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The unrestricted global effort to complete the COOL trial
(Kirkpatrick et al. World Journal of Emergency Surgery, 2023) Çolak, Elif
Background Severe complicated intra‑abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self‑perpetuating bio‑mediator generation, systemic inflammation, and multiple organ failure. A further therapeutic option may be open abdomen (OA) management with negative peritoneal pressure therapy (NPPT) to remove inflammatory ascites and attenuate the systemic damage from SCIAS, although there are definite risks of leaving the abdomen open whenever it might possibly be closed. This potential therapeutic paradigm is the rationale being assessed in the Closed Or Open after Laparotomy (COOL trial) (https:// clini caltr ials. gov/ ct2/ show/ NCT03 163095). Initially, the COOL trial received Industry sponsorship; however, this funding mandated the use of a specific trademarked and expensive NPPT device in half of the patients allocated to the intervention (open) arm. In August 2022, the 3 M/Acelity Corporation without consultation but within the terms of the contract canceled the financial support of the trial. Although creating financial difficulty, there is now no restriction on specific NPPT devices and removing a cost‑prohibitive intervention creates an opportunity to expand the COOL trial to a truly global basis. This document describes the evolution of the COOL trial, with a focus on future opportunities for global growth of the study. Methods The COOL trial is the largest prospective randomized controlled trial examining the random allocation of SCIAS patients intra‑operatively to either formal closure of the fascia or the use of the OA with an application of an NPPT dressing. Patients are eligible if they have free uncontained intraperitoneal contamination and physiologic derangements exemplified by septic shock OR severely adverse predicted clinical outcomes. The primary outcome is intended to definitively inform global practice by conclusively evaluating 90‑day survival. Initial recruitment has been lower than hoped but satisfactory, and the COOL steering committee and trial investigators intend with increased global support to continue enrollment until recruitment ensures a definitive answer. Discussion OA is mandated in many cases of SCIAS such as the risk of abdominal compartment syndrome associated with closure, or a planned second look as for example part of “damage control”; however, improved source control (locally and systemically) is the most uncertain indication for an OA. The COOL trial seeks to expand potential sites and proceed with the evaluation of NPPT agnostic to device, to properly examine the hypothesis that this treatment attenuates systemic damage and improves survival. This approach will not affect internal validity and should improve the external validity of any observed results of the intervention.
Global 30‑day morbidity and mortality of surgery for perforated peptic ulcer: GRACE study
(Surgical Endoscopy, 2024-04-28) Abouelazayem, Mohamed; Jain, Rajesh; Wilson, Michael S. J.; Martinino, Alessandro; Balasubaramaniam, Vignesh; Biffl, Walter; Coccolini, Federico; Riera, Manel; Wadhawan, Himanshu; Wazir, Ishaan; Abderaouf, Bettahar; Abramov, Daniil; Jayyab, Mustafa A. Abu; Al‑Shami, Khayry; Alfarwan, Ahmad; Alhajami, Faris M.; Alkaseek, Akram; Alozairi, Ous; Ammar, Ahmed Siddique; Atar, Burak; Baatarjav, Gan‑Erdene; Bains, Lovenish; Bakri, Ashraf; Bayramov, Nuru; Bhojwani, Rajesh; Brachini, Gioia; Calini, Giacomo; Campanelli, Michela; Cheng, Shi Yu; Choudhary, Charan Singh; Chowdhury, Sharfuddin; Çolak, Elif; Das, Jayanta Kumar; Dawani, Surrendar; Dönmez, Turgut; Elzayat, Ibrahim; Erdene, Sarnai; Faizi, Tashaba Qaiser; Frountzas, Maximos; Gafsi, Besma; Gentileschi, Paolo; Güler, Mert; Gupta, Gaurav; Harkati, Nour Elhouda; Harris, Matthew; Hasan, Doaa M.; Irowa, Omorodion Omoruyi; Jafferi, Salman; Jain, Sumita Agarwal; Han, Lai Jun; Kandiboyina, Satyanarayana Murthy; Karabulut, Mehmetu; Khamees, Almu’atasim; Khan, Shahzeb; Khan, Madiha Masood; Khaw, Cheng Jing; Kisielewski, Michal; Klib, Mohamad; Košir, Jurij A.; Krawczyk, Wiktor Jan; Lisi, Giorgio; Makama, Jerry Godfrey; Maqbool, Baila; Marques, Cláudia Neves; Meric, Serhat; Mietła, Mateusz Przemysław; Ads, Alaa Mohamed; Muhumuza, Joshua; Mulita, Francesk; Mustafayeva, Matanat; Omar, Mohammed A.; Omarov, Taryel; Pathak, Akshant Anil; Paul, Ratnadeep; Pavone, Giovanna; Podda, Mauro; Ram, Novinth Kumar Raja; Rauf, Fatima; Rauf, Sidra; Safy, Ahmed Mohamed; Sandag, Erdene; Şanlı, Ahmet Necati; Siddiqui, Adeela Z.; Sotiropoulou, Maria; Talib, Vikash; Tatar, Cihad; Thota, Anuroop; Tokocin, Merve; Tolat, Aditya; Uchikov, Petar Angelov; Valenzuela, José I.; Venkatappa, Sunil Kumar; Verras, Georgios‑Ioannis; Vlahović, Ivan; Zreeg, Dafer Abdulhakim S.; Cardoso, Victor Roth; Gkoutos, Georgios V.; Singhal, Rishi; Mahawar, Kamal; GRACE Study Collaborative Group
