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Permanent URI for this collectionhttps://hdl.handle.net/20.500.14288/3

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    Neuro-ophthalmic and neuro-otologic evaluation in individuals with motion sickness susceptibility
    (Aves, 2024) Aydin, Kubra; Kara, Eyyup; Uzun Adatepe, Nurten; Ataş, Ahmet; School of Medicine; Koç University Hospital
    BACKGROUND: Since the physiological background of motion sickness is not entirely clear, it was aimed to examine the physiological differences in groups consisting of individuals susceptible and non-susceptible to motion sickness. METHODS: Sixty subjects [motion sickness (MS) group: 33 female, 3 male; 28.8 ± 8.1 years; control group: 19 female, 5 male; 24.5 ± 4.3 years] were included in the study. Near visual acuity test on the treadmill in the presence of visual stimulation, pattern visual-evoked potentials, oculomo-tor tests, and computerized dynamic posturography were applied. Receiver operating characteristic analysis was performed to determine the parameter that provides the excellent discrimination between the groups. RESULTS: The most effective parameter in differentiating the study groups was determined as dynamic visual acuity with 77.8% sensitivity and 95.8% specificity. Significant differences were found in the vestibular (mean ± standard deviation: 0.63 ± 0.17), visual (0.77 ± 0.18), and composite scores (73.11 ± 11.89) of the patients (P = .000) in posturographic evaluation. In the visual-evoked potential examination, a significant decrease was found in the amplitude values between the P100-N145 waves in the binocular (5.0 ± 2.8, P = .002), right eye (7.6 ± 3.2, P = .009) and left eye (7.9 ± 2.9, P = .016) in the symptomatic patients. In binocular oculomotor evaluation, directional asymmetric findings were obtained. CONCLUSION: It has been shown that the most effective test parameter that distinguishes the MS susceptible and non-susceptible individuals is the dynamic visual acuity value. Based on the results of neuro-physiological tests, it was suggested that a possible visual-vestibular integration disorder in individuals susceptible to motion sickness may affect visual and vestibular performance.
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    Blood group-specific apheresis in combination with daratumumab as a rescue therapy of acute antibody-mediated rejection in a case of ABO- and human leukocyte antigen-incompatible kidney transplantation
    (Sage Publications Inc, 2023) Kraft, Leonie; Ender, Andrea; Suesal, Caner; Schwenger, Amelie; Amann, Kerstin; Boehmig, Georg A.; Schwenger, Vedat; Süsal, Caner; Koç University Transplant Immunology Research Centre of Excellence (TIREX); School of Medicine; Koç University Hospital
    We report a case of antibody-mediated rejection treated with the human CD38 monoclonal antibody daratumumab in a 58-year-old female patient with end-stage kidney disease due to autosomal dominant polycystic kidney disease who received an ABO- and human leukocyte antigen antibody-incompatible living donor kidney transplant. The patient experienced an episode of severe antibody-mediated rejection within the first week of transplantation. Blood-group-antibody selective immunoadsorption in combination with administration of four doses of daratumumab (each 1800 mg s.c.) led to a persistent decrease of ABO- and more interestingly donor-specific human leukocyte antigen antibody reactivity and resulted in clinical and histopathological remission with full recovery of graft function, which has remained stable until post-transplant day 212. This case illustrates the potential of targeting CD38 in antibody-mediated rejection.
