Browsing by Author "Yilmaz E."
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Item The evaluation of the proximal tibiofibular joint for patients with lateral knee pain(Elsevier, 2004) Bozkurt M.; Yilmaz E.; Akseki D.; Havitcioglu H.; Günal I.In contrast to important functions of the proximal tibiofibular joint (PTFJ), there appear a few clinical and radiological studies concerning the PTFJ pathologies. Although almost all of the joints have been investigated in detail by MRI, review of the literature reveals none on the pathologies of PTFJ. Thirty-eight knees of 32 patients with lateral knee pain were evaluated clinically and radiologically. All had tenderness over the PTFJ and lateral hamstring tightness. MRI examination revealed effusion of the PTFJ in 22 knees and partial ruptures of anterior or posterior tibiofibular ligament, lateral collateral ligament or biceps femoris tendon in 25 knees. All patients were treated by manipulative physiotherapy of the PTFJ and strengthening and stretching exercises of the surrounding structures. All patients were followed-up 12-36 months (mean 28 months) after the treatment protocol, and complete relief of the symptoms was recorded in 28 of the 38 knees. Although spontaneous pain was not present in five patients, there was tenderness over the PTFJ by palpation. No change in the symptoms was recorded in five patients. These results suggest that PTFJ pathologies should be kept in mind in the evaluation of lateral knee pain and MRI examination provides useful information. © 2003 Elsevier B.V. All rights reserved.Item Minimizing short-term complications in patients who have undergone cardiac invasive procedure: A randomized controlled trial involving position change and sandbag(2007) Yilmaz E.; Gürgün C.; Dramali A.Objective: The study aimed to evaluate the effects of putting a sandbag on femoral access site after cardiac invasive procedure and changing patients' position in bed on vascular complications rate and the severity of back pain related to the duration of bed rest after procedure. Methods: This randomized controlled study included 169 patients divided into five different groups assigned randomly. Group 1 patients were applied 4.5 kg sandbag for 30 minutes and Group 2 patients were applied 2.3 kg sandbag for 2 hours on femoral access site after procedure. Group 1 and 2 patients' body positions were changed every hour beginning from the second hour. Group 3 patients received application of 4.5 kg sandbag for 30 minutes and Group 4 patients were applied 2.3 kg sandbag for 2 hours on femoral access site after procedure and these patients' body positions were not changed after catheterization. Group 5 patients remained in supine position without changing position and had no application of a sandbag. Results: The incidence of vascular complications was not significantly different in the group with application of sandbag when compared with the group without application of sandbag. Back pain was reported more often in the patients whose positions were not changed and whose heads of beds were not raised (p<0.05). Conclusion: Sandbag was not effective in decreasing the incidence of the vascular complications after procedure. To increase the comfort and to decrease the back pain of the patient, the patient's position should be changed and the head of the bed should be raised about 30 or 45 degrees.Item Comparison of clinical assessments with computerized tomography pulmonary angiography results in the diagnosis of pulmonary embolism; [Pulmoner emboli tanisinda klinik olasiliklarin bilgisayarli tomografi pulmoner anjiyografi bulgulari ile karşilaştirilmasi](2007) Gülcü A.; Akkoçlu A.; Yilmaz E.; Öztürk B.; Osma E.; Şengün B.Pulmonary embolism (PE) is difficult to diagnose. We investigated the relationship between computed tomography pulmonary angiography (CTPA) with clinical assessments and thrombus localization. 56 patients with the suspicion of PE; 27 male, 29 female were included. They were evaluated by empirical and Wells clinical assessments, tested with D-Dimer. According to the combination of both CTPA was performed where necessary (if one of the clinical assessments was high or intermediate or those with low clinical probability and high D-Dimer) in the algorithm we used. CTPA was regarded as gold standard. Dyspnea, chest pain, tachypnea, crackles were the most common symptoms and signs in patients having PE. Recent surgery within the risk factors was significantly higher in the PE present group. PE was diagnosed in 31 (55.4%) patients with CTPA. According to the empirical assessment 20 (64.5%) of the patients had high, 10 (32.3%) had intermediate and 1 (3.2%) had low clinical