Researcher:
Çetiner, Mustafa

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Mustafa

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Çetiner

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Çetiner, Mustafa

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2013 - 201915

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    Diagnostic contribution of (18)F-FDG-PET/CT in fever of unknown origin
    (Elsevier Sci Ltd, 2014) Tokmak, Handan; N/A; Ergönül, Önder; Demirkol, Mehmet Onur; Çetiner, Mustafa; Ferhanoğlu, Ahmet Burhan; Faculty Member; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; 110398; 196946; N/A; 18320
    Objectives: Fever of unknown origin (FUO) remains one of the most compelling diagnostic issues in medicine. We aimed to evaluate the potential clinical contribution of 18-fluoro-2-deoxyglucose positron emission tomography/computed tomography (F-18-FDG-PET/CT) in the identification of the underlying cause of FUO. Methods: Fifty consecutive patients (27 men and 23 women; age range 16-88 years) with FUO based on the revised definition criteria were included in the study. A diagnostic protocol including biochemistry, histopathology, and microbiological tests was performed and the patients were followed up. FDG-PET was performed in 25 of the 50 patients (12 males and 13 females; age range 16-88 years) in order to determine the etiology of the patient's fever. PET-CT images were obtained with the Gemini Philips TF F-18-FDG-PET/CT camera after a 60-min 'standard uptake' period following an injection of a mean 330 MBq (range 290-370 MBq) intravenous F-18-FDG. Results: A total of 21 patients were available for analysis of the diagnostic contribution of PET/CT (two patients were undiagnosed and two had non-contributory PET/CT findings). F-18-FDG-PET/CT was able to precisely detect the cause of fever in 60% of the cases (n = 15). The accuracy, sensitivity, and specificity of this imaging modality were 90.5%, 93.8%, and 80%, respectively. Among the cases with a true-positive F-18-FDG-PET/CT finding (i.e., 15 cases), the identified underlying causes of FUO included localized infection (n = 7), non-infective inflammatory process (n = 5), and malignancy (n = 3). Conclusions: Further studies to confirm the high diagnostic yield of F-18-FDG-PET/CT observed in the present study would lend support to the inclusion of this imaging modality in the initial diagnostic workup of patients with suspected FUO. (C) 2013 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. All rights reserved.
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    Rituximab desensitization in three patients with severe rituximab allergy
    (Mosby-Elsevier, 2017) N/A; N/A; Öztürk, Erman; Özyiğit, Sabiha Leyla Pur; Öztürk, Ayşe Bilge; Akay, Olga Meltem; Çetiner, Mustafa; Ferhanoğlu, Ahmet Burhan; Doctor; Doctor; Faculty Member; Faculty Member; Faculty Member; Faculty Member; N/A; N/A; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; Koç University Hospital; N/A; N/A; N/A; N/A; N/A; 214687; 147629; 170966; N/A; 18320
    Rituximab is a chimeric monoclonal antibody that targets CD20 positive B cells and has a positive effect on both overall and progression-free survival in B-cell lymphoid malignancies. Combination rituximab with chemotherapy treatment provide survival improvement. Although rituximab is an important treatment option in hematological malignancies, the risk of allergic reactions is high. These reactions are usually IgE-mediated and can be varied in regard of severity from urticaria to anaphylaxis. It is an option to interrupt the treatment and ommit rituximab therapy who had allergic reactions. Drug desensitization is another option and successful results have been reported by applying desensitization to such reactions. Drug desensitization alters the immune response to induce a state of temporary clinical tolerance to the allergic drug by giving gradual increasing of doses of drug at fixed time intervals. Herein, we present 3 cases successfully treated with rituximab desensitization. The cases were using rituximab with the diagnosis of Burkitt lymphoma, follicular lymphoma, and marginal zone lymphoma, respectively. Two cases had grade 2 and 1 case had grade 3 systemic allergic reaction with rituximab. There was no known allergy history in all 3 cases. All patients tolerated the desensitization protocol. The subsequent treatments of the patients were also given by desensitization protocol. A total of 12 desensitizations were administered to 3 cases. No severe or life-threating reactions were observed in subsequent applications. To date applying desensitization protocols ensure rituximab treatment safely. Rituximab desensitization can be performed at trained allergy centers, and it may be an appropriate option for rituximab allergic patients.
