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Article Citation - WoS: 9Citation - Scopus: 10Impact of Hospital-Acquired Acute Kidney Injury on Covid-19 Outcomes in Patients With and Without Chronic Kidney Disease: a Multicenter Retrospective Cohort Study(Tubitak Scientific & Technological Research Council Turkey, 2021) Ozturk, Savas; Turgutalp, Kenan; Arıcı, Mustafa; Çetinkaya, Hakkı; Altıparmak, Mehmet Rıza; Aydın, Zeki; Ateş, Kenan; Dolarslan, Mursıde Esra; Seyahi, Nurhan; Yıldız, Alaattın; Bora, FeyzaBackground/aim: Hospital-acquired acute kidney injury (HA-AKI) may commonly develop in Covid-19 patients and is expected to have higher mortality. There is little comparative data investigating the effect of HA-AKI on mortality of chronic kidney disease (CKD) patients and a control group of general population suffering from Covid-19. Materials and methods: HA-AKI development was assessed in a group of stage 3–5 CKD patients and control group without CKD among adult patients hospitalized for Covid-19. The role of AKI development on the outcome (in-hospital mortality and admission to the intensive care unit [ICU]) of patients with and without CKD was compared. Results: Among 621 hospitalized patients (age 60 [IQR: 47–73]), women: 44.1%), AKI developed in 32.5% of the patients, as stage 1 in 84.2%, stage 2 in 8.4%, and stage 3 in 7.4%. AKI developed in 48.0 % of CKD patients, whereas it developed in 17.6% of patients without CKD. CKD patients with HA-AKI had the highest mortality rate of 41.1% compared to 14.3% of patients with HA-AKI but no CKD (p < 0.001). However, patients with AKI+non-CKD had similar rates of ICU admission, mechanical ventilation, and death rate to patients with CKD without AKI. Adjusted mortality risks of the AKI+non-CKD group (HR: 9.0, 95% CI: 1.9–44.2) and AKI+CKD group (HR: 7.9, 95% CI: 1.9–33.3) were significantly higher than that of the non-AKI+non-CKD group. Conclusion: AKI frequently develops in hospitalized patients due to Covid-19 and is associated with high mortality. HA-AKI has worse outcomes whether it develops in patients with or without CKD, but the worst outcome was seen in AKI+CKD patients.Key words: Acute kidney injury, chronic kidney disease, Covid-19, hospitalization, mortalityArticle Citation - WoS: 2Çocukluk Çağı Kanser Yaşayanlarında Nefrotoksisitenin İncelenmesi ve Glomerüler Filtrasyon Hızı Yöntemlerinin Karşılaştırılması(Dr Behcet Uz Cocuk Hastaliklari ve Cerrahisi, 2021) Erdem, Arzu Yazal; Emir, Suna; Çakar, Nilgün; Demir, Ahmet; Özyörük, Derya; Demir, Haci AhmetAmaç: Çocukluk çağı kanserlerinde artan sağkalım oranları, uzun süreli tedaviye bağlı yan etkilere ve geç nefrotoksisite için olası risk faktörlerine odaklanmaya yol açmıştır. Amacımız kanser tedavisi alıp iyileşen çocuklarda nefrotoksisiteyi belirlemek ve glomerül filtrasyon hızının hesaplanmasında tahmini glomeruler filtrasyon hızı ile kreatinin klirensinin birbiri ile uyumunu araştırmaktır. Yöntem: Sisplatin, karboplatin, ifosfamid ve/veya yüksek doz metotreksat ile kanser tedavileri tamamlanmış 59 çocuğun glomerüler ve tübüler disfonksiyonları değerlendirildi. Bulgular: Ortalama tanı yaşı 10,7±5,5 yıl (2,5-23), ortalama takip süresi 2,6±2,1 yıl (0,5-8) olan 59 hastanın %65’inde böbrek fonksiyon bozukluğu tespit edildi. Böbrek fonksiyon bozukluğunun en yaygın bulgusu azalmış glomeruler filtrasyon hızı (n:19, %32,2), artmış üriner β2-mikroglobulin atılımı (n:12, %20,4), ardından mikroalbuminuri (n:6, %10,1) idi. Kombine kemoterapi ile tedavi edilenlerde, yüksek doz metotreksat ile tedavi edilenlere göre istatistiksel anlamlı düşük tubüler fosfor reabsorbsiyonu saptandı. Serum sistatin-C ve Schwarz formülü ile hesaplanan tahmini glomeruler filtrasyon hızının birbiri ile tutarlı olduğu (r=0,563, p=0,00) bulundu. Sonuç: Çocukluk çağında kanser tedavisi alıp iyileşenlerde yüksek oranda böbrek komplikasyonlarının geliştiği gösterilmiştir. Çocukluk çağı kanser yaşayanlarında, Schwartz formülü veya sistatin-C ile tahmini glomerüler filtrasyon hızının hesaplanmasının kreatinin klirensiyle uyumlu olduğunu gösterdik. 