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Reply to the letter to the editor: 'Coronary atherosclerosis burden and coronary artery tortuosity'
(Kare Publishing, 2025) Özyaşar, Mehmet; Doğduş, Mustafa; Yılmaz, Ahmet; Altıntaş, Mehmet Sait; Yetkin, Ertan
To the Editor, First, we would like to thank the author1 and the editorial team for their attention to and interest in our work. We deeply value your constructive criticism and contributions, which we see as an opportunity for further improvement. Collateral circulation plays a significant role in the prognosis of coronary artery disease.2 We acknowledge the importance of considering the effect of collateral circulation when calculating Gensini scores.3 In our retrospective study, while evaluating cases of chronic coronary syndrome that underwent coronary angiography, the coronary collateral flow assessment (Rentrop) score (3) was 0 in all cases. However, we accept that this detail should have been clarified more explicitly in our article. Our study aimed to minimize confounding factors as much as possible to realistically examine the relationship between coronary artery tortuosity and coronary atherosclerosis. While we acknowledged in the limitations section of our study that this might introduce a potential bias in patient selection,4 we accept that it would have been beneficial to explicitly state that we sought to eliminate the effect of collateral circulation. One of the key strengths of our study is the large patient cohort, along with the meticulous exclusion of other confounding factors. In conclusion, while recognizing the importance of collateral circulation, we believe that our study provides important information about the relationship between coronary artery tortuosity and atherosclerotic plaque burden. We hope this research contributes to a deeper understanding of coronary artery disease and offers a new perspective for future studies.
The Asian Pacific association for the study of the liver clinical practice guidelines for the diagnosis and management of metabolic dysfunction-associated fatty liver disease
(Springer, 2025) Eslam, Mohammed; Fan, Jian-Gao; Yu, Ming-Lung; Wong, Vincent Wai-Sun; Cua, Ian Homer; Liu, Chun-Jen; Tanwandee, Tawesak; Örmeci, Necati; K. Sarin, Shiv; George, Jacob
Metabolic dysfunction-associated fatty liver disease (MAFLD) affects over one-fourth of the global adult population and is the leading cause of liver disease worldwide. To address this, the Asian Pacific Association for the Study of the Liver (APASL) has created clinical practice guidelines focused on MAFLD. The guidelines cover various aspects of the disease, such as its epidemiology, diagnosis, screening, assessment, and treatment. The guidelines aim to advance clinical practice, knowledge, and research on MAFLD, particularly in special groups. The guidelines are designed to advance clinical practice, to provide evidence-based recommendations to assist healthcare stakeholders in decision-making and to improve patient care and disease awareness. The guidelines take into account the burden of clinical management for the healthcare sector.
Acute-on-chronic liver failure (ACLF): The ‘Kyoto consensus’-steps from Asia
(Springer, 2025) Choudhury, Ashok; Kulkarni, Anand V.; Arora, Vinod; Sood, Ajit; Dökmeci, Abdul Kadir; Chowdhury, Abhijeet; Koshy, Abraham; Duseja, Ajay; Örmeci, Necati; Mishra, Ajay Kumar
Acute-on-chronic liver failure (ACLF) is a condition associated with high mortality in the absence of liver transplanta tion. There have been various defnitions proposed worldwide. The frst consensus report of the working party of the Asian Pacifc Association for the Study of the Liver (APASL) set in 2004 on ACLF was published in 2009, and the “APASL ACLF Research Consortium (AARC)” was formed in 2012. The AARC database has prospectively collected nearly 10,500 cases of ACLF from various countries in the Asia–Pacifc region. This database has been instrumental in developing the AARC score and grade of ACLF, the concept of the ‘Golden Therapeutic Window’, the ‘transplant window’, and plasmapheresis as a treatment modality. Also, the data has been key to identifying pediatric ACLF. The European Association for the Study of Liver-Chronic Liver Failure (EASL CLIF) and the North American Association for the Study of the End Stage Liver Disease (NACSELD) from the West added the concepts of organ failure and infection as precipitants for the development of ACLF and CLIF-Sequential Organ Failure Assessment (SOFA) and NACSELD scores for prognostication. The Chinese Group on the Study of Severe Hepatitis B (COSSH) added COSSH-ACLF criteria to manage hepatitis b virus-ACLF with and without cirrhosis. The literature supports these defnitions to be equally efective in their respective cohorts in identifying patients with high mortality. To overcome the diferences and to develop a global consensus, APASL took the initiative and invited the global stakeholders, including opinion leaders from Asia, EASL and AASLD, and other researchers in the feld of ACLF to identify the key issues and develop an evidence-based consensus document. The consensus document was presented in a hybrid format at the APASL annual meeting in Kyoto in March 2024. The ‘Kyoto APASL Consensus’ presented below carries the fnal recommendations along with the relevant background information and areas requiring future studies.
