Dahili Tıp Bilimleri Bölümü

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Citation - WoS: 3
Citation - Scopus: 3
The prognostic value of ORBIT risk score in predicting major bleeding in patients with acute coronary syndrome
(ScienceDirect, 2023) Günlü, Serhat; Arpa, Abdulkadir; Kayan, Fethullah; Güzel, Tuncay; Kılıç, Raif; Aktan, Adem; Altintaş, Bernas; Karahan, Mehmet Zülkif
Background: The most significant adverse effect of antithrombotic medication in acute coronary syndrome (ACS) is major bleeding, which is related to increased mortality. Studies on ORBIT risk score in predicting major bleeding in ACS patients are limited. Objective: This research aimed to examine whether the ORBIT score calculated at the bedside can identify major bleeding risk in patients with ACS. Methods: This research was retrospective, observational, and conducted at a single center. Analyses of receiver operating characteristics (ROC) were utilized to define the diagnostic value of CRUSADE and ORBIT scores. The predictive performances of the two scores were compared using DeLong's method. Discrimination and reclassification performances were evaluated by the integrated discrimination improvement (IDI), and net reclassification improvement (NRI). Results: The study included 771 patients with ACS. The mean age was 68.7 ± 8.6 years, with 35.3 % females. 31 patients had major bleeding. Twenty-three of these patients were BARC 3 A, five were BARC 3 B, and three were BARC 3 C. Bleeding history [OR (95 % CI), 2.46 (1.02-5.94), p = 0.021], hemoglobin levels [OR (95 % CI), 0.54 (0.45-0.63), p < 0.001], and age > 74 years [OR (95 % CI), 1.03 (1.01-1.06), p = 0.039] were independent predictors of major bleeding. The ORBIT score was an independent predictor of major bleeding in the multivariate analysis: continuous variables [OR (95 % CI), 2.53 (2.61-3.95), p < 0.001] and risk categories [OR (95 % CI), 3.06 (1.69-5.52), p < 0.001]. Comparison of c-indexes for major bleeding events revealed a non-significant difference for the discriminative ability of the two tested scores (p = 0.07) with a continuous NRI of 6.6 % (p = 0.026) and an IDI of 4.2 % (p < 0.001). Conclusion: In ACS patients, the ORBIT score independently predicted major bleeding.
Citation - WoS: 2
The Significance of Frontal Plane QRS-T Angle for Estimating Non-Dipper Hypertension
(Cureus, 2022) Evsen, Ali; Karahan, Mehmet Zülkif
Objective: The frontal QRS-T angle (fQRS-T) is linked to myocardial ischemia and ventricular arrhythmias. On the other hand, non-dipper hypertension is a risk factor for cardiac adverse events. The objective of this research was to determine whether the fQRS-T, a marker of ventricular heterogeneity, could be used to predict non-dipper hypertensive individuals in the lack of left ventricular hypertrophy. Methods: The observational study was carried out retrospectively. Patients diagnosed with hypertension were included in this study. Blood tests were routinely conducted for all patients. Electrocardiography (ECG) was conducted for each patient and echocardiography was performed. Blood pressure (BP) values were collected from the ambulatory Holter records. According to ambulatory Holter monitoring, the individuals were separated into two groups. The association between fQRS-T and hypertension was investigated. Results: The research involved 123 patients, with an average age of 51.85±8.22 years, comprising 76 women (61.8%) and 47 males (38.2%). According to ambulatory Holter monitoring, patients were separated into dippers (n=65) and non-dippers (n=58). There were no statistically significant in the laboratory and echocardiographic variables (p>0.05). QT dispersion (QTd) and fQRS-T were substantially greater in the non-dipper group than in the dipper group (p=0.043 and p<0.001, respectively). Independent determinants of non-dipper status were determined by univariate and multivariate logistic regression analyses. fQRS-T was found to be the only independent indicator of non-dipper status (OR: 1.03, 95%CI: 1.02-1.06, p<0.001). Conclusion: The fQRS-T may be a useful marker for estimating non-dipper hypertensive individuals in the lack of left ventricular hypertrophy.
Citation - WoS: 2
Citation - Scopus: 2
The effect of body mass index on complications in cardiac implantable electronic device surgery
(WILEY, 2023) Güzel, Tuncay; Demir, Muhammed; Aktan, Adem; Kılıç, Raif; Arslan, Bayram; Günlü, Serhat; Altıntaş, Bernas; Karahan, Mehmet Zülkif; Özbek, Mehmet; Aslan, Burhan; Arpa, Abdulkadir; Coşkun, Mehmet Sait; Altunbaş, Mahsum; Tüzün, Rohat; Akgümüş, Alkame; Karadeniz, Muhammed; Aydın, Saadet; Güzel, Hamdullah; Aslan, Selen Filiz; Söner, Serdar; Taş, Ahmet; Ertaş, Faruk
Background: Cardiac implantable electronic device (CIED) procedures are prone to complications. In our study, we investigated the effect of body mass index (BMI) on CIED-related complications. Methods: 1676 patients who had undergone CIED surgery (de novo implantation, system upgrade, generator change, pocket revision or lead replacement) at two heart centers in Turkey and met the study criteria were included in our study. For analysis of primary and secondary endpoints, patients were classified as non-obese (BMI < 25 kg/m2), overweight (25 ≤ BMI < 30 kg/m2), and obese (BMI ≥ 30 kg/m2). The primary endpoint was accepted as cumulative events, including the composite ofclinically significant hematoma (CSH), pericardial effusion or tamponade, pneumoth- orax, and infection related to the device system. Secondary outcomes included each component of cumulative events. Results: The rate of cumulative events, defined as primary outcome, was higher in the obese patient group, and we found a significant difference between the groups (3.0%, 4.3%, 8.9%, p = .001). CSH and pneumothorax rates were significantly higher in the obese patient group (0.3%, 0.9%, 1.9%, p = .04; 1.0%, 1.4%, 3.3%, p = .04, respectively). According to our multivariate model analysis; gender (OR:1.882, 95%CI:1.156–3.064, p = .01), hypertension (OR:4.768, 95%CI:2.470–9.204, p < .001), BMI (OR:1.069, 95%CI:1.012–1.129, p = .01) were independent predictors of cumulative events rates. Conclusions: Periprocedural complications associated with CIED (especially hematoma and pneumothorax) are more common in the group with high BMI.