Background There is little international data on morbidity and mortality of surgery for perforated peptic ulcer (PPU). This study aimed to understand the global 30-day morbidity and mortality of patients undergoing surgery for PPU and to identify variables associated with these. Method We performed an international study of adults (≥ 18 years) who underwent surgery for PPU from 1st January 2022 to 30th June 2022. Patients who were treated conservatively or had an underlying gastric cancer were excluded. Patients were divided into subgroups according to age (≤ 50 and > 50 years) and time from onset of symptoms to hospital presentation (≤ 24 and > 24 h). Univariate and Multivariate analyses were carried out to identify factors associated with higher 30-day morbidity and mortality. Results 1874 patients from 159 centres across 52 countries were included. 78.3% (n = 1467) of the patients were males and the median (IQR) age was 49 years (25). Thirty-day morbidity and mortality were 48.5% (n = 910) and 9.3% (n = 174) respectively. Median (IQR) hospital stay was 7 (5) days. Open surgery was performed in 80% (n = 1505) of the cohort. Age > 50 years [(OR = 1.7, 95% CI 1.4–2), (OR = 4.7, 95% CI 3.1–7.6)], female gender [(OR = 1.8, 95% CI 1.4–2.3), (OR = 1.9, 95% CI 1.3–2.9)], shock on admission [(OR = 2.1, 95% CI 1.7–2.7), (OR = 4.8, 95% CI 3.2–7.1)], and acute kidney injury [(OR = 2.5, 95% CI 1.9–3.2), (OR = 3.9), 95% CI 2.7–5.6)] were associated with both 30-day morbidity and mortality. Delayed presentation was associated with 30-day morbidity [OR = 1.3, 95% CI 1.1–1.6], but not mortality. Conclusions This study showed that surgery for PPU was associated with high 30-day morbidity and mortality rate. Age, female gender, and signs of shock at presentation were associated with both 30-day morbidity and mortality.
Are surgeons going to be left holding the bag? Incisional hernia repair and intra-peritoneal non-absorbable mesh implant complications
(Journal of Clinical Medicine, 2024-01-31) Kirkpatrick, Andrew W.; Coccolini, Federico; Tolonen, Matti; Minor, Samual; Catena, Fausto; Celotti, Andrea; Gois, Emanuel; Perrone, Gennaro; Novelli, Giuseppe; Garulli, Gianluca; Ioannidis, Orestis; Sugrue, Michael; Simone, Belinda De; Tartaglia, Dario; Lampella, Hanna; Ferreira, Fernando; Ansaloni, Luca; Parry, Neil G.; Çolak, Elif; Podda, Mauro; Noceroni, Luigi; Vallicelli, Carlo; Rezende-Netos, Joao; Ball, Chad G.; McKee, Jessica; Moore, Ernest E.; Mather, Jack
Ventral incisional hernias are common indications for elective repair and frequently complicated by recurrence. Surgical meshes, which may be synthetic, bio-synthetic, or biological, decrease recurrence and, resultingly, their use has become standard. While most patients are greatly benefited, mesh represents a permanently implanted foreign body. Mesh may be implanted within the intra-peritoneal, preperitoneal, retrorectus, inlay, or onlay anatomic positions. Meshes may be associated with complications that may be early or late and range from minor to severe. Long-term complications with intra-peritoneal synthetic mesh(IPSM) in apposition to the viscera are particularly at risk for adhesions and potential entericfistula formation. The overall rate of such complications is difficult to appreciate due to poor long-term follow-up data, although it behooves surgeons to understand these risks as they are the ones who implant these devices. All surgeons need to be aware that meshes are commercial devices that are delivered into their operating room without scientific evidence of efficacy or even safety due to the unique regulatory practices that distinguish medical devices from medications. Thus, surgeons must continue to advocate for more stringent oversight and improved scientific evaluation to serve our patients properly and protect the patient–surgeon relationship as the only rationale long-term strategy to avoid ongoing complications.
Characteristics and surgical outcomes of patients with atraumatic splenic rupture
(Journal of International Medical Research, 2022-01-28) Çolak, Elif; Çiftçi, Ahmet Burak
Objective: Although rare, late-diagnosed atraumatic splenic rupture (ASR) may result in mortality. We investigated the occurrence of ASR cases at our centre over the previous six years. Methods: This was a retrospective, cross-sectional study that included all patients who underwent emergency splenectomy due to ASR between January 01, 2015, and January 01, 2021. Results: Of the 203 patients who underwent splenectomy, 15 met our criteria for ASR. Median age was 55 years (34–90), and 10 (67%) patients were male. Most common pre-existing diseases were diabetes mellitus (6, 40%) and heart valve disease (5, 33%). Ten (67%) patients had splenic rupture due to splenic infarction and abscess. There were two (13%) cases with diffuse large B cell lymphoma (DLBCL) and two (13%) cases with lung cancer and spleen metastasis. Median length of hospital stay was 6 days (2–24) and three (20%) patients died in hospital. Conclusions: Male sex, previous splenic infarctions, haematological malignancies, lung cancer spleen metastases, underlying cardiovascular disease and diabetes mellitus may increase the risk for ASR. Further prospective controlled studies are needed to confirm our results.
