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Kılıç S, Kılıç Ö, Belivermiş M, Ergül HA. Chronology of PAH and PCB pollution using sediment core in the Golden Horn estuary (Sea of Marmara). Mar Pollut Bull 2023; 187:114570. [PMID: 36642004 DOI: 10.1016/j.marpolbul.2023.114570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/05/2022] [Accepted: 12/31/2022] [Indexed: 06/17/2023]
Abstract
The sources and depositional history of 16 polycyclic aromatic hydrocarbons (PAHs) and 18 polychlorinated biphenyl (PCBs) congeners in the Golden Horn estuary (İstanbul) were investigated using a dated sediment core for the period between 1880 and 2012. The concentrations of PAHs and PCBs were calculated for every 4 cm slices of the sediment core and ranged from 1203.5 to 3441.4 ng/g and 5.4 to 41.4 ng/g, respectively. The diagnostic ratios indicated that the maximum PAH values correspondence to combustion after a crude oil-carrying Romanian tanker (Independenta) accident in the İstanbul Strait in 1979. The historical deposition of PAHs and PCBs in the Golden Horn was influenced by municipal effluent and heavy industrial dischargers approximately 50 years. When the Silahtarağa thermal power plant (TPP) was operating, PCB pollution rose; however, after a thorough rehabilitation effort and the outlawing of PCB use in the 1990s, pollution levels significantly tended to decrease.
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Affiliation(s)
- S Kılıç
- Department of Biology, Faculty of Science, Kocaeli University, 41380 Umuttepe, Kocaeli, Turkey.
| | - Ö Kılıç
- Department of Biology, Faculty of Science, Istanbul University, 34134 Vezneciler, Istanbul, Turkey
| | - M Belivermiş
- Department of Biology, Faculty of Science, Istanbul University, 34134 Vezneciler, Istanbul, Turkey
| | - H A Ergül
- Department of Biology, Faculty of Science, Kocaeli University, 41380 Umuttepe, Kocaeli, Turkey
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Şabanoğlu C, Sinan ÜY, Akboğa MK, Çoner A, Gök G, Kocabaş U, Bekar L, Gazi E, Cengiz M, Kılıç S, İnanç İH, Çakmak HA, Zoghi M. Long-Term Prognosis of Patients with Heart Failure: Follow-Up Results of Journey HF-TR Study Population. Anatol J Cardiol 2023; 27:26-33. [PMID: 36680444 PMCID: PMC9893707 DOI: 10.14744/anatoljcardiol.2022.2171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/21/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Despite advances in therapeutic management of patients with heart failure, there is still an increasing morbidity and mortality all over the world. In this study, we aimed to present the 3-year follow-up outcomes of patients included in the Journey HF-TR study in 2016 that has evaluated the clinical characteristics and management of patients with acute heart failure admitted to the hospital and present a national registry data. METHODS The study was designed retrospectively between November 2016 and December 2019. Patient data included in the previously published Journey HF-TR study were used. Among 1606 patients, 1484 patients were included due to dropout of 122 patients due to inhospital death and due to exclusion of 173 due to incomplete data. The study included 1311 patients. Age, gender, concomitant chronic conditions, precipitating factors, New York Heart Association, and left ventricular ejection fraction factors were adjusted in the Cox regression analysis. RESULTS During the 3-year follow-up period, the ratio of hospitalization and mortality was 70.5% and 52.1%, respectively. Common causes of mortality were acute decompensation of heart failure and acute coronary syndrome. Angiotensin receptor blockers, betablockers, statin, and sacubitril/valsartan were found to reduce mortality. Hospitalization due to acute decompensated heart failure, acute coronary syndrome, lung diseases, oncological diseases, and cerebrovascular diseases was associated with the increased risk of mortality. Implantation of cardiac devices also reduced the mortality. CONCLUSIONS Despite advances in therapeutic management of patients with heart failure, our study demonstrated that the long-term mortality still is high. Much more efforts are needed to improve the inhospital and long-term survival of patients with chronic heart failure.
