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Ulgu MM, Laleci Erturkmen GB, Yuksel M, Namli T, Postacı Ş, Gencturk M, Kabak Y, Sinaci AA, Gonul S, Dogac A, Özkan Altunay Z, Ekinci B, Aydin S, Birinci S. A Nationwide Chronic Disease Management Solution via Clinical Decision Support Services: Software Development and Real-Life Implementation Report. JMIR Med Inform 2024; 12:e49986. [PMID: 38241077 PMCID: PMC10837759 DOI: 10.2196/49986] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/21/2023] [Accepted: 11/29/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The increasing population of older adults has led to a rise in the demand for health care services, with chronic diseases being a major burden. Person-centered integrated care is required to address these challenges; hence, the Turkish Ministry of Health has initiated strategies to implement an integrated health care model for chronic disease management. We aim to present the design, development, nationwide implementation, and initial performance results of the national Disease Management Platform (DMP). OBJECTIVE This paper's objective is to present the design decisions taken and technical solutions provided to ensure successful nationwide implementation by addressing several challenges, including interoperability with existing IT systems, integration with clinical workflow, enabling transition of care, ease of use by health care professionals, scalability, high performance, and adaptability. METHODS The DMP is implemented as an integrated care solution that heavily uses clinical decision support services to coordinate effective screening and management of chronic diseases in adherence to evidence-based clinical guidelines and, hence, to increase the quality of health care delivery. The DMP is designed and implemented to be easily integrated with the existing regional and national health IT systems via conformance to international health IT standards, such as Health Level Seven Fast Healthcare Interoperability Resources. A repeatable cocreation strategy has been used to design and develop new disease modules to ensure extensibility while ensuring ease of use and seamless integration into the regular clinical workflow during patient encounters. The DMP is horizontally scalable in case of high load to ensure high performance. RESULTS As of September 2023, the DMP has been used by 25,568 health professionals to perform 73,715,269 encounters for 16,058,904 unique citizens. It has been used to screen and monitor chronic diseases such as obesity, cardiovascular risk, diabetes, and hypertension, resulting in the diagnosis of 3,545,573 patients with obesity, 534,423 patients with high cardiovascular risk, 490,346 patients with diabetes, and 144,768 patients with hypertension. CONCLUSIONS It has been demonstrated that the platform can scale horizontally and efficiently provides services to thousands of family medicine practitioners without performance problems. The system seamlessly interoperates with existing health IT solutions and runs as a part of the clinical workflow of physicians at the point of care. By automatically accessing and processing patient data from various sources to provide personalized care plan guidance, it maximizes the effect of evidence-based decision support services by seamless integration with point-of-care electronic health record systems. As the system is built on international code systems and standards, adaptation and deployment to additional regional and national settings become easily possible. The nationwide DMP as an integrated care solution has been operational since January 2020, coordinating effective screening and management of chronic diseases in adherence to evidence-based clinical guidelines.
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Affiliation(s)
| | | | - Mustafa Yuksel
- Software Research Development and Consultancy Corporation, Ankara, Turkey
| | - Tuncay Namli
- Software Research Development and Consultancy Corporation, Ankara, Turkey
| | - Şenan Postacı
- Software Research Development and Consultancy Corporation, Ankara, Turkey
| | - Mert Gencturk
- Software Research Development and Consultancy Corporation, Ankara, Turkey
| | - Yildiray Kabak
- Software Research Development and Consultancy Corporation, Ankara, Turkey
| | - A Anil Sinaci
- Software Research Development and Consultancy Corporation, Ankara, Turkey
| | - Suat Gonul
- Software Research Development and Consultancy Corporation, Ankara, Turkey
| | - Asuman Dogac
- Software Research Development and Consultancy Corporation, Ankara, Turkey
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Sagir S, Seker U, Pekince Ozoner M, Yuksel M, Demir M. Oxidative stress, apoptosis, inflammation, and proliferation modulator function of visnagin provide gonadoprotective activity in testicular ischemia-reperfusion injury. Eur Rev Med Pharmacol Sci 2023; 27:9968-9977. [PMID: 37916367 DOI: 10.26355/eurrev_202310_34176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVE: Visnagin (Vis) is a compound found in the flowers and seeds of the Ammi visnaga plant with promising antioxidant and anti-inflammatory properties. We aimed to investigate the dose-dependent gonadoprotective effects of visnagin in rats while considering oxidative stress, apoptosis, and inflammation-related protein expression levels. MATERIALS AND METHODS: Twenty-eight adult rats were divided into four groups of seven animals each; control, ischemia/reperfusion (I/R), I/R+30Vis, and I/R+60Vis. Animals in control received no surgical application and were sacrificed at the end of the experiment. The rats in I/R, I/R + Vis30, and I/R + Vis60 were exposed to testicular ischemia and the animals in I/R + Vis30, and I/R + Vis60 groups received either 30 or 60 mg/kg visnagin intraperitoneal. At the end of the experiment, testis tissues were used for the measurement of oxidative stress, apoptosis, and inflammation. RESULTS: Our microscopic examinations indicated that I/R resulted in testicular degenerations and morphological alterations, which were improved in visnagin-treated animals. The biochemical analyses demonstrated that oxidative stress in the I/R group increased significantly (p<0.05) compared to the control group. The immunohistochemical examinations showed that pro-apoptotic Bax and Caspase 3 expressions, and pro-inflammatory tumor necrosis factor-alpha (TNF-α) levels were significantly up-regulated (p<0.05) but proliferating nuclear antigen (PCNA) levels in I/R group was significantly (p<0.001) down-regulated compared to the control group. CONCLUSIONS: Ischemia leading to testicular torsion is a reproductive health-affecting problem, and current surgical treatment methods might be insufficient to recover the testis due to the accumulation of reactive oxygen species (ROS). Our observations indicate that visnagin is a potential co-modality along with the surgical interventions for the recovery of ischemia encountered testis, but we believe the requirement of more detailed studies to explore the underlying signaling pathways and the strength of visnagin against testicular ischemia-reperfusion injury. Graphical Abstract https://www.europeanreview.org/wp/wp-content/uploads/GRAB.jpg.