probability within 31 PE present group, while with Wells scoring 8 (25.8%) had high, 17 (54.8%) had intermediate and 6 (19.4%) had low clinical probability. Sensitivity of the empirical assessment and Wells scoring was 97%, 80% while the specifity was 16%, 68% respectively. Positive and negative predictive values of empirical assessment were 59%, 80% and these values of Wells scoring were 76%, 73% respectively. Thrombus was localized in main pulmonary arteries in 45.8% of patients with high clinical probability according to the empirical assessment. With Wells scoring in 45.5% of the high probability patients and only in 4.3% of the low probibility patients thrombus was there. PE can be diagnosed noninvasioely. Since PE can easily be underdiagnosed, empirical assessment which is more sensitive will be appropriate. There is a significant correlation between clinical assessments and presence of PE in CTPA. As the severity of clinical assessment increases, thrombus settles more proximal.Item Effects of aroma inhalation on examination anxiety(2008) Kutlu A.K.; Yilmaz E.; Çeçen D.The study was planned as a randomized, controlled, prospective study to determine the effect of aromatherapy on test anxiety. The sample of the study was composed of 50 students who constituted the study group and 45 students who were the controls. The study group was exposed to lavender inhalation. The mean anxiety score of the study group (42.76 ± 12.48) was lower than that of the control group (51.51 ± 12.21), and the difference between the groups was statistically significant (p = .002). This study shows that aroma inhalation decreases examination anxiety. © 2008 National Organization for Associate Degree Nursing.Item Item Determination of the prevalence of low back pain among nurses working in hospitals; [Hastanede çalişan hemşirelerde bel aǧrisi prevalansinin saptanmasi](2008) Yilmaz E.; Özkan S.Objective: The aim of this descriptive research was to determine the prevalence low back pain (LBP), graduated according to the Oswestry Disability Index (ODI), seen among nurses. Material and Methods: The study consisted of 163 nurses working in Bandirma Kapidaǧ and M. Güven Karahan State Hospitals. Data was collected by using questionnaires and ODI without sampling from January 5 to February 5, 2006. Permission was obtained from the hospitals and nurses before starting the study. The data was analyzed in SPSS by using descriptive statistics and chis-quared test. Results: The mean age of nurses in the study was 34.51±6.71 years. 39.9% of the nurses had experienced an episode of LBP. The mean score of ODI was 7.06±4.61 and 69.2% of the injured group had moderate functional disability. There was a statistical correlation between LBP and working period, sleep regime and income level (p<0.05). There was no statistical correlation between LBP and educational status, working unit, and shift (p>0.05). Conclusion: In view of the results of this study; we recommend that nurses be trained to prevent LBP and given a regular exercise program for increasing the strength and endurance of the back muscles and the ergonomic arrangement of workplaces should be carried out.Item Reliability and validity of the Turkish version of the Chronic Heart Failure Questionnaire; [Kronik kalp yetersizliǧi Anketi'nin (KKYA) Türkçe sürümünün geçerlilik ve güvenilirliǧi](2010) Yilmaz E.; Eser E.; Gürgün C.; Kültürsay H.Objective: Any disease specific Health Related Quality of Life Instrument for Chronic Heart Failure (CHF) is lacking in Turkey. The aim of this study is to adapt the Chronic Heart Failure Questionnaire (CHQ) into Turkish and probe the reliability and validity of this questionnaire. Methods: There are four dimensions of this 20 items scale. These dimensions are: Dyspnea (5 items), fatigue (4 items), emotional status (7 items) and mastery (4 items). Response options were evaluated using a 7 -point Likert type scale. Quality of life (QOL) improves as the score increases. A total of 205 CHF patients hospitalized in the Department of Cardiology of Ege University hospital were enrolled in this study. The CHQ was applied to the patients twice with a wash-out period of 15 days. Confirmatory approach was used during the reliability and validity analysis. Cronbach alpha test was used for the reliability analysis. Confirmatory factor analysis (CFA) was used for the construct validity testing. NYHA classification for testing the criterion validity; SF-36 and WHOQOL-100 General Health and QOL facet for convergent validity testing of the Turkish version of the CHQ were used. Responsiveness to change was evaluated by Effect Size analysis by using test-retest data. Results: The range of