The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?
(De Simone et al. World Journal of Emergency Surgery, 2022) Çolak, Elif
Background: The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID‑19 pandemic. The aim of the ChoCO‑W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID‑19 disease with those who did not. Methods: Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1‑month followup. In October 2020, Delta variant of SARS CoV‑2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID‑19 were compared with those who did not. Results: A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID‑19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID‑19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001),WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID‑19 group. The COVID‑19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID‑19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID‑19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. Conclusions: The incidence of gangrenous cholecystitis is higher in COVID patients compared with non‑COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high‑grade Clavien‑Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non ‑COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands.
Acute biliary pancreatitis management during the coronavirus disease 2019 pandemic
(Healtcare, 2022-07-08) Çolak, Elif; Çiftçi, Ahmet Burak
Objective: We aimed to analyze and describe the management of acute biliary pancreatitis (ABP) during the coronavirus disease 2019 (COVID-19) pandemic. (2) Methods: This was a retrospective cohort study among patients with ABP during a control period (16 March 2019 to 15 March 2020; period 1) and a COVID-19 period (16 March 2020 to 15 March 2021; period 2). (3) Results: We included 89 patients with ABP, being 58 in period 1 and 31 in period 2. The mean patient age was 62.75 16.59 years, and 51 (57.3%) patients were women. The Quick Sequential Organ Failure Assessment score for sepsis and World Society of Emergency Surgery Sepsis Severity Score were significantly higher among patients in period 2. Twenty-two patients (37.9%) in period 1 and six (19.3%) in period 2 underwent cholecystectomy. There were no significant differences in surgical interventions between the two periods. The hospital mortality rate was 3.4 and 19.3% in period 1 and period 2, respectively. Mortality was significantly higher in period 2. Conclusion: During the COVID-19 pandemic, we observed a significant reduction in the number of patients with ABP but increased severity and mortality. Multicenter studies with more patients are needed to obtain additional evidence regarding ABP management during the COVID-19 pandemic.
Vaccination against SARS-COV-2 and mortality in hemodialysis patients: three is good
(Black Sea Journal of Health Science, 2023) Yavuz, Demet; Özen, Düriye Sıla Karagöz; Başbulut, Eşe; Bilgin, Melek; Demirağ, Mehmet Derya
This study has investigated the vaccination rates against SARS-CoV-2 infection, antibody response to vaccine types, and factors affecting mortality in maintenance hemodialysis patients.98 of 143 patients undergoing hemodialysis in our clinic had 3 doses of BNT162b2 (Pfizer-BioNTechh) or CoronaVac (Sinovac Life Sciences) vaccine. Of these 98 patients, blood samples were obtained from 52 patients who agreed to obtain serum samples before and after vaccination. The serum samples were analyzed using the Abbott SARS-CoV-2 immunoassay designed to detect IgG antibodies against the receptor-binding domain of the S1 subunit of the spike protein of SARS-CoV-2. The rate of vaccination with at least one dose of vaccine was 85.3%, and the frequency of SARS-CoV-2 infection was 58.7%. The patients whose antibody titer was obtained after the third dose of vaccine (n=52) were divided into two groups according to the last vaccine type, as BioNTechh group of 16 patients and the Sinovac group of 36 patients. Considering all 52 patients with 3 doses of vaccine, the median antibody level was 397.3 (min-max) (4.5-40000) before the third vaccine dose, while 1325.3 (minmax) (10.5-40000) after the third vaccine dose (P<0.001). In patients with the last vaccine dose of Sinovac (n=36), the median antibody titer was 168.2 (min-max) (4.5-40000) before the third vaccine dose, while 851.7 (min-max) (55.2-40.000) after the third vaccine dose (P<0.01). In patients with the last vaccine dose of BioNTechh, the median antibody titer was 2738.6 (min-max) (9.437723.4) before the third vaccine dose, while 37575.8 (min-max) (10.5-40000) after the third vaccine dose (P=0.002). The frequency of SARS-CoV-2 infection (P=0.001) and SARS-CoV-2 infection-related mortality rates were significantly lower in vaccinated patients than in unvaccinated patients (P<0.001). SARS-CoV-2 vaccine doses elicited a high seropositive response in patients receiving maintenance dialysis. Those who received the last (3rd) dose of vaccine with BNT162b2 had higher antibody levels than those with CoronaVac/Sinovac. In addition, regardless of the vaccine type, being vaccinated with any of them decreased the incidence of SARS CoV-2 infection and the mortality rate.