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Affiliation(s)
- Cengiz Şabanoğlu
- Department of Cardiology, Kırıkkale Yüksek İhtisas Hospital, Kırıkkale, Turkey
| | - Ümit Yaşar Sinan
- Department of Cardiology, İstanbul University-Cerrahpaşa Institute of Cardiology, İstanbul, Turkey
| | - Mehmet Kadri Akboğa
- Department of Cardiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ali Çoner
- Department of Cardiology, Başkent University Hospital, Antalya, Turkey
| | - Gülay Gök
- Department of Cardiology, Faculty of Medicine, İstanbul Medipol University, İstanbul, Turkey
| | - Umut Kocabaş
- Department of Cardiology, Başkent University Hospital, İzmir, Turkey
| | - Lütfü Bekar
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Emine Gazi
- Department of Cardiology, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Mahir Cengiz
- Department of Cardiology, Faculty of Medicine, İstanbul Aydın University, İstanbul, Turkey
| | - Salih Kılıç
- Department of Cardiology, Adana City Training and Research Hospital, Adana, Turkey
| | - İbrahim Halil İnanç
- Department of Cardiology, Faculty of Medicine, Haliç University, İstanbul, Turkey
| | - Hüseyin Altuğ Çakmak
- Department of Cardiology, Adana City Training and Research Hospital, Adana, Turkey
| | - Mehdi Zoghi
- Department of Cardiology, Ege University Hospital, İzmir, Turkey
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Özcan Abacıoğlu Ö, Yıldırım A, Koyunsever NY, Karadeniz M, Kılıç S. Relationship between atherogenic index of plasma and stent thrombosis in patients with acute coronary syndrome. Anatol J Cardiol 2022; 26:112-117. [PMID: 35190359 PMCID: PMC8878917 DOI: 10.5152/anatoljcardiol.2021.193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE Stent thrombosis (ST) is an uncommon but serious complication in patients undergoing percutaneous coronary intervention (PCI). This study aimed to investigate the effect of atherogenic index of plasma (AIP) on ST. METHODS Among the 10,258 patients who underwent coronary angiography between January 2018 and December 2020, 239 patients who underwent PCI with the diagnosis of acute coronary syndrome (ACS) due to ST were included as the study group (ST group) and 459 patients who underwent percutaneous intervention for ACS and did not have any in-stent lesion as the control group (non-ST group). ST classification was done according to the Academic Research Consortium definition. RESULTS The mean age of the patients was 63.3±10.6 years (483 male, 69.2%). The groups were similar in terms of characteristic properties, comorbidities, and the drugs being used (p>0.05 for all). Drug eluting stents were used in 86.5% of the patients. In the ST group, the median time from stent implantation to thrombosis was 285 days. Mean AIP and the ratio of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) were statistically significantly higher in the ST group than in the controls (p<0.001 and p=0.018, respectively), and a positive correlation was observed between time from stent implantation to thrombosis and AIP and TG/HDL-C (rS=0.229, p=0.010 and rS=0.222, p=0.010, respectively). Multivariate logistic regression analysis revealed that stent length, prior ST elevation myocardial infarction, TG/HDL-C, and AIP were independent predictors of ST. CONCLUSION AIP is an easy calculable biomarker, and the performance of AIP to predict ST is better than TG/HDL-C.
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Affiliation(s)
- Özge Özcan Abacıoğlu
- Department of Cardiology, Adana City Training and Research Hospital; Adana-Turkey
| | - Arafat Yıldırım
- Department of Cardiology, Adana City Training and Research Hospital; Adana-Turkey
| | | | - Mine Karadeniz
- Department of Hematology, Faculty of Medicine, Hacettepe University; Ankara-Turkey
| | - Salih Kılıç
- Department of Cardiology, Adana City Training and Research Hospital; Adana-Turkey
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Gök G, Çoner AÇ, Çınar T, Kılıç S, Yenerçağ M, Öz A, Ekmekçi C, Özlük Ö, Zoghi M, Ergene AO, Türk UÖ. Evaluation of demographic and clinical characteristics of female patients presenting with MINOCA and differences between male patients: A subgroup analysis of MINOCA-TR registry. Turk Kardiyol Dern Ars 2022; 50:4-13. [DOI: 10.5543/tkda.2022.86219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abacıoğlu ÖÖ, Kaplan M, Yıldırım A, Küçükosmanoğlu M, Kılıç S. Assessment of the relationship among breast milk intake, birth pattern, antibiotic use in infancy, and premature atherosclerosis. Turk Kardiyol Dern Ars 2021; 49:303-311. [PMID: 34106064 DOI: 10.5543/tkda.2021.70659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Previous studies have shown cesarean section (C-section) and antibiotic use in the infantile period lead to chronic diseases in later life. It is also known that breastfeeding, which forms the basal system of immunity, is a protector in neonates. In this study, we aimed to investigate the association between breastfeeding, antibiotic use, C-section, and premature atherosclerosis. METHODS A total of 100 patients who underwent coronary angiography and had stenosis in at least 1 epicardial vessel and 100 controls with normal coronaries were included in the study. In addition to traditional risk factors, type of delivery, breast milk intake and duration, and antibiotic use and frequency were evaluated for each participant. Lipid profile was added to the study procedure. Angiographic images of the study groups were examined to calculate the Gensini score. RESULTS Smoking, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and family history were different between the groups. In the control group, 3 were born via C-section, whereas 26 were born via C-section in the atherosclerosis group (p<0.001). Breast milk intake and duration was also significantly higher in the control group (p=0.018). Antibiotic use was less in the control group, but there was no statistically significant difference (p=0.099). In multivariate logistic regression analysis, diabetes mellitus, smoking, and C-section were predictors of atherosclerosis (p=0.036, p=0.001, and p=0.003, respectively). In receiver operating characteristics curve analysis, the ability of C-section to predict premature atherosclerosis was superior to diabetes but not to smoking (area under curve, 0.607; p=0.023). CONCLUSION Mode of delivery and breast milk intake should be evaluated and considered among the risk factors of premature atherosclerosis.