Citation - WoS: 4
Citation - Scopus: 4
Early puberty paradox: an investigation of anxiety levels of mothers and children, children's quality of life, and psychiatric diagnoses
(SpringerLink, 2023) Kardaş, Burcu; Kardaş, Ömer; Demiral, Meliha; Özbek, Mehmet Nuri
Early puberty signs lead to an increase in anxiety levels of parents and children. The aim of this study was to investigate the quality of life and anxiety levels of girls and their mothers who were admitted to a pediatric endocrinology clinic with concerns about early puberty. Girls and their mothers who were admitted to endocrinology outpatient clinic with concerns about early puberty were compared to healthy control group. Screen for Child Anxiety Related Emotional Disorders (SCARED) parent form, Quality of Life for Children Scale (PedsQL) parent form, and Beck Anxiety Inventory (BAI) were administered to the mothers. Children were evaluated with the Schedule for Afective Disorders and Schizophrenia for School-Age Children (Kiddie-SADS Lifetime Version) (K-SADS-PL). The study sample consisted of 92 girls and 62 of them were administered to clinic with concerns about early puberty. There were 30 girls in early puberty group (group 1), 32 girls were in the normal development group (group 2), and 30 were in the healthy control group (group 3). The anxiety level of group 1 and group 2 was signifcantly higher, and their quality of life was signifcantly lower when compared to group 3 (p<0.001). Mother’s anxiety level was found signifcantly higher in group 2 (p<0.001). It has shown that anxiety level and quality of life of children were associated with anxiety level of mothers and the current Tanner stage (r=0.302, p<0.005). Conclusion: Mothers and children who have concerns about early puberty are negatively afected when early puberty is a possibility. For this reason, educating parents will prevent negative impacts of this situation on children. At the same time, it will decrease health burden.
Citation - Scopus: 1
The predictive effect of shock index on mortality in patients with acute heart failure
(AME Publishing, 2023) Günlü, Serhat; Kayan, Fethullah; Karahan, Mehmet Zülkif
Background: The predictive usefulness of the shock index (SI), which is determined as a proportion of heart rate (HR) to systolic blood pressure (SBP), and age-adjusted SI (SI × age) for clinical outcomes other than mortality in acute heart failure (AHF) is not well established. This research aimed to examine whether SI and SI × age measured non-invasively at a patient’s bedside can identify mortality risk in patients admitted to the coronary care unit (CCU) with AHF. Methods: This research was carried out as a retrospective case-control study. Indices were calculated. The receiving operating characteristic (ROC) and Youden index were applied to calculate the optimal SI and SI × age cut-off for estimating mortality. Using multivariate analysis to determine independent indicators of mortality in patients with AHF. Results: A total of 1,468 patients who were hospitalized at the CCU with AHF were included. The population’s median age was 81 (73–91) years and 53.7% were male. In the survivor group, the median SI was 0.6 (0.5–0.75), and the median SI × age was 46 (38–58). In the non-survivor group, the median SI was 0.62 (0.55–0.81) and the median SI × age was 53 (44–66). According to the Youden index, the best value of SI was 0.56 with a specificity of 46% and a sensitivity of 70%, and the best value of SI × age was 44.8 with a specificity of 48% and a sensitivity of 76%. In the multivariate analysis, the power of SI × age to predict mortality was 2.39 times greater than other independent predictors. Conclusions: SI and SI × age calculated in the CCU may be valuable prognostic markers for identifying AHF patients at high risk for adverse outcomes.
