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Öğe Potent Ameliorative Effects of Rosmarinic Acid on Tramadol-Induced Neurotoxicity in the Brain and Hippocampus; by Suppressing Oxidative stress, Apoptosis, ER stress, and Regulating Cognitive Functions(Springer, 2025) Karaca, Onur; Şimşek, Hasan; Akaras, Nurhan; Gür, Cihan; İleritürk, Mustafa; Kandemir, Özge; Küçükler, Sefa; Karaca, Şeyda Öte; Kandemir, Fatih MehmetTramadol (TRM) is a synthetic opioid analgesic that acts on the central nervous system and is used to treat moderate or severe pain. However, the incidence of its abuse is increasing. Rosmarinic acid (RA) is a natural flavonoid known for its antioxidant, anti-inflammatory, and neuroprotective properties. In this study, we determined the ameliorative effects of RA against TRM-induced neurotoxicity. Thirty five rats were divided into 5 groups; control, RA, TRM, TRM + RA25 and TRM + RA50. TRM 50 mg/kg was administered intraperitoneally, and RA 25 and 50 mg/kg doses were administered by oral gavage for 14 days. Water Maze Test (WMT) was performed to assess cognitive function. Oxidative stress, inflammation, endoplasmic reticulum (ER) stress, apoptosis damage pathways, glial fibrillary acidic protein (GFAP), and brain-derived neurotrophic factor (BDNF) activities were determined in brain and hippocampus tissues. The structural and functional integrity of the tissues were also analyzed. RA decreased TRM-induced increased oxidative stress, inflammation, ER stress, and apoptotic damage levels. In addition, it improved neuronal survival and activity by bringing BDNF and GFAP activities closer to normal in brain tissue. RA restored the structural properties of brain and hippocampus tissues disrupted by tramadol. These findings were also demonstrated using WMT, which improved the arrival time to the quadrant in which the platform was located and the time spent in the quadrant. RA reduces TRM-induced neurotoxicity by reducing inflammation, oxidative stress, ER stress, and apoptotic damage and increases neuronal survival and activity.Öğe Hesperidin ameliorates vancomycin-induced kidney injury via multipathway modulation: Nrf-2/HO-1, Caspase-3/Bax/Bcl-2, ATF-4, KIM-1 and improved renal tissue function(Elsevier Inc., 2025) Gencer, Selman; Şimşek, Hasan; Akaras, Nurhan; Gür, Cihan; İleritürk, Mustafa; Kandemir, Özge; Küçükler, Sefa; Kankılıç, Nazım Abdülkadir; Kandemir, Fatih MehmetVancomycin (VCM) is a therapeutic agent used to treat drug-resistant gram-positive bacteria. However, its high-dose use is associated with nephrotoxicity, limiting its clinical application. Hesperidin (HES), a flavonoid naturally found in citrus fruits, exhibits various biological and pharmacological activities, including anti-inflammatory, antioxidant, and anticancer effects. While HES has been shown to exert protective effects in several organ systems, its potential role in preventing VCM-induced nephrotoxicity remains unclear. This study investigates whether HES can mitigate VCM-induced renal damage through its antioxidant and anti-inflammatory properties. VCM was administered intraperitoneally at a dose of 200 mg/kg for seven days. HES (100 mg/kg and 200 mg/kg) was administered orally for seven days. Biochemical, and molecular methods were used to investigate indicators of oxidative stress, ER stress damage, apoptotic and autophagic death in kidney tissue. Additionally, histological methods were used to determine the structural and functional characteristics of kidney tissue. HES treatment alleviated VCM-induced oxidative stress by increasing antioxidants (SOD, CAT, GPx, GSH) and reducing increased MDA levels, a marker of lipid peroxidation. In addition, HES increased antioxidant activity by activating the Nrf2 signaling pathway. VCM-induced increases in apoptotic Bax, Caspase-3, and P53 were reduced by HES, while the decreased level of antiapoptotic Bcl-2 was increased. HES reduced VCM-induced ER stress damage by reducing the levels of ATF-4, ATF-6, eIF2-α, and CHOP. HES treatment attempted to preserve kidney function and structural integrity. Overall, HES was effective in reducing VCM-induced nephrotoxicity damage and may be an effective treatment option.