Browsing by Author "Özdemir, N"
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Item Clinicopathological Reflections of Hashimoto's Thyroiditis and Papillary Thyroid Carcinoma CoexistenceAkcura, C; Alkan, S; Güney, SC; Çavdar, GG; Senol, E; Tan, AY; Özdemir, N; Aydede, H; Hekimsoy, ZObjective: Papillary thyroid carcinoma (PTC) is the most common subtype of thyroid cancer. Hashimoto's thyroiditis (HT), a chronic inflammation of the thyroid gland, is one of the most common autoimmune diseases worldwide. In this study, we aimed to determine the relationship between PTC and HT and the clinicopathological effects of the combination of HT and PTC on the course of PTC. Methods: In this cross-sectional retrospective study, PTC cases who underwent surgery and were followed up at our institution's endocrinology outpatient clinic between 2014 and 2022 were divided into two groups according to the presence of HT. Demographic data of both groups, pathological features of the tumor, and preoperative laboratory findings were examined. Results: A total of 42.4% (n=118) of 278 cases were accompanied by HT. The mean age of the patients was 46.44 +/- 12.2 years. The majority of patients were female (80.6%, n=224). Multifocality was significantly less common in the HT group (p=0.037). Conclusion: Although multifocality was significantly less common in the HT group, no other statistically significant parameter was discovered in other clinicopathological findings. In light of these findings, the effect of HT on the course of PTC cannot be clearly determined. Considering the conflicting results regarding the effect of HT-PTC coexistence on the course of PTC in the literature, a comprehensive prospective study on this subject is necessary.Item Kyphectomy in neonates with meningomyeloceleÖzdemir, N; Özdemir, SA; Özer, EAPurpose Kyphosis is the most severe spinal deformity associated with meningomyelocele (MMC) and is seen in approximately 15% of neonates. Our purpose is to present our clinical experience, to discuss the technique and deformity correction in kyphectomy in neonates with MMC, and to assess its long-term outcomes. Method In this prospective study, the authors reviewed eight cases submitted to surgery between 2013 and 2015. We evaluated clinical characteristics that were analyzed, as were the operative technique employed, and angle range of the kyphosis deformity postcorrection follow-up. Results Neonatal kyphectomy was performed of six females and two males. The mean birth weight was 2780 g, and the mean age at the time of surgery was 5.6 days. There were S-shaped type deformity in lumbar region in all neonates. In the correction of the kyphotic deformity, a total vertebrae were removed from four patient, whereas a partial vertebrectomy was done in four. The mean operative time was 116 min. No patients did not require the blood transfusion. There were no serious complications, and wound closure was successful in all patients. The mean follow-up period was 4 years and 3 months (range 36-61 months), except one patient who died 1 week after discharge. The mean preoperative kyphosis of 75.6 degrees (range, 50 degrees-90 degrees) improved at last follow-up to 35 degrees (range 15 degrees-55 degrees). All patients had surgical procedures for hydrocephalus. Three patients had surgery for Chiari type II malformation. The mean hospital stay was 27.7 days. Conclusion Kyphectomy performed at the time of dural sac closure in the neonate is a safe procedure with excellent correction.Item Beyond Infection: Unmasking the Impact of COVID-19 on Diabetes Emergency TrendsGüney, SC; Akçura, C; Alkan, S; Çavdar, GG; Özdemir, N; Hekimsoy, ZIntroduction The relationship between COVID-19 and diabetes has been demonstrated in many studies. However, it is thought that the psycho-socioeconomic effects of the pandemic led to a worsening of glycemic control and an increase in diabetes-associated clinical emergencies in diabetic patients without a diagnosis of COVID19. Objectives We aimed to reveal the change in the frequency of diabetes-related clinical emergencies before and during the COVID-19 pandemic. Patients and methods The data of the patients requiring endocrinology consultations in Manisa Celal Bayar University Faculty of Medicine Emergency