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Affiliation(s)
- Özge Özcan Abacıoğlu
- Department of Cardiology, Adana City Training and Research Hospital, Adana, Turkey
| | - Mehmet Kaplan
- Department of Cardiology, Gaziantep,University School of Medicine, Gaziantep, Turkey
| | - Arafat Yıldırım
- Department of Cardiology, Adana City Training and Research Hospital, Adana, Turkey
| | | | - Salih Kılıç
- Department of Cardiology, Adana City Training and Research Hospital, Adana, Turkey
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Kurt IH, Şen Ö, Kuçükosmanoğlu M, Salkın FÖ, Urgun ÖD, Şahin Ş, Çolak S, Kılıç S. The Influence of Aortic Pulse Wave Velocity on Short-Term Functional Capacity in Patients with Mild Paravalvular Regurgitation Following Transcatheter Aortic Valve Implantation. Braz J Cardiovasc Surg 2020; 35:504-511. [PMID: 32864931 PMCID: PMC7454626 DOI: 10.21470/1678-9741-2019-0454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Recently, the clinical significance of mild paravalvular aortic regurgitation (PAR) has been evaluated and suggested that it can be predictor of clinical outcomes. In our study, we aimed to investigate the interaction of aortic pulse wave velocity (PWV) and mild PAR and their effects on the functional status of patients after transcatheter aortic valve implantation (TAVI). METHODS A total of 109 consecutive patients with symptomatic severe aortic stenosis were enrolled prospectively. After TAVI procedure, they were divided in to three groups according to PAR and PWV measurements. Patients without PAR were defined as the NonePAR group (n=60), patients with mild PAR and normal PWV were defined as the MildPAR-nPWV group (n=23), and patients with mild PAR and high PWV were defined as the MildPAR-hPWV group (n=26). RESULTS Compared with other groups, the MildPAR-hPWV group was older (P<0.001), hypertensive (P=0.015), and had a higher pulse pressure (P=0.018). In addition to PWV, this group had lower aortic regurgitation index (ARI) (P=0.010) and higher rate of New York Heart Association (NYHA) class II (at least) patients (P<0.001) in 30-day follow-up period. On multivariate regression analysis, the MildPARhPWV group (odds ratio=1.364, 95% confidence interval 1.221-1.843; P=0.011) as well as N-terminal-pro-brain natriuretic peptide levels and ARI were independently related with 30-day functional NYHA classification. However, NonePAR or MildPAR-nPWV group was not an independent predictor of early functional status. CONCLUSION It was concluded that high PWV may adversely affect early functional status in patients with mild PAR in contrast to normal values following TAVI.
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Affiliation(s)
- Ibrahim Halil Kurt
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Ömer Şen
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Mehmet Kuçükosmanoğlu
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Fatma Özge Salkın
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Örsan Deniz Urgun
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Şeyda Şahin
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Salih Çolak
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Salih Kılıç
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
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Gök G, Kılıç S, Sinan ÜY, Turkoglu E, Kemal H, Zoghi M. Epidemiology and clinical characteristics of hospitalized elderly patients for heart failure with reduced, mid-range and preserved ejection fraction. Heart Lung 2020; 49:495-500. [PMID: 32434698 DOI: 10.1016/j.hrtlng.2020.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Elderly patients hospitalized with heart failure (HF) have high mortality rates and requires specific evidence based theraphy, however there are few studies which have focused on patients older than 80 years hospitalized with HF. The aim of the present study is to evaluate the overall clinical characteristics, management, and in-hospital outcomes of elderly patients hospitalized with HF. METHODS Journey-HF study was conducted in 37 different centers in Turkey and recruited 1606 patients who were hospitalized with HF between September 2015 and September 2016. In this study, clinical profile of patients ≥ 80 years old and 65-79 years old hospitalized with HF were described and compared based on EF-related classification: HFrEF (HF with reduced ejection fraction), HFmrEF (HF with mid-range ejection fraction) and HFpEF (HF with preserved ejection fraction). RESULTS A total of 1034 elder patients (71.6% 65-79 years old and 28.4% ≥80 years old) were recruited. Of the 65-79 years old patients 67.4% had HFrEF, 16.2% had HFmrEF and 16.3% had HFpEF. Among patients ≥80 years old 61.6% had HFrEF, 15.6% had HmrEF and 22.8% had HFpEF. When compared with patients with HFrEF and HFmrEF, patients ≥80 years old with HFpEF were more likely to be older, have atrial fibrilation (AF), and less likely to have diabetes mellitus (DM), coronary artery disease (CAD) or to be recieving an angiotensin-converting enzyme inhibitor (ACEi) or beta blocker theraphy. When compared to patients 65-79 years old with HFpEF, patients ≥80 years with HFpEF had a higher rate of AF and less likely DM. Acute coronary syndrome was the most common precipitant factor for hospitalization in both age groups with HFrEF group. Arrhythmia was a major precipitant factor for hospitalization of patients ≥80 years old with HFpEF. Non-compliance with theraphy was a major problem of patients ≥80 years old with HFrEF. CONCLUSION Elderly patients with HFrEF, HFmrEF and HFpEF each had characterized unique patient profiles and the guideline recommended medications were less likely to be used in these patient populations. In hospital mortality rate is worrisome and reflects a need for more specific tretment strategy.