Öğe Protective Effects of Baicalein and Bergenin Against Gentamicin-Induced Hepatic and Renal Injuries in Rats: An Immunohistochemical and Biochemical Study(John Wiley and Sons Inc, 2025) Ekinci Akdemir, Fazile Nur; Yıldırım, Serkan; Kandemir, Fatih Mehmet; Küçükler, Sefa; Eraslan, Ersen; Güler, Mustafa CanDrug-induced organ toxicity is a significant health concern, with gentamicin known for its effective antibacterial properties but also severe side effects, particularly cytotoxicity in liver and kidney tissues. This current study observed the preventive role of baicalein and bergenin against hepatic and renal injuries caused by gentamicin in rats. Methods: Thirty-two male Sprague Dawley rats were divided into four groups, namely, control, gentamicin (gentamicin 80 mg/kg/day), baicalein (gentamicin 80 mg/kg/day + baicalein 100 mg/kg/day) and bergenin (gentamicin 80 mg/kg/day + bergenin 100 mg/kg/day). Hepatotoxicity and nephrotoxicity were induced by giving gentamicin (80 mg/kg/day). We evaluated the biochemical markers, including alkaline phosphatase (ALP), urea, alanine transaminase (ALT), creatinine and aspartate transaminase (AST) levels, antioxidant enzymes, oxidative stress parameters and histopathological and immunohistochemical changes. Results: Gentamicin increased oxidative stress parameters and decreased antioxidant activity. The treatment with baicalein and bergenin significantly restored these markers. Conclusions: Baicalein and bergenin significantly mitigated gentamicin-induced hepatic and renal toxicity by restoring biochemical markers, reducing oxidative stress and enhancing antioxidant enzyme activity. Histopathological and immunohistochemical analyses confirmed the protective effects of both compounds against organ damage. No statistically significant differences were observed between the two drugs for these parameters. These results suggest their potential as therapeutic agents to prevent gentamicin-induced organ toxicity.Öğe A Comparative Assessment of Large Language Models in Pediatric Dialysis: Reliability, Quality and Readability(John Wiley and Sons Inc, 2025) Ensari, Esra; Akyol Önder, Esra Nagehan; Ertan, PelinThis study evaluated the reliability, quality, and readability of ChatGPT (OpenAI, San Francisco, CA), Gemini (Google, Mountain View, CA), and Copilot (Microsoft Corp., Washington, DC) which are among the most widely used large language models (LLMs) today in answering frequently asked questions (FAQs) related to pediatric dialysis. Methods: A total of 45 FAQs were entered into LLM. The Modified DISCERN (mDISCERN) scale assessed reliability; the Global Quality Score (GQS) evaluated quality; and readability was assessed using five metrics: Coleman-Liau Index (CLI), Simple Measure of Gobbledygook (SMOG), Gunning Fog Index (GFI), Flesch Reading Ease (FRE) and Flesch–Kincaid Grade Level (FKGL). Questions were directed to the chat robots twice, on January 25, 2025, and February 1, 2025. Results: All three chatbots displayed high reliability, achieving median mDISCERN scores of 5. Quality scores on the GQS were similarly high, with median scores of 5 across platforms; however, Gemini exhibited greater variability (range 1–5) compared to ChatGPT-4o and Copilot (ranges 3–5). Readability scores revealed that chatbot responses were written at an advanced level. Conclusion: This study found that LLMs responses to dialysis FAQs were reliable and high quality, but difficult to read; improving readability through expert-reviewed content could increase their impact on public health.Öğe Hepatoprotective Effects of Royal Jelly Against Vincristine-Induced Hepatotoxicity in Rats: A Biochemical and Molecular Study(Multidisciplinary Digital Publishing Institute (MDPI), 2025) Erzincan, Rahime; Çağlayan, Cüneyt; Kandemir, Fatih Mehmet; İzol, Ebubekir; Gür, Cihan; İleritürk, MustafaVincristine (VCR) is a chemotherapeutic agent classified as a vinca alkaloid. Royal jelly (RJ) is a significant bee product produced by worker bees, characterized by its high protein content. This study aims to investigate the protective effects of RJ against VCR-induced liver damage. VCR was intraperitoneally administered at a dose of 0.1 mg/kg body weight (b.w.) and RJ was orally administered at doses of 150 and 300 mg/kg b.w. Both treatments were applied to the rats on days 1–6 and 9–14. The composition of RJ was analyzed using LC-MS/MS, revealing the presence of 15 different phytochemical compounds with strong antioxidant properties. Serum samples obtained from the rats were analyzed for ALT, ALP, and AST levels. While these enzyme levels were significantly elevated in the VCR group, a notable reduction was observed following RJ administration. Additionally, SOD, CAT, GPx, and GSH antioxidant parameters, along with MDA levels, were evaluated in liver tissue samples. The results indicated a decrease in SOD, CAT, GPx, and GSH activities/levels and an increase in MDA levels in the VCR group. Furthermore, ELISA was used to assess JAK2, STAT3, and mTOR/PI3K/AKT