Fibromyalgia syndrome (FMS): Neural therapy as a key to pain reduction and quality of life
(Salient Visionary Publications LLC, 2025) Nazlıkul, Hüseyin; Ural Nazlıkul, Fatma Gülçin
Fibromyalgia syndrome (FMS) is a complex chronic pain disorder characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive impairments. Its global prevalence is estimated at 2–3%, with women between the ages of 30 and 60 being most commonly affected. The pathophysiology of FMS is multifactorial, involving central sensitization processes, dysfunctions of pain inhibition mechanisms, and chronic inflammatory and neuroendocrine disturbances. Pathophysiological Mechanisms: Central sensitization: Increased pain processing in the central nervous system. Neuroendocrine dysfunction: Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, altered cortisol and serotonin levels. Lymphatic dysfunction: Edema, inflammation, and accumulation of toxins. Silent inflammation: Chronic inflammatory processes with elevated cytokine activity (e.g., TNF-α, IL-6). Neural Therapy as a Treatment Approach Neural therapy addresses autonomic dysregulation and restores the balance between the sympathetic and parasympathetic nervous systems. Key therapeutic strategies include: Local infiltrations: Procaine or lidocaine injections to reduce pain sensitivity. Segmental therapy: Treatment of spinal reflex zones to regulate the autonomic nervous system. Interference field therapy: Identification and treatment of chronic irritative foci. Adjunctive measures, such as manual lymphatic drainage, anti-inflammatory nutrition, and micronutrient therapy, can enhance treatment efficacy. The combination of neural therapy and regulatory medicine shows promising results in reducing pain, improving sleep quality, and restoring quality of life.
The effect of patient education in treatment of fibromyalgia: A randomized controlled trial
(Kare Publishing, 2025) Aşık, Hatice Kübra; Demir, Saliha Eroğlu; Özaras, Nihal; Rezvani, Aylin; Aydın, Teoman; Güler, Mustafa; Poşul, Sevde; Poyraz, Emine
Objective: Fibromyalgia syndrome (FMS) can be treated with a variety of pharmaceutical and non-pharmacological approaches. The purpose of this study was to evaluate the effects of patient education and a home exercise program on FMS patients' pain, fatigue, functioning, and quality of life. Materials and Methods: The study included patients who satisfied the American College of Rheumatology's FMS criteria. They were split up into two groups at random. A schedule of at-home exercise was given to both groups. Furthermore, Group 2 patients participated in patient education sessions. At baseline and eight weeks later, both groups underwent examinations. Evaluation criteria included the Nottingham Health Profile (NHP) for quality of life, the Beck Depression Inventory (BDI) for psychological status, the Visual Analogue Scale for pain severity (VASp) and exhaustion (VASf), and the Fibromyalgia Impact Questionnaire (FIQ) for functional status. Results: The primary clinical and demographic characteristics of the two groups were comparable at baseline. Although the values of VASp (p=0.014), VASf (p=0.011), BDI (p=0.043), NHP subscales (p<0.05), FIQ (p=0.012) showed statistically significant improvements in Group 2, only Group 1's FIQ score significantly improved (p=0.027). There were substantial differences in VASp (p=0.026), VASf (p<0.001), BDI (p<0.001), and all NHP subscales except sleep problems, FIQ scores (p=0.036) between the two groups in favor of Group 2 at the end of eight weeks. Conclusion: Patients with FMS should receive patient education in addition to home-based exercise, which is an effective treatment for reducing symptoms, enhancing psychological well-being, and improving quality of life.
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.

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