To determine LDL phenotypes using lipids, lipoproteins, apoproteins, and sdLDL through association rule mining
(J Clin Pract Res, 2023) Atak, Mehtap; Kıvrak, Mehmet; Nalkıran, Hatice Sevim; Uydu, Hüseyin Avni; Şatıroğlu, Ömer
Objective: The atherogenic lipoprotein phenotype is closely associated with the risk assessment of Coronary Artery Disease (CAD) and the monitoring of treatment processes. Particularly, high levels of small dense low-density lipoprotein (sdLDL) and low levels of large buoyant low-density lipoprotein (lbLDL) are critical in determining Pattern B. This study aims to determine the lipid phenotype using the Association Rule Mining (ARM) method, based on concentrations of lipids, lipoproteins, apoproteins, and sdLDL. Materials and Methods: This retrospective case-control study utilized analytical research methods. Numerical variables were expressed as mean, standard deviation, median, and min-max values. Statistically significant differences were observed between the low-density lipoprotein (LDL) size categories in terms of triglycerides (TG), LDL, high-density lipoprotein (HDL), apolipoprotein B (ApoB), apolipoprotein E (ApoE), sdLDL, and lbLDL distributions. ARM was employed to detect the lipoprotein phenotype. Results: Statistically significant differences were found between the LDL size categories in distributions of TG, LDL, HDL, ApoB, ApoE, sdLDL, and lbLDL (pTG <0.001, pLDL =0.03, pHDL <0.001, pApoB =0.016, pApoE =0.004, psdLDL <0.001, and plbLDL <0.001). The ARM method revealed that the probability of phenotype B is 100% for sdLDL values in the range of 15.5–109 and lbLDL values in the range of 0–31.5. Conclusion: This study introduces a contemporary approach for detecting lipoprotein phenotypes using ARM, further substantiating the strong correlation between atherogenic phenotypes and sdLDL.
The frequency of ANA-positivity and inflammatory markers in COVID-19
(Journal of European Internal Medicine Professionals, 2023) Duran, Tuğba Izci; Pamukçu, Melih; Kayhan, Sanem; Battal, İsmet; Demirağ, Mehmet Derya
Background: Immune system activation plays an important role inpathogenesis and mortality in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The inflammatory response during the disease is caused by the innate and adaptive immune systems. Anti nuclear antibody (ANA) positivity rate increases in SARS-CoV-2-positive patients due to adaptive immune system activation. This study aims to investigate the association between ANA-positivity rate and pulmonary symptoms,and inflammatory markers (C-reactive protein [CRP] and fibrinogen). Material and Methods: One hundred five consecutive patients with the diagnosis of COVID-19 were included in this cross-sectional study. Participants were divided into groups according to the ANA and pulmonary symptom status. Clinical (gender, age) and biochemical (hemogram, liver function tests, kidney function tests, D-Dimer, CRP, and fibrinogen) were compared between the groups and the impact of ANA positivity on pulmonary symptoms development was assessed. Results: Of the 105 patients, 60 of them had no pulmonary symptoms. The remaining 45 patients had at least one pulmonary symptom. ANA immunofluorescence assay (IFA) positivity rate was 19% (20/105 patients) in the study group. 60% of the ANA-positive patients were positive at 1/160, 30% at 1/320 and 10% at 1/1000 titer. ANA-IFA positivity rate was found higher among patients with pulmonary symptoms; however, the difference was not statistically significant (26.7% vs. 8/60 13.3%, respectively; p=.085). The CRP and fibrinogen levels were (6.9 vs. 3.4, p=.132, and 346.5 vs. 326, p=.183) among ANA positive and negative patients. Twelve (63.2%) patients with ANA-positivity had pulmonary symptoms, and 33 (39.3%) patients with ANA-negativity had pulmonary symptoms (p=0.058). Conclusions: Although there is no difference between patients with or without pulmonary symptoms, ANA, which may reflect the pathogenetic role of adaptive immune dysregulation, can often be detected in patients with Coronavirus disease 2019.
Investigation of the effect of SGLT-2 inhibitors on the triglyceride/glucose index in diabetic patients: a cross sectional study
(The European Research Journal, 2025) Özen, Düriye Sıla Karagöz; Kayabaş, Abdülcelil; Van, Rana İlhan; Demirağ, Mehmet Derya
Objectives: The aim of this study is to estimate the change in the Triglyceride Glucose Index (TyG index), in patients with type 2 Diabetes Mellitus who are using a sodium-glucose cotransporter-2 (SGLT2) inhibitor, and to evaluate the effect of these drugs on triglyceride glucose index. Methods: This is a cross-sectional study of 55 diabetic patients in our internal medicine clinic in Turkey. Triglyceride, glucose, and glycosylated hemoglobin (HbA1c) values were measured at the beginning of the treatment and the 3rd-month follow-up. The TyG index of the patients before starting SGLT-2 inhibitor treatment and at the end of 3 months of treatment was calculated by the researchers using the data in the hospital digital records. Results: The mean age of 55 patients (56.4% male) was 62.7±10.2 years. The number of patients using dapagliflozin 10 mg was 15 (27.3%) and the number of patients using empagliflozin was 41 (72.8%). It was determined that fasting plasma glucose, TyG index, and HbA1c values before starting SGLT-2 inhibitor treatment and in the 3rd month of treatment decreased significantly (P<0.001, P=0.002 and P<0.001, respectively). According to the correlation analysis results between TyG index and HbA1c, it was determined that the values both before treatment and in the 3rd month of treatment showed a correlation (r=0.516, P<0.001 and r=0.448, P=0.001, respectively). Conclusions: SGLT-2 inhibitor usage significantly reduces TyG index in diabetic patients, and new studies are needed to investigate the effect of these drugs on triglyceride index among pre-diabetic patients.