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Affiliation(s)
- S Sagir
- Department of Urology, Faculty of Medicine, Mardin Artuklu University, Mardin, Turkey.
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Ermerak NO, Yuksel M. Modification of the Nuss procedure: the crossed bar technique for new subtypes of pectus excavatum. Gen Thorac Cardiovasc Surg 2023; 71:577-583. [PMID: 37179507 DOI: 10.1007/s11748-023-01940-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND We aim to describe four new subtypes of PE in detail and represent modification of the Nuss procedure called crossed bar technique for their optimum correction with good results. METHODS 101 patients who underwent crossed bar technique between August 2005 and February 2022 were included into the study. RESULTS The mean age of the patient series was 21.1 (range 15-38 years) years. Mean Haller index was 3.87. Mean operation duration was 86.84 min. 2 bars were used in 74 (73.3%) of the patients whereas 3 bars were preferred in 27 (26.7%) of them. Mean hospital stay was 4.1 (2-8) days, and all the patients were seen routinely on postoperative follow-up at 1st, 6th, and 18th months. Quality of life questionnaires revealed satisfaction. CONCLUSIONS Cross bar technique yields satisfactory results for these new subtypes and can be performed safely with good results in these selected group of patients.
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Affiliation(s)
- Nezih Onur Ermerak
- Department of Thoracic Surgery, Marmara University School of Medicine, Istanbul, Turkey.
| | - Mustafa Yuksel
- Department of Thoracic Surgery, Demiroglu Bilim University School of Medicine, Istanbul, Turkey
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Yuksel M, Luo W, McCloy B, Mills J, Kayaharman M, Yeow JTW. A precise and rapid early pregnancy test: Development of a novel and fully automated electrochemical point-of-care biosensor for human urine samples. Talanta 2023; 254:124156. [PMID: 36525867 DOI: 10.1016/j.talanta.2022.124156] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
Human chorionic gonadotropin (hCG), a glycoprotein hormone secreted from the placenta, is an important biomarker for pregnancy. In this study, we designed a precise, rapid and fully automatic device with an electrochemical point-of-care biosensor capable of quantitative hCG detection from human urine samples for early pregnancy detection. Gold and Ag/AgCl electrodes, whose structure with optimum isopotential region and current density, were simulated using COMSOL Multiphysics® software and custom-made from Flex Medical. The sensing surface was fabricated with DSP self-assembled monolayers (SAMs) and covalently immobilized anti-hCG-beta antibody. The detection method involved a sandwich assay using anti-hCG alpha-HRP. Based on an automated agitation design implemented in our device, the surface reaction rate is significantly improved comparing to routinely performed sandwich assays, and therefore a rapid detection of very low concentration can be achieved. Electrochemical impedance spectroscopy (EIS) and chronoamperometry (CA) measurements were used to characterize the immobilization of the antibodies and to determine the sensor activities respectively. The sensors displayed a limit of detection (LOD) of 2.17 mIU/ml within established clinical hCG levels for early detection of pregnancy. They responded very well to hCG, but not to luteinizing hormone (LH), which has a high degree of cross-reactivity with hCG. The results showed that the immunosensor has high specificity, good reproducibility, and long-term stability for the detection of hCG in urine samples.
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Affiliation(s)
- Mustafa Yuksel
- Dept. of Systems Design Engineering, University of Waterloo, ON, Canada; SannTek Labs Inc, Waterloo, Ontario, Canada
| | - Wei Luo
- SannTek Labs Inc, Waterloo, Ontario, Canada
| | | | | | - Muhammed Kayaharman
- SannTek Labs Inc, Waterloo, Ontario, Canada; Dept. of Electrical and Computer Engineering, University of Waterloo, ON, Canada
| | - John T W Yeow
- Dept. of Systems Design Engineering, University of Waterloo, ON, Canada; Waterloo Institute for Nanotechnology, University of Waterloo, ON, Canada.