Citation - WoS: 5
Citation - Scopus: 6
Bronchiectasis in Türkiye: Data From a Multicenter Registry (Turkish Adult Bronchiectasis Database)
(Galenos Publ House, 2024) Edis, Ebru Cakir; Cilli, Aykut; Kizilirmak, Deniz; Coskun, Ayson Sakar; Guler, Nurcan; Cicek, Sedat; Sayiner, Abdullah
Background: Bronchiectasis is a chronic lung disease characterized by permanent bronchial wall dilatation. Although it has been known as an orphan disease, it has recently gained attention because of registry -based studies and drug research. Aims: We aimed to use a multicenter database to analyze and compare data regarding the etiology, associated comorbidities, microbiological characteristics, and preventive strategies of bronchiectasis in T & uuml;rkiye to those of other countries. Study Design: A multicenter prospective cohort study. Methods: The multicenter, prospective cohort study was conducted between March 2019 and January 2022 using the Turkish Adult Bronchiectasis Database, in which 25 centers in T & uuml;rkiye participated. Patients aged > 18 years who presented with respiratory symptoms such as cough, sputum, and dyspnea and were diagnosed with non -cystic fibrosis bronchiectasis using computed tomography were included in the study. Demographic information, etiologies, comorbidities, pulmonary functions, and microbiological, radiological, and clinical data were collected from the patients. Results: Of the 1,035 study participants, 518 (50%) were females. The mean age of the patients was 56.1 +/- 16.1 years. The underlying etiology was detected in 565 (54.6%) patients. While postinfectious origin was the most common cause of bronchiectasis (39.5%), tuberculosis was identified in 11.3% of the patients. An additional comorbidity was detected in 688 (66.5%) patients. The most common comorbidity was cardiovascular disease, and chronic obstructive pulmonary disease (COPD) and bronchiectasis was identified in 19.5% of the patients. The most commonly detected microbiological agent was Pseudomonas aeruginosa (29.4%). Inhaled corticosteroids (ICS) were used in 70.1% of the patients, and the frequency of exacerbations in the last year was significantly higher in patients using ICS than in nonusers (p < 0.0001). Age [odds ratio (OR): 1.028; 95% confidence interval (CI): 1.005-1.051], cachexia (OR: 4.774; 95% CI: 2,054-11,097), high modified medical research council dyspnea scale score (OR: 1,952; 95% CI: 1,459-2,611), presence of chronic renal failure (OR: 4,172; 95% CI: 1,249-13,938) and use of inhaled steroids (OR: 2,587; 95% CI: 1,098-6,098) were significant risk factors for mortality. Mortality rates were higher in patients with COPD than in those with no COPD (21.7-9.1%, p = 0.016). Patients with bronchiectasis and COPD exhibited more frequent exacerbations, exacerbation -related hospitalizations, and hospitalization in the intensive care unit in the previous year than patients without COPD. Conclusion: This is the first multicenter study of bronchiectasis in T & uuml;rkiye. The study results will provide important data that can guide the development of health policies in T & uuml;rkiye on issues such as infection control, vaccination, and the unnecessary use of antibiotics and steroids.
Mardin İl Merkezinde 1-6 Yaş Grubu Çocuğu Olan Annelerin Yanıklarda İlk Uygulamalarının İncelenmesi
(2013) Battaloğlu İnanç, Betül; Say Şahin, Deniz; Demir, Cemil
Amaç: Bu çalışmada, annelerin yanık ve ilk yardım hakkındaki bilgi düzeylerinin belirlenmesi, yanıkla karşılaştıklarında ne yapacakları, acil uygulamaların tespit edilmesi ve araştırma sonunda annelere doğru bilgi verilerek, bu konudaki bilgi eksikliklerinin giderilmesi amaçlandı. Gereç ve Yöntem: Araştırmaya katılacak olan anneler, 1-6 yaş grubu çocuğu olan, 25-49 yaş grubundaki anneler arasından, randomize olarak seçilen, araştırma hakkında bilgilendirildikten sonra, katılmak isteyen 1000 gönüllü anneye, anket yoluyla uygulandı. Bulgular: Çocukların, % 21.6’sında yanık meydana geldiği, yanıkların % 81.4’ünün ev içinde, %18.6’sının ev dışında oluştuğu, yanık vakalarına, 2-4 yaş grubunda karşılaşıldığı, annelerin yanık konusunda bilgi eksikliklerinin olduğu ve yanığa ilk müdahale konusunda, araştırmaya katılan tüm annelerin % 89.6’sının bilgilerini yeterli bulmadıkları saptandı. Sonuç: Çalışmamız sonucunda, annelerin yanıkta ilk yardım konusunda, bilgi eksikliklerinin var olduğu saptandı. Bu konuda, annelerin bilgi eksikliklerinin uygulanacak eğitim faaliyetleri ile giderilmesi, annelerin doğru uygulamalar konusunda bilgilendirilmesi gerekliliği görülmüştür.