Cronbach alpha values is 0.72-0.94. A considerable ceiling and floor effects were observed for the dyspnea dimension of the scale but no problematic items were observed for the entire scale. The CFA results supported the original four factors scale structure. Criterion and construct validity rebuts were satisfactory. Effect sizes obtained among dimensions of the CHQ were between 0.13 and 0.56. Conclusion: Overall results revealed that Turkish version of the CHQ is a reliable and valid instrument to be used for the evaluation of CHF patients. © 2010 by AVES Yayi{dotless}nci{dotless}li{dotless}k Ltd.Item The psychometric properties of the Turkish version of myocardial infarction dimensional assessment scale (MIDAS); [Miyokart enfarktüsü boyutsal deǧerlendirme ölçeǧi (MIDAS) türkçe sürümünün psikometrik özellikleri](2011) Yilmaz E.; Eser E.; Şekuri C.; Kültürsay H.Objective: The purpose of this study was to describe the psychometric properties of the Myocardial Infarction Dimensional Assessment Scale (MIDAS). Methods: This is a methodological cultural adaptation study. The MIDAS consists of 35-items covering seven domains: physical activity, insecurity, emotional reaction, dependency, diet, concerns over medication, and side effects which are rated on a five-point Likert scale from 1: never to 5:always. The highest score of MIDAS is 100.Quality of life (QOL) decreases as the score of scale increases. Overall 185 myocardial infarction (MI) patients were enrolled in this study. Cronbach alpha was used for the reliability analysis. The criterion validity, structural validity, and sensitivity analysis approach was used for validity analysis. New York Heart Association (NYHA) and the Canadian Cardiovascular Society Functional Classifications (CCSFC) for testing the criterion validity; SF-36 for construct validity testing of the Turkish version of the MIDAS were used. Results: The range of Cronbach alpha values is 0.79-0.90 for seven domains of the scale. No problematic items were observed for the entire scale. Medication related domains of the MIDAS showed considerable floor effects (35.7%-22.7%). Confirmatory Factor analysis indicators [Comparative Fit Index (CFI)=0.95 and Root Mean Square Error of Approximation (RMSEA)=0.075] supported the construct validity of MIDAS. Convergent validity of the MIDAS was confirmed with correlation of SF-36 scale where appropriate. Criterion validity results was also satisfactory by comparing different stages of the NYHA and the CCSFC (p<0.05). Conclusion: Overall results revealed that Turkish version of the MIDAS is a reliable and valid instrument. (Anadolu Kardiyol Derg 2011; 11: 386-401) Copyright 2011 by AVES Yayincilik Ltd.Item The reliability and validity of the Turkish version of the constipation risk assessment scale(2011) Kutlu A.K.; Yilmaz E.; Çeçen D.; Eser E.The aim of this study is to translate into the Turkish language, and test the reliability and validity, of the Turkish version of the Constipation Risk Assessment Scale (CRAS). This study consisted of 245 adult in-patients who were hospitalized in the medical and surgical clinics of Celal Bayar University Hospital in January through May 2007. The patients were categorized into two groups (constipated and not constipated) according to Rome II criteria. All participants were assessed with the CRAS. The CRAS was retested on 32 patients selected randomly from among the initial constipated group (n =152). The statistical analysis consisted of reliability and validity analyses. Test-retest comparison and internal consistency were used to assess the reliability of the instrument. Divergence and known groups approaches were used to test for construct validity. Correlation analysis using the Pearson's coefficient was conducted to assess the test-retest. For testing of the criteria and known groups, Student's t test and Mann-Whitney U test were used. Cronbach's = value for the constipated respondents was r = 61.9. According to the effect size comparisons, the most effective variable on the CRAS score was perception of constipation risk requirement. The overall score and subsection score correlations were also found acceptable (r = 0.47-0.57). © The Society of Gastroenterology Nurses & Associates 2011. All Rights Reserved.Item The Turkish validity and reliability of the venous insufficiency epidemiological and economic study-quality of life/symptoms scales(2011) Kutlu A.; Yilmaz E.; Çeçen D.; Eser E.; Özbakkaloǧlu A.The aim of the study was to test Turkish validity and reliability of Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms (VEINES-QoL/Sym) in patients with chronic venous insufficiency (CVI). A total of 118 patients with CVI hospitalized