Evaluatıon of colorectal cancer screening awareness and compliance rates over the age of 40: single center data in Türkiye
(Black Sea Journal of Health Science, 2024) Özen, Düriye Sıla Karagöz; Ergin, Elif Dağıstan; Ergin, Ali Uğur; Demirağ, Mehmet Derya
The frequency of colorectal cancer is increasing under the age of 50, and new sights have emerged regarding the initiation of screening in the earlier age group. This study aims to measure the consciousness of patients over the age of 40 about colorectal cancer screening and to reveal the screening rates of individuals over the age of 50. 300 consecutive patients who applied to our center and were older than 40 years of age were included. The questionnaire was created based on current guidelines and literature knowledge by the investigators and done through face-to-face interviews. Patients over 50 years of age who did not undergo screening were analyzed by dividing them into groups according to their socio-demographic characteristics and colorectal cancer risk factors. While 64.7% of the participants stated that they knew about colorectal cancer screening, only 32.4% of the participants aged 50 and over had colorectal cancer screening. The vast majority of patients stated that they did not have enough knowledge about the subject. The rate of participants who stated that they were considering entering the cancer screening program after completing this questionnaire was 73.7%. Colorectal cancer screening rates of non-smokers, women, and married participants were higher than the other group (P=0.016, P=0.017, and P=0.033, respectively). This study shows low screening compliance of individuals over the age of 50. We think that it is important to encourage and inform all adults over the age of 40 about colorectal cancer screening for public health.
Acute kidney injury is associated with in-hospital mortality of patients with covid-19, but less common among variant b.1.1.7 positive sars-cov-2 infection
(Black Sea Journal of Health Science, 2023) Yavuz, Demet; Kadı, Nezaket; Özen, Düriye Sıla Karagöz; Bilgin, Melek; Demirağ, Mehmet Derya
The aim of this study is to compare the rates of acute kidney injury (AKI) occurence and mortality between hospitalized patients with SARS-CoV-2 infection variant B.1.1.7 positive and negative. 200 hospitalized patients with SARS-CoV-2 infection included in the study. The sociodemographic characteristics of the patients and the laboratory values were obtained retrospectively from the patient files and electronic records. 121 patients with variant B.1.1.7 positive SARS-CoV-2 (group I) and 79 patients with variant B.1.1.7 negative SARS-CoV-2 (group II) included in the study. Acute kidney injury developed at a higher rate in group II patients [15/79 (19%),] compared to group I patients [7/121 (5.8%)] (P=0.004). When 180 patients without chronic kidney disease included in the analysis, acute kidney injury developed in 7 (6.4%) of 110 variant-positive patients, while acute kidney injury developed in 13 (18.6%) of 70 variant-negative patients (P=0.011). It was shown that, AKI development was lower in variant positive patients compared to variant negative patients (OR: 0.32 and 95% CI: 0.12 – 0.88, P=0.027) and age was an independent risk factor for AKI (OR: 1.06 and 95% CI: 1.02 – 1.11, P=0.002). The development of AKI, presence of pre-dialysis chronic kidney disease and age were found to be independent risk factors for mortality [respectively (OR: 6.09 and 95% CI: 1.64 – 22.58, P=0.005), (OR: 5.37 and 95% CI: 1.38 – 20.93, P=0.016), (OR: 1.06 and 95% CI: 1.02 – 1.11, P=0.005)].
The hepatoprotective effects of camellia sinensis on cisplatin-induced acute liver injury
(Life, 2024) Yılmaz, Adnan; Dizman, Fatih; Akyıldız, Kerimali; Karakaş, Sibel Mataracı; Mercantepe, Tolga; Avni, Hüseyin; Tümkaya, Levent; Öztürk, Köksal
Acute liver injury is an increasing global health problem. It is a widespread side effect of cisplatin treatment in the clinic and can lead to liver failure if not treated promptly. Previous studies haverevealed that green tea can protect some organsfromtreatments. However, thepotential of white tea to prevent the negative effects of acute liver injury has not been addressed so far. The purpose of this study was to investigate the reduction in cisplatin-induced liver injury in rats receiving white tea. Female Sprague Dawley rats with similar weight were selected in this study. Twenty-four rats were divided into three groups of eight animals each and ad libitum nutrition was provided. The control and cisplatin groups were given tap water only, while the white tea + cisplatin group received white tea at a 0.5% weight/volume concentration for four weeks. At the end of the fourth week, the white tea + cisplatin group and the cisplatin group received a single dose of cisplatin (7 mg/kg) via the intraperitoneal route. Five days after that procedure, the rats were anesthetized. Liver tissues and blood samples were collected, which were used for biochemical and histopathological analyses. According to biochemical results, liver tissue MDA and GSH, serum ALT, and AST levels significantly increased in the cisplatin group compared to the control group. Compared with the cisplatin group, although MDA, AST, ALT, and GSH levels were lower in the white tea + cisplatin group, only GSH levels were statistically different. The examination of histopathological and immunohistochemical findings revealed apoptotic cells, vascular congestion, and sinusoidal dilatation in the cisplatin group compared to the control group. This adverse event decreased in the white tea + cisplatin group compared to the cisplatin group. In conclusion, white tea exhibits an ameliorating effect on cisplatin-induced liver injury.