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García-Lorenzo B, Gorostiza A, González N, Larrañaga I, Mateo-Abad M, Ortega-Gil A, Bloemeke J, Groene O, Vergara I, Mar J, Lim Choi Keung SN, Arvanitis TN, Kaye R, Dahary Halevy E, Nahir B, Arndt F, Dichmann Sorknæs A, Juul NK, Lilja M, Sherman MH, Laleci Erturkmen GB, Yuksel M, Robbins T, Kyrou I, Randeva H, Maguire R, McCann L, Miller M, Moore M, Connaghan J, Fullaondo A, Verdoy D, de Manuel Keenoy E. Assessment of the Effectiveness, Socio-Economic Impact and Implementation of a Digital Solution for Patients with Advanced Chronic Diseases: The ADLIFE Study Protocol. Int J Environ Res Public Health 2023; 20:3152. [PMID: 36833849 PMCID: PMC9966680 DOI: 10.3390/ijerph20043152] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/20/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
Due to population ageing and medical advances, people with advanced chronic diseases (ACD) live longer. Such patients are even more likely to face either temporary or permanent reduced functional reserve, which typically further increases their healthcare resource use and the burden of care on their caregiver(s). Accordingly, these patients and their caregiver(s) may benefit from integrated supportive care provided via digitally supported interventions. This approach may either maintain or improve their quality of life, increase their independence, and optimize the healthcare resource use from early stages. ADLIFE is an EU-funded project, aiming to improve the quality of life of older people with ACD by providing integrated personalized care via a digitally enabled toolbox. Indeed, the ADLIFE toolbox is a digital solution which provides patients, caregivers, and health professionals with digitally enabled, integrated, and personalized care, supporting clinical decisions, and encouraging independence and self-management. Here we present the protocol of the ADLIFE study, which is designed to provide robust scientific evidence on the assessment of the effectiveness, socio-economic, implementation, and technology acceptance aspects of the ADLIFE intervention compared to the current standard of care (SoC) when applied in real-life settings of seven different pilot sites across six countries. A quasi-experimental trial following a multicenter, non-randomized, non-concurrent, unblinded, and controlled design will be implemented. Patients in the intervention group will receive the ADLIFE intervention, while patients in the control group will receive SoC. The assessment of the ADLIFE intervention will be conducted using a mixed-methods approach.
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Affiliation(s)
- Borja García-Lorenzo
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
| | - Ania Gorostiza
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
| | - Nerea González
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
- Osakidetza Basque Health Service, Barrualde-Galdakao, Integrated Health Organisation, 48960 Galdakao, Spain
| | - Igor Larrañaga
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
| | - Maider Mateo-Abad
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
- Biodonostia Health Research Institute, Paseo Dr. Begiristain s/n, 20014 Donostia, Basque Country, Spain
| | - Ana Ortega-Gil
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
| | | | - Oliver Groene
- OptiMedis, Burchardstrasse 17, 20095 Hamburg, Germany
| | - Itziar Vergara
- Biodonostia Health Research Institute, Paseo Dr. Begiristain s/n, 20014 Donostia, Basque Country, Spain
| | - Javier Mar
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
- Unidad de Investigación AP-OSIs, Hospital Alto Deba, 20500 Arrasate-Mondragón, Gipuzkoa, Spain
- Instituto de Investigación Sanitaria Biodonostia, 20014 San Sebastián, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 48960 Galdakao, Spain
- Unidad de Gestión Sanitaria, Hospital Alto Deba, 20500 Arrasate-Mondragón, Gipuzkoa, Spain
| | - Sarah N. Lim Choi Keung
- School of Engineering, University of Birmingham, Birmingham B15 2TT, UK
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry CV4 7AL, UK
| | - Theodoros N. Arvanitis
- School of Engineering, University of Birmingham, Birmingham B15 2TT, UK
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry CV4 7AL, UK
- Digital & Data Driven Research Unit, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Rachelle Kaye
- Assuta Medical Centre Ashdod, Ashdod 7747629, Israel
| | | | - Baraka Nahir
- Assuta Medical Centre Ashdod, Ashdod 7747629, Israel
- Maccabi Healthcare Services Southern Region, Omer 8496500, Israel
| | - Fritz Arndt
- Gesunder Werra-Meißner-Kreis GmbH, 37269 Eschwege, Germany
| | - Anne Dichmann Sorknæs
- Internal Medical & Emergency Department M/FAM, OUH, Svendvorg Hospital, Baagøes Allé 15, Indgang 51, 5700 Svendborg, Denmark
| | - Natassia Kamilla Juul
- Internal Medical & Emergency Department M/FAM, OUH, Svendvorg Hospital, Baagøes Allé 15, Indgang 51, 5700 Svendborg, Denmark
| | - Mikael Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development Östersund, Umeå University, 901 87 Umeå, Sweden
| | - Marie Holm Sherman
- R&D Project Office, Region Jämtland Härjedalen, 831 30 Östersund, Sweden
| | | | - Mustafa Yuksel
- SRDC, ODTU Teknokent Silikon Blok Kat: 1 No: 16 Cankaya, Ankara 06800, Turkey
| | - Tim Robbins
- Digital & Data Driven Research Unit, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Ioannis Kyrou
- Digital & Data Driven Research Unit, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Harpal Randeva
- Digital & Data Driven Research Unit, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Roma Maguire
- Department of Computing and Information Sciences, University of Strathclyde, Glasgow G1 1XQ, UK
| | - Lisa McCann
- Department of Computing and Information Sciences, University of Strathclyde, Glasgow G1 1XQ, UK
| | - Morven Miller
- Department of Computing and Information Sciences, University of Strathclyde, Glasgow G1 1XQ, UK
| | - Margaret Moore
- Department of Computing and Information Sciences, University of Strathclyde, Glasgow G1 1XQ, UK
| | - John Connaghan
- Department of Computing and Information Sciences, University of Strathclyde, Glasgow G1 1XQ, UK
| | - Ane Fullaondo
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
| | - Dolores Verdoy
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
| | - Esteban de Manuel Keenoy
- Kronikgune Institute for Health Services Research, Ronda de Azkue 1, Torre del Bilbao Exhibition Centre, 48902 Barakaldo, Basque Country, Spain