signaling pathways. VCR administration led to a decrease in mTOR/PI3K/AKT levels and an increase in JAK2 and STAT3 levels. In addition, the mRNA transcription levels of inflammation (NF-κB, TNF-α, and IL-1β), endoplasmic reticulum (ER) stress (IRE-1, GRP78, PERK, and ATF-6), and autophagy markers (LC3A and LC3B) were examined. A significant increase in inflammation, ER stress, and autophagy-related markers was observed in the VCR-treated group. Lastly, the protein expression levels of Bax, Bcl-2, Caspase-3, and NF-κB were evaluated. VCR treatment increased Bax, Caspase 3, and NF-κB levels, whereas Bcl-2 levels were decreased. However, following RJ administration, all these parameters were reversed, demonstrating significant improvements. In conclusion, these findings suggest that RJ may exert a protective effect against VCR-induced liver damage.Öğe Therapeutic potential of rosmarinic acid in tramadol-induced hepatorenal toxicity: Modulation of oxidative stress, inflammation, RAGE/NLRP3, ER stress, apoptosis, and tissue functions parameters(Elsevier Ltd, 2025) Karaca, Onur; Akaras, Nurhan; Şimşek, Hasan; İleritürk, Mustafa; Küçükler, Sefa; Gencer, Selman; Kandemir, Fatih MehmetTramadol (TRM), a widely used opioid analgesic for moderate to severe pain, is associated with liver and kidney toxicity at high doses or prolonged use. This study investigates the protective role of rosmarinic acid (RA), a natural phenolic compound known for its antioxidant, anti-inflammatory, and cell-protective properties, against TRM-induced hepatorenal toxicity. Methods: Thirty-five male Wistar rats were divided into five groups: Control, TRM, RA, TRM + RA25, and TRM + RA50. Rats received TRM (50 mg/kg) and RA (25 or 50 mg/kg), with liver and kidney function tests, oxidative stress, inflammation, ER stress, apoptosis, and tissue damage indicators assessed through qRT-PCR, ELISA, Western blotting, H&E, and immunohistochemical analysis. Results: TRM induced liver and kidney dysfunctions, evident from increased ALT, AST, ALP, urea, creatinine, nephrin, TIM-1 and 8-OHdG levels, along with activated oxidative stress, inflammation, ER stress, and apoptosis pathways. RA significantly reduced these effects, ameliorating histologic and immunohistochemical markers of tissue damage and inflammation. Conclusion: RA demonstrates therapeutic potential by mitigating TRM-induced hepatorenal toxicity and preserving tissue integrity.Öğe Ameliorative effect of morin on diclofenac-induced testicular toxicity in rats: An investigation into different signal pathways(Mashhad University of Medical Sciences, 2025) Şimşek, Hasan; Akaras, Nurhan; Gür, Cihan; Küçükler, Sefa; İleritürk, Mustafa; Kandemir, Fatih MehmetDiclofenac (Diclo) is a therapeutic agent used in the treatment of pain and inflammatory diseases, but it is also toxic to the human body. Morin is a flavonoid found naturally in plants and has many biological and pharmacological activities, including anti-inflammatory, anti-oxidant, and anticancer activities. This study aimed to investigate the efficacy of Morin in Diclo-induced testicular toxicity. Materials and Methods: Morin (50 mg/kg and 100 mg/kg) was administered orally for five days, while Diclo was administered intraperitoneally at 50 mg/kg on days 4 and 5. Biochemical, molecular, and histological methods were used to investigate oxidative stress, inflammation, apoptosis, and endoplasmic reticulum (ER) stress damage indicators in testicular tissue. Results: Morin treatment attenuated Diclo-induced oxidative stress damage by increasing anti-oxidant levels (SOD, CAT, GPx, GSH, Nrf-2, HO-1, and NQO1) and decreasing MDA levels, an indicator of lipid peroxidation. Morin reduced levels of the inflammatory mediators NF-κB protein. Increases in apoptotic Bax and Caspase-3 by Diclo were reduced by Morin, while decreased antiapoptotic Bcl-2 level was increased. Morin reduced Diclo-induced ER stress injury by decreasing ATF-6, PERK, IRE1, GRP-78, and CHOP levels. Also, Diclo decreased COX-2 levels. Conclusion: Overall, Morin may be an effective treatment of choice for testicular tissue damage associated with Diclo toxicity and may reduce the level of damage.