Browsing by Author "Yasar B."

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    Perioperative immunonutrition ameliorates the postoperative immune depression in patients with gastrointestinal system cancer (prospective clinical study in 42 patients)
    (Universa Press, 2004) Ateş E.; Yilmaz S.; Erkasap S.; Ihtiyar E.; Kaya Y.; Pehlivan T.; Ustuner Z.; Yasar B.; Kiper H.
    Cancer surgery is a major challenge for patients to develop immune depression in postoperative period. Several cytokines can depress immune cell subpopulations. Increased cytokine response after surgery is assumed to arise mainly from lipooxygenase pathway acting on membrane arachidonic acid. Therefore; investigators focused their efforts to alter the membrane fatty acid profile by changing the nutritional regimen with ε-3 fatty acid supplementation and encouraging results were obtained after surgery. Despite the theoretical and clinical advantage of enteral nutrition many surgeons remain committed to parenteral nutrition for feeding of patients due to maintain bowel rest and fear of anastomosis leakage at the postoperative period. Several studies investigating role of the postoperative immunonutrition reported that beneficial immunological changes were associated with reduction of infectious complications. Interestingly; these findings were observed at least five days after the surgery in which the highest incidence of complications was seen. In this prospective study including 42 patients eligible for curative gastric or colon cancer surgery; we investigated the beneficial effect of enteral immunonutrition (EEN) compared to total parenteral hyperalimentation (TPN) beginning from the preoperative period. Cortisol and CRP levels as stress parameters significantly increased one day after surgery in both groups but they rapidly returned to (on POD1) preoperative baseline level in EEN group whereas these values remained high in the TPN group. Additionally a significant decrease in natural killer (NK) cells and CD8+ levels were observed in both groups. However they recovered on POD3 in EEN group and on POD6 in TPN group. CD4+ subset remained almost same as pre-operative value in the TPN group whereas it increased from (%) 40.14 to 46.40,51.29 and 54.7 on PO 6th hr, POD3 and POD6 in the EEN group. Our findings suggest that preoperative nutrition via the enteral route provided better regulation of postoperative immune system restoration than parenteral nutrition. On the basis of our findings we recommend enteral immunonutrition to be started at the preoperative period rather than postoperatively before a major operation whenever the enteral route is feasible.
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    Evaluation of 601 children with multisystem inflammatory syndrome (Turk MISC study)
    (Springer Science and Business Media Deutschland GmbH, 2023) Yilmaz D.; Ekemen Keles Y.; Emiroglu M.; Duramaz B.B.; Ugur C.; Aldemir Kocabas B.; Celik T.; Ozdemir H.; Bayturan S.; Turel O.; Erdeniz E.H.; Cakici O.; Cakmak Taskin E.; Erbas İ.C.; Genceli M.; Sari E.E.; Caymaz C.; Kizil M.C.; Sutcu M.; Demirbuga A.; Alkan G.; Bagcı Z.; Timurtas Dayar G.; Ozkan E.A.; Tekin Yilmaz A.; Akca M.; Yesil E.; Kara S.S.; Akturk H.; Yasar B.; Umit Z.; Uygun H.; Erdem N.; Buyukcam A.; Karadag Oncel E.; Tuter Oz S.K.; Cetin H.S.; Anil A.B.; Yilmaz R.; Zengin N.; Uzuner S.; Albayrak H.; Borakay O.; Topal S.; Arslan G.; Yazar A.; Ozer A.; Kendirli T.; Kara E.M.; Demirkol D.; Battal F.; Kosker M.; Metin Akcan O.; Kihtir H.S.; Gul D.; Zararci K.; Alakaya M.; Kula N.; Celik E.; Petmezci E.; Evren G.; Kara Aksay A.; Konca C.; Sert A.; Arslan D.; Bornaun H.; Tekeli O.; Bal A.; Sahin I.O.; Demir S.; Sap F.; Akyol M.B.; Tanidir I.C.; Donmez Y.N.; Ucar T.; Coban S.; Arga G.; Hancerli Torun S.; Karpuz D.; Celik S.F.; Varan C.; Elmali F.; Oncel S.; Belet N.; Hatipoglu N.; Dalgic Karabulut N.; Turgut M.; Somer A.; Kuyucu N.; Dinleyici E.C.; Ciftci E.; Kara A.
    Purpose: Due to its link with the 2019 coronavirus, the multisystem inflammatory syndrome in children (MISC) has garnered considerable international interest. The aim of this study, in which MISC patients were evaluated multicenter, and the data of the third period of the Turk-MISC study group, to compare the clinical and laboratory characteristics and outcomes of MISC patients who did and did not require admission to an intensive care unit (ICU). Methods: This retrospective multicenter observational study was carried out between June 11, 2021, and January 01, 2022. The demographics, complaints, laboratory results, system involvements, and outcomes of the patients were documented. Results: A total of 601 patients were enrolled; 157 patients (26.1%) required hospitalization in the intensive care unit (ICU). Median age was 8 years (interquartile range (IQR) 4.5–11.3 years. The proportion of Kawasaki disease-like features in the ICU group was significantly higher than in the non-ICU group (56.1% vs. 43.2% p = 0.006). The ICU group had considerably lower counts of both lymphocytes and platelets (lymphocyte count 900 vs. 1280 cells × μL, platelet count 153 vs. 212 cells × 103/ μL, all for p< 0.001). C-reactive protein, procalcitonin, and ferritin levels were significantly higher in the ICU group (CRP 164 vs. 129 mg/L, procalcitonin 9.2 vs. 2.2 μg/L, ferritin 644 vs. 334 μg/L, all for p< 0.001). Being between ages 5–12 and older than 12 increased the likelihood of hospitalization in the ICU by four [95% confidence intervals (CI)1.971–8.627] and six times (95% CI 2.575–14.654), respectively, compared to being between the ages 0–5. A one-unit increase in log d-dimer (µg/L) and log troponin (ng/L) was also demonstrated to increase the need for intensive care by 1.8 (95% CI 1.079–3.233) and 1.4 times (95% CI 1.133–1.789), respectively. Conclusion: By comparing this study to our other studies, we found that the median age of MISC patients has been rising. Patients requiring an ICU stay had considerably higher levels of procalcitonin, CRP, and ferritin but significantly lower levels of lymphocyte and thrombocyte. In particular, high levels of procalcitonin in the serum might serve as a valuable laboratory marker for anticipating the need for intensive care. What is Known: • Lymphopenia and thrombocytopenia were an independent predictor factors in patients with MISC who needed to stay in intensive care unit. • The possibility of the need to stay in the intensive care unit in patients with MISC who had Kawasaki disease-like findings was controversial compared with those who did not. What is New: • A one-unit increase log D dimer and log troponin was demonstrated to require for intensive care unit by 1.8 and 1.4 times, respectively. • Serum procalcitonin levels had the best performance to predict stay in the intensive care unit stay. © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.