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Öğe Be Aware of Critical Drugs in Emergency Departments: An Extreme Iatrogenic Insulin Overdose via Subcutaneous and Intramuscular Routes(Emergency Medicine Physicians Assoc Turkey, 2021) Coşkun, Figen; Vural, Sevilay; Eroğlu, Oğuz; Cömertpay, Ertan; Durmaz, Senay ArıkanIntroduction: Insulin is a highly used parenteral medication in emergency departments. Although most severe insulin overdoses occur as suicide attempts, medication errors can be the reason. We aimed to highlight the potential medication errors in emergency departments due to the poor control of critical drugs like insulin and the similarities between the brand names of drugs, as we experienced during this case. Case Report: We present a 75-year-old diabetic woman with an extreme insulin overdose. A total of 3000 UI of insulin was administered by subcutaneous and intramuscular routes. She developed typical and atypical episodes of hypoglycemia requiring intravenous dextrose, a high-calorie diet, and glucagon administration. Almost all of the classic side effects of glucagon occurred during her intensive care unit follow-up. She recovered without any sequela or recurrence of hypoglycemia at the end of 5 days of admission. Conclusion: Insulin overdose can be a life-threatening condition by causing hypoglycemia. Albeit rare, insulin overdose can occur as a medication error in hospitals. To prevent such incidents for emergency departments, the medication errors should be objectively laid out, and proactive strategies should be integrated without adversely affecting acute care.Öğe Automated Classification of Rheumatoid Arthritis, Osteoarthritis, and Normal Hand Radiographs with Deep Learning Methods(Springer, 2022) Üreten, Kemal; Maraş, Hadi HakanRheumatoid arthritis and hand osteoarthritis are two different arthritis that causes pain, function limitation, and permanent joint damage in the hands. Plain hand radiographs are the most commonly used imaging methods for the diagnosis, differential diagnosis, and monitoring of rheumatoid arthritis and osteoarthritis. In this retrospective study, the You Only Look Once (YOLO) algorithm was used to obtain hand images from original radiographs without data loss, and classification was made by applying transfer learning with a pre-trained VGG-16 network. The data augmentation method was applied during training. The results of the study were evaluated with performance metrics such as accuracy, sensitivity, specificity, and precision calculated from the confusion matrix, and AUC (area under the ROC curve) calculated from ROC (receiver operating characteristic) curve. In the classification of rheumatoid arthritis and normal hand radiographs, 90.7%, 92.6%, 88.7%, 89.3%, and 0.97 accuracy, sensitivity, specificity, precision, and AUC results, respectively, and in the classification of osteoarthritis and normal hand radiographs, 90.8%, 91.4%, 90.2%, 91.4%, and 0.96 accuracy, sensitivity, specificity, precision, and AUC results were obtained, respectively. In the classification of rheumatoid arthritis, osteoarthritis, and normal hand radiographs, an 80.6% accuracy result was obtained. In this study, to develop an end-to-end computerized method, the YOLOv4 algorithm was used for object detection, and a pre-trained VGG-16 network was used for the classification of hand radiographs. This computer-aided diagnosis method can assist clinicians in interpreting hand radiographs, especially in rheumatoid arthritis and osteoarthritis.Öğe Acute pancreatitis in Turkey: Results of a nationwide multicenter study(Elsevier, 2024) Koksal, Aydin Seref; Tozlu, Mukaddes; Sezgin, Orhan; Oğuz, Dilek; Kalkan, Ismail Hakk; Altıntaş, Engin; Yaraş, SerkanBackground: Acute pancreatitis (AP) is the most common gastrointestinal disease requiring hospitalization, with significant mortality and morbidity. We aimed to evaluate the clinical characteristics of AP and physicians ' compliance with international guidelines during its management. Methods: All patients with AP who were hospitalized at 17 tertiary centers in Turkey between April and October 2022 were evaluated in a prospective cohort study. Patients with insufficient data, COVID-19 