Öğe The Protective Effects of Chrysin on Acrylamide-Induced Hepatotoxicity: Insights Into Oxidative Stress, Inflammation, Apoptosis, Autophagy, and Histological Evaluation in Rats(John Wiley and Sons Inc, 2025) Gencer, Selman; Akaras, Nurhan; Şimşek, Hasan; Gür, Cihan; İleritürk, Mustafa; Küçükler, Sefa; Kandemir, Fatih MehmetAcrylamide (ACR) is a toxic chemical with a high carcinogenic risk that is released as a result of heating or processing foods at high temperatures. Chrysin (CHR) is a flavonoid that is naturally found in foods such as honey and passionflower and stands out with its antioxidant, anticancer, and anti-inflammatory properties. This study aims to determine the protective effects of CHR in ACR-induced hepatotoxicity. ACR was administered orally at a dose of 38.27 mg/kg; CHR (25 or 50 mg/kg) was administered orally for ten days. Biochemical and molecular methods were used to investigate oxidative stress, inflammation, and apoptotic markers in liver tissue. Additionally, histological methods were used to determine the liver tissue's structural and functional characteristics and autophagy. CHR treatment alleviated ACR-induced oxidative stress by increasing antioxidants (SOD, CAT, GPx, GSH) and reducing increased oxidant MDA. CHR reduced inflammatory activity by inactivating NF-κB and pro-inflammatory cytokines. ACR-induced increases in apoptotic Casp-3, Casp-6, Casp-9, and Bax were reduced by CHR, while the decreased level of antiapoptotic Bcl-2 was increased. It was also determined immunohistochemically that CHR inhibited autophagic Beclin-1 activity. CHR was effective in reducing ACR-induced hepatotoxicity damage and may be an effective treatment option.Öğe Investigation of the effects of morin on potassium bromate-induced brain damage in rats via different pathways with biochemical and histopathological methods(Elsevier Ltd, 2025) Aygörmez, Serpil; Küçükler, Sefa; Gür, Cihan; Akaras, Nurhan; Maraşlı, Şaban; Kandemir, Fatih MehmetAim: Potassium bromate (KBrO3) is a colorless, odorless substance used as a food additive. It causes multiple organ damage and neurotoxicity. Morin is a flavonoid from the Moraceae family known to have anti-inflammatory, antioxidant, antiapoptotic, antiautophagic, and neuroprotective properties. Therefore, this study aimed to investigate the effects of Morin against KBrO3-induced brain damage. Methods: 62 mg/kg KBrO3 and 50–100 mg/kg Morin were administered to 35 male rats by oral gavage daily for 14 days. Various analyses were performed using molecular, biochemical, and histological methods. Results: The analyses results showed that KBrO3 application decreased antioxidant markers and raised lipid peroxidation in the brain tissue. The KBrO3 application triggered apoptosis, endoplasmic reticulum stress, and inflammation. Morin treatment increased enzymatic and nonenzymatic antioxidant levels and decreased lipid peroxidation. In addition, Morin alleviated KBrO3-induced apoptosis, endoplasmic reticulum stress, and inflammation in the brain tissue. The histopathological analysis revealed an increase in degenerative changes, as well as pyknotic changes and vacuolization in cells, in neurons in the KBrO3 group. Increased hyperemia and congestion were detected in the meninges and vessels in the cerebral cortex. Conclusion: KBrO3 application caused toxicity in the brain tissue and impaired tissue integrity, whereas Morin treatment alleviated KBrO3-induced toxicity.Öğe Planned iliohypogastric neurectomy for prevention of chronic pain after inguinal hernia repair(Springer-Verlag Italia s.r.l., 2025) Gemici, Kazım; Özeren, ErsinPurpose: The present study aimed to investigate the effect of planned ilohypogastric neurectomy (IHPN) in preventing chronic postoperative inguinal pain (CPIP) after anterior herniorrhaphy (AH). Materials and methods: This prospective, randomized study was conducted between 2016 and 2023. Emergency and incarcerated hernia cases, bilateral inguinal hernias, cases with complications such as postoperative hematoma infection, cases in which the neuroanatomy of the inguinal region was unintentionally damaged, femoral hernias, and paraplegic patients with loss of sensation who underwent anterior inguinal herniorrhaphy with prolene mesh were excluded, and the remaining 1375 patients were included in this study. The patients were randomized into preoperative control and study groups. After further excluding 247 patients (18%) in whom the IHN could not be identified during the operation, 82% of the 1375 patients (n = 1128) were included in this study. In the control group, the RCA segment of the IHN that would remain under the mesh was preserved (control group = G1 = 534). The second group in which this segment of the RCA was excised comprised the study group (G2 = 594). Two groups were prospectively followed and pain scores (PS) were recorded regularly with a 4-point scale. The average follow-up period was 15 months (range 11–19 months) in G1 and 14 months (range 10–18 months) in G2. Results: The number of patients with CPIP was 68 in G1 and 19 in G2, this difference was found to be statistically significant (p: < 0.001). There were 19 patients in G1 and 41 patients in G2 with loss of sensation in the operation area, and a significant difference was detected in this respect (p = 0.012). Conclusion: The rate of developing CPIP was significantly lower in patients who underwent IHPN during anterior herniorrhaphy than in those who did not undergo IHPN. The subjective nature of the pain sensation complicates measuring and scoring this sensation and methodologically limits the study.