The association of Sort1 expression with LDL subfraction and inflammation in patients with coronary artery disease
(Acta Cardiologica, 2024) Atak, Mehtap; Nalkıran, Hatice Sevim; Bostan, Mehmet; Uydu, Hüseyin Avni
Background: Controversial effect of sortilin on lipoprotein metabolism in the development of atherosclerosis reveals the need for more extensive research Objectives: The aim of this study was to investigate the association between Sort1 gene expression and lipids, lipoprotein subfractions, and inflammation in CAD. Methods: The study population included 162 subjects with CAD and 49 healthy individuals. The Sort1 gene expression level was determined by qRT-PCR using Human Sortilin TaqMan Gene Expression Assays. Lipoprotein subclasses were analysed by the Lipoprint system. Serum levels of apolipoprotein and CRP were measured by autoanalyzer. Results: Sort1 gene expression and atherogenic subfraction (SdLDL) levels were significantly higher (p<0.001) while atheroprotective subfraction (LbLDL) was lower in the subjects with CAD (p<0.050). Also, increased Sort1 gene expression levels were observed in those with higher CRP values. Conclusions: Our findings reveal that the high Sort1 gene expression has a prominent linear relationship with both the atherogenic LDL phenotype and proinflammation, thereby might contribute to the occurrence of CAD.
Propolis reduces inflammation and dyslipidemia caused by high-cholesterol diet in mice by lowering ADAM10/17 activities
(Nutrients, 2024) Yiğit, Ertuğrul; Değer, Orhan; Korkmaz, Katip; Yiğit, Merve Hüner; Uydu, Hüseyin Avni; Mercantepe, Tolga; Demir, Selim
Atherosclerosis is one of the most important causes of cardiovascular diseases. A disin tegrin and metalloprotease (ADAM)10 and ADAM17 have been identified as important regulators of inflammation in recent years. Our study investigated the effect of inhibiting these enzymes with selective inhibitor and propolis on atherosclerosis. In our study, C57BL/6J mice (n = 16) were used in the control and sham groups. In contrast, ApoE-/- mice (n = 48) were used in the case, water extract of propolis (WEP), ethanolic extract of propolis (EEP), GW280264X (GW-synthetic inhibitor), and solvent (DMSO and ethanol) groups. The control group was fed a control diet, and all other groups were fed a high-cholesterol diet for 16 weeks. WEP (400 mg/kg/day), EEP (200 mg/kg/day), and GW(100 µg/kg/day) were administered intraperitoneally for the last four weeks. Animals were sacrificed, and blood, liver, aortic arch, and aortic root tissues were collected. In serum, total cholesterol (TC), triglycerides (TGs), and glucose (Glu) were measured by enzymatic colorimetric method, while interleukin-1β (IL-1β), paraoxonase-1 (PON-1), and lipoprotein-associated phospholipaseA2 (Lp-PLA2) were measured by ELISA. Tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), myeloperoxidase (MPO), interleukin-6 (IL-6), interleukin-10 (IL-10), and interleukin-12 (IL-12) levels were measured in aortic arch by ELISA and ADAM10/17 activities were measured fluorometrically. In addition, aortic root and liver tissues were examined histopathologically and immunohistochemically (ADAM10 and sortilin primary antibody). In the WEP, EEP, and GW groups compared to the case group, TC, TG, TNF-α, IL-1β, IL-6, IL-12, PLA2, MPO, ADAM10/17 activities, plaque burden, lipid accumulation, ADAM10, and sortilin levels decreased, while IL-10 and PON-1 levels increased (p < 0.003). Our study results show that propolis can effectively reduce atherosclerosis-related inflammation and dyslipidemia through ADAM10/17 inhibition.
Long-term protective effects of lamotrigine in a rat ovarian ischemia-reperfusion model
(Tissue and Cell, 2024) Aktepe, Rıza; Üçüncü, Yılmaz; Tümkayaç, Levent; Mercantepe, Tolga; Topçu, Atilla; Uydu, Hüseyin Avni; Atake, Mehtap
Ovarium torsion is a gynecological emergency that is common in women of reproductive age and requires early diagnosis and intervention. In this study, we aimed to investigate the long-term anatomical, histological and biochemical protective effects of lamotrigine in ovariums in the ischemia – reperfusion (I–R) model created experimentally in rats. A total of 40 female Sprague-Dawley rats, 14 weeks old, weighing 220–270 g were used in the study. The subjects were randomly distributed to form 4 groups named SHAM group, I - R group, I - R + Lamotrigine (LTG) group and R +LTG group. Under general anesthesia, the ovaries of the rats were reached and ischemia was created for 3 h with vascular clamps. 20 mg / kg LTG was administered intraperitoneally (ip.) to group 3 30 min before ischemia and to group 4 30 min before reperfusion. At the third hour of ischemia, the vascular clamps were opened and the abdomen of the rats was closed according to the surgical procedure. The rats were followed up for 28 days postoperatively and the ovarium tissues taken on the 28th day were examined anatomically and histologically. Biochemically, estradiol (E2), follicle stimulating hormone (FSH) and antimullerian hormone (AMH) levels were measured from blood samples taken from their hearts. Granulosa cells with diffuse vaculations were observed in degenerative follicles in group I-R. Again in this group, severe hemorrhage, fibrosis and edematous areas were observed in the ovarium stroma (Ovarian Histopathological Scoring (OHS): 7). In the I - R +LTG group, OHS was statistically significantly lower than the I - R group (OHS: 2; p < 0.000). In the R +LTG group, although the OHS score was calculated to be lower than the I - R group, there was no statistically significant difference (OHS: 6; p >0.05). The protective effect of LTG against experimentally created ischemia and reperfusion damage was determined anatomically and histologically. No protective effect of LTG was observed in terms of FSH, E2 and AMH values measured from the blood sera of rats. These findings may provide a basis for future studies using LTG to treat ovarian ischemia-reperfusion injury.