Citation - WoS: 1
Clinical characteristics of patients presented with primary adrenal insufficiency due to a p.R451W mutation in the CYP11A1 gene
(Karger, 2023) Çayır, Atilla; Demirbilek, Hüseyin; Özbek, Mehmet Nuri; Kurt, İlknur; Karaoğlan, Murat; Albayrak, Serpil; Dündar, Bumin Nuri; Güran, Tülay
Background and objective: The first and rate-limiting step of steroidogenesis is the conversion of cholesterol to pregnanolone which is catalyzed by the P450scc side chain cleavage enzyme (encoded by CYP11A1 gene-SCC). Homozygous recessive mutations of the CYP11A1 gene cause a global steroid hormone deficiency thereby disorders of sexual development in 46, XY individuals with a variable phenotype depending on the mutation characteristics. About 60 cases of SCC deficiency due to CYP11A1 gene mutation have been reported so far. The most common mutation is the c.1351C>T (p.R451W) mutation, which has been detected in 12 cases. We, herein, present the clinical characteristics of 14 cases presented with adrenal insufficiency due to p.R451W mutation in the CYP 11A1 gene. Design and method: Data were retrospectively collected from tertiary pediatric endocrine centers using a standardized proforma. Family history, presenting age, clinical, biochemical, and hormonal characteristics, treatment options, and the follow-up characteristics obtained during their latest follow-up visits were recorded. Results: 14 patients (M/F:7/7) from 10 consanguineous Turkish families were recruited. The mean age of the diagnosis was 3.8±2.4(Range: 1.04-8.5 years). All of the male subjects were completely virilized with no sign of DSD. The main presenting complaints were signs and symptoms of primary adrenal insufficiency. However, despite having signs and symptoms 3 subjects were diagnosed when investigated due to the history of their affected siblings. While glucocorticoid deficiency (elevated ACTH, low cortisol) was present in all cases, none of the male cases had undervirilization excluding androgen deficiency. Mild mineralocorticoid (MC) deficiency was detected in 10/14 of the cases which were recovered in 2 subjects during follow-up. More strikingly, one patient with no MC deficiency at presentation had developed a salt-wasting adrenal crisis during acute illness. Although a deterioration was detected in height SDS, there was not a statistically significant difference between height SDS at presentation (-0.64±1.4), at the latest follow-up visit(-0.90±1.4), and target height SDS (-0.63±0.6). Conclusion: In the present largest case series with a p.R451W mutation in the CYP11A1 gene our results confirmed a milder phenotype for all steroid hormones. Particularly lack of virilization defect in male subjects, and lack of salt-wasting crisis until a relatively late age of diagnosis suggested mild MC and androgen deficiency. Nevertheless, lack of MC deficiency at presentation does not exclude the risk of developing a salt-wasting adrenal crisis. Therefore special caution requires for patients with no MC replacement, particularly during acute illnesses.
Citation - WoS: 3
Aging and cardiac implantable electronic device complications: is the procedure safe in older patients?
(ELSEVIER, 2023) Güzel, Tuncay; Aktan, Adem; Kılıç, Raif; Günlü, Serhat; Arslan, Bayram; Arpa, Abdulkadir; Güzel, Hamdullah; Tatlı, İsmail; Aydın, Saadet; Suzan, Veysel; Demir, Muhammed
Background In this study, we investigated whether there is a higher incidence of cardiac implantable electronic devices (CIED) procedures related complications in older (≥75 years) than in younger (<75 years) patients. Methods This retrospective cohort study enrolled patients who had undergone CIED procedures (de novo implantation, system upgrade, generator substitution, pocket revision or lead replacement) at two heart centers in Turkey between January 2011 and May 2023. The primary composite endpoint included clinically signifcant hematoma (CSH), pericardial efusion or tamponade, pneumothorax, and infection related to the device system. Secondary outcomes included each component of the composite end point. Results The overall sample included 1923 patients (1419<75 years and 504 aged≥75 years). There was no diference between the groups in terms of cumulative events defned as primary outcome (3.5% vs. 4.4%, p=0.393). Infection related to device system was signifcantly higher in the≥75 age group (1.8% vs. 3.4%, p=0.034). There was no signifcant diference between the groups in terms of clinically signifcant hematoma and pneumothorax (0.7% vs. 0.4%, p=0.451, 1.4% vs. 1.0%, p=0.477, respectively). In multivariate model analysis, no association was found between age≥75 years and infection related to the device system. Conclusion Infection rates were relatively higher in the patient group aged≥75 years. This patient group should be evaluated more carefully in terms of infection development before and after the procedure.
Citation - WoS: 3
Citation - Scopus: 3
Aging and cardiac implantable electronic device complications: is the procedure safe in older patients?
(Springer, 2023) Güzel, Tuncay; Aktan, Adem; Kılıç, Raif; Günlü, Serhat; Arslan, Bayram; Arpa, Abdulkadir; Güzel, Hamdullah; Tatlı, İsmail; Aydın, Saadet; Suzan, Veysel; Demir, Muhammed
Background: In this study, we investigated whether there is a higher incidence of cardiac implantable electronic devices (CIED) procedures related complications in older (≥ 75 years) than in younger (< 75 years) patients. Methods: This retrospective cohort study enrolled patients who had undergone CIED procedures (de novo implantation, system upgrade, generator substitution, pocket revision or lead replacement) at two heart centers in Turkey between January 2011 and May 2023. The primary composite endpoint included clinically significant hematoma (CSH), pericardial effusion or tamponade, pneumothorax, and infection related to the device system. Secondary outcomes included each component of the composite end point. Results: The overall sample included 1923 patients (1419 < 75 years and 504 aged ≥ 75 years). There was no difference between the groups in terms of cumulative events defined as primary outcome (3.5% vs. 4.4%, p = 0.393). Infection related to device system was significantly higher in the ≥ 75 age group (1.8% vs. 3.4%, p = 0.034). There was no significant difference between the groups in terms of clinically significant hematoma and pneumothorax (0.7% vs. 0.4%, p = 0.451, 1.4% vs. 1.0%, p = 0.477, respectively). In multivariate model analysis, no association was found between age ≥ 75 years and infection related to the device system. Conclusion: Infection rates were relatively higher in the patient group aged ≥ 75 years. This patient group should be evaluated more carefully in terms of infection development before and after the procedure.