24 saatlik idrar toplayamayan çocuklarda tahmini glomeruler filtrasyon hızı hesaplaması pratik bir yaklaşımdır.Other Current Induction Therapy Strategies and Anti-T Lymphocyte Globulin Usage in Kidney Transplantation: Consensus-Based Recommendations by a Turkish Expert Panel(Aves, 2024) Çakır, Ülkem; Dinçkan, Ayhan; Karadoğan, Nayim; Keven, Kenan; Koçak, Hüseyin; Koç, Serkan Kubilay; Yıldız, Alaattin; Turkmen, Aydin; Töz, Hüseyin; Sezer, SirenThis advisory committee convened to review national and global kidney transplantation dynamics and provide recom- mendations on the use of anti-T lymphocyte globulin (ATLG) for prevention and treatment of rejection after allogeneic kidney transplantation. A critical evaluation of 6 relevant articles released up to October 2022 was performed to reveal their importance in clinical practice. Additionally, 27 key questions on the indication, dosage of ATLG, and risk stratification were used for the Delphi technique with 8 members of the Turkish Society of Nephrology including 5 kidney transplanta- tion (KTx) subcommittee members and a surgeon experienced in solid organ transplantation. The committee declared that Türkiye had great potential in KTx; however, increase in transplantation would be possible in the case of raise in the deceased donor transplantation. As a consensus, ATLG was strongly recommended for induction and rejection treatment. Also, committee members recommended the safe dosage range in steroid resistant acute rejection as 2.5-3 mg/kg daily for 5-7 days, and the median of preferred dosage in induction sounded as 2-2.5 mg/kg daily for 3 days in intermediate risk state. Additionally, post-transplant infection and malignancy cases due to immunosuppression were much rarely encoun- tered than they were in the past.Article Citation - WoS: 2Citation - Scopus: 2Role of Surveillance Screening in Detecting Tumor Recurrence After Treatment of Childhood Cancers(Aves, 2021) Kısa, Pelin Teke; Emir, Suna; Teke Kısa, PelinObjective: As the survival rates in children with cancer reach up to 80%, this improvement in survival increases the number of patients under follow-up. After cancer treatment is completed, patients are taken to follow-up surveillance to ensure the early detection of recurrence and the late effects of treatments. The frequency and necessity of surveillance screening tests are controversial. This study aimed to assess the efficacy of surveillance screening in the detection of recurrence. Material and methods: The files of 533 children who were diagnosed as having cancer at our pediatric oncology clinic between 2004 and 2013 were retrospectively evaluated. We looked at outcomes after recurrence, the timing and pattern of recurrence, the presence of symptoms during recurrence, physical examination findings, tumor marker levels, laboratory findings, and radiologic tests. Results: Of the 63 patients with recurrence, 23 were symptomatic and 40 were asymptomatic at the time of the recurrence. Tumor location and time of the recurrence did not affect the post recurrence survival. The median post-recurrence survival for patients was 13 (range, 1-98) months. The median post-relapse survival was 10 (range, 1-73) months in patients with symp-tomatic recurrence, and 16 (range, 1-98) months in patients with asymptomatic recurrence. It was determined that patients in whom recurrence was identified with surveillance tests had longer post-relapse survival time. The 5-year survival rate of 23 patients with symptomatic recurrence was 12.2%; this rate was 49.5% in asymptomatic patients (p<0.05).Conclusions: It should be considered that surveillance testing offers the benefit of prolonging post recurrence survival.Article Identification of Bacterial Vaginal Microbiota Via Metagenomic Approach(Galenos Publ House, 2022) Ucak, Samet; Sudagidan, Mert; Yurt, Mediha Nur Zafer; Tasbasi, Behiye Busra; Acar, Elif Esma; Tuna, Bilge Guvenc; Ozalp, Veli Cengiz; Ozalp, Cengiz; Dogan, SonerAim: The aim of the current study was to identify vaginal bacterial microbiota of 38 Turkish women using the high -throughput next -generation sequencing and metagenomic approach at different taxonomic levels from the kingdom to the species level. Materials and Methods: Vaginal swab samples (n=38) were collected in the DNA/RNA shield collection tubes at Yeditepe University Hospital, Department of Obstetrics and Gynecology in June 2021 and DNA extraction was performed by ZymoBIOMICS DNA miniprep kit. The information related to age, marital status, preliminary diagnosis and anamnesis status of patients