Service between March 2018 and March 2022 were included. In total, 269 consultations were analyzed. The March 2018- March 2020 period was considered as pre-COVID, and March 2020- March 2022 as the COVID-19 period. The frequency of diabetes-related conditions between these two periods was compared. Results Compared to the pre-COVID period, there was a significant increase in the frequency of admissions with diabetic ketosis, hyperglycemic hyperosmolar state, hypoglycemia, and hyperglycemia in the COVID-19 period (p=0.022, p=0.037, p=0.044, and p=0.004 respectively). Although an increase was observed in the frequency of diabetic ketoacidosis (DKA) cases, no statistical significance was found. When the mortality data of the patients was evaluated, the total number of deaths was seen to increase significantly in the COVID-19 period (p=0.01). It was observed that the ratio of type 2 diabetes mellitus (DM)/type 1 DM among DKA patients increased significantly in the COVID-19 period (p=0.001). Conclusions It can be concluded that the increasing trend in diabetic emergencies that started even before the pandemic is exacerbated by COVID-19, especially in patients with poor glycemic control.Item The correlation of communication skills and emotional expressions among nursing students in Turkey: A public university sampleYildirim, S; Durgu, N; Özdes, AB; Özdemir, NBackground & Aim: Expressing emotions is very important both in interpersonal relationships and in the protection and maintenance of the individual's mental health. However, the individual must have certain skills to express his feelings healthily. The most important of these is communication skills. This research aimed to examine the correlation between communication skills and emotional expressions of nursing students. Methods & Materials: This correlational study was conducted among nursing students at a public university faculty of nursing in Turkey between 2016 and 2017. Of the total of 1423 students, 632 nursing students were selected using the convenience sampling method. The Introductory Information Form, the Berkeley Expressivity Questionnaire and the Communication Skills Scale were used to collect data. The Mann-Whitney U, Kruskal-Wallis H, and Pearson correlation tests were used for the analysis of the data. Results: The mean total Berkeley Expressivity Questionnaire score of the students was found to be 79.45 +/- 10.11, and the mean total score of the Communication Skills Scale was 97.67 +/- 11.20. Emotional expressions are affected by gender, marital status, class, income level, family structure, the residence where they have lived the longest, place of residence and working status (p <= 0.05, p<0.01). It was found that there was a positive-directed correlation between students' emotional expressions and communication skills (p<0.01). Conclusion: It was concluded that communication skills and some sociodemographic characteristics of nursing students are correlated with their emotional expressions.Item Biochemical characteristics and calcium and PTH levels of patients with high normal and elevated serum 25(OH)D levels in Turkey: DeVIT-TOX surveyPekkolay, Z; Yavuz, DG; Saygili, ES; Degertekin, CK; Topaloglu, O; Önder, ÇE; Soylu, H; Taskaldiran, I; Pazir, AE; Ugur, K; Tanrikulu, S; Firat, SN; Atak, BM; Batman, A; Omma, T; Cagiltay, E; Özdemir, N; Altuntas, SÇ; Imga, NN; Karakiliç, E; Hekimsoy, Z; Kilinç, F; Yay, A; Eroglu, M; Tuzcu, AKA Summary Vitamin D intake over the recommended dose is usually associated with high serum 25(OH)D levels and generally not associated with symptoms of hypercalcemia. High doses of cholecalciferol need to be avoided to protect against vitamin D toxicity and related complications. Strict adherence to the clinical guidelines for treating vitamin D deficiency can ensure safe and effective treatment. Purpose We observed a tendency to use high doses of cholecalciferol for vitamin D deficiency treatment or vitamin D supplementation. We aimed to determine the biochemical characteristics of patients with high normal and elevated serum 25(OH)D levels. Methods An online invitation was sent to all tertiary endocrinology clinics in Turkey to complete an online retrospective survey (DeVIT-TOX Survey) for patients diagnosed with high