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von Tottleben M, Grinyer K, Arfa A, Traore L, Verdoy D, Lim Choi Keung SN, Larranaga I, Jaulent MC, De Manuel Keenoy E, Lilja M, Beach M, Marguerie C, Yuksel M, Laleci Erturkmen GB, Klein GO, Lindman P, Mar J, Kalra D, Arvanitis TN. An Integrated Care Platform System (C3-Cloud) for Care Planning, Decision Support, and Empowerment of Patients With Multimorbidity: Protocol for a Technology Trial. JMIR Res Protoc 2022; 11:e21994. [PMID: 35830239 PMCID: PMC9330187 DOI: 10.2196/21994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 12/18/2020] [Accepted: 10/02/2021] [Indexed: 11/16/2022] Open
Abstract
Background There is an increasing need to organize the care around the patient and not the disease, while considering the complex realities of multiple physical and psychosocial conditions, and polypharmacy. Integrated patient-centered care delivery platforms have been developed for both patients and clinicians. These platforms could provide a promising way to achieve a collaborative environment that improves the provision of integrated care for patients via enhanced information and communication technology solutions for semiautomated clinical decision support. Objective The Collaborative Care and Cure Cloud project (C3-Cloud) has developed 2 collaborative computer platforms for patients and members of the multidisciplinary team (MDT) and deployed these in 3 different European settings. The objective of this study is to pilot test the platforms and evaluate their impact on patients with 2 or more chronic conditions (diabetes mellitus type 2, heart failure, kidney failure, depression), their informal caregivers, health care professionals, and, to some extent, health care systems. Methods This paper describes the protocol for conducting an evaluation of user experience, acceptability, and usefulness of the platforms. For this, 2 “testing and evaluation” phases have been defined, involving multiple qualitative methods (focus groups and surveys) and advanced impact modeling (predictive modeling and cost-benefit analysis). Patients and health care professionals were identified and recruited from 3 partnering regions in Spain, Sweden, and the United Kingdom via electronic health record screening. Results The technology trial in this 4-year funded project (2016-2020) concluded in April 2020. The pilot technology trial for evaluation phases 3 and 4 was launched in November 2019 and carried out until April 2020. Data collection for these phases is completed with promising results on platform acceptance and socioeconomic impact. We believe that the phased, iterative approach taken is useful as it involves relevant stakeholders at crucial stages in the platform development and allows for a sound user acceptance assessment of the final product. Conclusions Patients with multiple chronic conditions often experience shortcomings in the care they receive. It is hoped that personalized care plan platforms for patients and collaboration platforms for members of MDTs can help tackle the specific challenges of clinical guideline reconciliation for patients with multimorbidity and improve the management of polypharmacy. The initial evaluative phases have indicated promising results of platform usability. Results of phases 3 and 4 were methodologically useful, yet limited due to the COVID-19 pandemic. Trial Registration ClinicalTrials.gov NCT03834207; https://clinicaltrials.gov/ct2/show/NCT03834207 International Registered Report Identifier (IRRID) RR1-10.2196/21994
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Affiliation(s)
- Malte von Tottleben
- empirica Gesellschaft für Kommunikations- und Technologieforschung mbH, Bonn, Germany
| | - Katie Grinyer
- empirica Gesellschaft für Kommunikations- und Technologieforschung mbH, Bonn, Germany
| | - Ali Arfa
- empirica Gesellschaft für Kommunikations- und Technologieforschung mbH, Bonn, Germany
| | - Lamine Traore
- Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, Inserm, Sorbonne Université, Université Paris 13, Paris, France
| | - Dolores Verdoy
- Kronikgune Institute for Health Services Research, Barakaldo, Spain
| | - Sarah N Lim Choi Keung
- Institute of Digital Healthcare (IDH), Warwick Manufacturing Group, University of Warwick, Coventry, United Kingdom
| | - Igor Larranaga
- Kronikgune Institute for Health Services Research, Barakaldo, Spain.,Basque Health Service (Osakidetza), Debagoiena Integrated Healthcare Organisation, Research Unit, Arrasate-Mondragón, Guipúzcoa, Spain
| | - Marie-Christine Jaulent
- Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, Inserm, Sorbonne Université, Université Paris 13, Paris, France
| | | | - Mikael Lilja
- Unit of Research, Education, and Development Östersund, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Marie Beach
- South Warwickshire University NHS Foundation Trust, Warwick, United Kingdom
| | | | - Mustafa Yuksel
- Software Research Development and Consultancy Cooperation, SRDC A.S., Ankara, Turkey
| | | | - Gunnar O Klein
- School of Business (Informatics), Örebro University, Örebro, Sweden
| | | | - Javier Mar
- Basque Health Service (Osakidetza), Debagoiena Integrated Healthcare Organisation, Research Unit, Arrasate-Mondragón, Guipúzcoa, Spain
| | | | | | - Theodoros N Arvanitis
- Institute of Digital Healthcare (IDH), Warwick Manufacturing Group, University of Warwick, Coventry, United Kingdom
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Pournik O, Ahmad B, Lim Choi Keung SN, Khan O, Despotou G, Consoli A, Ayadi J, Gilardi L, Laleci Erturkmen GB, Yuksel M, Gencturk M, Gappa H, Breidenbach M, Mohamad Y, Velasco CA, Cramaiuc O, Ciobanu C, Gómez Jiménez E, Avendaño Céspedes A, Alcantud Córcoles R, Cortés Zamora EB, Abizanda P, Steinhoff A, Schmidt-Barzynski W, Robbins T, Kyrou I, Randeva H, Ferrazzini L, Arvanitis TN. CAREPATH: Developing Digital Integrated Care Solutions for Multimorbid Patients with Dementia. Stud Health Technol Inform 2022; 295:487-490. [PMID: 35773917 DOI: 10.3233/shti220771] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CAREPATH project is focusing on providing an integrated solution for sustainable care for multimorbid elderly patients with dementia or mild cognitive impairment. The project has a digitally enhanced integrated patient-centered care approach clinical decision and associated intelligent tools with the aim to increase patients' independence, quality of life and intrinsic capacity. In this paper, the conceptual aspects of the CAREPATH project, in terms of technical and clinical requirements and considerations, are presented.