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Affiliation(s)
- Gülay Gök
- Department of Cardiology, Medipol Üniversity Faculty of Medicine, İstanbul.
| | - Salih Kılıç
- Department of Cardiology, University of Health Sciences, Adana Training and Research Hospital, Adana, Turkey
| | - Ümit Yaşar Sinan
- Department of Cardiology, İstanbul University Cerrahpasa Institute of Cardiology, İstanbul
| | - Ebru Turkoglu
- Department of Cardiology, Izmir Kemalpasa State Hospital, Izmir, TURKEY
| | - Hatice Kemal
- Department of Cardiology, Near East University, School of Medicine, Girne, CYPRUS
| | - Mehdi Zoghi
- Department of Cardiology, Ege University Faculty of Medicine, İzmir, Turkey
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Saraçoğlu E, Ural D, Kılıç S, Vuruşkan E, Şahin T, Ağaçdiken Ağır A. Left atrial appendage 2D-strain assessed by transesophageal echocardiography is associated with thromboembolic risk in patients with atrial fibrillation. Turk Kardiyol Dern Ars 2019; 47:111-121. [PMID: 30874509 DOI: 10.5543/tkda.2019.39482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the relationship of left atrial appendage (LAA) mechanics assessed using 2-dimensional (2D)-strain analysis of the gray scale images obtained during transesophageal echocardiography (TEE) to the conventional LAA functional parameters, CHA2DS2-VASc score, and the presence of spontaneous echo contrast (SEC) and/or LAA thrombus in patients with non-valvular atrial fibrillation (AF). METHODS The study included 126 patients with AF and 30 controls with a sinus rhythm who were referred for TEE. The global, medial, lateral and apical LAA longitudinal 2D-strain of all patients and the CHA2DS2-VASc score of AF patients were evaluated. RESULTS The global, medial, lateral, and apical LAA longitudinal 2D-strain results of AF patients were significantly lower than those of the controls and revealed moderate but significant correlations with LAA flow velocity and LAA area change. Patients with a CHA2DS2-VASc score of 0 or 1 had the highest LAA 2D-strain values and the results revealed that the LAAemptying velocity and LAA lateral and medial 2D-strain values were independent correlates of CHA2DS2-VASc score. SEC was detected in 84 patients, of whom, 42 had dense SEC and 27 had thrombus in the LAA. Multivariate analysis indicated that LAA emptying velocity, LAA area change, and LAA medial 2D-strain were independently associated with the presence of dense SEC/thrombus. In ROC analysis, cut-off values for global, medial, apical, and lateral 2D-strain for the presence of dense SEC/ thrombus were 6.0% p=0.011), 8.0% (p=0.032), 6.0% (p=0.033), and 5.4% (p=0.004), respectively. CONCLUSION Global and regional LAA mechanics were significantly related to conventional LAA functional parameters and to the presence of LAA-dense SEC/thrombus in patients with AF and may be useful as complementary data for estimating future thromboembolism.
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Affiliation(s)
- Erhan Saraçoğlu
- Department of Cardiology, Gaziantep Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Dilek Ural
- Department of Cardiology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Salih Kılıç
- Department of Cardiology, Gaziantep Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Ertan Vuruşkan
- Department of Cardiology, Gaziantep Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Tayfun Şahin
- Department of Cardiology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Ayşen Ağaçdiken Ağır
- Department of Cardiology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
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Affiliation(s)
- Salih Kılıç
- Clinic of Cardiology, Dr. Ersin Arslan Research and Training Hospital, Gaziantep, Turkey
| | - Ahmet Çelik
- Department of Cardiology, Mersin University School of Medicine, Mersin, Turkey
| | - Mehdi Zoghi
- Department of Cardiology, Ege University School of Medicine, İzmir, Turkey
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Doğduş M, Kılıç S, Vuruşkan E. Author`s Reply. Anatol J Cardiol 2019; 21:350-351. [PMID: 31142728 PMCID: PMC6683221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mustafa Doğduş
- Department of Cardiology, Karaman State Hospital; Karaman-Turkey,Address for Correspondence: Dr. Mustafa Doğduş, Karaman Devlet Hastanesi, Kardiyoloji Kliniği, Larende Mah. Ahmet Öktem Cad. No: 3 Turkuaz 3 Sitesi Karaman, Merkez 70100 Karaman-Türkiye Phone: +90 338 226 33 25 E-mail:
| | - Salih Kılıç
- Department of Cardiology, Doctor Ersin Arslan Training and Research Hospital; Gaziantep-Turkey
| | - Ertan Vuruşkan
- Department of Cardiology, Faculty of Medicine, Gaziantep University; Gaziantep-Turkey
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Kılıç S, Saraçoğlu E, Çekici Y, Yıldırım A, Kuzu Z, Kılıç DD, Kayıkçıoglu M. Comparison of secondary prevention in coronary heart disease patients living in rural and urban areas. Turk Kardiyol Dern Ars 2019; 47:128-136. [PMID: 30874515 DOI: 10.5543/tkda.2018.68782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of the present study was to assess differences between urban and rural patients with coronary heart disease (CHD) with respect to secondary prevention. METHODS This cross-sectional study included all consecutive patients diagnosed with CHD at 2 cardiology clinics between January 2016 and January 2017. The demographic characteristics and laboratory parameters were recorded at routine control visits. The patients were divided into 2 groups according to residence based on their statements: urban (n=1752) and rural (n=456). RESULTS The median age of the patients was 64 years (interquartile range: 12 years). A mean of 4.1+-2.1 years had passed after the first (index) coronary event. It was determined that 22.2% of the patients continued to