and those aged below 18 years were excluded. The definitions were based on the 2012 revised Atlanta criteria. Results: The study included 2144 patients (median age:58, 52 % female). The most common etiologies were biliary (n = 1438, 67.1 %), idiopathic (n = 259, 12 %), hypertriglyceridemia (n = 128, 6 %) and alcohol (n = 90, 4.2 %). Disease severity was mild in 1567 (73.1 %), moderate in 521 (24.3 %), and severe in 58 (2.6 %) patients. Morphology was necrotizing in 4.7 % of the patients. The overall mortality rate was 1.6 %. PASS and BISAP had the highest accuracy in predicting severe pancreatitis on admission (AUC:0.85 and 0.81, respectively). CT was performed in 61 % of the patients, with the majority (90 %) being within 72 h after admission. Prophylactic NSAIDs were not administered in 44 % of the patients with post-ERCP pancreatitis (n = 86). Antibiotics were administered to 53.7 % of the patients, and 38 % of those received them prophylactically. Conclusions: This prospective study provides an extensive report on clinical characteristics, management and outcomes of AP in real -world practice. Mortality remains high in severe cases and physicians ' adherence to guidelines during management of the disease needs improvement in some aspects. (c) 2023 IAP and EPC. Published by Elsevier B.V. All rights reserved.Öğe A New Predictor for Insulin Resistance in Polycystic Ovary Syndrome: InsuTAG(Bentham Science Publ Ltd, 2024) Omma, Tülay; Gökçe, Aksanur; Çelik, Mustafa; Karahan, İrfan; Çulha, Cavit; Gülçelik, Neşe ErsözBackground: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among women of reproductive age. PCOS leads to metabolic dysfunction such as dyslipidemia, obesity, and glucose intolerance based on hyperandrogenemia, hyperinsulinemia, and dysregulated adipokine secretion.Objective: The aim of this study was to investigate whether a new marker, InsuTAG (fasting insulinxfasting triglycerides) could predict insulin resistance (IR) in patients of PCOS.Methods: In this study, retrospective data of 300 female patients diagnosed with PCOS were analyzed. The relationship between InsuTAG and HOMA-IR, TyG, and TG/HDL-C scores related to insulin resistance was evaluated. In addition, the distribution of the cases according to the cut-off values was determined.Results: Log-transformed forms of InsuTAG and HOMA-IR, TyG and TG/HDL-C results were positively correlated, respectively. (r = 0.85, p < 0.001; r = 0.78, p < 0.001; r = 0.72, p < 0.001). Sensitivity, specificity, positive predictive value and negative predictive values for InsuTAG were calculated as 85%, 85%, 82% and 88%, respectively.Conclusion: This study is the first to compare the InsuTAG, another predictor of insulin resistance, with other IR markers in women with PCOS. InsuTAG is a novel biomarker based on plasma sampling of insulin and triglyceride, with minimally invasive, inexpensive and orientally accessible features.Öğe A Case of Miliary Tuberculosis Detected with Laryngeal Oedema: Complication with Septic Shock and Thrombocytopaenia(Aves, 2013) Bulcun, Emel; Ekici, Aydanur; Ekici, Mehmet; Gülhan, Pınar Yıldız; Güngör, Ömür; Kazkayası, MustafaTuberculosis, a disease with a wide clinical spectrum, can involve all tissues and organs. A 57-year-old case appeared in the form miliary tuberculosis after laryngeal oedema. Septic shock developed in the course of tuberculosis. Thrombocytopaenia then developed, while septic shock improved following antituberculosis treatment. Thrombocytopaenia improved after rifampicin was removed from the treatment regimen. We decided to present our case here as an interesting form of tuberculosis with complications.