serum 25(OH)D levels (> 88 ng/mL) between January 2019 and December 2019. The patients were evaluated according to the presence of signs and symptoms of hypercalcemia and doses of vitamin D intake, evaluated into the following three groups according to their 25(OH)D levels: group 1, > 150 ng/mL; group 2, 149-100 ng/mL; and group 3, 99-88 ng/mL. Results A total of 253 patients were included in the final analysis (female/male: 215/38; mean age, 51.5 +/- 15.6 years). The average serum 25(OH)D level was 119.9 +/- 33 (range, 88-455) ng/mL, and the average serum calcium level was 9.8 +/- 0.7 (range, 8.1-13.1) mg/dL. Most (n = 201; 75.4%) patients were asymptomatic despite having high serum 25(OH)D and calcium levels. The serum 25(OH)D level was significantly higher in the symptomatic groups than in the asymptomatic groups (138.6 +/- 64 ng/mL vs. 117.7 +/- 31 ng/mL, p < 0.05). The most common cause (73.5%) associated with high serum 25(OH) D levels was the inappropriate prescription of a high dose of oral vitamin D (600.000-1.500.000 IU) for treating vitamin D deficiency/insufficiency in a short time (1-3 months). The cut-off value of 25 (OH) D level in patients with hypercalcemia was found to be 89 ng/mL [median 116.5 (89-216)]. Conclusions High dose of vitamin D intake is associated with a high serum 25 OH D level, without symptoms of hypercalcemia. Inappropriate prescription of vitamin D is the primary cause for elevated 25(OH) D levels and related hypercalcemia. Hypercalcemia may not be observed in every patient at very high 25(OH) D levels. Adherence to the recommendation of guidelines is essential to ensure safe and effective treatment of vitamin D deficiency.Item Predictive and Prognostic Factors in Ovarian and Uterine CarcinosarcomasCicin, I; Özatli, T; Türkmen, E; Özturk, T; Özçelik, M; Çabuk, D; Gökdurnali, A; Balvan, Ö; Yildiz, Y; Seker, M; Özdemir, N; Yapar, B; Tanriverdi, Ö; Günaydin, Y; Menekse, S; Öksüzoglu, B; Aksoy, A; Erdogan, B; Hacioglu, MB; Arpaci, E; Sevinç, ABackground: Prognostic factors and the standard treatment approach for gynaecological carcinosarcomas have not yet been clearly defined. Although carcinosarcomas are more aggressive than pure epithelial tumours, they are treated similarly. Serous/clear cell and endometrioid components may be predictive factors for the efficacy of adjuvant chemotherapy (CT) or radiotherapy (RT) or RT in patients with uterine and ovarian carcinosarcomas. Heterologous carcinosarcomas may benefit more from adjuvant CT. Aims: We aimed to define the prognostic and predictive factors associated with treatment options in ovarian (OCS) and uterine carcinosarcoma (UCS). Study Design: Retrospective cross-sectional study Methods: We retrospectively reviewed the medical records of patients with ovarian and uterine carcinosarcoma from 2000 to 2013, and 127 women were included in this study (24 ovarian and 103 uterine). Patients admitted to seventeen oncology centres in Turkey between 2000 and December 2013 with a histologically proven diagnosis of uterine carcinosarcoma with FIGO 2009 stage I-III and patients with sufficient data obtained from well-kept medical records were included in this study. Stage IV tumours were excluded. The patient records were retrospectively reviewed. Data from 104 patients were evaluated for this study. Results: Age (>= 70 years) was a poor prognostic factor for UCS (p=0.036). Pelvic +/- para aortic lymph node dissection did not affect overall survival (OS) (p=0.35). Macroscopic residual disease was related with OS (p<0.01). The median OS was significantly longer in stage I-II patients than stage III patients (p=0.03). Adjuvant treatment improved OS (p=0.013). Adjuvant radiotherapy tended to increase the median OS (p=0.075). However, this tendency was observed in UCS (p=0.08) rather than OCS (p=0.6). Adjuvant chemotherapy had no effect on OS (p=0.15). Adjuvant radiotherapy significantly prolonged the median OS in patients with endometrioid component (p=0.034). A serous/clear cell component was a negative prognostic factor (p=0.035). Patients with serous/clear cell histology for whom adjuvant chemotherapy was applied had significantly longer OS (p=0.019), and there was no beneficial effect of adjuvant radiotherapy (p=0.4). Adjuvant chemotherapy