Citation - WoS: 1
Citation - Scopus: 1
Effectiveness of Valproic Acid in the Treatment of Sydenham's Chorea and a Literature Review
(Sage Publications inc, 2024) Ozgun, Nezir; Akdeniz, Osman
There is still no evidence-based guideline and consensus on the treatment Sydenham's Chorea (SC). The first-line medication preference of specialists depends on personal experience and is variable. In this study, we evaluate the treatment results of pediatric patients who were treated with valproic acid (VPA). The medical records of 17 patients diagnosed with SC were reviewed retrospectively. The mean time to clinical improvement was found as approximately 5 days, the mean duration of remission as 13.60 & PLUSMN; 3.94 weeks and the mean duration of medication use was found as 17.96 & PLUSMN; 3.81 weeks. No side effects were observed in any of the patients and relapse occurred in 2 patients. A positive correlation was found between the initial C-reactive protein (CRP) level and the duration of medication use. Until evidence-based guidelines are established, VPA can be used as an effective, safe, and inexpensive first-line treatment option, especially in pediatric patients.
The Efficacy of Iron and Piracetam in Breath Holding Spells and Levetiracetam in Anoxic Epileptic Seizures
(Artuklu International Journal of Health Sciences, 2023) ÖZGÜN, Nezir; AKDENİZ, Osman; ÇELİK, Muhittin; SARBAY, Hakan; TOKTAŞ, İzzettin
Introduction: In this study, the patients diagnosed with breath holding spell (BHS) or anoxic epileptic seizures and initiated at least one out of iron or piracetam or levetiracetam therapies were evaluated. Material and Methods: We retrospectively evaluated 194 BHS patients. Iron therapy was initiated in case of iron deficiency anemia or case of ferritin values under 12 ng/dl even if there was no anemia. The patients having no iron deficiency anemia, low ferritin and anoxic epileptic seizures were administered piracetam and the patients diagnosed with anoxic epileptic seizures were administered levetiracetam. Results: One hundred and eight patients (55.7%) were male. The mean age was 21.39±12.78 months. Iron therapy was initiated in 87 patients, piracetam to 96, and levetiracetam in 11 patients. Seizure numbers were manifestly decreased in all groups by the end of the first month after treatment concerning pretreatment levels (p<0.05). Conclusions: We determined that the spells were reduced or completely stopped in all groups. Levetiracetam seems to be considerably effective in patients developing anoxic epileptic seizures after BHS.
Diyastolik Disfonksiyon Tanısında Elektrokardiyografik Diyastolik Endeksinin Prognostik Rolü
(2023) Günlü, Serhat
Amaç: Sol ventrikülün diyastolik disfonksiyonu (LVDD), korunmuş ejeksiyon kalp yetmezliği olan bireylerde baskın etiyolojidir. Yüksek tansiyon miyokardda yapısal anormalliklere neden olur ve LVDD'nin seyrini hızlandırır. EKG özelliklerinden belirlenen elektrokardiyografik diyastolik indeks (EDI), sol ventrikül hipertrofisi ile LVDD'nin varlığı arasındaki bağlantı hakkında bilgi verebilir. Bu çalışmanın amacı, hipertansif bireylerde LVDD'yi tanımlamak için EDI göstergesini belirlemekti. Metod: Bu araştırmaya 2022 yılının Ocak ve Aralık ayları arasında sırayla 162 hipertansif hasta dahil edildi. Hastalar, LVDD'si olan ve olmayanlar olarak ayrıldı. [aVL R genliği (V1S genliği + V5R genliği)/PWLI genliği], EDI için formüllerdir. ROC eğrisi analizi kullanılarak, EDI'nin LVDD için öngörü değeri değerlendirildi. Tek değişkenli ve çok değişkenli lojistik regresyon analizi kullanılarak, LVDD'nin bağımsız faktörleri değerlendirildi. İki çok değişkenli model kullanıldı (model I: sürekli değişken olarak EDI ve kategorik değişken olarak model II). Sonuç: Hastalar LVDD olup olmamasına göre iki gruba ayrıldı (LVDD'si olmayan 85 hasta, grup 1; LVDD'si olan 77 hasta, grup 2). Araştırma örnekleminin ortalama yaşı 49±14 idi ve hastaların %42,6'sı erkekti. Çalışmaya katılanların EDI düzeyi 8,50±7,30 idi (Tablo 1). Tablo 1. Clinicalcharacteristics of the studypopulation PARAMETERS LVDD (-) n=85 LVDD (+) n=77 P-value Age (Years) 52.7±1.4 46.1±2.3 0.018 Gender, male, n(%) 28 (33.2) 40 (52.6) 0.009 Smoking, n (%) 36 (41.9) 39 (50.5) 0.305 Diabetesmellitus, n (%) 9 (10.5) 17 (22.7) 0.033 LVEDD, mm 46±4 46±3 0.124 LVESD, mm 28±3 29±2 0.057 IVST, mm 1.0±0.1 1.1±0.2 <0.001 LVEF, % 62±5 60±3.5 0.028 LA, mm 35±4 36±3 0.031 E/A ratio 1.4±0.3 0.9±0.5 <0.001 D1 P waveamplitude, mV 0.1±0.04 0.1±0.05 0.181 aVL R amplitude, mV 0.3±0.3 0.5±0.3 <0.001 V1S amplitude, mV 0.7±0.4 0.7±0.5 0.043 V5R amplitude, mV 1.0±0.5 1.1±0.7 0.093 V1S +V5R amplitude, mV 1.7±0.7 2.0±0.9 0.005 EDI 5.2±3.7 10.6±8.5 <0.001 LVEDD: Leftventricularend-diastolicdimension, LVESD: Leftventricularend-systolicdimension, IVST: Interventricularseptumthickness, LVEF: Leftventricularejectionfraction, LA: Leftatrial, EDI: ElectrocardiographicDiastolic Index. Grup 2'nin EDI puanı, grup 1'inkinden önemli ölçüde daha yüksekti (p <0.001). LVDD'yi tahmin etmek için EDI eğrisi altında kalan alan %0,752 olarak hesaplandı (%95 güven aralığı = 0,651-0,853; p<0,001) (Şekil 1). Şekil 1. ROC analysis of the EDI toestimatediastolicdysfunction EDI eşik değeri 7,4 mV'den büyük olduğunda, LVDD'yi %70'lik bir duyarlılık ve %69'luk bir özgüllükle tahmin eder. Tek değişkenli lojistik regresyon kullanılarak LVDD, EDI ile ilişkilendirildi [OR=1,248, %95 güven aralığı (CI)=1,159 - 1,345, p <0,001]. EDI'yi hem sürekli değişken hem de kategorik değişken olarak incelemek için iki farklı çok değişkenli regresyon modeli oluşturuldu. Her iki modelde de EDI'nin LVDD'nin erken bir göstergesi olduğu ortaya çıktı. Tartışma: Sol atriyal boyutlardaki değişikliklere tipik olarak septal veya arka sol ventrikül duvar kalınlığında bir artış eşlik eder ve bu da sonunda sol ventrikülün hipertrofisi veya yeniden şekillenmesi olarak kendini gösterir. Bu sonuçlar oldukça yaygın olduğundan ve hipertansif kalp hastalığı olan bireylerde artış gösterdiğinden, DD'li hastalarda görülen en yaygın anormalliklerden biridir. Birden fazla grup, DD'de sol ventrikül hipertrofisini ve anlamlı kardiyomiyosit hipertrofisinin histolojik kanıtları ve normalden daha büyük bir sol ventrikül kas kütlesi ile sistolik fonksiyonun korunduğu kalp yetmezliğini belgelemiştir. Arteriyel hipertansiyonu olan bireylerde, uzamış QRS ve QT/QTc aralığı gibi elektrokardiyografik karakteristiklerin genişlemiş bir sol ventrikül kas kütlesini düşündürdüğü bilinmektedir. Bu, DD ve QTc süresinin Doppler'den türetilen parametreleri arasında bir korelasyon olduğunu gösteren önceki çalışmalarla uyumludur. İkincisi ayrıca, uzun QT aralığı ile anormal mekanik fonksiyon arasındaki ilişkinin gözlemlendiği ve hayvan ve hücresel deneylerle desteklendiği kalıtsal uzun QT Sendromları kapsamındaki hastalar için literatürde kapsamlı bir şekilde tartışılmıştır. Patofizyolojik olarak, aksiyon potansiyeli süresinin uzaması, hücre içi kalsiyum birikimi yoluyla belirgin mekanik işlev bozukluğuna neden olabilir. Bununla birlikte, yukarıda belirtilen analizlerin tanısal performansının yanı sıra korelasyonu da, muhtemelen yalnızca bir elektrokardiyografik parametre kullanılarak belirli bir derecede basitleştirme nedeniyle oldukça mütevazıydı. Aslında, aynı grup tarafından daha yeni bir analizde önerildiği gibi, QTc uzamasına Ttepe – Eğilim aralığının uzaması neden olabilir. Önceki çalışmalardan farklılık büyük olasılıkla, ilkinde psödonormal ve/veya kısıtlayıcı dolum paterni olan hastaların daha büyük yüzdesi ile açıklanabilir, bu da daha ileri bir kardiyak hastalık aşamasını ve dolayısıyla daha belirgin repolarizasyon değişikliklerini düşündürür. Tedavi: EDI, ucuz olması, kolayca bulunabilmesi ve uygulanmasının basit olması nedeniyle hipertansiyon nedeniyle takip edilen bireylerde DD'yi tahmin etmek için önemli bir tarama modelidir.
Vatanından Uzakta Ölmek” Palyatif Bakım Kliniğinde Ölen 7 Suriye Uyruklu Hasta ve Ülkemizin Sığınmacıların Sağlık İhtiyaçlarını Karşılamadaki Rolü
(2022) Akelma, Hakan; Karahan, Mehmet Zülkif
Savaşlar, iç çatışmalar telafisi mümkün olmayan yıkımlara neden olup, en çok da sivilleri etkilemektedir. Yıkımın etkisi başta ikincil şahıslara ihtiyaç duyan çocuk, yaşlı ve kadınlar için daha belirgindir. Şu anda dünyadaki sığınmacıların yarısından fazlası Suriye’de hayatlarını kurtarmak için ülkelerinden ayrılmak zorunda kalan sığınmacılardan oluşmaktadır. Siyasal, sosyal, kültürel ve ekonomik açıdan toplumu ve bireyleri etkileyen yurdundan edilme durumu sağlık sorunlarını da beraberinde getirmektedir. Sığınmacılar zor yaşam koşulları, barınma, beslenme, şiddet ve psikolojik travmalar gibi birçok neden ile sağlık bakım sisteminde en kırılgan ve savunmasız gruplardandır. Kendi yaşam alanlarından zorunlu olarak ayrılan bireylerin yaşam konforlarının azalması ve yaşadıkları psikolojik yıkım, beraberinde bulaşıcı hastalıklar, kardiyovasküler hastalıklar, diyabet, kanser ve akciğer hastalıkları gibi kronik hastalıkların riskini artırmaktadır. Bu hastalıklara bağlı palyatif bakım ünitelerine yatışlar artmakta ve bu kliniklerde yaşam koşullarından daha iyi şartlarda sağlık hizmeti almakta ancak hastalıklarının şiddetine göre ölümler gerçekleşmektedir. Türkiye, sığınmacılara mümkün olan en iyi yaşam koşullarını ve kapsamlı insani yardımı sağlamaktadır. Sığınmacılar hem kamplarda hem de barındıkları iskânlarda tüm sağlık hizmetlerini sürdürmektedir. Bu sığınmacılar aynı şekilde gerekli durumlarda palyatif bakım hizmetlerinden faydalanmaktadır. Bu çalışmanın amacı palyatif bakım kliniklerde özellikle kanser, diyabet ve diğer kronik hastalıklar sonucu hayatını kaybeden sığınmacı hastaların değerlendirilmesi ve bunun yanında ülkemiz sağlık bakımındaki desteğini vurgulamaktır.