Öğe Mortality Trends from Ischemic Heart Disease in Turkey: 2009-2019(Kare Publ, 2022) Yalım, Zafer; Doğan, Nurhan; Yalım, Sümeyra AlanObjective: Cardiovascular diseases still play an important role in public health and epidemiology as the leading cause of death worldwide. Ischemic heart disease is the most common reason in this group. This study aims to analyze the latest trends in ischemic heart disease mortality rates in Turkey by age, gender, and region using the Turkish Statistical Institute mortality data and evaluate the results. Methods: We have obtained ischemic heart disease mortality data (2009-2019, in 12 regions) for Turkey from the mortality database of the Turkish Statistical Institute. Joinpoint analysis was used to estimate the annual percentage change and average annual percentage change to identify significant changes in trends. Results: The mean mortality rate for ischemic heart disease in Turkey was in an increasing trend from 2009 to 2019 (annual percentage change=1.7 (-0.8; 4.3), P = .166). This increase was more pronounced in women (annual percentage change = 2.2 (-0.7; 5.2), P=.121) compared to men (annual percentage change = 1.4 (-1.1; 3.9), P = .235). When the period between 2015 and 2019 was evaluated, it was determined that ischemic heart disease mortality was in a decreasing trend in the groups over 65 years of age. The death rate due to ischemic heart disease is almost 2 times higher in men than in women in Turkey, and this rate ratio is highest in the Istanbul region. Conclusion: Although ischemic heart disease mortality trends have decreased globally, our country's average is still on an increasing trend. However, significant decreases have been observed in ischemic heart disease mortality rates, especially in the group over 65 years of age, in the last 5 years.Öğe Diagnosis of osteoarthritic changes, loss of cervical lordosis, and disc space narrowing on cervical radiographs with deep learning methods(Turkish Joint Diseases Foundation, 2022) Maraş, Yüksel; Tokdemir, Gül; Üreten, Kemal; Atalar, Ebru; Duran, Semra; Maraş, HakanObjectives: In this study, we aimed to differentiate normal cervical graphs and graphs of diseases that cause mechanical neck pain by using deep convolutional neural networks (DCNN) technology. Materials and methods: In this retrospective study, the convolutional neural networks were used and transfer learning method was applied with the pre-trained VGG-16, VGG-19, Resnet-101, and DenseNet-201 networks. Our data set consisted of 161 normal lateral cervical radiographs and 170 lateral cervical radiographs with osteoarthritis and cervical degenerative disc disease. Results: We compared the performances of the classification models in terms of performance metrics such as accuracy,Öğe Pancreas and kidney changes in type 2 diabetes patients: the role of diffusion-weighted imaging(Tubitak Scientific & Technological Research Council Turkey, 2021) Şahan, Mehmet Hamdi; Özdemir, Adnan; Asal, Nese; Karadeniz Bilgili, Yasemin Mirace; Doğan, Adil; Güngüneş, AşkınBackground/aim: The aim of this study was to compare renal and pancreatic apparent diffusion-coefficient (ADC) values of diabetic patients and control subjects and to examine their potential association with several diabetes-related clinical parameters. Materials and methods: A total of 80 sex-and age-matched patients were included in the study. Of them, 40 were patients with type 2 diabetes and 40 were nondiabetic participants. Abdominal diffusion-weighted MRIs of both groups were retrospectively reviewed. Diabetes-related clinical parameters were recorded. Results: The difference between the mean ADC values of the patient group and the control group was significant (p = 0.012). It was also found that the mean pancreatic ADC values of diabetic patients and the control group significantly differed (p = 0.02). Besides, there were positive correlations between the mean pancreatic ADC values and age, Hb1Ac level, treatment type, and disease duration (p < 0.05). While eGFR values positively correlated with the mean renal ADC values (p < 0.05), there were negative correlations between such values and age, serum creatinine level, and disease duration (p < 0.05). Conclusion: Renal and pancreatic ADC values of diabetic patients could potentially play a role, as markers of renal and pancreatic functions, in clinical decisions in the follow-up of such patients.