in 3 different hospitals were enrolled in this study. VEINES-QoL/Sym, translated to Turkish with a standard methodology, was applied to the patients and was evaluated for acceptability, reliability, validity, and responsiveness. Cronbach α (including if item deleted) values were used for the reliability analysis. Construct and criterion validity approaches were used for validity analysis. Cronbach α values are.86 for the VEINES-QOL and.81 for the VEINES-Sym. No problematic items were observed for the scale. The VEINES-QoL/Sym was significantly sensitive to clinical, etiology, anatomy, and pathophysiology (CEAP) classification, indicating good criterion validity. Significant correlation was found between scores of SF-36 and VEINESQoL (r =.43-.66). Turkish version of the VEINES-QOL/Sym was found reliable and valid for Turkish patients with CVI. © The Author(s) 2011.Item Effect of physical and psychosocial factors on occupational low back pain(2012) Yilmaz E.; Dedeli O.Background: Musculoskeletal pain, in particular low back pain, is one of the most common occupational health problems and accounts for a large number of workers' compensational days and disability in modern industrialised societies. It is believed that occupational musculoskeletal pain is caused by multiple factors, generally categorised into physical, psychosocial and lifestyle ones. Aims: The aim of this review was to evaluate role of psychosocial and physical risk factors in work-related low back pain in the light of current literature. Methods and material: The method of this review evaluated both research and review studies in national and international literature which about role of psychosocial and physical risk factors in work-related low back pain. Results: Various physical factors mechanical impacts have been found to be associated with pain in different body regions. Heavy physical work, heavy or frequent manuel operations, repeated rotation of the trunk, whole body vibration and prolonged sitting were positively associated with low back pain. Psychosocial factors at work have also been shown to play important roles in the development of low back pain. Factors such as work demands, decision latitude, symptoms of stress and social support have been reported as important psychosocial factors at work. However, the causal and independent contribution of the work enviroment on the incidence of low back pain is stil debated, especially with regard to psychosocial factors. Conclusion: A number of researchers have been examined the evidence for psychosocial factors at work as risk factors for back pain in recent years. It is recommended to be addressed psychosocial factors as physical factors as for management of work related low back pain.Item Antituberculosis drug resistance patterns in adults with tuberculous meningitis: Results of haydarpasa-iv study(BioMed Central Ltd., 2015) Senbayrak S.; Ozkutuk N.; Erdem H.; Johansen I.S.; Civljak R.; Inal A.S.; Kayabas U.; Kursun E.; Elaldi N.; Savic B.; Simeon S.; Yilmaz E.; Dulovic O.; Ozturk-Engin D.; Ceran N.; Lakatos B.; Sipahi O.R.; Sunbul M.; Yemisen M.; Alabay S.; Beovic B.; Ulu-Kilic A.; Cag Y.; Catroux M.; Inan A.; Dragovac G.; Deveci O.; Tekin R.; Gul H.C.; Sengoz G.; Andre K.; Harxhi A.; Hansmann Y.; Oncu S.; Kose S.; Oncul O.; Parlak E.; Sener A.; Yilmaz G.; Savasci U.; Vahaboglu H.Background: Tuberculous meningitis (TBM) caused by Mycobacterium tuberculosis resistant to antituberculosis drugs is an increasingly common clinical problem. This study aimed to evaluate drug resistance profiles of TBM isolates in adult patients in nine European countries involving 32 centers to provide insight into the empiric treatment of TBM. Methods: Mycobacterium tuberculosis was cultured from the cerebrospinal fluid (CSF) of 142 patients and was tested for susceptibility to first-line antituberculosis drugs, streptomycin (SM), isoniazid (INH), rifampicin (RIF) and ethambutol (EMB). Results: Twenty of 142 isolates (14.1 %) were resistant to at least one antituberculosis drug, and five (3.5 %) were resistant to at least INH and RIF, [multidrug resistant (MDR)]. The resistance rate was 12, 4.9, 4.2 and 3.5 % for INH, SM, EMB and RIF, respectively. The monoresistance rate was 6.3, 1.4 and 0.7 % for INH, SM and EMB respectively. There was no monoresistance to RIF. The mortality rate was 23.8 % in fully susceptible cases while it was 33.3 % for those exhibiting monoresistance to INH, and 40 % in cases with MDR-TBM. In compared to patients without resistance to any first-line drug, the relative risk of death for INH-monoresistance and MDR-TBM was 1.60 (95 % CI, 0.38-6.82) and 2.14 (95 % CI, 0:34-13:42), respectively. Conclusion: INH-resistance and MDR rates seemed not to be worrisome in our study. However, considering their adverse effects on treatment, rapid detection of resistance to at least INH and RIF would be most beneficial for designing anti-TB therapy. Still, empiric TBM treatment should be started immediately without waiting the drug susceptibility testing. © 2015 Senbayrak et al.Item A descriptive, cross-sectional study to assess quality of life and sexuality in Turkish patients with a colostomy(Cliggott Publishing Co., 2017) Yilmaz E.; Çelebi D.; Kaya Y.; Baydur H.A stoma affects personality, self-esteem, and body image, inevitably impacting lifestyle and quality of life (QOL). A descriptive, cross-sectional study was conducted between May 1, 2015 and May 1, 2016 to evaluate the effect of a stoma on sexual function and QOL among patients receiving care in a general surgery clinic of a university hospital in the western region of Turkey. Eligibility requirements included patients willing to participate, >18 years of age, with a colostomy for at least 4 months, who were married and/or with a sexual partner and in otherwise good physical and mental health with no rectal nerve damage or receiving radio-or chemotherapy. Data were collected during face-To-face interviews. Demographic variables (age, gender, body mass index [BMI], educational status, income level); and clinical information (duration of the precipitating disease, and stoma duration, cause, and type) were collected, and the International Index of Erectile Function (IIEF) measure; the Index of Female Sexual Function (IFSF); and a Stoma Quality of Life Scale (SQOLS) were completed. Statistical analyses were performed using descriptive statistics, Spearman's correlation coefficient, and the Mann-Whitney U test. Of the 57 study participants, 57.9% were >60 years old (mean age: 59.81 ± 10.12), more than half (57.92%) were male, 33.3% had a permanent stoma, and the mean duration of the stoma was 9.60 ± 6.40 months. Scores for all 3 outcomes were low; mean IIEF score was 3.64 ± 2.47 (range 2-10), mean IFSF score was 13.04 ± 5.19 (range 9-29), and mean SQOLS was 45.10 ± 18.88 (range 0-100). Eighteen (18) of the 33 men (54.5%) had severe, 5 (15.2%) had moderate, and 9 (27.3%) had mild erectile dysfunction. The IFSF total score for all female patients was <30; all female patients experienced sexual dysfunction. A negative correlation between age and the SQOLS subscale sexuality/body image was found (rs =-0.305, P <.05). A positive correlation was found among BMI, erectile function (rs = 0.350, P <.05), sexual desire (rs = 0.474, P <.01), and intercourse satisfaction (rs = 0.385, P <.05). These study results provide reference data for future study and underscore the importance of assessing and addressing QOL and sexuality concerns among patients with a colostomy. © 2018 HMP Communications. All rights reserved.Item Internalized stigma in psoriasis: A multicenter study(Blackwell Publishing Ltd, 2017) Alpsoy E.; Polat M.; FettahlıoGlu-Karaman B.; Karadag A.S.; Kartal-Durmazlar P.; YalCın B.; Emre S.; Didar-Balcı D.; Bilgic-Temel A.; Arca E.; Koca R.; Gunduz K.; Borlu M.; Ergun T.; Dogruk-Kacar S.; Cordan-Yazici A.; Dursun P.; Bilgic O.; Gunes-Bilgili S.; Sendur N.; Baysal O.; Halil-Yavuz I.; Yagcioglu G.; Yilmaz E.; Kavuzlu U.; Senol Y.Internalized stigma is the adoption of negative attitudes and stereotypes of the society regarding a person's illness. It causes decreased self-esteem and life-satisfaction, increased depression and suicidality, and difficulty in coping with the illness. The primary aim of this study was to investigate the internalized stigma state of psoriatic patients and to identify the factors influencing internalized stigma. The secondary aim was to identify the correlation of internalized stigma with quality of life and perceived health status. This multicentre, cross-sectional study comprised 1485 patients. There was a significant positive correlation between mean values of Psoriasis Internalized Stigma Scale (PISS) and Psoriasis Area and Severity Index, Body Surface Area, Dermatological Life Quality Index and General Health Questionnaire-12 (P < 0.001 in all). Lower percieved health score (P = 0.001), early onset psoriasis (P = 0.016), family history of psoriasis (P = 0.0034), being illiterate (P < 0.001) and lower income level (P < 0.001) were determinants of high PISS scores. Mean PISS values were higher in erythrodermic and generalized pustular psoriasis. Involvement of scalp, face, hand, genitalia and finger nails as well as arthropathic and inverse psoriasis were also related to significantly higher PISS scores (P = 0.001). Our findings imply that psoriatic