were collected. To determine the vaginal microbiota, a metagenomic approach was applied using 16S rRNA amplicon sequencing. Results: The dominant phylum Firmicutes was followed by Proteobacteria, Actinobacteria, Tenericutes, Fusobacteria, and Synergistetes in the vaginal samples. Lactobacillus was the most abundant genus followed by Prevotella, Enterobacter, Gardnerella, and Dialister. Lactobacillus iners was dominant at the species level in vaginal swab samples, followed by Gardnerella vaginalis, Enterobacter tabaci, Prevotella timonensis, Prevotella bivia, and Lactobacillus jensenii. Canonical correspondence analysis (CCA) showed that Proteobacteria and Fusobacteria were mainly related to married/single variable with the highest percentages, whereas Actinobacteria and Tenericutes were related to age variable at the phylum level. Campylobacter , Atopobium , Enterobacter , and Lactococcus were mainly found in married/single variable with the highest percentages, whereas Anaerococcus, Streptococcus, Sutterella , and Veillonella were related to age. Moreover, CCA showed that Campylobacter ureolyticus, Lb. jensenii , and Atopobium vaginae were associated with married/single variable, whereas Lactobacillus johnsonii and G. vaginalis were found in age variable with the highest percentages at the species level. Conclusion: Vaginal diseases are still a major public health concern. The vaginal microbiota, which has been studied in more depth in recent years, has been discovered to be more complicated than previously imagined thanks to technological developments. More patient investigations are needed to confirm and develop these findings.Article Pankreas Cerrahisi Sonrası Histopatolojik Değerlendirme: Hpb’ye Özgü Patologlar ile Spesifik Olmayan Patologların Sonuçlarının Karşılaştırılması(Turkish Surgical Assoc, 2023) Emral, Ahmet Cihangir; Dikmen, Kürşat; Tahernejad, Maryam; Sardari, Khotan; Pour, Ali Rahman; Ekinci, Özgür; Kerem, MustafaGiriş ve Amaç: Bu çalışmanın amacı, aynı cerrahi ekip tarafından pankreatikoduodenektomi yapılan hastaların spesmenlerinin HPB-spesifik pato- loglar ve genel patologların değerlendirme sonuçlarını karşılaştırmaktır. Gereç ve Yöntem: Periampuller bölgede pankreatikoduodenektomi (PD) uygulanan 159 hastanın patoloji sonuçları retrospektif olarak incelendi. HPB-spesifik patologlar (S grubu) ve diğer patologların (NS grubu) histopatolojik değerlendirme sonuçları karşılaştırıldı. Patoloji spesmenleri değerlendirilerek, tümör boyutu (mm), total lenf nodu, metastatik lenf nodu, cerrahi sınır pozitif/negatifliği (RO/R1/R2 rezeksiyonu) ve vasküler rezeksiyon yapılan hastaların verileri gruplar karşılaştırılarak değerlendirildi. Bulgular: HPB-spesifik patologlar (S grubu) tarafından 91 hastanın, non-spesifik grupta (NS grubu) ise 68 hastanın spesmen sonuçları incelendi. Ortalama toplam lenf nodu sayısı ve diseke edilen metastatik lenf nodu sayısı açısından karşılaştırıldığında istatistiksel olarak anlamlı sonuç göz- lendi (sırasıyla p= 0,04, p< 0,01). Ayrıca cerrahi sınır pozitifliği (R1) S grubunda istatistiksel olarak daha yüksek bulundu (p= 0,02). Sonuç: HPB ameliyatlarının başarısının kliniğe yansıyabilmesi için patoloji spesmenlerinin HPB-spesifik patologlar tarafından incelenmesi önem taşımaktadır.Article Citation - WoS: 16Citation - Scopus: 19The Triglyceride-Glucose Index Predicts Peripheral Artery Disease Complexity(Tubitak Scientific & Technological Research Council Turkey, 2020) Karaduman, Bilge Duran; Ayhan, Hüseyin; Keles, Telat; Bozkurt, Engin; Duran Karaduman, BilgeBackground/aim: High levels of triglyceride (TG) and fasting blood glucose (FBG) values increase atherosclerosis risk. This study\revaluates the relationship between peripheral artery disease (PAD) severity and complexity, as assessed by TransAtlantic InterSociety\rConsensus-II (TASC-II) classification and the triglyceride-glucose (TyG) index.\rMaterials and methods: A total of 71 consecutive patients with PAD (males 93%, mean age 63.3 ± 9.7), who underwent percutaneous\rperipheral intervention were included retrospectively. The patients were divided into two groups according to the angiographically\rdetected lesions. Those with TASC A-B lesions were included in Group 1, and those with TASC C-D lesions were included in Group 2.