Relationship Between Atrial Fibrillation Recurrence and Frontal QRS-T Angle After Effective Cardioversion
(Cureus, 2023) Özen, Kaya; Karahan, Mehmet Zülkif
Objective: Maintaining sinus rhythm is important in the management of atrial fibrillation (AF). After cardioversion, there is a significant probability of AF recurrence. There is limited research on the relationship between AF recurrence and ECG parameters. This study aimed to evaluate whether the frontal plane QRS-T angle (fQRS-T), a predictor of ventricular heterogeneity, could be used to predict AF recurrence following cardioversion. Methods: The study was conducted as a retrospective observational study. Patients diagnosed with acuteonset AF for the first time were included in the study. All patients underwent an ECG after cardioversion, and ECG parameters were evaluated. The patients were separated into two groups based on the presence of AF recurrence during hospitalization after cardioversion. The relationship between the fQRS-T and AF recurrence was also examined. Results: A total of 162 patients, comprising 68 women (41.9%) and 94 men (58.1%) with an average age of 59.4±6.5 years, were enrolled in the research. Based on the patient monitoring device findings, patients were separated into two groups: non-recurrent AF (n=118) and recurrent AF (n=44). P-wave duration was significantly longer in the recurrence group (p=0.009). The recurrence group's mean fQRS-T was significantly higher (p<0.001). AF recurrence was substantially higher in patients with fQRS-T >90 ̊compared to those with fQRS-T ≤90 ̊(56.1% vs. 14.2%, p <0.001). Increased fQRS-T >93.7 ̊indicated AF recurrence with 78.3% sensitivity and 83.4% specificity (AUC {area under curve}:0.748, p < 0.001). In multivariate analysis, fQRS-T was revealed to be an early indicator of recurrent AF (OR: 1.882, 95%CI: 1.358-2.881, p<0.001). Conclusion: The fQRS-T, an easily determinable parameter from automatic identification ECG recordings, may be useful for predicting the early return of AF after successful cardioversion.
Transradial Approach in Coronary Angiography from Past to Present
(2023) Günlü, Serhat
The transradial approach is a novel method for coronary angiography and percutaneous coronary intervention. Its popularity has grown since its initial application and is now a common technique in many facilities. This is because the transradial approach is less invasive than the conventional approach, which requires catheter placement into the coronary arteries. Transradial access is safer than trans-femoral access because it results in fewer complications at the interventional site, requires a shorter hospital stay, enables the patient to be mobilized sooner, provides a higher degree of patient comfort, and carries a lower risk of significant bleeding events. This research examines the advantages of accessing coronary arteries through the radial artery, as well as the suggestions made by the guidelines and the challenges generated by the technique. All these issues were discussed in light of existing studies.
Citation - WoS: 7
Citation - Scopus: 10
Metabolic Syndrome in School Children in Mardin, South-Eastern of Turkey
(AVES Ibrahim Kara, 2014) Battaloğlu İnanç, Betül
Amaç: Okul çocukları popülasyonunda, metabolik sendrom (MES) prevelansının tespit edilmesi amaçlandı.Gereç ve Yöntem: Türkiye'nin güneydoğusundaki, Mardin şehir merkezinde, üç ilköğretim okulundaki, 7-15 yaşları arası, üç bin dört yüz altmış çocuk, Nisan-Mayıs 2011'de çalışmaya dahil edildi. Yaş, cins, boy, ağırlık, bel çevresi, kalça çevresi, bel/kalça oranı, sistolik ve diyas tolik kan basınçları ölçüldü ve kan testleri kaydedildi. MES tanısı için Uluslararası Diyabet Federasyonu (IDF) kriterleri kullanıldı.Bulgular: Çocukların %9,42'si fazla kilolu ve %8'i obezdi. Obezite kızlarda %9,1, erkekler de %6,9'du. Obezite prevelansı, kızlar arasında erkeklerden daha yüksek ve anlamlıydı (p<0.001). Vücut kitle indeksi (VKI) ve bel ve kalça çevresi, bel/kalça oranı, sistolik ve diyasto lik kan basıncı, trigliserid arasında pozitif korelasyon bulundu (p=0.0001). Total kolesterol, trigliserid, VKI, sistolik ve diyastolik kan basıncı obez MES'lu grupta, obez olmayanlardan anlamlı farklı idi (p<0.05). Kızların bel/kalça oranı referans değerleri, erkeklerinkinden anlamlı olarak daha yüksekti (p>0.05). MES prevelansı %6,3'tü. MES, kızlarda ve obezlerde daha yüksekti. Obez çocuklarda MES oranı %30,3'tü.Sonuç: Çocukluk döneminde obezite, hipertansiyon ve MES sıklığı her geçen gün artmakta dır. Santral obezite ve yüksek vücut kitle indeksine sahip olan çocuklar, MES için daha dikkat li değerlendirilmelidir. Ve toplumun yaşam kalitesi, yaşam tarzı değişiklikleri ile risklerin azaltılması yoluna gidilerek, gerekli tedavi ve takiplerle sağlanmalıdır.