patients experience high levels of internalized stigma which are associated with psoriasis severity, involvement of visible body parts, genital area, folds or joints, poorer quality of life, negative perceptions of general health and psychological illnesses. Therefore, internalized stigma may be one of the major factors responsible from psychosocial burden of the disease. © 2017 Japanese Dermatological AssociationItem The Effect of Functional Disability and Quality of Life on Decision to Have Surgery in Patients With Lumbar Disc Herniation(Lippincott Williams and Wilkins, 2018) Yilmaz E.; Çikrikçioǧlu H.Y.; Baydur H.Background/Purpose: This study aimed to determine the effect of functional disability and quality of life (QoL) on the decision to have surgery in patients with lumbar disc herniation (LDH). Method/Design: This is descriptive and cross-sectional survey. A total of 239 patients were included in the study. Data were collected using a personal information form, Surgical Belief and Attitudes Questionnaire (SBAQ), Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ) and Short Form-36 (SF-36). The data analysis was undertaken using Mann-Whitney U test, χ2 test, and logistic regression model. Results: Patients were found to have low mean scores in the SF-36 subscales and SBAQ and high mean scores in ODI, RMDQ, and VAS. Six weeks after the first interview, 48.1% of patients decided to undergo surgery. A statistically significant difference was found between a decision to have surgery and the ODI, RMDQ, VAS, SBAQ scores and 6 of the 8 SF-36 subscales (except for role physical and general health; p <.05). Patients who had higher functional disability, pain intensity, and SBAQ score and those with lower QoL were more likely to decide to undergo surgery. Conclusions: The results of the study showed that patients with LDH who have been referred for surgery experience high functional disability and pain and a poor QoL, and that these factors have an impact on their decision to have surgery process. © 2018 by National Association of Orthopaedic Nurses.Item Effects of nutritional Vitamin D supplementation on markers of bone and mineral metabolism in children with chronic kidney disease(Oxford University Press, 2018) Lerch C.; Shroff R.; Wan M.; Rees L.; Aitkenhead H.; Bulut I.K.; Thurn D.; Bayazit A.K.; Niemirska A.; Canpolat N.; Duzova A.; Azukaitis K.; Yilmaz E.; Yalcinkaya F.; Harambat J.; Kiyak A.; Alpay H.; Habbig S.; Zaloszyc A.; Soylemezoglu O.; Candan C.; Rosales A.; Melk A.; Querfeld U.; Leifheit-Nestler M.; Sander A.; Schaefer F.; Haffner D.; Cortina G.; Arbeiter K.; Dusek J.; Ranchin B.; Fischbach M.; Zalosczyk A.; Galiano M.; Büscher R.; Gimpel C.; Kemper M.; Doyon A.; Wühl E.; Pohl M.; Wygoda S.; Jeck N.; Kranz B.; Wigger M.; Montini G.; Lugani F.; Testa S.; Vidal E.; Matteucci C.; Picca S.; Jankauskiene A.; Zurowska A.; Drodz D.; Tkaczyk M.; Urasinski T.; Litwin M.; Szczepanska M.; Texeira A.; Peco-Antic A.; Bucher B.; Laube G.; Anarat A.; Basin E.; Cakar N.; Bilginer Y.; Erdogan H.; Donmez O.; Balat A.; Caliskan S.; Civilibal M.; Emre S.; Ozcelik G.; Mir S.; Sözeri B.; Yavascan O.; Tabel Y.; Ertan P.; Prytula A.; Bachetta J.; Klaus G.; Geßner M.; Schmitt C.P.; Stabouli S.; Reusz G.; Verrina E.; Groothoff J.; Tondel C.; Gamero M.A.; Petrosyan E.; Bakkaloglu S.A.; Dursun I.Background: We investigated the effects of nutritional vitamin D supplementation on markers of bone and mineral metabolism, i.e. serum levels of fibroblast growth factor 23(FGF23), Klotho, bone alkaline phosphatase (BAP) and sclerostin, in two cohorts with chronic kidney disease (CKD). Methods: In all, 80 vitamin D-deficient children were selected: 40 with mild to moderate CKD from the ERGO study, a randomized trial of ergocalciferol supplementation [estimated glomerular filtration rate (eGFR) 55 mL/min/1.73 m2], and 40 with advanced CKD from the observational Cardiovascular Comorbidity in Children with Chronic Kidney Disease (4C) study (eGFR 24 mL/min/1.73 m2). In each study, vitamin D supplementation was started in 20 children and 20 matched children not receiving vitamin D served as controls. Measures were taken at baseline and after a median period of 8 months. Age- and gender-related standard deviation scores (SDSs) were calculated. Results: Before vitamin D supplementation, children in the ERGO study had normal FGF23 (median 0.31 SDS) and BAP (-0.10 SDS) but decreased Klotho and sclerostin (-0.77 and - 1.04 SDS, respectively), whereas 4C patients had increased FGF23 (3.87 SDS), BAP (0.78 SDS) and sclerostin (0.76 SDS) but normal Klotho (-0.27 SDS) levels. Vitamin D supplementation further increased FGF23 in 4C but not in ERGO patients. Serum Klotho and sclerostin normalized with vitamin D supplementation in ERGO but remained unchanged in 4C patients. BAP levels were unchanged in all patients. In the total cohort, significant effects of vitamin D supplementation were noted for Klotho at eGFR 40-70mL/min/1.73m2. Conclusions: Vitamin D supplementation normalized Klotho and sclerostin in children with mild to moderate CKD but further increased FGF23 in advanced CKD. © The Author(s) 2018. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.Item Indoxyl sulfate associates with cardiovascular phenotype in children with chronic kidney disease(Springer Verlag, 2019) Holle J.; Querfeld U.; Kirchner M.; Anninos A.; Okun J.; Thurn-Valsassina D.; Bayazit A.; Niemirska A.; Canpolat N.; Bulut I.K.; Duzova A.; Anarat A.; Shroff R.; Bilginer Y.; Caliskan S.; Candan C.; Harambat J.; Özcakar Z.B.; Soylemezoglu O.; Tschumi S.; Habbig S.; Yilmaz E.; Balat A.; Zurowska A.; Cakar N.; Kranz B.; Ertan P.; Melk A.; Azukaitis K.; Schaefer F.Background: Cardiovascular disease is the leading cause of death in children with chronic kidney disease (CKD). Serum levels of gut-derived uremic toxins increase with deterioration of kidney function and are associated with cardiac comorbidities in adult CKD patients. Methods: Indoxyl sulfate (IS) and p-cresyl sulfate (pCS) were measured by high-performance liquid chromatography in serum of children participating in the Cardiovascular Comorbidity in Children with CKD (4C) Study. Results were correlated with measurements of the carotid intima-media thickness (cIMT), central pulse wave velocity (PWV), and left ventricular mass index (LVMI) in children aged 6–17 years with initial eGFR of 10–60 ml/min per 1.73 m2. Results: The median serum levels of total IS and of pCS, measured in 609 patients, were 5.3 μmol/l (8.7) and 17.0 μmol/l (21.6), respectively. In a multivariable regression model, IS and pCS showed significant positive associations with urea and negative associations with eGFR and uric acid. Furthermore, positive associations of pCS with age, serum albumin, and non-Mediterranean residency and a negative association with glomerular disease were observed. By multivariable regression analysis, only IS was significantly associated with a higher cIMT SDS at baseline and progression of PWV SDS within 12 months, independent of other risk factors. Conclusions: Serum levels of gut-derived uremic toxins IS and pCS correlated inversely with eGFR in children. Only IS was significantly associated with surrogate markers of cardiovascular disease in this large pediatric CKD cohort. © 2019, IPNA.Item Low levels of urinary epidermal growth factor predict chronic kidney disease progression in children(Elsevier B.V., 2019) Azukaitis K.; Ju W.; Kirchner M.; Nair V.; Smith M.; Fang Z.; Thurn-Valsassina D.; Bayazit A.; Niemirska A.; Canpolat N.; Bulut I.K.; Yalcinkaya F.; Paripovic D.; Harambat J.; Cakar N.; Alpay H.; Lugani F.; Mencarelli F.; Civilibal M.; Erdogan H.; Gellermann J.; Vidal E.; Tabel Y.; Gimpel C.; Ertan P.; Yavascan O.; Melk A.; Querfeld U.; Wühl E.; Kretzler M.; Schaefer F.; Arbeiter K.; Rosales A.; Dusek J.; Zaloszyc A.; Liebau M.; Weber L.; Muschiol E.; Büscher R.; Oh J.; Thurn-Valassina D.; Haffner D.; John U.; Wygoda S.; Jeck N.; Wigger M.; Testa S.; Murer L.; Matteucci C.; Jankauskiene A.; Drozdz D.; Zurowska A.; Zaniew M.; Litwin M.; Nimierska A.; Teixeira A.; Peco-Antic A.; Laube G.; Anarat A.; Duzova A.; Bilginer Y.; Caliskan S.; Mir S.; Sözeri B.; Kranz B.; Dorn B.; Baskin E.; Soylemezoglu O.; Emre S.; Candan C.; Kiyak A.; Ozcelik G.; Shroff R.; Rachin B.; Szczepanska M.; Donmez O.; Balat A.; Aksu N.; Yilmaz E.; Bakkaloglu A.; Ozaltin F.; Sallay P.; Bonzel K.-E.; Wingen A.-M.; Balasz I.; Trivelli A.; Perfumo F.; Müller-Wiefel D.-E.; Möller K.; Offner G.; Enke B.; Hadtstein C.; Mehls O.; Hohbach-Hohenfellner K.; Jeck N.; Klaus G.; Ardissino G.; Montini G.; Charbit M.; Niaudet P.; Afonso A.C.; Fernandes-Teixeira A.; Picca S.; Berg U.B.; Celsi G.; Fischbach M.; Terzic J.; Fydryk J.; Urasinski T.; Coppo R.; Peruzzi L.; Grenda R.; Neuhaus T.J.Urinary epidermal growth factor (uEGF) has recently been identified as a promising biomarker of chronic kidney disease (CKD) progression in adults with glomerular disease. Low levels of uEGF predict CKD progression and appear to reflect the extent of tubulointerstitial damage. We investigated the relevance of uEGF in pediatric CKD. We performed a post hoc analysis of the Cardiovascular Comorbidity in Children with CKD (4C) study, which prospectively follows children aged 6–17 years with baseline estimated glomerular filtration rate (eGFR) of 10–60 ml/min/1.73 m2. uEGF levels were measured in archived urine