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    Anesthesiological and surgical perspectives on using 8 MMHG versus 12 MMHG pneumoperitoneum pressures during robotic radical prostatectomy: Results of a prospective randomized study
    (Turkish Assoc Trauma Emergency Surgery, 2024) N/A; Manici, Mete; Aykanat, İbrahim Can; Tarım, Kayhan; Gürkan, Yavuz; Canda, Abdullah Erdem; School of Medicine; Koç University Hospital
    BACKGROUND: This study aims to compare the effects of 8 mmHg and 12 mmHg pneumoperitoneum (PNP) pressures on operative, postoperative, and anesthesiological parameters in robot -assisted laparoscopic radical prostatectomy (RARP). METHODS: In this prospective study, 43 patients undergoing RARP performed by a single experienced surgeon were randomly assigned to either the low-pressure group (8 mmHg - Group I) or the standard -pressure group (12 mmHg - Group II). We evaluated the operative and postoperative parameters from both urological and anesthesiological perspectives. All patients were treated using the AirSeal (R) insufflation system. RESULTS: No statistically significant differences were observed between the groups in terms of console time, estimated blood loss, time to first flatus, or hospital length of stay. PNP was increased due to bleeding in six patients in the 8 mmHg group and two patients in the 12 mmHg group. Except for the heart rate measured five minutes after the initial incision, there were no observed differences between the groups in terms of blood pressure, ventilation, and administered medications. The heart rate was significantly lower in Group I (54.4 vs. 68.8, p=0.006). Additionally, during the surgery, the number of manipulations performed by the anesthesiologists, including drug administrations and ventilator management, was significantly lower in Group I (6.1 vs. 9.6, p=0.041). CONCLUSION: In RARP, while the 8 mmHg PNP pressure does not demonstrate differences in operative parameters compared to the 12 mmHg pressure, it offers the advantage of requiring fewer anesthetic interventions, thus minimizing the impact on cardiovascular and respiratory systems.
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    Thermal immersion in managing greater weever sting: A case study on delayed recovery
    (Turkish Assoc Trauma Emergency Surgery, 2024) Eyinç, Erim; N/A; Aslan, Lercan; Gökdemir, Erdinç; Çalışkan, Emrah; School of Medicine; Koç University Hospital
    We report the case of a 49-year-old woman who suffered an envenomation from a greater weever during a seaside vacation along the Aegean coast in Izmir, Türkiye. Following the incident, she experienced intense pain and sought treatment at an emergency department, where she received analgesics and cold compresses. Unfortunately, this approach failed to alleviate her pain, which persisted for approximately 24 hours. On the twelfth day, with symptoms worsening and the emergence of a larger wound than the one sustained on the day of the incident, she visited the University Hospital for further care, where she received periodic wound cleaning and a six-week antibiotic treatment regimen for possible osteomyelitis after suspicious findings on her Magnetic Resonance Imaging. The standard treatment for piscine envenomation involves hot water immersion to neutralize thermolabile toxins, providing pain relief and preventing subsequent complications. The water temperature should be between 40 and 45 degrees Celsius, and the affected body part should be immersed for at least 60 minutes. This case underscores the critical nature of hot water immersion in managing envenomation, a step which, if omitted, can result in extended pain duration and the evolution of a wound requiring over five months to heal.
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    Evaluation of the interrater reliability of sonographic measurements of muscle thickness of 38 piriformis muscles in 19 patients with piriformis syndrome
    (International Scientific Information, Inc., 2024) Caglar, Sibel; Taşkıran, Özden Özyemişçi; School of Medicine
    Background: The piriformis muscle is a flat superficial muscle of the deep gluteal muscles that externally rotates the hip. Ultrasound is widely used to identify the piriformis muscle, especially for guidance of the needle during injections; however, its diagnostic use has recently gained popularity. The operator-dependent nature of ultrasound requires demonstration of reliability between operators. This study aimed to evaluate interrater reliability of sonographic measurements of muscle thickness of 38 piriformis muscles in 19 patients with piriformis syndrome. Material/Methods: An ultrasound transducer was placed transversely on the sacral spinous process and moved caudo-laterally until the piriformis muscle was visualized under the gluteus maximus while patients were lying in prone position. The thickness of piriformis muscle was measured with a 2 to 5-MHz broadband curvilinear transducer in 3 regions (thickest regions of muscle over the ilium, near the greater trochanter, and near the sacrum). The interrater reliability of measurements of 2 examiners who were blinded to each other’s measurements was assessed by intraclass correlation coefficient. Results: In total, 114 samples from 38 piriformis muscles of 19 patients with a diagnosis of piriformis syndrome were evaluated by 2 raters in this study. The median (interquartile range) patient age was 41 (15) years. Intraclass correlation coefficient value for overall thickness measurements of piriformis muscle was 0.836. Intraclass correlation coefficient values for 3 different regions were over the ilium, near the greater trochanter, and near the sacrum were 0.777, 0.883, and 0.811, respectively. Conclusions: Ultrasound measurement of piriformis muscle thickness has good interrater reliability.
