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Article Importance of Alkaline Phosphatase as a Predictor of Transient Hypoparathyroidism After Parathyroidectomy(Springernature, 2025) Gulen, Merter; Emral, Ahmet Cihangir; Sariyildiz, Gulcin TurkmenBackgroundThere are insufficient studies that have investigated the relationship between temporary hypoparathyroidism (hypoPTH) and the preoperative serum alkaline phosphatase (ALP) level in patients with no renal function disorder who have undergone isolated parathyroidectomy. The aim of this study was to determine whether or not the preoperative serum ALP level could be a marker which could predict the development of postoperative temporary hypoPTH. MethodsThis cross-sectional study included 158 patients aged > 18 years who were diagnosed with primary hyperparathyroidism (PHPT) between 2017 and 2022. The demographic data of the patients were retrieved from the hospital records. The patients were separated into two groups according to the serum calcium level after the parathyroidectomy, as the normal group and the temporary hypoPTH group. The determinants of temporary hypoPTH developing after parathyroidectomy in PHPT patients were investigated using multivariate logistic regression analysis. ResultsTemporary hypoPTH was determined in 25.3% of patients. The mean age and 25-O-HD level were determined to be lower in the patients who developed temporary hypoPTH compared to those who did not. The preoperative serum ALP, parathormone, and 24-h urine calcium levels were determined to be higher in the cases that developed temporary hypoPTH. As a result of the regression analysis, only the serum ALP level was determined to be an independent risk factor predicting the development of temporary hypoPTH (p: 0.005, OR: 1.021). In the ROC analysis, when a cutoff value of 119.5 pg/mL was taken for ALP, it was determined to have 73% sensitivity and 72% specificity for the prediction of the development of temporary hypoPTH. ConclusionsThe most appropriate treatment for symptomatic PHPT patients selected with positive imaging is minimally invasive parathyroidectomy. The most important postoperative complications are hypocalcemia and hypoPTH. The preoperative serum ALP level may be helpful in determining patients at risk of developing temporary hypoPTH following parathyroidectomy.Article Breast Cancer Management During the Covid Pandemic(Coll Physicians & Surgeons Pakistan, 2024) Sariyildiz, Gulcin Turkmen; Ayhan, Fikriye FigenObjective: To explore the impact of COVID-19 among both the newly diagnosed patients and patients under follow-up for breast cancer by focusing on patients' accessibility to management and comparing the distribution of them before and during pandemic. Study Design: Single -centric retrospective study. Place and Duration of the Study: Department of General Surgery and Department of Physical Medicine and Rehabilitation, Atilim University, Medicana International Ankara Hospital, Ankara, Turkiye, from March 2018 to 2022. Methodology: The data were collected to analyse numbers and distributions of physician visits regarding breast cancer. Results: The mean age of patients was 55.98 +/- 12.60 years. The percentages of newly diagnosed cases showed similarity (7.37% vs. 9.79%) before and during the pandemic (p = 0.18). The number of imaging studies decreased by 53.33% in patients under follow-up (p = 0.006), despite screening tests showed a similar trend (p = 0.145). General surgery visits marked up (+44.6%), in contrast to plastic surgery visits (-42.04%, p <0.001). Patients' admissions decreased in many COVID-19 related clinics (pulmonology, emergency, internal medicine, and intensive care), but cardiology (+96.59%) and rehabilitation (+75%) admissions increased during the pandemic (p <0.001). The number of medical oncology and radiation oncology visits did not change (p >0.05). Conclusion: Total number of physician visits was similar before and during the pandemic despite the changing distribution. While COVID-19 led to markedly rising trends of surgical, cardiological, and rehabilitative management in patients with breast cancer, falling trends were seen in other specialities except oncology which showed a plateau during two years. The falling trends of visits to pulmonology, emergency, internal medicine, and intensive care clinics may be explained by crowded COVID-19 cases.Article Citation - WoS: 9Citation - Scopus: 13The Evaluation of Oxidative Stress in the Young Adults With