Öğe Assessment of erythrocyte morphology in patients with type 2 diabetes mellitus: a pilot study of electron microscopy-based analysis in relation to healthy controls(Tubitak Scientific & Technological Research Council Turkey, 2021) Mortaş, Tülay; Durmaz, Şenay Arıkan; Sezen, Şaban Cem; Savranlar, YaseminBackground/aim: The present study aimed to assess erythrocyte morphology in newly diagnosed type 2 diabetes mellitus patients using scanning electron microscopy. Materials and methods: In total, 30 patients admitted to endocrine outpatient clinics were included in the study. The patients were divided into two groups according to their fasting blood glucose levels: type 2 diabetes mellitus (n = 15, fasting blood glucose levels >= 126 mg/dL) and control (n = 15, fasting blood glucose levels < 99 mg/dL). The patient's demographic characteristics, haemoglobin A1c levels, and scanning electron microscopy findings regarding erythrocyte morphology were recorded. Results: There was no significant difference between the control and type 2 diabetes mellitus group in terms of the participants' age (51.13 +/- 8.53 vs. 50.33 +/- 8.72 years, p = 0.8) and the male/female ratio (9/6 vs. 9/6). In the control group, discocytes were abundant, echinocytes were rare, and spherocytes were absent. On the other hand, discocytes were less common and echinocyte-shaped erythrocytes were more common in the type 2 diabetes mellitus group than in the control group. In addition, spherocytes were detected in the type 2 diabetes mellitus group. Moreover, the diameter of discocytes was significantly lower (p = 0.014), and blood glucose and haemoglobin A1c levels were significantly higher (p < 0.05 for both) in the type 2 diabetes mellitus group than in the control group. Conclusion: Our findings indicate that high glucose levels in type 2 diabetes mellitus patients lead to significant alterations in erythrocyte morphology, including decreased erythrocyte deformability and the formation of echinocytes and spherocytes due to eryptosis. The possibility of decreased erythrocyte deformability due to excessive eryptosis may disturb microcirculation in newly diagnosed, treatment-naive type 2 diabetes mellitus patients who do not have any complications.Öğe Presenting Turkish Inappropriate Medication Use in the Elderly (TIME) Criteria Set in Turkish(Galenos Publ House, 2021) Bahat, Gülistan; Ilhan, Birkan; Erdoğan, Tuğba; Halil, Meltem; Savaş, Sumru; Ülger, Zekeriya; Akyüz, Filiz[Abstract No tAvailable]Öğe Effects of Potentially Inappropriate Medications in Older Patients with Gastrointestinal System Cancer(Galenos Publ House, 2023) Özkan, Melike; Karahan, İrfan; Yalçın, Selim; Şengül Ayçiçek, GözdeObjective: Potentially inappropriate medications (PIM) is a crucial problem in the geriatric population. The amount of prescription and unadherence increase because of the different problems encountered in cancer patients. Our aim was to evaluate the effects of PIM in patients with gastrointestinal system cancer and to investigate its relationship with chemotherapy side effects, mortality, and progression. Methods: This retrospective cohort study assessed 154 patients with gastrointestinal system cancer. Demographics and disease features, the presence of PIM according to the TIME-to-STOP criteria and baseline laboratory parameters were recorded. The effects of PIM on survival and adverse treatment events were evaluated. Results: 66.9% of the cases were male and 33.1% were female. The mean age was 71.9 +/- 6.4 years. The most common side effects of chemotherapy are nausea, vomiting, kidney injury, and pain. The most frequently used prescriptions among the 98 PIMs were gliclazide, hyoscine N-butylbromide, simethicone, diphenoxylate atropine, and thiocolchicoside. PIM was detected in 68.1% of the participants. Chemotherapy side effects were more common in PIM group (p<0.001, odds ratio =5.6). PIM had no effect on mortality. Factors associated with mortality were age, stage, albumin, creatinine, operation history, and progression. A significant relationship was found between age, cancer stage, albumin, creatinine, operation history, and PIM in the regression model. There was no relationship between PIM and progression-free survival. Conclusion: Chemotherapy toxicity may increase with PIM detected on diagnosis. We suggest that PIM is an important factor in predicting the side effects of chemotherapy and minimizing the adverse effects.