Methemoglobinemia and acute ıntravascular hemolysis after naphthalene poisoning in a pediatric patient
(SciELO Argentina, 2023) Orhan, Özhan; Talay, Mehmet Nur
Poisoning by naphthalene is uncommon in children. It is a type of poisoning brought on by ingesting, inhaling, or coming into touch with naphthalene-containing substances on the skin. Patients typically present with an initial onset of dark brown urine, watery diarrhea, and bile vomit. The signs include fever, tachycardia, hypotension, and low pulse oximetry readings even with oxygen support. Hemolytic anemia, methemoglobinemia, renal failure, and hyperbilirubinemia are all detected in blood tests. Erythrocyte transfusion, ascorbic acid, methylene blue, and N-acetylcysteine (NAC) therapies are provided to inpatients in addition to symptomatic treatment. We present a 23-month-old male patient who developed methemoglobinemia and acute ıntravascular hemolysis, who was followed up in the intensive care unit for five days due to naphthalene intoxication. Although naphthalene poisoning is very rare, it should be known that it has fatal consequences, and more care should be taken in its use and sale
Evaluation of Frontal QRS-T Angle in Patients with Coronary Artery Ectasia
(Sociedade Brasileira de Cardiologia – SBC, 2023) Karahan, Mehmet Zülkif; Aktan, Adem; Güzel, Tuncay; Kayan, Fethullah; Günlü, Serhat
Background: Coronary artery ectasia (CAE) is defined by focal enlargement of the coronary artery exceeding 1.5 times the adjacent normal segment. CAE can often cause arrhythmias, heart failure, sudden death, and myocardial ischemia. Ischemia due to microvascular dysfunction may be responsible for the ventricular heterogeneity in CAE. Objectives: The aim of our study was to evaluate the frontal QRS-T angle in patients with CAE. Methods: Our study included 55 patients with CAE and 50 individuals in the control group. Demographic characteristics and electrocardiographic parameters were compared between the two groups. Categorical variables were compared using the chi-square test. Continuous variables were compared using unpaired Student’s t-test. P values < 0.05 were considered statistically significant. The frontal QRS-T angle was calculated from 12-lead electrocardiograms (ECGs) using the automatic report from the electrocardiography machine. Results: The average age of patients with CAE was 63.2 ± 3.4 years, with 18 women among them. The control group had an average age of 61.1 ± 3.2 years, with 28 women included. There was no significant difference in demographic parameters between the two groups. Compared to the control group, patients with CAE had significantly wider frontal QRS-T angle (p < 0.001), as well as longer QTmax duration, p = 0.002; Tp-Te interval, p = 0.02; and QT dispersion (QTd), p = 0.04. Conclusion: The frontal QRS-T angle can be calculated easily and time-efficiently using surface electrocardiography. In this study, we showed for the first time that the frontal QRS-T angle was significantly increased in patients with CAE.
Our Treatment Experience in Poisoning With Calcium Channel Blockers: a Series of Twelve Cases
(Briefland, 2024) Talay, Mehmet Nur; Orhan, Ozhan; Ozbek, Mehmet Nuri; Kangin, Murat; Turanli, Ese Eda
Background: Intoxications with cardiovascular system drugs constitute a small percentage of all poisoning cases. Calcium Channel Blockers (CCBs) are the most common drug poisoning in this group. Objectives: We aimed to evaluate the effectiveness of treatments for CCB poisoning and add to the current body of literature by outlining the clinical treatments we employ for bradyarrhythmia, hypotension, and resistant vasodilation resulting from CCB poisoning, as well as sharing our clinical insights in this field. Methods: Twelve patients, ranging in age from 1 month to 18 years, were admitted to the Tertiary Paediatric Intensive Care Unit (PICU) for treatment of medication poisoning related to the CCB group. Patients who ingested several drugs that caused CCB were not allowed to participate in the trial. Results: Twelve patients were followed up in the PICU due to poisoning with CCB group drugs. Of the patients, 7 were male and 5 were female. Five of the patients had taken CCB medication with the purpose of committing suicide, and 7 of them accidentally. All of the patients who received CCB to commit suicide had taken verapamil. Five patients whose hypotension and bradycardia continued were administered inotropes. In addition to PI, calcium gluconate, intravenous lipid, glucagon, insulin, bicarbonate, and methylene blue were given as therapy to our symptomatic patients. Plasmapheresis was applied to a patient who was hospitalized in the PICU due to a sudden loss of consciousness. Conclusions: In the management of patients with CCB poisoning, the use of hyperinsulinemia euglycemia, intravenous lipid emulsion treatment, glucagon treatments, and treatments including methylene blue and extracorporeal life support should be considered in cases of resistant hypotension, bradycardia, and coma in the early period.

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