dışlandı. Fizik muayenede vulvada ciltte hiperemi dışında patoloji saptanmadı. Külotunda kahverengi akıntı görüldü. Laboratuvar incelemelerinde anormallik yoktu. Kadın hastalıkları ve doğum ana bilim dalından konsültasyon istendi, vajinada yabancı cisim görülerek çok küçük bir parça tuvalet kâğıdı çıkarıldı. Vajinadan kanama olgularında ayırıcı tanıda vulvovajinit, yabancı cisim, cinsel istismar, travma, puberte prekoks ve tümörler yer almalıdır. Puberte öncesi ortaya çıkan vajinal kanamalarda öncelikle yabancı cisim düşünülmelidir.
The impact of domestic violence and sexual assault on family dynamics and child development: A comprehensive review
(AVES, 2025) Brockstedt, Matthias; Uğur Baysal, Serpil; Daştan, Kadir
This review synthesizes current research on domestic violence and sexual assault, focusing on their short-term and long-term effects on family dynamics, particularly on the development and well-being of children and adolescents. The article employs a curated body of literature, including surveys, reviews, program evaluations, and international health reports, to elucidate the direct and collateral damage caused by such trauma within families. The review critically examines the intersecting consequences of abuse, including immediate psychological distress and long-term socio-economic and educational disruptions for affected youths. Additionally, the review examines structural impediments and cultural intricacies that shape reporting prac tices and access to support services. The role of civil legal aid and victim advocacy in promoting survivor safety and justice is discussed, supported by findings from service evaluation studies. The review also addresses the exacerbating effects of the Coronavirus pandemic on domes tic violence rates and service provision, noting increased occurrences of domestic abuse and decreased pursuit of urgent care and support, highlighting research conducted from the pan demic’s start through 2023. Emergent studies reveal a rise in domestic abuse occurrences and a decline in urgent care and support pursuit, emphasizing the need for adapted intervention strategies. The review offers evidence-based recommendations for policymakers, healthcare providers, and community organizations, stressing the necessity of persistent and collaborative efforts to address and prevent domestic violence. The ultimate goal is to advocate for a stron ger international response to repair harm and prevent future occurrences, ensuring a safer environment for all family members, particularly children and adolescents.
Comparison of ocular posterior segment parameters in the pediatric population with migraine without aura and tension-type headache
(Hacettepe University Institute of Child Health, 2024) Kıvrak, Ulviye; Köle, Mehmet Tolga; Kandemir, İbrahim; Kaytan, İsmail
Background. This study aims to compare the posterior ocular structure parameters in children with migraine without aura (MWA), tension-type headache (TTH), and a healthy control group. Methods. The study included 31 patients with MWA, 29 patients with TTH, and 38 healthy controls between 6 and 18 years of age. For all participants, the detailed eye examination and measurements including peripapillary retinal nerve fiber layer (pRNFL) thickness, central macular thickness (CMT), subfoveal choroidal thickness (SCT), macular vessel densities and foveal avascular zone (FAZ) parameters measured by optical coherence tomography (OCT) and OCT-angiography (OCTA), were obtained from the patient files. Results. The mean age was 12.1±3.3 years in MWA patients, 12.4±2.8 years in TTH patients, and 11.9±3.8 years in the healthy controls (p=0.844). Among the groups, the mean pRNFL thickness, CMT, and SCT values were lowest in the MWA group. However, this difference was not statistically significant (p=0.621, p=0.854 and p=0.201, respectively). The mean and four-quadrant (superior, inferior, temporal, nasal) pRNFL thicknesses, the CMT, and the SCT were not statistically significant between the groups (p=0.621, p=0.500, p=0.186, p=0.565, p=0.744, p=0.854 and p=0.201, respectively). The macular vascular densities were lower in MWA patients than in the other two groups, and there was a statistically significant difference between the groups only in the nasal quadrant of the deep retinal capillary plexus (p = 0.014). There were also no statistically significant differences between the groups in the superficial and deep FAZ area parameters (p=0.652 and p=0.985). Conclusion. This study suggested that differential diagnosis between MWA and TTH can be difficult in childhood, as these conditions, which can present with ocular symptoms, may also be characterized by changes in posterior segment parameters. Long-term studies incorporating OCT-A in larger patient populations may provide valuable insights into retinal changes associated with these two distinct headache spectrums.