was effective in heterologous tumours (p=0.026). In multivariate analysis, the stage and chemotherapy were prognostic factors for all patients. Age was an independent prognostic factor for UCS. However, serous/clear cell histology and radiotherapy tended to be significant prognostic factors. Conclusion: The primary location, the histological type of sarcomatous and the epithelial component may be predictive factors for the efficacy of chemotherapy or radiotherapy in UCS and OCS.Item The effect of the gastrectomy on survival in patients with metastatic gastric cancer: a study of ASMOYazici, O; Özdemir, N; Duran, AO; Menekse, S; Ali, M; Sendur, N; Karaca, H; Göksel, G; Arpaci, E; Hacibekiroglu, I; Bilgetekin, I; Kaçan, T; Özkan, M; Aksoy, S; Aksoy, A; Çokmert, S; Uysal, M; Elkiran, ET; Çiçin, I; Büyükberber, S; Zengin, NAim: To investigate the role of surgical resection of primary tumor on overall survival (OS) in advanced gastric cancer patients at the time of diagnosis. Patients & methods: The survival rates of metastatic gastric cancer patients whose gastric primary tumor was resected at time of diagnosis were compared with metastatic gastric cancer patients whose primary tumor was nonresected. Results: The median progression-free survival and OS in operated and nonoperated group were 10 versus 6, 14 versus 9 months, respectively (p < 0.001). In multivariate analysis, gastric resection of primary tumor, Eastern Cooperative Oncology Group performance status, second-line chemotherapy had a significant effect on OS (hazard ratio [HR]: 0.52 [95% CI: 0.38-0.71], HR: 0.57 [95% CI: 0.42-0.78], HR: 1.48 [1.09-2.01]; p <= 0.001, p = 0.001 and p = 0.012, respectively). Conclusion: Subpopulations of patients with metastatic gastric cancer might benefit from surgical removal of primary tumor.Item Clinical and demographic aspects of Paget disease of bone: A multicentric study from TurkeyYavuz, DG; Aytürk, S; Çetinkalp, S; Bayraktar, F; Kulaksizoglu, M; Hekimsoy, Z; Aydin, H; Uygur, M; Deniz, F; Ipekçi, S; Atmaca, A; Saraç, F; Özdemir, N; Cantürk, Z; Mert, M; Sancak, S; Ertörer, E; Duran, C; Akarsu, E; Deyneli, O; Selek, A; Gürlek, AObjective: Paget disease of bone (PDB) is a metabolic bone disease that has been rarely reported in the Eastern countries. This study aimed to evaluate the clinical and demographic characteristics of patients with PDB followed up at endocrinology clinics in Turkey. Methods: An invitation was sent to tertiary endocrinology clinics to complete a survey on the dernc:graphic, clinical, radiological, and laboratory parameters, as well as treatment modalities of patients with PDB. This study enrolled clinically and radiologically proven 185 patients with PDB from 18 endocrinology centers based in 10 cities of Turkey. Results: This cohort of PDB had female preponderance (women/men: 105/80) with a mean age, during diagnosis, of 57 +/- 10 years. Most of the patients (59.6%) were symptomatic at diagnosis. Bone pain and headache were the predominant clinical symptoms. Polyostotic disease was observed in 67.5% (n=125) of patients. Frequently affected bones were skull (41.6%), pelvis (53.5%), spine (41%), and femur (25.4%). Moreover, 17 patients with skull involvement had hearing loss. Mean serum alkaline phosphatase (ALP) level (552 +/- 652 IU/L; range: 280-5762 IU/L) was over the normal reference cutoff with normal serum calcium levels. Intravenous bisphosphonates (zoledronic acid, 5 mg; pamidronate, 60-90 mg) were the most used drugs (75%) for the treatment of PDB. Most of the patients (87.1%) treated with intravenous bisphosphonates responded well, with a decrease in serum ALP level (117 +/- 114 IU/L) in the 12th month of therapy. Furthermore, 16 patients relapsed after the second year of therapy; 3 patients did not respond to the initial intravenous bisphosphonate treatment. Conclusion: The patients with PDB followed up by endocrinology clinics of Turkey exhibited polyostotic disease with classical clinical, radiological, and biochemical features and women's predominance with good response to intravenous bisphosphonate therapy.Item Prevalence of Vitamin D Deficiency and Hypervitaminosis D Among Adult Patients Admitted to the Tertiary Care Hospitals in