Öğe Response to commentary on: ChatGPT-4o's performance on pediatric vesicoureteral reflux(Elsevier Ltd, 2025) Akyol Önder, Esra Nagehan; Ensari, Esra; Ertan, PelinThe current study evaluated the reliability and readability of ChatGPT-4o’s responses regarding pediatric vesicoureteral reflux [1]. The sources of information have been rapidly evolving, with AI and chatbots, such as ChatGPT, emerging as significant contributors. The scope of artificial intelligence (AI) usage has been expanding in the medical field. However, further research and validation by researchers and healthcare professionals are required before AI can be widely used as a reliable public source of information.Öğe 18β-glycyrrhetinic acid Mitigates bisphenol A-induced liver and renal damage: Inhibition of TNF-α/NF-κB/p38-MAPK, JAK1/STAT1 pathways, oxidative stress and apoptosis(Elsevier Ltd, 2025) Darendelioğlu, Ekrem; Cağlayan, Cüneyt; Küçükler, Sefa; Bayav, İbrahim; Kandemir, Fatih Mehmet; Ayna, Adnan; Sağ, SevdaBisphenol A (BPA) has been commonly used in various consumer products, including water bottles, food containers, and canned food linings. However, there are concerns about its potential toxicity to human health, particularly its impact on the liver and kidneys. The objective of this research was to investigate the potential ameliorative effects of 18β-glycyrrhetinic acid (GA) against BPA-induced hepatotoxicity and nephrotoxicity in rats. The animals were supplemented with BPA (250 mg/kg b.w.) alone or with GA (50 and 100 mg/kg b.w.) for 14 days. GA treatment alleviated the BPA-induced hepato-renal tissue injuries through reducing the serum ALT, AST and ALP levels, and urea and creatinine levels. GA co-treatment also increased activities of SOD, CAT and GPx enzymes and levels of GSH, and suppressed MDA levels in BPA induced tissues. BPA also induced inflammation by increasing the levels of TNF-α, NF-κB, JAK1, STAT1, P38 MAPK and JNK in liver and kidney tissues and GA treatment ameliorated these effects. BPA triggered apoptosis by increasing caspase-3, Bax, and cytochrome c at protein levels and also by decreasing the antiapoptotic Bcl-2 level. However, treatment with GA (50 and 100 mg/kg) decreased apoptosis. Overall, our results have revealed the potential ameliorative mechanisms of GA, as a possible agent for BPA-induced hepatotoxicity and nephrotoxicity.Öğe Potential impact of obstetric history on postmenopausal fragility fracture risk: A reassessment of the Fracture Risk Assessment Tool(Turkish Joint Diseases Foundation, 2025) Sezgin, Aydan; Saçıntı, Huriye Güvenç; Osmanlı, Elşad; Mangır, Kübra; Saçıntı, Koray Görkem; Sezgin, Erdem ArasObjectives: This study aimed to evaluate the impact of integrating obstetric parameters into the Fracture Risk Assessment Tool (FRAX) on the precision of risk assessment. Patients and methods: In this retrospective study, patients who experienced postmenopausal fragility fractures of the distal radius, proximal femur, or lumbar vertebrae between January 1, 2021, and December 31, 2023, were included. Obstetric histories, along with standard FRAX parameters, were obtained by phone interviews. Based on the FRAX major osteoporotic fracture risk score calculated without bone mineral density, patients were classified into high-, intermediate-, and low-risk group categories. Differences in age at menarche, age at menopause, lactation duration, gravidity, and parity were analyzed across risk categories. Results: A total of 328 patients (mean age: 64.5±5.8 years; range, 55 to 75 years) were included. The mean FRAX score was 16±8.8 (range, 3 to 58), and 85, 191, and 52 patients were classified as high-, intermediate-, and low-risk, respectively. A positive correlation was observed between FRAX scores and both later age at menarche and earlier menopause (p<0.001 and p=0.008, respectively). The mean age at menopause was significantly different between the high- and low-risk groups (46.4 vs. 49.3 years, p=0.016). The intermediate-risk group was also evaluated, showing no significant differences in obstetric parameters compared to the low-risk group (p>0.05). Conclusion: Although late menarche is not explicitly included in FRAX, its association with higher fracture risk was evident. The established influence of early menopause on FRAX scores supports its role in fracture risk estimation. However, the inclusion of additional obstetric parameters did not enhance the predictive accuracy of FRAX in this cohort.