collected within 6 months of enrollment. Congenital abnormalities of the kidney and urinary tract were the most common cause of CKD, with glomerular diseases accounting for <10% of cases. Median eGFR at baseline was 28 ml/min/1.73 m2, and 288 of 623 participants (46.3%) reached the composite endpoint of CKD progression (50% eGFR loss, eGFR < 10 ml/min/1.73 m2, or initiation of renal replacement therapy). In a Cox proportional hazards model, higher uEGF/Cr was associated with a decreased risk of CKD progression (HR 0.76; 95% CI 0.69–0.84) independent of age, sex, baseline eGFR, primary kidney disease, proteinuria, and systolic blood pressure. The addition of uEGF/Cr to a model containing these variables resulted in a significant improvement in C-statistics, indicating better prediction of the 1-, 2- and 3-year risk of CKD progression. External validation in a prospective cohort of 222 children with CKD demonstrated comparable results. Thus, uEGF may be a useful biomarker to predict CKD progression in children with CKD. © 2019 International Society of NephrologyItem Internalized stigma in pediatric psoriasis: A comparative multicenter study(Korean Dermatological Association, 2020) Alpsoy E.; Polat M.; Yavuz I.H.; Kartal P.; Balci D.D.; Karadag A.S.; Bilgic A.; Arca E.; Karaman B.F.; Emre S.; Adisen E.; Sendur N.; Bilgic O.; Yazici A.C.; Yalcin B.; Koca R.; Gunduz K.; Borlu M.M.; Ergun T.; Dursun P.; Bilgili S.G.; Adanir A.S.; Gulekon A.; Yagcioglu G.; Yilmaz E.; Kavuzlu U.; Senol Y.Background: Internalized stigma, adoption of negative attitudes and stereotypes of the society regarding persons' illness, has not been studied previously in pediatric psoriasis patients. Objective: We aimed to investigate the internalized stigma in pediatric psoriasis patients and to determine differences according to factors affecting internalized stigma compared to adult psoriasis patients. Methods: This multicenter, cross-sectional, comparative study included 125 pediatric (55 female, 70 male; mean age±standard deviation [SD], 14.59±2.87 years) and 1,235 adult psoriasis patients (577 female, 658 male; mean age±SD, 43.3±13.7 years). Psoriasis Internalized Stigma Scale (PISS), Dermatology Life Quality Index (DLQI), Perceived Health Status (PHS), and the General Health Questionnaire (GHQ)-12 were the scales used in the study. Results: The mean PISS was 58.48±14.9 in pediatric group. When PISS subscales of groups were compared, the pediatric group had significantly higher stigma resistance (p=0.01) whereas adult group had higher scores of alienation (p=0.01) and stereotype endorsement (p=0.04). There was a strong correlation between mean values of PISS and DLQI (r=0.423, p=0.001). High internalized stigma scores had no relation to either the severity or localization of disease in pediatric group. However, poor PHS (p=0.007) and low-income levels (p=0.03) in both groups, and body mass index (r=0.181, p=0.04) in the pediatric group were related to high PISS scores. Conclusion: Internalized stigma in pediatric patients is as high as adults and is related to poor quality of life, general health, and psychological illnesses. Unlike adults, internalized stigma was mainly determined by psoriasis per se, rather than disease severity or involvement of visible body parts, genitalia or folds. Copyright © The Korean Dermatological Association and The Korean Society for Investigative Dermatology.Item A qualitative study of the operating room experience of patients who underwent surgery under spinal anesthesia: “It was like an adventure”(Blackwell Publishing, 2020) Yilmaz E.; Toğaç H.K.; Çetinkaya A.; Toğaç S.This study aimed to explore the experiences of the people who underwent orthopedic surgery under spinal anesthesia and to report their feelings and thoughts. The study was carried out using a qualitative approach. Twenty-one patients were interviewed who underwent orthopedic surgery on the first or second postoperative day. Content analysis was performed after the collection of raw data. NVIVO 12 Pro software was used for data analysis. The frequency count (f) and participant codes (P) were used for the presentation of the findings. The themes and frequency counts obtained by analyzing the interviews with the patients were as follows: “Time passed like watching a movie” (f = 213), “Like an adventure” (f = 587), and “See, feel, look” (f = 405). Five of 21 participants (23.8%) stated that they would not recommend spinal anesthesia. The findings generally indicated the anxiety caused by the unknown, fear in the preanesthetic period, operation experienced like an adventure, and a process generally completed with satisfaction. © 2020 John Wiley & Sons Australia, Ltd