smoke. The rate of quitting was significantly higher in the urban group (20.5% vs. 11.2%; p<0.001). The presence of hypertension (64.3% vs. 56.7%), diabetes mellitus (45.6% vs. 39.2%), cerebrovascular events (9.2% vs. 3.8%), and chronic obstructive pulmonary disease (11.4% vs. 5.5%) was significantly greater among the rural patients (p<0.05 for each). In all, 34.2% were obese, and the number of obese patients was significantly greater among the rural patients (46.4% vs. 31.2%; p<0.001). The number of patients performing regular exercise was significantly lower in the rural patient group (34.4% vs. 23.9%; p<0.001). Overall, 88.9% of the patients were taking antiplatelet agents, 62.1% were taking statins, 73.1% were taking beta-blockers, and 34.2% were taking ACEI/ARB. The rate of medication use was significantly greater among urban patients compared with rural patients (p<0.05 in all cases). CONCLUSION Secondary prevention efforts among patients with CHD require additional improvement. Moreover, secondary prevention is currently less successful among the rural population than the urban population.
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Affiliation(s)
- Salih Kılıç
- Department of Cardiology, Gaziantep Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Erhan Saraçoğlu
- Department of Cardiology, Gaziantep Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Yusuf Çekici
- Department of Cardiology, Gaziantep Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Arafat Yıldırım
- Department of Cardiology, Gaziantep Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Zülfiye Kuzu
- Department of Cardiology, Gaziantep Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Dilara Deniz Kılıç
- Department of Internal Medicine, Nizip State Hospital, Gaziantep, Turkey
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Polat Ekinci A, Kılıç S, Babuna Kobaner G. Early-onset and persistent traumatic granuloma of the tongue (Riga-Fede disease) associated with neonatal teeth and Down syndrome. J Eur Acad Dermatol Venereol 2018; 33:e131-e132. [PMID: 30422352 DOI: 10.1111/jdv.15336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Polat Ekinci
- Department of Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, İstanbul Tıp Fakültesi Deri ve Zührevi Hastalıklar Anabilim Dalı Millet Caddesi 34093 Çapa-Fatih/İstanbul, Turkey
| | - S Kılıç
- Department of Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, İstanbul Tıp Fakültesi Deri ve Zührevi Hastalıklar Anabilim Dalı Millet Caddesi 34093 Çapa-Fatih/İstanbul, Turkey
| | - G Babuna Kobaner
- Department of Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, İstanbul Tıp Fakültesi Deri ve Zührevi Hastalıklar Anabilim Dalı Millet Caddesi 34093 Çapa-Fatih/İstanbul, Turkey
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Kılıç S, Çelik A, Çekirdekçi E, Altay S, Elçik D, Akboğa MK, Durukan M, Yayla Ç, Zoghi M. The Prevalence and Risks of Inappropriate Combination of Aspirin and Warfarin in Clinical Practice: Results From WARFARIN-TR Study. Balkan Med J 2018; 36:17-22. [PMID: 30079702 PMCID: PMC6335934 DOI: 10.4274/balkanmedj.2017.1472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The use of warfarin and aspirin in combination is restricted to limited patients under relevant guidelines. Aims To evaluate the prevalence of the inappropriate combination of aspirin and warfarin therapy in daily practice and its risks. Study Design Cross-sectional study. Methods The awareness, efficacy, safety, and time in the therapeutic range of warfarin in the Turkish population study is a multi-center observational study that includes 4987 patients using warfarin for any reason between January 1, 2014, and December 31, 2014. To determine the prevalence of inappropriate combination use in daily practice, all patients who had a history of atherosclerotic disease (ischemic heart disease, peripheral artery disease) or cerebrovascular disease (n=1498) were excluded. The data of 3489 patients were analyzed. We defined inappropriate combination as all patients who received aspirin and warfarin regardless of the indication for warfarin use, under the direction of the European Society of Cardiology guideline recommendation. Results The mean age of patients was 59.2±13.8 years (41.8% male). The prevalence of the inappropriate use of warfarin and aspirin combination was 20.0%. The prevalence of combination therapy in patients with a primary indication for mechanical heart valve, non-valvular atrial fibrillation, and other reasons was 20.5%, 18.7%, and 21.0%, respectively. Multivariate logistic regression analysis revealed that age (odds ratio, 1.009; 95% confidence interval, 1.002-1.015; p=0.010), heart failure (odds ratio, 1.765; 95% confidence interval, 1.448-2.151; p<0.001), smoking (odds ratio, 1.762; 95% confidence interval, 1.441-1.153; p<0.010), chronic kidney disease (odds ratio, 2.057; 95% confidence interval, 1.494-2.833; p<0.001), and deep vein thrombosis (odds ratio, 0.463; 95% confidence interval, 0.229-0.718; p=0.001) were independent predictors of combination therapy (r2=0.66). The mean time in therapeutic range of patients receiving combination therapy was significantly lower than in those on warfarin monotherapy (51.6±27.05 vs. 54.7±23.93; p=0.006). Overall, 19.4% (n=677) of patients had a bleeding event (major bleeding 13.0%, n=88) within a year. Percentages of patients with combination therapy were significantly higher in patients with major bleeding than in patients without major bleeding (29.5% vs. 19.7%; p=0.023). Conclusion Our study demonstrated that 20.0% of patients taking warfarin use concomitant aspirin inappropriately in daily practice. Patients receiving aspirin with warfarin were demonstrated to have more comorbidities, lower time in therapeutic range levels, and higher bleeding rates.