Öğe Clofarabine, cyclophosphamide, and etoposide (CLOVE) in adult patients with relapsed/refractory acute T-cell lymphoblastic leukemia: single-center experience(Cukurova Univ, Fac Medicine, 2023) Güven, Zeynep Tuğba; Tubay, Saziye Esra; Çelik, Serhat; Keklik, Muzaffer; Ünal, AliPurpose: Clofarabine is a second-generation purine analog that inhibits DNA synthesis. It is used as an effective new agent in relapsed refractory acute leukemia. We aimed to report our single center experience about CLOVE protocol as a clofarabine-based regimen in patients with relapsed or refractory T-cell acute lymphoblastic leukemia.Materials and Methods: Thirteen patients with relapsed or resistant T-cell acute lymphoblastic leukemia were included in this study. Patients were administered clofarabine (40 mg/m2/day), etoposide (100 mg/m2/day), and cyclophosphamide (440 mg/m2/day) (5 days chemotherapy). The patients' data were reviewed retrospectively, the demographic and clinical characteristics of patients were recorded.Results: The patients' median age was 47, and 77% (n:10) of them were male. The median number of chemotherapy regimens they received before clofarabine was 3. Of the patients, 54% (n=7) presented with relapse, and 46% (n=6) with refractory disease. Hematological side effects were observed in all patients during treatment, and 4 (31%) patients were complicated by febrile neutropenia. Other side effects were hepatotoxicity 39%, skin reaction 2%, nausea 54%, and mucositis 31%. Three (23%) patients were unresponsive to treatment. A response was obtained in 10 (77%) patients. Allogeneic stem cell transplantation was performed in 4 of 5 patients with complete response. The median follow-up time after CLOVE was 2.3 (0.69- 26.02) months. The median estimated survival time was 21.04 & PLUSMN; 3.88 (95%CI: 13.43-28.64) months. Overall survival was 85.7% at three months and 57.1% at one year. Three patients were alive at the end of our study.Conclusion: The combination of clofarabine, etoposide, and cyclophosphamide (CLOVE) appears to be successful in achieving a response in relapsing or resistant acute leukemia. However, more effective regimens are still needed.Öğe Evaluation of abdominal computed tomography findings in patients with COVID-19: a multicenter study(Turkish Soc Radiology, 2023) Onur, Mehmet Ruhi; Özbay, Yakup; Idilman, Ilkay; Karaosmanoglu, Ali Devrim; Ramadan, Selma Uysal; Barlik, Funda; Aydin, SonayPURPOSETo evaluate the frequency of abdominal computed tomography (CT) findings in patients with coronavirus disease-2019 (COVID-19) and interrogate the relationship between abdominal CT findings and patient demographic features, clinical findings, and laboratory test results as well as the CT atheroscle-rosis score in the abdominal aorta.METHODSThis study was designed as a multicenter retrospective study. The abdominal CT findings of 1.181 patients with positive abdominal symptoms from 26 tertiary medical centers with a positive polymerase chain-reaction test for severe acute respiratory syndrome coronavirus 2 were reviewed. The frequency of ischemic and non-ischemic CT findings as well as the association between CT findings, clinical features, and abdominal aortic calcific atherosclerosis score (AA-CAS) were recorded.RESULTSIschemic and non-ischemic abdominal CT findings were detected in 240 (20.3%) and 328 (27.7%) patients, respectively. In 147 patients (12.4%), intra-ab-dominal malignancy was present. The most frequent ischemic abdominal CT findings were bowel wall thickening (n = 120; 10.2%) and perivascular infil-tration (n = 40; 3.4%). As for non-ischemic findings, colitis (n = 91; 7.7%) and small bowel inflammation (n = 73; 6.2%) constituted the most frequent disease processes. The duration of hospital stay was found to be higher in patients with abdominal CT findings than in patients without any positive findings (13.8 & PLUSMN; 13 vs. 10.4 & PLUSMN; 12.8 days, P < 0.001). The frequency of abdominal CT findings was significantly higher in patients who did not survive the infection than in patients who were discharged after recovery (41.7% vs. 27.4%, P < 0.001). Increased AA-CAS was found to be associated with a higher risk of ischemic conditions in abdominal CT examinations.CONCLUSIONAbdominal symptoms in patients with COVID-19 are usually associated with positive CT findings. The presence of ischemic findings on CT correlates with poor COVID-19 outcomes. A high AA-CAS is associated with abdominal ischemic findings in patients with COVID-19.