Öğe ChatGPT-4o?s performance on pediatric Vesicoureteral reflux(Elsevier Ltd, 2025) Akyol Önder, Esra Nagehan; Ensari, Esra; Ertan, PelinVesicoureteral reflux (VUR) is a common congenital or acquired urinary disorder in children. Chat Generative Pre-trained Transformer (ChatGPT) is an artificial intelligence-driven platform offering medical information. This research aims to assess the reliability and readability of ChatGPT-4o?s answers regarding pediatric VUR for general, non-medical audience. Materials and methods: Twenty of the most frequently asked English-language questions about VUR in children were used to evaluate ChatGPT-4o?s responses. Two independent reviewers rated the reliability and quality using the Global Quality Scale (GQS) and a modified version of the DISCERN tool. The readability of ChatGPT responses was assessed through the Flesch Reading Ease (FRE) Score, Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), and Simple Measure of Gobbledygook (SMOG). Results: Median mDISCERN and GQS scores were 4 (4–5) and 5 (3–5), respectively. Most of the responses of ChatGPT have moderate (55 %) and good (45 %) reliability according to the mDISCERN score and high quality (95 %) according to GQS. The mean ± standard deviation scores for FRE, FKGL, SMOG, GFI, and CLI of the text were 26 ± 12, 15 ± 2.5, 16.3 ± 2, 18.8 ± 2.9, and 15.3 ± 2.2, respectively, indicating a high level of reading difficulty. Discussion: While ChatGPT-4o offers accurate and high-quality information about pediatric VUR, its readability poses challenges, as the content is difficult to understand for a general audience. Conclusion: ChatGPT provides high-quality, accessible information about VUR. However, improving readability should be a priority to make this information more user-friendly for a broader audience.Öğe Prognostic value of systemic immune-inflammatory index in pulmonary embolism(Galenos Yayınevi, 2024) Mermer, Mehmet; Kaçer, İlker; Çağlar, AhmetThis study aimed to investigate the extent to which the systemic immune-inflammatory index (SII) is associated with patients with acute pulmonary embolism (PE), compare the SII with other commonly used biomarkers and scoring systems, and evaluate its suitability for routine use in PE risk classification. Materials and Methods: Patients with acute PE admitted in 2021 were retrospectively reviewed. A cut-off value for the SII was obtained to examine the predictive value of the SII for 30-day mortality as the primary outcome. The secondary outcome of the study was to compare the SII with other predictors of 30-day mortality in patients with acute PE. Results: A total of 139 patients with a mean age of 68.33±14.58 years were included in the study. The cut-off value for 30-day mortality was an SII of ?0.904 (sensitivity: 88.5%; specificity: 58.4%; area under the curve: 0.803; p<0.001). Lactate, age, right ventricular dysfunction (RVD), and SII ?0.904 were independent risk factors for 30-day mortality in PE (p<0.05). The SII has a strong correlation with lactate and the presence of RVD (p<0.001). Conclusion: The SII was found to be strongly associated with RVD, age, and lactate in patients with acute PE. Prospective studies may prove that the SII can fill the gap of inexpensive, rapid, and accessible prognostic biomarkers in rural emergency departments where echocardiography is not accessible.Öğe Evaluation of the effect of age-related macular degeneration type and stage on the risk of parkinson’s disease(Eskişehir Osmangazi Üniversitesi, 2024) Yaşar, Erdoğan; Gürlevik, Uğur; Bilgeç, Mustafa Değer; Güneş, MuzafferThe aim of the study was to investigate the distance between Parkinson's Disease (PD) and Age-Related Macular Degeneration (AMD) type and stage.. Our prospective study, the dry-type AMD group consisted of 296 patients with early and 284 patients with late-stage. The neovascular AMD group included 285 early and 277 late-stage patients. The control group consisted of 300 patients. AMD patients were grouped as dry and neovascular type and early and late stage. The patients were questioned about the use of drugs for PD, and the use was recorded as having the disease. If any of