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Affiliation(s)
- Omid Pournik
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | - Bilal Ahmad
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | | | - Omar Khan
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | - George Despotou
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | | | | | | | | | - Mustafa Yuksel
- Software Research Development and Consultancy Cooperation, Ankara, Turkey
| | - Mert Gencturk
- Software Research Development and Consultancy Cooperation, Ankara, Turkey
| | - Henrike Gappa
- Fraunhofer Institute for Applied Information Technology FIT, Germany
| | | | - Yehya Mohamad
- Fraunhofer Institute for Applied Information Technology FIT, Germany
| | - Carlos A Velasco
- Fraunhofer Institute for Applied Information Technology FIT, Germany
| | | | | | - Elena Gómez Jiménez
- Complejo Hospitalario Universitario de Albacete, Servicio de Salud de Castilla-La Mancha (SESCAM), Albacete, Spain
| | - Almudena Avendaño Céspedes
- Complejo Hospitalario Universitario de Albacete, Servicio de Salud de Castilla-La Mancha (SESCAM), Albacete, Spain
- CIBERFES, Instituto de Salud Carlos III, Madrid, Spain
| | - Rubén Alcantud Córcoles
- Complejo Hospitalario Universitario de Albacete, Servicio de Salud de Castilla-La Mancha (SESCAM), Albacete, Spain
| | - Elisa Belén Cortés Zamora
- Complejo Hospitalario Universitario de Albacete, Servicio de Salud de Castilla-La Mancha (SESCAM), Albacete, Spain
- CIBERFES, Instituto de Salud Carlos III, Madrid, Spain
| | - Pedro Abizanda
- Complejo Hospitalario Universitario de Albacete, Servicio de Salud de Castilla-La Mancha (SESCAM), Albacete, Spain
- CIBERFES, Instituto de Salud Carlos III, Madrid, Spain
- Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha, Spain
| | | | | | - Timothy Robbins
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ioannis Kyrou
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Harpal Randeva
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Theodoros N Arvanitis
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Peake AR, Khan O, Lim Choi Keung SN, Yuksel M, Laleci Erturkmen GB, Arvanitis TN. Structural and Semantic Mapping of Application Programming Interfaces. Stud Health Technol Inform 2022; 295:478-482. [PMID: 35773915 DOI: 10.3233/shti220769] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Modern healthcare providers rely upon Electronic Healthcare Records (EHR) systems to record patient data inside their own organization. Some healthcare providers share this data to facilitate patient care with other providers. Medical devices and healthcare providers can use differing standards of recording healthcare information. The Structural and Semantic Mapper Proxy API solution offers a practical way to tackles the issues of Structural and Semantic mapping of Application Programing Interfaces (API) in a healthcare context to enable connection of all existing systems to a healthcare providers EHR creating a single source of truth regarding the treatment of patients and enabling healthcare providers to bridge the gap between external EHR systems.
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Affiliation(s)
- Ashley R Peake
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | - Omar Khan
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | | | - Mustafa Yuksel
- Software Research Development and Consultancy Cooperation, Ankara, Turkey
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9
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Sayan B, Bekiroglu N, Yuksel M. Pectus cross bars increase hospital readmission rates due to serous pleural effusion. Gen Thorac Cardiovasc Surg 2021; 70:352-358. [PMID: 34784003 DOI: 10.1007/s11748-021-01732-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 08/18/2021] [Accepted: 11/02/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Pectus Excavatum's (PE) surgical treatment should be patient specific. In this article, we aimed to compare parallel and cross bar variations of the Nuss method and analyze if there is any difference in results. METHODS In this study, a total of 891 patients treated with the Nuss method between August 2005 and February 2018 were considered. These were retrieved from a prospectively recorded PE database. Of these, 276 double-bar patients were included in the study. Patients with parallel bars (225 cases) and patients with crossed bars (51 cases) were compared in terms of age, gender, symmetry, family history, additional anomalies, mean operation time, postoperative hospital stay (days) and hospital readmission rate. RESULTS The mean age was measured at 20.7 for parallel bar patients and 20.1 for crossed bars patients. There was no statistically significant difference in terms of age, gender, and mean operation time between two groups. On the other hand, statistical significance was found between two groups when analyzing the deformities' symmetry, patients' family history and additional anomalies. The statistically significant difference of postoperative hospital stay between two groups is clinically negligible. Postoperative hospital readmission rates due to serous pleural effusion were found to be significantly increased in patients with crossed bars (p < 0.001). CONCLUSION While pleural effusion requiring readmission was statistically more frequent in cross bars, in centers where thoracentesis can be managed, Nuss method can still be applied safely, even in cases with difficult, complex deformities. LEVEL OF EVIDENCE III. Treatment study.