White tea reduces dyslipidemia, inflammation, and oxidative stress in the aortic arch in a model of atherosclerosis induced by atherogenic diet in apoE knockout mice
(Pharmaceuticals, 2024) Yiğit, Merve Hüner; Atak, Mehtap; Yiğit, Ertuğrul; Suzan, Zehra Topal; Kıvrak, Mehmet; Uydu, Hüseyin Avni
Objective: In this study, we aimed to evaluate the potential effects of white tea (WT) in the atherosclerosis process characterized by oxidative stress, inflammation, and dyslipidemia. Methods: In our study, apolipoprotein E knockout (ApoE−/−) mice (RRID: IMSR_JAX:002052) and C57BL/6J mice (RRID: IMSR_JAX:000664) were used. In the atherosclerosis model induced by an atherogenic diet (AD), WT was administered via oral gavage at two different concentrations. The animals were sacrificed by decapitation under anesthesia, and their serum and aortic tissues were collected. Total cholesterol (TC), triglyceride (TG), interleukin (IL)-1β, IL-6, IL-10, IL-12, tumor necrosis factor-α (TNF-α), interferon-γ, myeloperoxidase, paraoxonase-1, lipoprotein-associated phospholipase A2, oxidized low-density lipoprotein (Ox-LDL), lectin-like oxidized LDL receptor (LOX-1), a disintegrin, and metalloprotease (ADAM) 10 and 17 activities were determined via colorimetric, enzyme-linked immunoassay, and fluorometric methods. Results: WT supplementation decreased serum Ox-LDL, LOX-1, TC,andTGlevelsbyapproximately50%. TNF-andIL-6levelswerereducedbyapproximately 30% in the aortic arch. In addition, ADAM10/17 enzyme activities were found to be reduced by approximately 25%. However, no change in the AD-induced fibrotic cap structure was observed in the aortic root. Conclusions: The findings indicate that white tea effectively reduced oxidative stress, inflammation, and dyslipidemia in atherosclerosis but does not affect atheroma plaque morphology.
Komplike üriner sistem enfeksiyonuyla takip edilen hastaların değerlendirilmesi: tek merkez deneyimi
(Journal of Immunology and Clinical Microbiology, 2024) Özkan, Bahar Büşra; Günal, Özgür; Demirağ, Mehmet Derya; Sözen, Selda; Kılıç, Süleyman Sırrı
Giriş: Üriner sistem enfeksiyonu (ÜSE) en sık karşılaşılan ve en çok antibiyotik kullanılan enfeksiyon hastalıklarından birisidir ve tedavisinde geniş spektrumlu antibiyotik kullanılması antibiyotik direnç oranlarının hızla artmasına sebep olmaktadır. Bu çalışmada kliniğimizde yatarak tedavi edilen komplike ÜSE olan hastalarımızda saptanan etkenleri ve bu etkenlerin antibiyotik direnç profilini ortaya koymayı hedefledik. Yöntem: Çalışmamızda bir yıllık süre içerisinde kliniğimizde komplike ÜSE tanısıyla yatarak tedavi edilen hastalar retrospektif olarak değerlendirildi. Bulgular: Çalışmaya 69’u (%44,8) erkek, 85’i (%55,2) kadın 154 hasta dahil edildi ve ortalama yaş 68,9 ± 15,3 yıl idi. Hastalarımızda ek hastalık olarak en sık; esansiyel hipertansiyon (n:87,%56,5), tip 2 diabetes mellitus (n:74,% 48,1), ve serebrovasküler hastalık/ koroner arter hastalığı (n:49,% 31,8) bulunmaktaydı. ÜSE etkeni olarak ise en sık; Escherichia coli (E.coli) (% 46,1) , Klebsiella spp (% 14,9) ve Candida spp (%7,1) saptandı. E.coli’lerin %42,6’sı genişlemiş spektrumlu beta-laktamaz (GSBL)üretirken, Klebsiella spp’lerin %13’ünün GSBL ürettiği belirlendi. Siprofloksasinin direnç sıklığının GSBL pozitiflerde GSBL negatif bakterilere göre istatistiksel olarak anlamlı düzeyde yüksek olduğu (%84,8/%35,9, p<0,001) saptandı. Özellikle alternatif tedavi seçeneği olabilecek trimetoprim/sülfametoksazol (%56,7 / %36,2), amikasin (%37 / %19) ve fosfomisine (%13,3 / %28,1) ait direnç oranları yüksek düzeylerde saptanmakla birlikte GSBL pozitif ve negatif olan bakterilerde benzer oldukları gözlendi. Sonuç: Antibiyotik direnç oranları arttıkça enfeksiyonların hem tedavisi zorlaşmakta hem de maliyeti artmaktadır. Bu nedenle ÜSE tedavisi için lokal ve ulusal sürveyans verilerine dayanarak uygun antibiyotiğin uygun doz ve sürede verilmesine özen gösterilmelidir. Aim: Urinary tract infection (UTI) is one of the most common infectious diseases and broad-spectrum antibiotics are commonly used for its treatment. Increased use of these antibiotics is leading to a rapid increase in antibiotic resistance rates in the treatment of UTIs. In this study, we aimed to determine the causative agents and antibiotic resistance profile of these agents in patients with complicated urinary tract infections treated as inpatients in our clinic. Methods: In the present study, we retrospectively evaluated the inpatients with complicated urinary tract infections in our clinic within a one-year period. Results: The study included 154 patients (69 (44.8%) were male, 85 (55.2%) were female) with a mean age of 68.9 ± 15.3 years. The most common comorbidities were essential hypertension (n:87, 56.5%), type 2 diabetes mellitus (n:74, 48.1%), and cerebrovascular disease/coronary artery