Non-invasive TensorTip MTX hemoglobin measurement validation study
(Galenos Publishing House, 2024) Gökdağ, Eren; Sarı Doğan, Fatma; Gülbin, Aydoğdu Umaç; Güneysel, Özlem
Objective: Point of care devices are fast and easy to use but their true potential is still waiting to come up. TensorTip MTX is a non-invasive medical device can measure various bioparameters, including hemoglobin. Purpose of this study is to measure the correlation between TensorTip MTX and our routine laboratuvary analysis of hemoglobin and to see that device is useable in emergency department settings for situations like gastroinstestinal bleeding and acute traumatic hemorrhages. Methods: In the month after the ethical board approval, we conduct our study in 147 patients. Their hemoglobin levels were already measured while their course of emergency department visit. To gather accurate data of hemoglobin measurement of TensorTip MTX, device put on the ring finger of the patients and wait at least 45 seconds for measurement. All measurement documented and recorded by researcher. Measurements from blood samples and TensorTip MTX device are compared with intraclass correlation coefficient (ICC) and Pearson correlation coefficient. Results: In 147 patients; 61.2% (n=90) were male, 38.8% (n=57) were female and ages are between 18 and 89. Mean age is 55.72±20.30 years; 23.1% (n=34) of them is under 35 years old, 76.9% (n=113) over 35 years. Statistically, the correlation between hemoglobin levels measured by the reference method and TensorTip was found to be 42.4%, which is statistically signficant (p=0.001; p<0.01) [ICC: 0.424; 95% confidence interval (CI): 0.281-0.548]. Correlation between hematocrit level measurements is 46.9% significantly compatible (p=0.001; p<0.01) (ICC: 0.429; 95% CI: 0.333-0.586). Conclusion: Our study showed that correlation between reference measurement and TensorTip MTX device is fair (ICC: 0.424 for hemoglobin and 0.429 for hematocrit). Further studies needed to determine that this device is suitable or not to identify the need of blood transfusion and management of patients with acute hemorrhages in the emergency settings for now.
Early period survival and neurologic prognosis in newborns with perinatal asphyxia: A tertiary center experience and a mortality chart
(Brieflands, 2025) Yaman, Akan; Kandemir, İbrahim; Alp Ünkar, Zeynep
Background: Clinicians require more data regarding mortality and brain damage risk factors in perinatal asphyxia. Objectives: To assess early term outcomes and identify mortality risk factors in perinatal asphyxia. Methods: This study was conducted in a referral-center tertiary intensive care unit in Istanbul, Turkey, between 2016 and 2023. We included all patients who underwent therapeutic hypothermia treatment due to perinatal asphyxia. We recorded laboratory follow-up data, magnetic resonance imaging (MRI) findings, amplitude-integrated electroencephalograms (aEEG) results, mortality, and clinical outcomes. Both conventional frequentist statistical methods and Bayesian methods were used for analysis. Results: A total of 164 patients were included in the study, with an overall mortality rate of 9.8%. Risk factors for mortality included LDH, troponin I, INR, lactate, 2nd day creatinine, voltage anomalies, seizures, and male gender, as well as APGAR scores. A basic chart for mortality prediction was developed. The Sarnat score showed strong evidence, and APGAR 1 showed anecdotal evidence for association with brain damage, although brain damage was independent of laboratory results and other clinical findings, based on moderate and anecdotal evidence from Bayesian calculations. Cranial MRI findings revealed profound damage in 14.8% of Sarnat 1, 21.8% of Sarnat 2, and 50% of Sarnat 3 patients. Conclusions: This study presents prognostic factors for survival and brain damage in perinatal asphyxia. We recommend obtaining cranial MRI for all patients diagnosed with asphyxia, as most laboratory tests were independent of brain damage. Given that profound brain damage can occur even in Sarnat stage I patients, we emphasize the importance of therapeutic hypothermia for these patients.
The worldwide medical impact of hepatitis D virus infection: Focus to Central Asia
(Academic Press, 2025) Aghayeva, Gulnara; Rizzetto, Mario; Örmeci, Necati; Turcanu, Adela; Abbas, Zaigham; Bedewy, Essam; Satapathy, Sanjaya K.; Al-Mahtab, Mamun; Singh, Shivaram Prasad; Akbar, Sheikh Mohammad Fazle; Ala, Aftab; Schiano, Thomas D.
Hepatitis D virus (HDV) requires hepatitis B virus (HBV) for its replication. Concurrent infection with HBV and HDV results in more severe disease outcomes than infection with HBV alone, inducing cirrhosis, fulminant hepatitis, and hepatocellular carcinoma, and representing a significant cause of global mortality. Central Asia remains an area of high HDV prevalence but local features of the infection were poorly detailed in the past. Until recently, interferon has represented the only treatment option in patients with chronic hepatitis D; however, it is associated with low efficacy and a high burden of side effects. The discovery of the entry inhibitor bulevirtide has represented a breakthrough in HDV treatment. Other compounds (i.e., lonafarnib, new anti-hepatitis B virus drugs) are under development to provide alternative or combined strategies for HDV cure.
Non‑cirrhotic portal fibrosis/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.
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.

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