the complaints seen in the PD were present, the patient was referred to a neurologist. PD was detected in 1% of the control group and 4.6% in the neovascular type AMD group, and this difference was significant (p:0.04). This difference was present in both the early (%4.5) and late-stage (%4.6 ) (p:0.04, p:0.04). PD was determined 3.78 times greater among neovascular AMD patients(p:0.03), and significant association was present in both early (3.72 times) and late-stage (3.82 times) (p:0.03, p:0.03). In the dry-type AMD group 2.7% PD was detected and there was no statistical difference (p>0.05). This difference was not significant in the early stage (%2.3) or late-stage (%2.8) and also there was no association with dry-type AMD (p>0.05). Also, unilateral and bilateral involvement in AMD was not associated with PD (p>0.05). Our study revealed the association between both early and late neovascular AMD and PD. However, any significant relationship was not detected in terms of both unilateral and bilateral involvement.Öğe Prevalence, distribution, and prognostic significance of morphological variants of neuroendocrine tumors of the gastrointestinal tract - a multicenter study(Versalius University Medical Publisher, 2024) Akay, Ebru; Ordu, Melike; Çoban, Ganime; Darakcı, Seher; Topaloğlu, Nahit; Taştekin, Filiz Meral; Ekinci, Büşra; Şahin, Nurhan; Gucin, Zuhal; Karaman, HaticeThe incidence and prevalence of neuroendocrine neoplasms (NENs) in many organs are increasing. Although such NENs have similar grades, they may exhibit quite different behaviors. In this multicenter study, we aimed to investigate the prevalence and distribution of different morphological NEN variants in the non-pancreatic gastrointestinal (GI) tract and determine whether they can guide prognosis prediction. Two hundred and fifty-six patients diagnosed with NENs originating from the GI tract from 7 different centers were included in the study. In 89 (36.6%) cases, different morphological variants were detected. When the variants were grouped according to their aggressiveness as described in the literature, a statistically significant relationship between aggressiveness and the variables organ and age was found ( p < 0.05). The oncocytic variant was found to metastasize more than the other aggressive types (42.9%). The paraganglioma-like variant was found to have a smaller size, lower proliferation index, and a more benign clinical course. This study demonstrated that well-differentiated GI neuroendocrine tumors (GI-NETs) have considerable morphological diversity. Generally, case reports of rare morphological variants of GI-NETs are available in the literature. We believe that our study contributes to a better understanding of the prevalence, localization, and significance of morphological variations in GI-NETs.Öğe Does heart failure have an effect on the progress of diabetic retinopathy(Bayrakol Medical Publisher, 2024) Yaşar, Erdoğan; Aktaş, Halil; Gül, Murat; Gürlevik, UğurTo evaluate the effect of concomitant heart failure on diabetic retinopathy (DR) in patients with Diabetes Mellitus (DM). Material and Methods: In this cross-sectional study, 40 eyes of 20 patients with DM alone (control group) and 70 eyes of 35 patients with heart failure and DM were included. Anterior segment and dilated fundus examination were performed in all patients. DR was classified as mild, moderate, severe non -proliferative DR and proliferative DR. According to the ejection fraction (EF), the stage of heart failure was classified as decreased (HFrEF) if LVEF <40%, moderate (HFmrEF) if LVEF was 40-49%, and preserved (HFpEF) if LVEF >= 50%. After this staging of HF patients; 13 were classified as HFpEF, 12 as HFmrEF and 10 as HFrEF Results: In our cross-sectional study, the mean age of the patients in the HF+DM+ group consisting of 35 patients was 54.4 +/- 12.6 and the mean age of the control group consisting of 20 patients was 51.7 +/- 6.8. PDR and DR in the HFrEF group were found to be significantly higher than the control (p=0.02, p=0.04 respectively. In addition, as a result of examining the relationship between the factors affecting the severity of DR, the duration of DM (p=0.01, OR=1.62), HbA1c (p=0.03, OR=2.95) and HF severity (p=0.02, OR=1.86). Discussion: Our study shows that the risk of PDR is increased in the HFrEF stage in patients with HF accompanying DM, in addition to blood glucose regulation, HF treatment may contribute positively to DR.