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Affiliation(s)
- Bihter Sayan
- Department of Thoracic Surgery, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey.
| | - Nural Bekiroglu
- Department of Biostatistics, School of Medicine, Marmara University, Istanbul, Turkey
| | - Mustafa Yuksel
- Department of Thoracic Surgery, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
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10
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Sahin S, Yildirim M, Bektas O, Yuksel M, Kartal A, Teber S. NEUROMUSCULAR JUNCTION RELATED DISORDERS. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.325] [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: 10/20/2022]
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11
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Erturkmen GBL, Yuksel M, Baskaya M, Sarigul B, Teoman A, Yilmaz G, de Manuel E. Interoperability Architecture of the ADLIFE Patient Empowerment Platform. Stud Health Technol Inform 2021; 281:936-941. [PMID: 34042811 DOI: 10.3233/shti210316] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chronic diseases introduce challenges for the patients to manage the changing requirements of the disease. Patient empowerment activities are a critical component to assist patients in their long-term care journey. In order to be effective, patient empowerment tools need to be well-integrated with the chronic disease management tools used at the clinical sites. This paper explores and analyzes the exploitation of HL7 FHIR to design and implement an interoperable patient empowerment platform that can be seamlessly integrated with external chronic disease management and Electronic Health Record (EHR) systems.
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Affiliation(s)
| | - Mustafa Yuksel
- SRDC Software Research Development & Consultancy Corp, Ankara, Turkey
| | - Mert Baskaya
- SRDC Software Research Development & Consultancy Corp, Ankara, Turkey
| | - Bunyamin Sarigul
- Informatics Institute, Middle East Technical University, Ankara, Turkey
| | - Alper Teoman
- SRDC Software Research Development & Consultancy Corp, Ankara, Turkey
| | - Gökhan Yilmaz
- SRDC Software Research Development & Consultancy Corp, Ankara, Turkey
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12
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Eraybar S, Yuksel M, Aygun H, Ay MO, Kaya H, Bulut M. Lymphocyte/mean platelet volume ratio, a new marker; is it effective in predicting the prognosis of COVID-19 cases? ACTA ACUST UNITED AC 2021; 122:413-417. [PMID: 34002615 DOI: 10.4149/bll_2021_068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This study aims to determine the prognostic significance of the lymphocyte/mean platelet volume ratio (LMR) in terms of the clinical course of the disease in patients with COVID-19. METHODS Patients over 18 who were evaluated for COVID-19 during the period from April 1, to April 30, 2020 were retrospectively scanned. Patients with at least 1 positive PCR test result were as assigned to Group 1 while patients with negative test results were assigned to Group 2. The LMR ratio was calculated by dividing the lymphocyte value by that of MPV. The relationship between LMR, severity of patients' CT findings and 28-day mortality was evaluated. RESULTS A total of 938 patients were included in the study. It was observed that the lymphocyte and LMR levels were significantly different in those who died within 28 days (p < 0.001, p ≤ 0.001). In the ROC analysis for the LMR level, the area under the curve (AUC) was found to be 0.737 (95% CI 0.639‒0.834). When the cut‑off value of LMR was 0.045, the sensitivity was found to be 99.0 % and specificity was 15.2 %. CONCLUSION LMR can be a guide in multiple cases of care provided to critical patients, as is the case in the COVID-19 pandemic and can be used in recognizing critical patients (Tab. 5, Fig. 1, Ref. 21).
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13
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Giray E, Ermerak NO, Bahar-Ozdemir Y, Kalkandelen M, Yuksel M, Gunduz OH, Akyuz G. A Comparative Study on Short-Term Effects of Compression Orthosis and Exercises in the Treatment of Pectus Carinatum: A Randomized Controlled Pilot Feasibility Trial. Eur J Pediatr Surg 2021; 31:147-156. [PMID: 32146715 DOI: 10.1055/s-0040-1701699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Pectus carinatum (PC) is a congenital chest wall deformity which is characterized by the protrusion of the sternum and costal cartilages. Although orthotic and exercise therapies are commonly offered by physicians for PC treatment, there is a lack of evidence on the benefits of exercises and how long the orthosis should be worn. The aim of this study is to investigate the effects and feasibility of custom-made compression orthosis and exercises in the treatment of PC. MATERIALS AND METHODS Patients with PC aged 7 to 17 years old were randomized into three groups: compression orthosis 23 hours, compression orthosis 8 hours, and control group. All groups received exercises for 1 hour a day for 3 weeks. Additionally, compression orthosis 23 hours group wore the orthosis for 23 hours a day, while compression orthosis 8 hours group wore the orthosis for 8 hours a day. PC protrusion, pressure of correction, thorax lateral and anteroposterior parameters, external chest wall measurements, and Nuss Questionnaire were evaluated before and after the treatment. Also, adverse effects, retention, and compliance were assessed. Feasibility was evaluated by calculating the percentages of recruitment, retention, and safety. RESULTS The compression orthosis 23 hours group showed greater improvements than the other groups. After treatment, all groups showed significant changes in protrusion, pressure of correction, and external chest wall measurements. Adverse events occurred with similar frequency across groups. Retention percentages did not differ among groups. CONCLUSION Compression orthosis use for 23 hours can be recommended rather than its use for 8 hours because 23 hours of orthosis use has better correction and similar adverse effects.