disease (n:49, 31.8%). The most common UTI agents were E.coli (46.1%), Klebsiella spp (14.9%), and Candida spp (7.1%). While 42.6% of these E.coli produced extended spectrum beta-lactamase (ESBL), 13% of Klebsiella spp produced ESBL. The frequency of ciprofloxacin resistance was statistically significantly higher in ESBL-positive bacteria compared to ESBL-negative bacteria (84.8%/35.9%, p<0.001). Resistance rates to trimethoprim/ sulfamethoxazole (56.7% / 36.2%), amikacin(37% / 19%), and fosfomycin (13.3% / 28.1%), which may be alternative treatment options, were found to be at high levels, yet they were similar in ESBL-positive and negative bacteria. Conclusion: Increasing rates of antibiotic resistance make the treatment of infections more difficult and costly. Therefore, appropriate antibiotics should be administered at the optimum dose and duration based on local and national surveillance data for the treatment of UTIs.
Three years’ interventional neurology experience in Turkey with the Thrombite thrombectomy device in large vessel occlusion in the anterior circulation: safety, efficacy, and clinical outcome
(Frontiers in Neurology, 2024) Akpınar, Çetin Kürşad; Gürkaş, Erdem; Özdemir, Atilla Özcan; Doğan, Hasan; Önalan, Ayşenur; Yıldırım, Serhan; Memiş, Zülfikar; Aytaç, Emrah; Acar, Bilgehan Atılgan; Öğün, Muhammed Nur; Aykaç, Özlem; Kocabaş, Zehra Uysal; Acar, Türkan; Eryılmaz, Halil Alper; Topaktaş, Berkhan
Introduction: While the Thrombite device differs from the Solitare stent with its Helical open-side structure feature, it shows great similarity with its other features. We assessed the Thrombite device’s effectiveness and safety in this study. Materials and methods: The study was a retrospective analysis of patients who were included in the Turkish Interventional Neurology database and who had mechanical thrombectomy with the Thrombite device as the first choice between January 2020 and January 2023. The type of study is descriptive research. Result: Using the Thrombite thrombectomy device, 525 patients received treatment. The median baseline National Institutes of Health Stroke Scale (NIHSS) score was 13, the median initial Alberta Stroke Program Early Computed Tomography (ASPECT) score was 8, and the mean patient age was 68.6+11.7 years. Between the groin puncture and the successful recanalization, the median time was 34 minutes (interquartile range [IQR]: 15–45). 48.2% (modified treatment in cerebral infarction; mTICI) 2b/3% and 33.9% (mTICI 2c/3) were the first-pass recanalization rates. In the end, 87.7% of patients had effective recanalization (thrombolysis in cerebral infarction 2b/3). In the “first-pass” subgroup, the favorable functional result (modified Rankin Scale 0–2) was 51.8%, while it was 41.6% for the entire patient population. The rate of embolization into new territory/different territory were 2.1/0.1%. 23 patients (4.5%) had symptomatic hemorrhage. Conclusion: The Thrombite device showed a good safety profile and high overall successful recanalization rates in our experience.
Assessment of the burden of care and burnout level in caregivers of dementia patients in a home care setting
(Euras J Fam Med, 2022) Yurt, Nur Şimşek; Yavuz, Erdinç
Aim: This study aims to evaluate the factors affecting the care burden and burnout levels of caregivers with dementia patients receiving home care services. Methods: This descriptive study was conducted in Samsun Training and Research Hospital Home Care Services which paid a visit at home between March 20 and June 20, 2021. The caregivers of the patients who were followed up by the diagnosis of dementia were included in the study after having agreed to participate in the study with their written informed consents. The 'Socio-demographic Data Form', 'Zarit Burden Interview' and 'Maslach Burnout Inventory’ were administered to caregivers during face-to-face interviews. Results: A total of 157 caregivers were included in our study, of which 70.1% (n=110) were women. 68.2% (n=107) were in the 40-64 years age group. The mean Zarit Burden Interview score was calculated as 47.10±16.14 (min=21, max=85). 76.4% of caregivers had moderate to severe escalated care burden. Once the impact of the increase in caregiver burden score on Maslach Burnout Inventory subgroups was examined, the relationship was found to be positively significant with emotional exhaustion and depersonalization, and negatively significant with personal achievement. Conclusion: As the burden of care increases, the level of burnout of individuals increases. Female gender, illiteracy, lack of income, duration of care given which is prolonged for more than one year, and daily care duration exceeding 12 hours were determined as outstanding factors that increase the care burden and level of burnout.

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