TurkeyYavuz, DG; Ersoy, R; Altuntas, Y; Bilen, H; Pamuk, B; Apaydin, T; Temizkan, S; Altuntas, H; Mert, M; Akalin, A; Sert, M; Simsri, IY; Hekimsoy, Z; Cantürk, Z; Üç, ZA; Iplikci, S; Yasar, M; Unubol, M; Sezer, K; Toplaoglu, Ö; Iyidir, ÖT; Pekkolay, Z; Atmaca, A; Dikbas, O; Özdemir, N; Gül, K; Deniz, F; Ertörer, E; Karaca, Z; Elbüken, G; Arpaci, D; Agbaht, K; Turan, E; Anaforoglu, I; Bayraktaroglu, T; Haklar, G; Daglioglu, G; Tuzcu, A; Sahin, I; Çetinkalp, SObjective: Vitamin D deficiency is a common health problem around the world. This study aimed to evaluate the nationwide prevalence of vitamin D status in tertiary care hospitals in Turkey. Methods: Retrospectively, the data on vitamin D levels from 33 tertiary care hospitals' clinical bio-chemistry laboratories around Turkey between January and December were collected. Results: In total, 706 434 serum samples from adult subjects (female/male: 469 028/237 406; 66.4%/33.6%) were included. While vitamin D levels were sufficient in 20.3% (n = 14 222), they were insufficient in 21.9% (n = 154 360) and deficient in 57.8% (n = 408 882). We observed the highest rates of deficiency in those aged between 18 and 29 years (62.9%, n = 70 235) and lowest rates between 60 and 69 years (52.3%, n = 61 121) and between 70 and 79 years (52.3%, n = 32 397). Hypervitaminosis D was detected in 5.5% of adult subjects; highest rates of hypervitaminosis D were observed in those who were over 80 years (6.6%) and 70-79 years (6.5%) and the lowest in 18-29 years (2.8%). Discussion: In this cohort, over half of the subjects admitted to the tertiary care hospitals in Turkey had vitamin D deficiency and required vitamin D supplementation. The elderly population had the lowest prevalence of vitamin D insufficiency and the highest prevalence of hypervitaminosis D.Item Outcomes of high-risk breast lesions diagnosed using image-guided core needle biopsy: results from a multicenter retrospective studyOktay, A; Aslan, Ö; Taskin, F; Tunçbilek, N; Içten, SGE; Balci, P; Aribal, ME; Çelik, L; Örguç, IS; Demirkazik, FB; Gültekin, S; Aydin, AM; Durmaz, E; Kul, S; Binokay, F; Çetin, M; Emlik, GD; Akpinar, MG; Voyvoda, SNK; Polat, AV; Akin, IB; Yildiz, S; Poyraz, N; Özsoy, A; Öztekin, PS; Elverici, E; Bayrak, IK; Ikizceli, T; Dinç, F; Sezgin, G; Gülsen, G; Tunçbilek, I; Yalçin, SR; Çolakoglu, G; Aglamis, S; Yilmaz, R; Rona, G; Durhan, G; Güner, DC; Yabul, FÇ; Karabekmez, LG; Tutar, B; Göktas, M; Bugdayci, O; Suner, A; Özdemir, NPURPOSE The clinical management of high-risk lesions using image-guided biopsy is challenging. This study aimed to evaluate the rates at which such lesions were upgraded to malignancy and identify possible predictive factors for upgrading high-risk lesions. METHODS This retrospective multicenter analysis included 1.343 patients diagnosed with high-risk lesions using an image-guided core needle or vacuum-assisted biopsy (VAB). Only patients managed using an excisional biopsy or with at least one year of documented radiological follow-up were included. For each, the Breast Imaging Reporting and Data System (BI-RADS) category, number of samples, needle thickness, and lesion size were correlated with malignancy upgrade rates in different histologic subtypes. Pearson's chi-squared test, the Fisher-Freeman-Halton test, and Fisher's exact test were used for the sta-tistical analyses. RESULTS The overall upgrade rate was 20.6%, with the highest rates in the subtypes of intraductal papilloma (IP) with atypia (44.7%; 55/123), followed by atypical ductal hyperplasia (ADH) (38.4%; 144/375), lobular neoplasia (LN) (12.7%; 7/55), papilloma without atypia (9.4%; 58/611), flat epithelial atypia (FEA) (8.7%; 10/114), and radial scars (RSs) (4.6%; 3/65). There was a significant relationship between the upgrade rate and BI-RADS category, number of samples, and lesion size Lesion size was the most predictive factor for an upgrade in all subtypes.CONCLUSION ADH and atypical IP showed considerable upgrade rates to malignancy, requiring surgical excision. The LN, IP without atypia, pure FEA, and RS subtypes showed lower malignancy rates when the BI-RADS category was lower and in smaller lesions that had been adequately sampled using VAB. After being discussed in a multidisciplinary meeting, these cases could be managed with follow-up instead of excision.