Öğe Early Inflammation Related to Pediatric Obesity(Aves Yayincilik, Ibrahim Kara, 2023) Derhem, Baki; Karahan, İrfanObjective: Obesity is a serious health problem, has reached pandemic proportions and represents a major risk for several comorbidities. Some of the serum markers are considered to be associated with low-grade chronic inflammation. Neutrophil to lymphocyte ratio (NLR) is a new and cost-effective marker for the detection of subclinical inflammation that correlates with C-reactive protein (CRP) levels. The objectives of this study were to examine the relation between children's BMI and the bio-markers of early inflammatory predictors.Material and Methods: The retrospective study included 176 children aged 5-18 years who applied to a primary care setting in Turkiye be-tween January 2019 and March 2019. Participants with BMIs between 85-95 percentiles were defined as overweight and those over 95 per-centiles as obese. For all groups, hemogram parameters, cell volumes, and ratios were evaluated and compared. In addition, NLR and PLR were compared.Results: We found that neutrophil count and NLR were significantly different between the normal weight and overweight/obese groups (p= 0.001, p< 0.001 respectively) while hemoglobin, WBC, MPV, MCV, RDW, and PLR were similar in hemogram evaluation.Conclusion: Obesity is associated with low-grade inflammation levels and is reaching alarming rates among both children and adults. Our study suggested that neutrophil counts and NLR were significantly higher in overweight/obese children. Obesity-related studies involving pediatric patients are crucial to developing appropriate methods for preventing the development of further complications in adulthood.Öğe Can Dehydroepiandrosterone-Sulphate be a New Diagnostic Parameter in Idiopathic Hypogonadotropic Hypogonadism?(Galenos Publ House, 2022) Çadırcı, Kenan; Keskin, Havva; Bayrak, Muharrem; Çarlıoğlu, Ayşe; Ceylan Arıkan, SenayObjective: Dehydroepiandrosterone (DHEA) and its sulfate derivative DHEA-sulfate (DHEA-s) are major androgen hormones which are synthesis from the adrenal origin. The purpose of this study was to investigate DHEA-s levels in male patients with idiopathic hypogonadotropic hypogonadism (IHH) and to determine whether DHEA-s level are a useful marker for diagnosis of IHH.Methods: A total of 91 subjects, 31 males with IHH (mean age 19.7 +/- 2.6 years) and 60 healthy males (mean age 20.7 +/- 2.6 years), were enrolled in this study. The patients with IHH were selected from the subjects who had not yet started treatment for hypogonadism and who had no additional disease, while the healthy control group consisted entirely from individuals admitted to the same hospital outpatient clinic for routine check-ups. Both groups' blood sampling, anthropometric measures, and physical examination were undertakenResults: Mean DHEA-s level was 133.4 +/- 56.5 mu g/dL in the IHH group and 433.3 +/- 160.3 mu g/dL in the control group (p=0.000). The low DHEA-s level in patients with IHH was independent of age, cortisol, and adrenocorticotropic hormone (ACTH) at multivariate logistic regression analysis. The ROC analysis showed that DHEA-s <= 38.2 mu g/dL supports a diagnosis of IHH with 100% specificity and 100% sensitivity. DHEA-s was as predictive as total testosterone which is used in the diagnosis of patients with IHH.Conclusion: DHEA-s level was significantly lower in the males with IHH compared to controls. Therefore, DHEA-s may be a potential predictive marker for diagnosis of IHH.