Öğe Open Reduction and Plate Fixation, External Fixator, and Conservative Treatment for Intra-articular Distal Radius Fractures(Cureus, 2024) Akdemir, Mehmet; Kılıç, Ali İhsan; Kurt, Cengizhan; Çapkın, SercanDistal radius fractures are common fractures. Treatment of intra-articular fractures is controversial, with treatment modalities including closed reduction and casting, open reduction and plating, and closed reduction and fixation with an external fixator. In this study, we compared the clinical and radiological outcomes of our patients treated with three different methods for intra-articular distal radius fractures. We hypothesize that open reduction and plate application are superior. Methodology Adult patients with intra-articular (AO type B and C) fractures of the distal radius and treated with closed reduction-casting, volar locking plate, and external fixator were identified. Radiologically, joint stepping at the end of treatment, radial inclination, radial height, volar tilt, and distal ulna fracture were examined. For clinical scoring, Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) scores were computed. Obtained data were compared statistically between groups. Results A total of 164 patients were included in the study. Overall, the treatment modality was conservative in 61, volar with plating in 78, and external fixation in 25. The mean age of the patients was 53.7 years (range = 20-82 years). Overall, 39.6% of the patients were male and 60.4% were female. The mean follow-up period of the patients was 16.7 months (range = 12-28 months). No statistically significant difference was found between Q-DASH scores in the statistical evaluation (p > 0.05). There was a statistically significant difference between the groups in the radiological evaluation. When conservative treatment and the volar plate group were compared, the volar plate was superior in all radiological parameters (p < 0.05). Compared with conservative treatment and external fixation, only volar tilt and radial inclination angle were different. External fixation was better (p < 0.05). Radial length, volar compared to plate and external fixation tilt, and ulnar variance were better in the plate group (p < 0.05). Regarding joint stepping and radial, there was no difference in inclination between the two groups (p > 0.05). Reflex sympathetic dystrophy was seen in a total of 10 (6.1%) patients. Pin-site infection was seen in three (12%) patients in the external fixator group. Implant removal was performed in seven (9.0%) patients who developed plaque due to irritation and tenosynovitis. Early arthrosis was seen in three (4.3%) patients. Conclusions The treatment of distal radius intra-articular fractures should be evaluated and decided individually for each patient. No single method is directly superior to other methods. However, in some cases, the best results radiologically in the treatment of comminuted intra-articular fractures have been obtained in patients with volar plates.Öğe Admissions of Refugee and Turkish Children to Emergency Departments(Yuzuncu Yil Universitesi Tip Fakultesi, 2024) Kılıçaslan, Cengizhan; Özdemir Kaçer, Emine; Ateş, CanDue to increasing population of refugees, rapid alterations have been experienced in the racial and ethnic composition of our country. Such alterations have increased health services to those from different races/ethnic origins, especially in emergency departments (ED). In this study, we aimed to compare health services administered to refugees and Turkish citizens and give recommendations regarding health policies. Data were obtained from the hospital database, and one-year admissions to the pediatric ED were retrospectively analyzed. Such criteria as race, sex, and age of refugees and Turkish citizens were investigated through waiting time before the examination, length of stay in ED, findings of computed tomography (CT), magnetic resonance imaging (MRI) and ultrasonography (USG), and way of quitting ED. Refugees were observed to take boys more to ED, apply to ED more during the daytime, be admitted more often with green zone and polyclinic diagnoses, and undergo imaging techniques at a lower rate (p<0.001). However, refugees were also seen to stay in ED for a shorter time and have lower waiting times (p<0.001). Refugees were detected to benefit ED as visits to outpatient clinics, take younger children and boys more, stay in ED shorter, and undergo imaging techniques less due to such challenges as health insurance and language barriers and inability to access to medical call centers. Although statistically significant differences are considered to be mostly due to the use of ED, more studies are needed to elucidate ethnic/racial differences and implicit biases.