Covid-19 Mrna Vaccines Induced Acute Pericarditis- Myopericarditis(Dove Medical Press Ltd, 2022) Dursun, Ali Dogan; Saricam, Ersin; Sariyildiz, Gulcin Turkmen; Iscanli, Murat Dogan; Cantekin, Omer FarukBackground: During COVID-19 pandemic, several vaccines have been developed such as mRNA vaccines. However, acute pericarditis and myocarditis/myopericarditis cases have been described after mRNA vaccination. The mechanism for the development of cardiac involvement is unknown. Potential mechanism for oxidative stress associated with vaccine-induced heart involvement is unidentified. This study aimed to examine the role of oxidative stress and the heart involvement in young adults vaccinated with COVID-19 mRNA vaccines. Methods: In this cross-sectional study, a total of 23 participants were included and 10 of these participants were asymptomatic patients (control group). Comparison of the cardiac involvement and control group was made by using troponin I, C-reactive protein (hsCRP), D-dimer levels, and oxidative stress tests including nitric oxide, and imaging techniques (ECG, echocardiography, cardiovascular magnetic resonance). Results: The median age of acute pericarditis group (10 patients) was 22 years (Q1-Q3: 18.5-31), and the mean age was 24.4 +/- 7.5 years. The median age of myopericarditis group (3 patients) was 22 years (Q1-Q3 18.0-25.0), and the mean age was 21.6 +/- 3.5 years. All the myopericarditis cases were male. The patients with myopericarditis had higher troponin I level, hsCRP, and D-dimer levels (troponin I level; 1600.00 ng/mL; D-dimer; 1.20 mu g/mL, hsCRP; 3.0 mg/L, respectively; p < 0.05). Serum nitric oxide levels and OSI (total oxidant status, H2O2/total antioxidant status) were lower in myopericarditis group than the control and acute pericarditis group (p < 0.05). This shows inflammatory and procoagulant state. Conclusion: Vaccine-induced myopericarditis cases are associated with oxidative stress test abnormality (abnormal NO, OSI levels). However, there is no relationship between NO levels and other oxidative stress tests difference in vaccine-induced acute pericarditis. It is thought that vaccine-induced pericarditis and myopericarditis could have different pathogenesis. This could make it necessary to reassess the second dose of vaccination for vaccine-induced cardiac involvement cases.Article Clinical and Laboratory Evaluation of Acute Pericarditis Associated With Antinuclear Antibodies Positivity(Bentham Science Publ Ltd, 2023) Dursun, Ali Dogan; Saricam, Ersin; Erdem, Hakan; Sariyildiz, Gulcin Turkmen; Ozyer, Esref Umut; Bozkurt, Engin; Cantekin, Omer FarukBackground Up to 30% of patients with acute pericarditis develop recurrent pericarditis. Acute pericarditis may be a manifestation of an underlying systemic autoimmune disease. Therefore, we evaluated the characteristics of patients with acute pericarditis according to antinuclear antibodies (ANA) positivity/negativity. Methods Participants with acute pericarditis and negative ANA (n=29), recurrent pericarditis with positive ANA (n=30) and healthy controls (n=11) were examined. The groups were compared using serum parameters (ANA, C-reactive protein, leucocyte count, erythrocyte sedimentation rate, total antioxidant status, nitric oxide (NO), and oxidative stress index (OSI)) and imaging techniques (electrocardiogram, echocardiography, cardiovascular magnetic resonance, and venous Doppler ultrasound). Results In females, acute pericarditis associated with ANA occurred more frequently (p<0.001). ANA-positive acute pericarditis had significantly lower NO and OSI (p<0.05 and p<0.001, respectively) and pericardial inflammation on magnetic resonance. We found a pulmonary embolism in one patient with positive ANA. Slow venous flow (SVF) occurred more often in acute pericarditis associated with ANA than in the ANA-negative group on venous ultrasound (p<0.05). The prevalence of positive ANAs was 1.6 times higher among SVF patients than in controls. Conclusion This study suggests that acute pericarditis associated with ANA is more common in middle-aged females. SVF and lower oxidative stress tests were more common in patients with ANA-associated acute pericarditis. Acute pericarditis associated with ANA could be considered as a hypercoagulable state. Therefore, all newly diagnosed pericarditis patients (especially females) should be checked for ANA positivity. Awareness of this coexistence should be promptly addressed to establish management strategies.