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Affiliation(s)
- Salih Kılıç
- Department of Cardiology, Ege University School of Medicine, İzmir, Turkey
| | - Ahmet Çelik
- Department of Cardiology, Mersin University School of Medicine, Mersin, Turkey
| | - Elif Çekirdekçi
- Clinic of Cardiology, Tekirdağ Çorlu District State Hospital, Tekirdağ, Turkey
| | - Servet Altay
- Clinic of Cardiology, Edirne Sultan Murat 1. State Hospital, Edirne, Turkey
| | - Deniz Elçik
- Clinic of Cardiology, Ankara Research and Training Hospital, Ankara, Turkey
| | | | - Mine Durukan
- Clinic of Cardiology, Mersin City Research and Training Hospital, Mersin, Turkey
| | - Çağrı Yayla
- Clinic of Cardiology, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey
| | - Mehdi Zoghi
- Department of Cardiology, Ege University School of Medicine, İzmir, Turkey
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Kılıç S, Şimşek E, Soner Kemal H, Yüce Eİ, Türkoğlu C, Kayıkçıoğlu M. The role of specialized prevention clinics for the short term follow-up of acute coronary syndromes. Turk Kardiyol Dern Ars 2018; 45:498-505. [PMID: 28902639 DOI: 10.5543/tkda.2017.00400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the effect of specialized prevention clinics and standard clinics follow-ups on secondary protection after acute coronary syndrome (ACS) on cardiovascular risk factors. METHODS A total of 118 patients who received thrombolytic therapy after being diagnosed with ST-segment elevation myocardial infarction were followed up for 6 months. After ACS, patients in a specialized prevention clinic (Group 1) (n=67) and those in a standard clinic (Group 2) (n=51) were compared in terms of the change in their lifestyle, management of risk factors, and drug compliance. RESULTS No significant difference was found between groups in terms of baseline clinical and laboratory findings except for triglyceride level (Group 1: median 174 mg/dL; Group 2: median 136 mg/dL; p=0.039). Six months after indexing, smoking cessation (72.4% vs. 50%, p=0.037), diet compliance (43% vs.19.6%, p=0.012), and exercise rates (31% vs. 13.7%, p=0.044) were significantly higher in Group 1. Although the weight control rate was higher in Group 1, no significant difference was noted between the groups (27% vs. 15.6%, p=0.219). The rate of systolic and diastolic blood pressures >140/90 mmHg was significantly higher in Group 2 (23.5% vs. 9%, p=0.029) at 6 months. The median low-density lipoprotein cholesterol (LDL-C) value was significantly lower in Group 1 patients (Group 1: 91 mg/dL; Group 2: 102 mg/dL; p=0.042). Moreover, the rate of LDL-C ≤70 mg/dL or ≥50% reduction compared with baseline was significantly higher in Group 1 (32.8% vs. 13.7%, p=0.016). Although the recommended treatments were similar in both groups, the statin use rate was significantly higher in Group 1 (95.5% vs. 80.3%, p=0.021) at 6 months. CONCLUSION The results of the study showed that specialized prevention clinics were more effective during the management of cardiovascular risk factors after ACS.
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Affiliation(s)
- Salih Kılıç
- Department of Cardiology, Nizip State Hospital, Gaziantep, Turkey.