\rTyG index was calculated as formula: ln[fasting TG (mg/dL) × fasting plasma glucose (mg/dL)/2].\rResults: There were 40 patients in Group 1 (90.3% men, with a mean age of 63.6 ± 9.3 years) and 31 patients in Group 2 (96.8% men,\rwith a mean age of 62.0 ± 8.6 years). In the majority of patients in both groups, the target vessels are iliac arteries and femoral arteries.\rIn Group 2, platelet count and TyG index were significantly high, according to Group 1. The TyG index was significantly correlated with\rTASC-II, Rutherford category, HbA1c, and HDL-C.\rConclusion: In this present study, we showed that the TyG index was an independent predictor of peripheral artery disease complexity,\raccording to TASC-II classification, for the first time in the literature.Article Investigation of the Anti-Inflammatory Effects of Astaxanthin on Liver Tissue in Lipopolysaccharide-Induced Sepsis in Rats(Galenos Yayincilik, 2022) Cobaner, Nurdan; Yelken, Birgul; Erkasap, Nilufer; Ozkurt, Mete; Bektur, EzgiObjective: Corticosteroids are one of the treatment methods used to prevent inflammation in sepsis. This study aimed to determine the anti-inflammatory activity of astaxanthin in sepsis and compare it with dexamethasone. Materials and Methods: After approval of the local ethics committee, 40 Sprague-Dawley male rats were randomly assigned to the control group (n=8), lipopolysaccharide group (n=8), astaxanthin group (n=8), astaxanthin + lipopolysaccharide group (n=8) and dexamethasone + lipopolysaccharide group (n=8). On day 1, these groups were given dimethyl sulfoxide, Salmonella typhimurium lipopolysaccharide, astaxanthin dissolved in dimethyl sulfoxide, astaxanthin and lipopolysaccharide and dexamethasone and lipopolysaccharide, respectively. After 24 hours, rats underwent laparotomy, and liver and blood samples were taken. GraphPad Prism 6 was used for statistical analysis. P values less than 0.05 were considered significant. Results: Nuclear factor-kappa B levels in both treatment groups significantly decreased when compared with the lipopolysaccharide group. Apoptotic cells and reaction severity decreased significantly in the treatment groups compared with the lipopolysaccharide group. Conclusion: This study revealed that the use of astaxanthin had a positive effect on liver tissue undergoing treatment for sepsis. Moreover, despite some differences, measurement values were comparable when dexamethasone was administered.Article Evaluation of Covid-19 Cases Who Received Immunosuppressive Therapy at a Tertiary Care Hospital(Doc design informatics Co Ltd, 2022) Sayar, Merve Sefa; Acar, Ali; Bulut, Dilek; Celik, Sebahattin; Oguz, EminObjective: Immunosuppressive drugs are included in the treatment protocols of severe COVID-19 cases that may present with cytokine storm. In this study, we aimed to examine the characteristics of COVID-19 patients who received immunosuppressive therapy Methods: Patients diagnosed with COVID-19 and followed in the quarantine wards of our hospital between 01.03.2020-24.05.2020 were included in the study. Patient information was obtained retrospectively from patient files and discharge reports, and 263 COVID-19 patients-aged 18 and over-were included in the study. Results: The median age of the patients who received immunosuppressive therapy was 60.74 +/- 1.96, and 39.6% of them were women. The average symptom duration of the patients examined in the study at the time of admission to the hospital was 4.59 +/- 0.29 days. There was a significant difference in age, lymphocyte count, neutrophil/lymphocyte ratio, C-reactive protein, ferritin, D-Dimer, blood oxygen saturation, fever after antiviral therapy, qSOFA score, and total hospital stay between the two groups that received and did not receive immunosuppressive therapy (p<0.05). The need for immunosuppressive therapy increased 15.9 times over the age of 40, 15.6 times in the presence of diffuse involvement on thoracic CT, 6.6 times in the presence of chronic disease, 2.7 times in the presence of thrombocytopenia, and 1.7 times in the presence of lymphopenia (p <0.05).Conclusions: We observed that patients whose immunosuppressive therapy was added to their treatment protocols were admitted to the hospital later than others, had more prevalent involvement in thorax CT, high acute phase reactants, low SPO2, and more than one underlying disease.