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    Iron deficiency and anemia in heart failure
    (Aves, 2017) Yıldırım, Neslihan; Yılmaz, Mehmet Birhan; Yeşilbursa, Dilek; Çavuşoğlu, Yüksel; Altay, Hakan; Güvenç, Tolga Sinan; Temizhan, Ahmet; Çetiner, Mustafa; Ural, Dilek; Faculty Member; Faculty Member; School of Medicine; School of Medicine; NA; 1057
    Objective: Iron deficiency (ID) is the most common nutritionaldeficiency, and iron metabolism becomes further deterioratedin the presence of certain conditions, such as heart failure(HF). Atrial fibrillation (AF) has many similarities to HF, including a chronic inflammatory pathophysiology; however, theprevalence of ID and other hematinic deficiencies in AF patients have not been determined.Methods: In this study, the prevalence of iron (serum ferritin<100 µg/L or ferritin 100–299 µg/L with transferrin saturation<20%), vitamin B12 (<200 pg/mL), and folate deficiency (<4.0ng/mL) was evaluated in 101 patients with non-valvular AFwith preserved left ventricular ejection fraction and no signs ofHF, and the results were compared with 35 age- and gendermatched controls.Results: Anemia was detected in 26% of the patients. A totalof 48 (47.6%) patients had ID, 10 (9.9%) had a vitamin B12deficiency, and 13 (12.9%) had a folate deficiency. The prevalence of ID was similar in the controls and the paroxysmal AFpatients, but increased gradually in persistent and permanentAF. Univariate logistic regression analysis demonstrated thatpermanent vs. paroxysmal AF [Odds ratio (OR): 2.17; 95%confidence interval (CI): 0.82–5.69; p=0.011], high sensitive Creactive protein (OR: 1.47; 95% CI: 0.93–2.36; p=0.019), N-terminal pro b-type natriuretic peptide (OR: 1.24; 95% CI: 0.96–1.71; p=0.034), and white blood cell count (OR: 1.21; 95% CI:0.95–1.58; p=0.041) were associated with ID. In multivariableanalysis, permanent AF remained as an independent clinicalassociate of ID (OR: 4.30; 95% CI: 0.83–12.07; p=0.039).Conclusion: ID is common in permanent AF, as in HF. Inflammation and neurohormonal activation seem to contribute to itsdevelopment. / Kalp yetersizliği, insidans ve prevalansı giderek artan önemli bir toplum sağlığı problemidir. Tedavide sağlanan ilerlemelere rağ- men halen yaşam kalitesi düşük, hastaneye yatış oranları yüksek ve prognoz kötüdür. Kalp yetersizliğine eşlik eden hastalıklar klinik seyri olumsuz etkilemekte, prognozu kötüleştirmekte, tedaviyi güçleştirmekte ve klinik tablonun kontrolünü zorlaştırmaktadır. Bu nedenle kalp yetersizliğine yönelik tedavi ile birlikte komorbid durumların tedavisi ve kontrolünün sağlanması önemle vurgulanmaktadır. Kalp yetersizliğinde en sık rastlanan komorbid durumlardan biri demir eksikliği ve anemidir. Mevcut veriler demir eksikliği ve aneminin hem düşük ejeksiyon fraksiyonlu hem de korunmuş ejeksiyon fraksiyonlu kalp yetersizliğinde yaygın olduğunu göstermektedir. Aynı zamanda kalp yetersizliğinde demir eksikliği ve anemi kötü prognoz için bağımsız prediktörler olarak bulunmaktadır. Ayrıca demir eksikliği ve aneminin klinik tablonun ciddiyeti ile güçlü bir ilişkisi söz konusudur. Son yıllarda komorbid durum olarak demir eksikliği ve/veya aneminin eritropoietin, oral demir veya intravenöz demir ile tedavisiyle kalp yetersizliğinde klinik yarar sağlanıp sağlanamayacağına ilişkin çalışmalar yapılmıştır. Eritropoietin ve oral demir ile yapılan çalışmalarda beklenen klinik yararlar sağlanamamış ve istenmeyen olaylarda artış gözlenmiş- tir. Anemi olsun olmasın demir eksikliği bulunan kalp yetersizliği olgularında intravenöz demir tedavisi ile yapılan çalışmalarda mortalitede olmasa bile klinik sonuçlarda anlamlı yararların gösterilmesi kalp yetersizliğinde demir eksikliğini tedavi hedefi konumuna getirmiştir. Rehber niteliğinde hazırlanan bu belgenin amacı, kalp yetersizliğinde demir eksikliği ve anemiye yaklaşımı güncel kanıtlar eşliğinde değerlendirmektir.