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Özkaya E, Kılıç S. Severe adverse cutaneous drug reactions to antiepileptic drugs: 18 years of experience in a tertiary referral dermatology clinic in Turkey. J Eur Acad Dermatol Venereol 2018; 32:e268-e270. [DOI: 10.1111/jdv.14799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E. Özkaya
- Department of Dermatology and Venereology; Istanbul Medical Faculty; Istanbul University; Istanbul Turkey
| | - S. Kılıç
- Department of Dermatology and Venereology; Istanbul Medical Faculty; Istanbul University; Istanbul Turkey
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Saracoglu E, Kılıç S, Vuruşkan E, Düzen I, Çekici Y, Kuzu Z, Yıldırım A, Küçükosmanoğlu M, Çetin M. Prediction of subtle left ventricular systolic dysfunction in homozygous and heterozygous familial hypercholesterolemia: Genetic analyses and speckle tracking echocardiography study. Echocardiography 2018; 35:1289-1299. [PMID: 29870584 DOI: 10.1111/echo.14021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND AIMS Few studies have shown the direct effect of familial hypercholesterolemia (FH) on myocardial systolic function. Studies focused on heterozygote FH patients but not homozygote ones, and they did not perform genetic analyses. We aimed to evaluate all types of patients with FH using the potentially more sensitive speckle tracking echocardiography (STE) technique to identify early left ventricular (LV) dysfunction. METHODS Genetic analyses of patients with FH were conducted for LDL-receptor, PCSK9, and ApoB100. Nine homozygote, two compound heterozygote, and 82 heterozygote FH patients and 85 healthy subjects were prospectively studied. Longitudinal and circumferential strain measurements and conventional echocardiography findings were obtained. RESULTS LV ejection fractions were similar for all (homozygote, heterozygote, and control) groups. The LV average longitudinal strain (aLS) and average circumferential strain (aCS) levels were significantly reduced in the homozygote and heterozygote groups when compared with the controls (for aLS, P = .008 (<.001); for aCS, P =< .001). A significant inverse correlation was found between LDL-C levels and LS (P < .001, r = .728) and CS (P < .001, r = .642) for all FH patients. CONCLUSIONS This study demonstrates the potential of using systolic strain values obtained using 2D STE for determining lipotoxicity in the myocardium owing to hypercholesterolemia. Our study found that cardiac functions of homozygote patients who had the highest cholesterol levels were disrupted at very early ages. Therefore, starting lipid reduction treatment and early reverse LV remodelling therapy at early ages may be beneficial for high-risk patients.
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Affiliation(s)
- Erhan Saracoglu
- Dr. Ersin Arslan Education and Training Hospital, Gaziantep, Turkey
| | - Salih Kılıç
- Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Ertan Vuruşkan
- Dr. Ersin Arslan Education and Training Hospital, Gaziantep, Turkey
| | - Irfan Düzen
- Department of Cardiology, Gaziantep 25 Aralık State Hospital, Gaziantep, Turkey
| | - Yusuf Çekici
- Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Zülfiye Kuzu
- Dr. Ersin Arslan Education and Training Hospital, Gaziantep, Turkey
| | - Arafat Yıldırım
- Dr. Ersin Arslan Education and Training Hospital, Gaziantep, Turkey
| | | | - Mustafa Çetin
- Dr. Ersin Arslan Education and Training Hospital, Gaziantep, Turkey
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Kılıç S, Saraçoğlu E, Alkan G. A rare complication in a patient taking rivaroxaban: Alveolar hemorrhage. Turk Kardiyol Dern Ars 2018; 46:73-75. [PMID: 29339679 DOI: 10.5543/tkda.2017.53919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Alveolar hemorrhage (AH) is a heterogeneous clinical syndrome with a high mortality rate that is characterized by extensive bleeding into the alveolar spaces. AH usually develops secondary to immunological disease and, less frequently, to drug use. Presently described is the case of an 86-year-old woman with AH who had been using rivaroxaban for 6 months.
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Affiliation(s)
- Salih Kılıç
- Department of Cardiology, Nizip State Hospital, Gaziantep, Turkey.
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Baykal C, Kılıç S, Küçükoğlu R. Paraneoplastic pemphigus seen in four patients with haematological malignancies formerly treated with rituximab. J Eur Acad Dermatol Venereol 2017; 32:e50-e52. [PMID: 28758262 DOI: 10.1111/jdv.14500] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- C Baykal
- Department of Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - S Kılıç
- Department of Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - R Küçükoğlu
- Department of Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Kılıç S, Çelik A, Çakmak HA, Afşin A, Tekkeşin Aİ, Açıksarı G, Memetoğlu ME, Özpamuk Karadeniz F, Şahan E, Alıcı MH, Dereli Y, Sinan ÜY, Zoghi M. The Time in Therapeutic Range and Bleeding Complications of Warfarin in Different Geographic Regions of Turkey: A Subgroup Analysis of WARFARIN-TR Study. Balkan Med J 2017; 34:349-355. [PMID: 28443575 PMCID: PMC5615968 DOI: 10.4274/balkanmedj.2016.1617] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: The time in therapeutic range values may vary between different geographical regions of Turkey in patients vitamin K antagonist therapy. Aims: To evaluate the time in therapeutic range percentages, efficacy, safety and awareness of warfarin according to the different geographical regions in patients who participated in the WARFARIN-TR study (The Awareness, Efficacy, Safety and Time in Therapeutic Range of Warfarin in the Turkish population) in Turkey. Study Design: Cross-sectional study. Methods: The WARFARIN-TR study includes 4987 patients using warfarin and involved regular international normalized ratio monitoring between January 1, 2014 and December 31, 2014. Patients attended follow-ups for 12 months. The sample size calculations were analysed according to the density of the regional population and according to Turkish Statistical Institute data. The time in therapeutic range was calculated according to F.R. Roosendaal’s algorithm. Awareness was evaluated based on the patients’ knowledge of the effect of warfarin and food-drug interactions with simple questions developed based on a literature review. Results: The Turkey-wide time in therapeutic range was reported as 49.5%±22.9 in the WARFARIN-TR study. There were statistically significant differences between regions in terms of time in therapeutic range (p<0.001). The highest rate was reported in the Marmara region (54.99%±20.91) and the lowest was in the South-eastern Anatolia region (41.95±24.15) (p<0.001). Bleeding events were most frequently seen in Eastern Anatolia (41.6%), with major bleeding in the Aegean region (5.11%) and South-eastern Anatolia (5.36%). There were statistically significant differences between the regions in terms of awareness (p<0.001). Conclusion: Statistically significant differences were observed in terms of the efficacy, safety and awareness of warfarin therapy according to different geographical regions in Turkey.