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Affiliation(s)
- Esra Giray
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey
| | - Nezih Onur Ermerak
- Department of Thoracic Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Yeliz Bahar-Ozdemir
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey
| | - Melihat Kalkandelen
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey
| | - Mustafa Yuksel
- Department of Thoracic Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Osman Hakan Gunduz
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey
| | - Gulseren Akyuz
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey
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14
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Yozgat Y, Kus HD, Kahraman FU, Yuksel M, Firat CK, Toprak A, Yozgat CY, Yakut K, Sahin SS, Iscan A, Temur HO, Ergor SN, Erenberk U, Saritas T. Evaluation of cardiac arrhythmias by electrocardiographic markers in pediatric patients who have tuberous sclerosis without cardiac rhabdomyoma. Arch Pediatr 2021; 28:204-208. [PMID: 33715930 DOI: 10.1016/j.arcped.2021.02.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 12/11/2020] [Accepted: 02/13/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tuberous sclerosis (TS) is an autosomal dominant and hereditary disorder. Cardiac rhabdomyoma and arrhythmias are the most deleterious risk factors linked to TS. Although arrhythmias in pediatric patients with TS who have cardiac rhabdomyoma have been frequently reported, arrhythmia in patients who have TS without rhabdomyoma is rarely reported in the literature. The study aimed to assess the susceptibility of pediatric patients who have TS without cardiac rhabdomyoma to cardiac arrhythmia using electrocardiographic (ECG) markers. METHODS This prospective study included 10 patients who had TS without cardiac rhabdomyoma. The control group was made up of 30 healthy children of the same age and sex as the patient group. P wave, P wave dispersion, QT dispersion, QTc dispersion, TP-e interval, and TP-e interval dispersion were calculated on 12-lead surface ECGs for each patient in both groups and compared. RESULTS P wave, P wave dispersion, QT dispersion, and QTc dispersion were found to be significantly higher in the patient group (P<0.001). Furthermore, patients had a greater Tp-e interval and Tp-e interval dispersion than healthy children (P<0.001). CONCLUSION Pediatric patients with TS without cardiac rhabdomyoma might be prone to atrial and ventricular arrhythmias according to their prolonged ECG markers. Our findings suggest that patients with TS without cardiac rhabdomyoma need close monitoring for atrial and ventricular arrhythmias.
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Affiliation(s)
- Y Yozgat
- Department of pediatric cardiology, Bezmialem Vakif University, Istanbul, Turkey
| | - H D Kus
- Department of pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - F U Kahraman
- Department of pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - M Yuksel
- Department of pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - C K Firat
- Department of pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - A Toprak
- Department of biostatistics, Bezmialem Vakif University, Istanbul, Turkey
| | - C Y Yozgat
- Faculty of medicine, Bezmialem Vakif University, Istanbul, Turkey.
| | - K Yakut
- Department of pediatric cardiology, Bezmialem Vakif University, Istanbul, Turkey
| | - S S Sahin
- Department of pediatric neurology, Bezmialem Vakif University, Istanbul, Turkey
| | - A Iscan
- Department of pediatric neurology, Bezmialem Vakif University, Istanbul, Turkey
| | - H O Temur
- Department of radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - S N Ergor
- Department of neonatology, Bezmialem Vakif University, Istanbul, Turkey
| | - U Erenberk
- Department of pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - T Saritas
- Department of pediatric cardiology, Istanbul Medipol University, Istanbul, Turkey
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15
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Ergenekon A, Cenk M, Yilmaz Yegit C, Yuksel M, Guliyeva A, Toksoy Aksoy A, Bilicen G, Gokdemir Y, Erdem Eralp E, Rodopman Arman A, Karakoc F, Karadag B. WS11.1 The anxiety levels of children with cystic fibrosis and healthy children during the COVID-19 pandemic. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)00975-9] [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: 11/16/2022]
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16
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Basim P, Yuksel M. Peripheral inflammatory biomarkers as predictors of recurrence in surgically-treated anogenital condylomata acuminata patients. Int J STD AIDS 2020; 31:1380-1388. [PMID: 33104496 DOI: 10.1177/0956462420950562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The aim of this study was to examine the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) in patients with anogenital condylomata acuminata (CA) and their association with recurrence and squamous intraepithelial neoplasia development. We conducted a descriptive study in 95 patients that had undergone surgical treatment for CA. The descriptive data, disease characteristics, and pre-treatment peripheral inflammatory biomarkers (PIBs) were recorded retrospectively. All parameters were compared in those with recurrent and non-recurrent CA. All PIBs were significantly higher in patients with the greatest genital wart size of >2 cm in the squamous intraepithelial lesion (SIL) group. Human papillomavirus (HPV) types 16, 18, 31 and 33, known to carry high risk for anogenital cancer, were significantly related to higher SII. Greater wart size, high-grade squamous intraepithelial lesion (HSIL), and higher PLR and SII values were highly associated with recurrent disease (p = 0.003, 0.006, 0.005 and 0.000, respectively). Of all recurrences, 34.1% were explained by HSIL and increased PLR and SII values. The prediction of CA recurrence is important to determine those patients at high risk. PLR and SII can be used for risk analysis in selected patient groups.
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Affiliation(s)
- P Basim
- Department of General Surgery, Medical Faculty, Medipol University, Istanbul, Turkey
| | - M Yuksel
- Department of Dermatology, Medical Faculty, Medipol University, Istanbul, Turkey
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17
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Despotou G, Laleci Erturkmen GB, Yuksel M, Sarigul B, Lindman P, Jaulent MC, Bouaud J, Traore L, Lim Choi Keung SN, De Manuel E, Verdoy D, De Blas A, Gonzalez N, Lilja M, Sherman M, Von Tottleben M, Beach M, Marguerie C, Karni L, Klein GO, Kalra D, Chen R, Arvanitis TN. Localisation, Personalisation and Delivery of Best Practice Guidelines on an Integrated Care and Cure Cloud Architecture: The C3-Cloud Approach to Managing Multimorbidity. Stud Health Technol Inform 2020; 270:623-627. [PMID: 32570458 DOI: 10.3233/shti200235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND C3-Cloud is an integrated care ICT infrastructure offering seamless patient-centered approach to managing multimorbidity, deployed in three European pilot sites. Challenge: The digital delivery of best practice guidelines unified for multimorbidity, customized to local practice, offering the capability to improve patient personalization and benefit. METHOD C3-Cloud has adopted a co-production approach to developing unified multimorbidity guidelines, by collating and reconciling best practice guidelines for each condition. Clinical and technical teams at pilot sites and the C3-Cloud consortium worked in tandem to create the specification and technical implementation. RESULTS C3-Cloud offers CDSS for diabetes, renal failure, depression and congenital heart failure, with over 300 rules and checks that deliver four best practice guidelines in parallel, customized for each pilot site. CONCLUSIONS The process provided a traceable, maintainable and audited digitally delivered collated and reconciled guidelines.