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    The role of atopy in the pathogenesis of bleomycin pulmonary toxicity
    (W B Saunders Co Ltd, 2019) Atas, Esin Cetin; Deniz, Gunnur; N/A; Özyiğit, Sabiha Leyla Pur; Şenbaş, Zarif Asucan; Öztürk, Ayşe Bilge; Öztürk, Erman; Ergönül, Önder; Tabak, Levent; Ferhanoğlu, Ahmet Burhan; Çetiner, Mustafa; Doctor; Undergraduate Student; Faculty Member; Doctor; Faculty Member; Faculty Member; Faculty Member; Faculty Member; N/A; School of Medicine; School of Medicine; N/A; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; N/A; N/A; Koç University Hospital; N/A; N/A; N/A; N/A; 214687; N/A; 147629; N/A; 110398; 167625; 18320; N/A
    Introduction: Bleomycin pulmonary toxicity (BPT) is a potentially life-threatening consequence of bleomycin usage in patients. An overproduction of epithelium-derived cytokines, habitually linked to allergic inflammation, has been recently revealed in experimental models of BPT. Methods: We assessed retrospectively our cohort of patients with Hodgkin Lymphoma treated with bleomycin between 2014 and 2016 for their demographic, clinical features, including BPT development, atopy status and risk factors for BPT. Then they were invited for allergy testing and blood sample collection. The samples were stimulated with different stimuli (Bleomycin, IL-33, TSLP) for 24 h on cell culture. The culture supernatants were analysed for TGF-beta, Galectin3, Arginin, Amphiregulin, Eotaxin, IFN gamma, TNF alpha, IL1 beta, 4, 5, 6, 10, 13, 17, MIP-1 alpha, and bleomycin hydrolase (BLH) levels. Results: The cohort consisted of 51 patients showed that atopy was the only significant risk factor for BPT occurrence (OR: 7.2, p=0.007). Fourteen subjects were included for blood analysis. The analysis of supernatants at the unstimulated condition revealed that BLH and Amphiregulin were significantly lower in patients who had BPT than controls. The BLH cut-off that best identified a history of BPT was 175.31 (Sensitivity: 62.5%, specificity: 100%). Following the stimulation, BLH reduced compared to the unstimulated condition and the difference between groups remained significant (p < 0.05). Conclusion: Our study is the first to report that low levels of bleomycin hydrolase in allergic individuals may be predisposing to a possible pathway of fibrosis.
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    Complete remission of Burkitt Lymphoma after surgical excision: a case report
    (Springer, 2016) Bekoz, Hüseyin Saffet; Kantarcıoğlu, Bülent; Tecimer, Tülay; Uskent, Necdet; Sargın, Deniz; N/A; N/A; Çetiner, Mustafa; Ferhanoğlu, Ahmet Burhan; Faculty Member; Faculty Member; School of Medicine; School of Medicine; N/A; 18320
    Burkitt lymphoma (BL) is a highly aggressive B cell non-Hodgkin lymphoma that has a high proliferation rate. The prognosis for BL is generally favorable, with cure rate of 75-90 % with modern chemoimmunotherapy regimens. Prompt administration of multiagent immunochemotherapy regimens is critical, because BL is almost always fatal if left untreated. Nevertheless here we report a case of BL that is still in complete remission after more than 4 years without any further treatment after surgical excision of the involved lymph node.
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    Molecular pathophysiology and classification of Mds
    (Elsevier, 2017) N/A; Çetiner, Mustafa; Faculty Member; School of Medicine; N/A
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    Use of fluorodeoxyglucose positron emission tomography for diagnosis of bleomycin-induced pneumonitis in hodgkin lymphoma
    (Taylor & Francis, 2017) Gümüş, Terman; Örnek, Serdar; Özbalak, Murat; Çetiner, Mustafa; Falay, Fikri Okan; Demirkol, Mehmet Onur; Öztürk, Erman; Ferhanoğlu, Ahmet Burhan; Bölükbaşı, Yasemin; Faculty Member; Teaching Faculty; Faculty Member; Doctor; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; N/A; School of Medicine; School of Medicine; Koç University Hospital; N/A; 246484; 196946; N/A; 18320; 216814
    Bleomycin is an antineoplastic agent causing fatal pulmonary toxicity. Early diagnosis of bleomycin-induced pneumonitis is crucial to prevent irreversible damage. Pulmonary function tests are unreliable for identifying risk of bleomycin toxicity. Fluorodeoxyglucose PET/CT scanning can reveal inflammation secondary to pneumonitis but is not sufficiently specific for diagnosis. We retrospectively analyzed scans from 77 patients with Hodgkin lymphoma (median age 41 years, mean bleomycin dose 134 mg) to evaluate bleomycin-induced pneumonitis. We identified 13 patients with abnormal lung uptake of fluorodeoxyglucose. Tracer activity was predominantly diffuse, bilateral, in the lower lobes and subpleural areas. Interim scanning during treatment revealed pneumonitis in eight of 13 patients (asymptomatic in six). One asymptomatic patient died of bleomycin toxicity. For remaining 12 patients, bleomycin was discontinued and methylprednisolone given, all showed resolution of the pneumonitis. These findings suggest that routine interim or end-of-treatment FDG-PET/CT scanning could be beneficial for alerting clinicians to asymptomatic bleomycin-induced toxicity.