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Affiliation(s)
- Salih Kılıç
- Department of Cardiology, Ege University School of Medicine, İzmir, Turkey
| | - Ahmet Çelik
- Department of Cardiology, Mersin University School of Medicine, Mersin, Turkey
| | | | - Abdülmecit Afşin
- Department of Cardiology, İnönü University School of Medicine, Malatya, Turkey
| | - Ahmet İlker Tekkeşin
- Clinic of Cardiology, Siyami Ersek Training and Research Hospital, İstanbul, Turkey
| | - Gönül Açıksarı
- Clinic of Cardiology, İstinye State Hospital, İstanbul, Turkey
| | - Mehmet Erdem Memetoğlu
- Clinic of Cardiovascular Surgery, Siyami Ersek Training and Research Hospital, İstanbul, Turkey
| | | | - Ekrem Şahan
- Clinic of Cardiology, Atatürk Chest Disease and Chest Surgery Training and Research Hospital, Ankara, Turkey
| | | | - Yüksel Dereli
- Department of Cardiovascular Surgery, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey
| | - Ümit Yaşar Sinan
- Department of Cardiology, İstanbul University Institute of Cardiology, İstanbul, Turkey
| | - Mehdi Zoghi
- Department of Cardiology, Ege University School of Medicine, İzmir, Turkey
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Kurmuş Ö, Seyis S, Kılıç S, Uzunget SB, Konukçu İ, Ercan EA. OP-191 [AJC » Acute Coronary Syndromes] Usefullness Of The CHA2DS2VASc Score To Predict Intracoronary Thrombus Burden In ST-Elevation Myocardial Infarction Patients. Am J Cardiol 2017. [DOI: 10.1016/j.amjcard.2017.03.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kılıç S, Özkaya E, Baykal C, Vatansever S. Vemurafenib-induced toxic epidermal necrolysis: Is it an emerging side-effect of the drug? J Eur Acad Dermatol Venereol 2017; 31:e354-e355. [PMID: 28150343 DOI: 10.1111/jdv.14150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- S Kılıç
- Department of Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, 34093, Çapa-Istanbul, Turkey
| | - E Özkaya
- Department of Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, 34093, Çapa-Istanbul, Turkey
| | - C Baykal
- Department of Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, 34093, Çapa-Istanbul, Turkey
| | - S Vatansever
- Department of Medical Oncology, Institute of Oncology, Istanbul University, 34093, Çapa-Istanbul, Turkey
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Bozkurt D, Kılıç S, Kılıç D, Kılavuz A, Akçiçek F. Künt göğüs travması sonrası gelişen nefes darlığı ve karaciğer enzim yüksekliği. Ege Tıp Dergisi 2016. [DOI: 10.19161/etd.344227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Kılıç S, Sılan F, Hız MM, Işık S, Ögretmen Z, Özdemir Ö. Vitamin D Receptor Gene BSMI, FOKI, APAI, and TAQI Polymorphisms and the Risk of Atopic Dermatitis. J Investig Allergol Clin Immunol 2016; 26:106-10. [DOI: 10.18176/jiaci.0020] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bodur S, Özdamar Ö, Kılıç S, Gün İ. The efficacy of the systemic methotrexate treatment in caesarean scar ectopic pregnancy: A quantitative review of English literature. J OBSTET GYNAECOL 2014; 35:290-6. [DOI: 10.3109/01443615.2014.954101] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Kılıç S, Gazioglu S, Serap Zengin K, Ülkü Dübüş H, Boz C. Cervical vestibular evoked myogenic potentials to air-conducted sound in early amyotrophic lateral sclerosis. Neurophysiol Clin 2012; 42:119-23. [DOI: 10.1016/j.neucli.2012.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 12/27/2011] [Accepted: 01/01/2012] [Indexed: 10/14/2022] Open
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Karatepe B, Babür C, Karatepe M, Kılıç S. Seroprevalence of toxoplasmosis in horses in Niğde Province of Turkey. Trop Anim Health Prod 2009; 42:385-9. [DOI: 10.1007/s11250-009-9430-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 08/11/2009] [Indexed: 11/30/2022]
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