Öğe Serum ANGPTL4 and FGF2, energy-related blood biochemicals, cytokine responses and oxidative stress in dairy cows with subclinical ketosis(Ankara Univ, 2023) Kurtdede, Efe; Kurtdede, Arif; Öcal, Naci; Kara, ErdalIn this study, it was aimed to investigate the serum levels of ANGPTL4, FGF21, IL-1 beta, IL-6, SOD, MDA, and serum biochemical and hematological parameters in cows with subclinical ketosis. The mean serum beta-hydroxybutyric acid (BHB) level was 1.37 +/- 0.04 mmol/L in 10 dairy cows aged 3-5 years that were <21 days postpartum and diagnosed with subclinical ketosis. The mean serum BHB level was 0.40 +/- 0.08 mmol/L in 10 healthy dairy cows in the same period and in the same age range. An increase in serum AST (P<0.001) and a decrease in serum albumin levels (P<0.05) indicated altered liver functions. An increase in serum non-esterified fatty acid (P<0.001) and decreases in serum HDL, triglyceride, and total cholesterol levels (P<0.05) were interpreted as indicators of increased metabolic pathology risk due to negative energy balance. Increases in serum ANGPTL4, FGF2, IL-1 beta, IL-6, and MDA (P<0.001) and SOD levels (P<0.05) were evaluated as indicators of the development of effective metabolic, inflammatory, and oxidative stress. It was concluded that significant increases in serum ANGPTL4, FGF2, IL- 1 beta, IL-6, and MDA and SOD levels in dairy cows with subclinical ketosis were associated with negative energy balance, effective cytokine responses, and oxidative stress.Öğe Ultrasonographic/regional muscle measurements for diagnosing sarcopenia in older adults with and without dementia(Tubitak Scientific & Technological Research Council Turkey, 2022) Ülger, Zekeriya; Ayçiçek, Gözde Şengül; Kara, Özgür; Kara, MuratBackground/aim: Sarcopenia and dementia are growing concerns among older adults that muscle and brain atrophy may cooccur. We aimed to compare the age-related loss of muscle mass by using ultrasound (US), and skeletal muscle mass index (SMI) by bioelectrical impedance analysis in older adults with and without dementia. Materials and methods: A total of 221 older adults aged >= 65 years were included in the study. The diagnosis of sarcopenia was established if low muscle mass according to either SMI or sonographic gastrocnemius (GC) muscle thickness was combined with low grip strength. The diagnosis of dementia was based on the National Institute of Aging and Alzheimer's Association criteria and the major neurocognitive disorder definition in the Diagnostic and Statistical Manual of Mental Disorders-V. Muscle strength was measured by hand dynamometer and physical performance was assessed by 4-meter usual gait speed. Results: There were similar/moderate correlation coefficients between GC muscle thickness and SMI with functional parameters (all p < 0.01). Forty-six patients (20.8%) had dementia, and 21 (45.7%) of them had sarcopenia diagnosed by GC thickness (p < 0.001). Age was older but weight, body mass index, and all sarcopenia-related parameters were lower in dementia patients (all p < 0.01). When clinical variables were taken into binary logistic regression analyses, age [OR = 1.095 (95% CI: 1.028-1.167)], weight [OR = 0.918 (95% CI: 0.887-0.950)], and presence of dementia [OR = 5.109 (95% CI: 2.002-13.033)] were independently associated with sarcopenia diagnosed with GC muscle thickness (all p < 0.05). Conclusion: This study showed that sarcopenia is highly prevalent in older adults with dementia (45.7%) than without dementia (11.4%). Amongst different factors, increased age, having low body weight, and the presence of dementia independently increased the risk of sarcopenia diagnosed by GC muscle thickness (but not diagnosed by SMI) in older adults. Thus, we can evaluate easily and successfully the loss of (regional) muscle mass in dementia patients by using US in outpatient clinics.Öğe Use of deep learning methods for hand fracture detection from plain hand radiographs(Turkish Assoc Trauma Emergency Surgery, 2022) Üreten, Kemal; Sevinç, Hüseyin Fatih; İğdeli, Ufuk; Onay, Aslıhan; Maraş, YükselBACKGROUND: Patients with hand trauma are usually examined in emergency departments of hospitals. Hand fractures are frequently observed in patients with hand trauma. Here, we aim to develop a computer-aided diagnosis (CAD) method to assist physicians in the diagnosis of hand fractures using deep learning methods. METHODS: In this study, Convolutional Neural Networks (CNN) were used and the transfer learning method was applied. There were 275 fractured wrists, 257 fractured phalanx, and 270 normal hand radiographs in the raw dataset. CNN, a deep learning method, were used in this study. In order to increase the performance of the model, transfer learning