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    Predictive value of nutrition and inflammation-related indices on prognosis in type 2 diabetes mellitus patients with Coronavirus Disease-2019
    (KARE PUBL, 2023) Ekici, Mustafa; Menekse, Tugba Sanalp; Ciftciler, Rafiye; Batman, Adnan; Dereli, Dilek Yazıcı; School of Medicine; Koç University Hospital
    Objectives: This study aimed to demonstrate how the prognostic nutritional index (PNI) and systemic immune -inflammatory index (SII) help predict the severity and prognosis of patients with type 2 diabetes (T2DM) and coronavirus disease (Covid-19). Methods: This retrospective cohort study included 501 T2DM patients (male, 42.1%; female, 57.9%) who were hospitalized due to Covid-19 between April 2020 and December 2020. The patients were divided into survivors and non -survivors. After comparing demographic and laboratory data between the groups, the correlation of PNI and SII with clinical and laboratory data was evaluated. Results: The median (interquartile) ages of the non -survivor and survivor groups were 74 (15) and 69 (14) years, respectively, and the difference was significant (p<0.001). The PNI was significantly lower in the non -survivor group than in the survivor group (p<0.001). The SII was significantly higher in the non-survivor group than in the survivor group (p<0.001). PNI was negatively correlated with glucose levels (r=-0.115, p=0.011). If the cut-off PNI value of 29.1 was used, it had a sensitivity and specificity of 76.2% and 76.3%, respectively, in predicting the severity of the illness and the risk of death in T2DM patients. Conclusion: Consequently, the PNI and SII levels are effective in predicting survival and disease severity in patients with Covid-19 and T2DM.
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    Choroidal thickness in mild autonomous cortisol secretion
    (KARE PUBL, 2024) Cakir, Sezin Dogan; Cakir, Akin; Ozturk, Feyza Yener; Basmaz, Seda Erem; Saygili, Emre Sedar; Erol, Rumeysa Selvinaz; Sen, Esra Cil; Canat, Muhammed Masum; Altuntas, Yuksel; Batman, Adnan; Koç University Hospital
    Objectives: To evaluate the patients with mild autonomous cortisol secretion (MACS) by means of choroidal thickness (CT) and also investigate whether CT may be a diagnostic tool in the management of MACS or not. Methods: Twenty-seven patients with MACS and 25 age -sex -matched healthy controls were enrolled in this cross-sectional comparative study. All the participants underwent CT measurement by using Spectralis optical coherence tomography (Heidelberg Engineering, Heidelberg, Germany) with enhanced deep imaging mode at the subfoveal, 500-1000-1500 mu m nasal and 500-10001500 mu m temporal to the foveola. Results: The groups were similar in terms of spherical equivalence, age and axial lengths. The mean CT was significantly thicker in patients with MACS than controls in all measurement quadrants (p<0.001). There was no significant correlation between CT, size of the adenoma, basal cortisol, 1mg dexamethasone suppression test, salivary cortisol, 24 -hour total urine -free cortisol, ACTH and DHEAS levels. However, 2 mg dexamethasone suppression test results were found to be significantly correlated with CT in temporal 500-1000 and 1500 m quadrants (r=0.436, p=0.023, r=0.443, p=0.021 and r=0.488, p=0.010, respectively). Five (18.5%) eyes had pachychoroid pigment epitheliopathy in the MACS group. Conclusion: CT increases in patients with MACS and those tend to have pachychoroid pigment epitheliopathy more frequent than healthy individuals. A thicker choroid in the patients with MACS may be a novel biomarker both as a diagnostic tool for the degree of hypercortisolemia and cortisol-related comorbidity.
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    Prof. Dr. Kenan Midilli (1963-2022) Anısına
    (DOC Design Informatics Co Ltd, 2022) Aygun, Gokhan; Aygun, Pakize; Azap, Alpay; Benzonana, Nur; Kurt-Azap, Ozlem; Kuskucu, Mert Ahmet; Simsek-Yavuz, Serap; Turan, Ayfer; Can, Füsun; Ergönül, Önder; Koç Üniversitesi İş Bankası Enfeksiyon Hastalıkları Uygulama ve Araştırma Merkezi (EHAM) / Koç University İşbank Center for Infectious Diseases (KU-IS CID); School of Medicine
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    Evidence-based and experience-based medicine, which comes first: the chicken or the egg?
    (Universa Press, 2023) Saridogan, E.; Ata, Mustafa Barış; School of Medicine