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    Novel masters of erythropoiesis: hypoxia inducible factors and recent advances in anemia of renal disease
    (Karger Publishers, 2016) Solak, Yalçın; Siriopol, Dimitrie; Afsar, Baris; Covic, Adrian; N/A; Kanbay, Mehmet; Çetiner, Mustafa; Tarım, Kayhan; Faculty Member; Faculty Member; Researcher; School of Medicine; School of Medicine; School of Medicine; 110580; N/A; 327605
    Anemia seen in patients with chronic kidney disease is a particular form of 'anemia of chronic disease'. Although multifactorial in origin, erythropoiesis-stimulating agents (ESAs) and adjuvant iron therapy represent the primary treatment for anemia in chronic kidney disease. Subsequent clinical observations revealed that these ESA hyporesponsive patients often had increased systemic inflammation as a consequence of their comorbidities. Use of high ESA doses to overcome this ESA hyporesponsiveness posed some concerns regarding associated adverse events of therapy and increased mortality in this special patient population. Recognizing the pivotal roles of hypoxia inducible factors (HIFs) in orchestrating elements of erythropoiesis opened new avenues in the management of renal anemia. Several phase 1 and 2 studies confirmed the results of early experimental studies supporting the beneficial role of augmenting HIFs for erythropoiesis. In this review, we describe the physiologic functions of HIF in erythropoiesis with special emphasis on interactions with iron and hepcidin metabolism and inflammation.
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    Diagnostic contribution of F-18 FDG-PET/CT on the management of FUO
    (Springer, 2013) Tokmak, H.; Demirkol, O.; N/A; N/A; N/A; Ergönül, Önder; Çetiner, Mustafa; Ferhanoğlu, Ahmet Burhan; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; 110398; N/A; 18320
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    Diagnosis and treatment of iron deficiency anemia during pregnancy and the postpartum period: iron deficiency anemia working group consensus report
    (Galenos Yayınevi, 2015) Api, Olus; Breyman, Christian; Demir, Cansun; Ecder, Tevfik; Çetiner, Mustafa; Faculty Member; School of Medicine; N/A
    According to the World Health Organization (WHO), anemia is the most common disease, affecting >1.5 billion people worldwide. Furthermore, iron deficiency anemia (IDA) accounts for 50% of cases of anemia. IDA is common during pregnancy and the postpartum period, and can lead to serious maternal and fetal complications. The aim of this report was to present the experiences of a multidisciplinary expert group, and to establish reference guidelines for the optimal diagnosis and treatment of IDA during pregnancy and the postpartum period. Studies and guidelines on the diagnosis and treatment of IDA published in Turkish and international journals were reviewed. Conclusive recommendations were made by an expert panel aiming for a scientific consensus. Measurement of serum ferritin has the highest sensitivity and specificity for diagnosis of IDA unless there is a concurrent inflammatory condition. The lower threshold value for hemoglobin (Hb) in pregnant women is <11 g/dL during the 1st and 3rd trimesters, and <10.5 g/dL during the 2nd trimester. In postpartum period a Hb concentration <10 g/dL indicates clinically significant anemia. Oral iron therapy is given as the first-line treatment for IDA. Although current data are limited, intravenous (IV) iron therapy is an alternative therapeutic option in patients who do not respond to oral iron therapy, have adverse reactions, do not comply with oral iron treatment, have a very low Hb concentration, and require rapid iron repletion. IV iron preparations can be safely used for the treatment of IDA during pregnancy and the postpartum period, and are more beneficial than oral iron preparations in specific indications.