was applied with the pre-trained VGG-16, GoogLeNet, and ResNet-50 networks. RESULTS: The accuracy, sensitivity, specificity, and precision results in Group 1 (wrist fracture and normal hand) dataset were 93.3%, 96.8%, 90.3%, and 89.7% , respectively, with VGG-16, were 88.9%, 94.9%, 84.2%, and 82.4%, respectively, with Resnet-50, and were 88.1%, 90.6%, 85.9%, and 85.3%, respectively, with GoogLeNet. The accuracy, sensitivity, specificity, and precision results in Group 2 (phalanx fracture and normal hand) dataset were 84.0%, 84.1%, 83.8%, and 82.8%, respectively, with VGG-16, were 79.4%, 78.5%, 80.3%, and 79.7%, respectively, with Resnet-50, and were 81.7%, 81.3%, 82.1%, and 81.3%, respectively, with GoogLeNet. CONCLUSION: We achieved promising results in this CAD method, which we developed by applying methods such as transfer learning, data augmentation, which are state-of-the-art practices in deep learning applications. This CAD method can assist physicians working in the emergency departments of small hospitals when interpreting hand radiographs, especially when it is difficult to reach qualified colleagues, such as night shifts and weekends.Öğe The use of a covered expandable metal stent for the management of esophageotracheal fistula resulting from esophageal carcinoma: A case report(2004) Güliter, Sefa; Yakaryılmaz, Fahri; Değertekin, Bülent; Görgül, AhmetMalign özefagorespiratuvar fistül, tedavisi konusunda zorluklar olan nadir bir hastalıktır. Cerrahi bypass ile palyatif tedavi sıklıkla yapılamaz. Özefageal stentlerin kullanımı daha uygun olarak görülmektedir. Burada 64 yaşında özefagorespiratuvar fistül semptomları ile başvuran inoperabl özofagus karsinomlu bir olguyu sunmaktayız. Kaplı, genişleyebilen metalik bir stent başarılı bir şekilde özefagusa yerleştirildi. Hastanın semptomları hızla düzeldi ve hasta 16 ay yaşadı. Özefagorespiratuar fıstüllü hastalardaki inoperabl özefageal kanserlerin palyatif tedavisinde kaplı özefageal stentlerin kullanılması güvenli ve pratik bir alternatif tedavi şeklidir.Öğe The Effects of Metformin, Ethinyl Estradiol/Cyproterone Acetate, and Metformin Ethinyl Estradiol/Cyproterone Acetate Combination Therapy on Carotid Artery Intima-media Thickness in Patients with Polycystic Ovary Syndrome(2020) Ünal, Derya; Demirci, Hüseyin; Yılmaz, Murat; Kısa, Üçler; Tulmaç, Murat; Güliter, SefaIntroduction: Patients with polycystic ovary syndrome (PCOS) are in the risk group for early-onset cardiovascular disease. There are few studies evaluating physiological and inflammatory cardiovascular risk factors in PCOS. Our study aimed to measure carotid intima-media thickness (IMT) in PCOS cases and to assess the effects of metformin, ethinyl estradiol/cyproterone acetate (EE/CA) and metformin + EE/ CA combination therapy on carotid IMT, insulin resistance, C-reactive protein (CRP), apelin and adiponectin. Methods: Basal carotid IMT, insulin resistance [Homeostasis model assessment insulin resistance (HOMA-IR)], apelin, adiponectin, and CRP values were evaluated in 60 women with PCOS and 43 healthy volunteers between the ages of 18 and 45. After baseline evaluation, patients were divided into metformin (n=20), EE/CA (n=20) and metformin + EE/CA (n=20) treatment groups. Treatment regimens were administered for six months. At the end of the treatment, the same parameters were reevaluated. Results: Compared with the control group, CRP (p=0.003), HOMA-IR (p=0.004) and IMT (p=0.049) were significantly higher, and adiponectin (p=0.002) and apelin (p=0.031) levels were significantly lower in patients with PCOS. At the end of the six-month treatment, the adiponectin level in the metformin (p=0.012) and metformin + EE/CA groups (p=0.012), and the apelin level in the metformin (p=0.024), EE/CA (p=0.024) and metformin + EE/CA groups (p=0.024) were significantly higher. There was no statistically significant change in CRP level in all treatment groups (p>0.05). There was no statistically significant change in carotid IMT value in all treatment groups (p>0.05). Conclusion: According to these results, we can say that women with PCOS have subclinical atherosclerosis and that metformin treatment has a positive effect on subclinical atherosclerosis.