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Affiliation(s)
- George Despotou
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | | | - Mustafa Yuksel
- SRDC Software Research Development and Consultancy Corp, Ankara, Turkey
| | - Bunyamin Sarigul
- SRDC Software Research Development and Consultancy Corp, Ankara, Turkey
| | | | | | - Jacques Bouaud
- Inserm, Sorbonne University, University of Paris 13, LIMICS, France.,AP-HP, Delegation for Clinical Research and Innovation, Paris
| | - Lamine Traore
- Inserm, Sorbonne University, University of Paris 13, LIMICS, France
| | | | | | - Dolores Verdoy
- Kronikgune, Institute for Health Services Research, Spain
| | | | | | - Mikael Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education, and Development Östersund Hospital, Umeå University, Umeå, Sweden
| | | | | | | | | | - Liran Karni
- Örebro University School of Business, Informatics, Örebro, Sweden
| | - Gunnar O Klein
- Örebro University School of Business, Informatics, Örebro, Sweden
| | - Dipak Kalra
- European Institute for Innovation through Health Data, Belgium
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18
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Buzcu H, Ozbeyli D, Yuksel M, Cilingir Kaya OT, Kasimay Cakir O. Nesfatin-1 protects from acute pancreatitis: role of melanocortin receptors. J Physiol Pharmacol 2020; 70. [PMID: 32084645 DOI: 10.26402/jpp.2019.6.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/30/2019] [Indexed: 11/03/2022]
Abstract
Nesfatin-1, a recently discovered peptide, was shown to have anti-inflammatory effects. Acute pancreatitis (AP) is a life-threatening condition caused by various reasons. Although the etiology of AP is well-known, its pathogenesis is not clear. The aim of this study is to investigate the possible anti-inflammatory role of nesfatin-1 and its probable protective underlying mechanisms in an acute pancreatitis model. Caerulein was applied intraperitoneally to induce acute pancreatitis in Sprague-Dawley female rats. Nesfatin-1 was administered 5 minutes before the application of caerulein to determine its potential anti-inflammatory role on AP. Five minutes before nesfatin-1 injection, in order to investigate the underlying mechanism, oxytocin receptor antagonist (atosiban), melanocortin receptor antagonist (HS024), or ghrelin receptor antagonist (cortistatin) were administered. Five minutes after nesfatin-1 administration, two doses of caerulein were applied one hour apart. The rats were sacrified 12 hours after the first caerulein dose for serum and pancreatic tissue sampling. Microscopic damage scoring, malondialdehyde and glutathione levels, myeloperoxidase activity, luminol and lucigenin chemiluminescence levels in pancreatic tissue and amylase, lipase, trypsinogen-2 levels in serum were evaluated. Oxidative damage was decreased with nesfatin-1 treatment in the acute pancreatitis model (P < 0.05 - 0.001). The administration of HS024 reversed the effect of nesfatin-1, via increasing lipase, amylase, trypsinogen-2, malondialdehyde (MDA), myeloperoxidase (MPO) and lucigenin levels (P < 0.05 - 0.01). Atosiban pre-treatment elevated MPO activity, luminol and lucigenin chemiluminescence levels (P < 0.01 - 0.001) and cortistatin increased lucigenin and luminol chemiluminescence (P < 0.05 - 0.01). Although receptor antagonists reversed the effect of nesfatin-1 on related biochemical parameters, no significant difference was found in histological scoring. Our results indicated that nesfatin-1 had an anti-inflammatory effect on acute pancreatitis via mainly effecting melanocortin receptors.
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Affiliation(s)
- H Buzcu
- Marmara University School of Medicine, Department of Physiology, Istanbul, Turkey
| | - D Ozbeyli
- Marmara University Vocational School of Health Related Services, Istanbul, Turkey
| | - M Yuksel
- Marmara University Vocational School of Health Related Services, Istanbul, Turkey
| | - O T Cilingir Kaya
- Marmara University School of Medicine, Department of Histology and Embryology, Istanbul, Turkey
| | - O Kasimay Cakir
- Marmara University School of Medicine, Department of Physiology, Istanbul, Turkey.
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19
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Kocaaslan FND, Ozkan MC, Akdeniz Z, Sacak B, Erol B, Yuksel M, Celebiler O. Use of abdominal negative pressure wound therapy in different indications: a case series. J Wound Care 2019; 28:240-244. [PMID: 30975060 DOI: 10.12968/jowc.2019.28.4.240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/11/2022]
Abstract
Negative pressure wound therapy (NPWT) is a widely used wound management system. Several articles have been published on the advantages and complications of this system. Abdominal dressing negative pressure system (abdominal NPWT) is a newer technology, developed and used in open abdomen cases. The adherence of the sponge to the intra-abdominal organs is prevented by a polyurethane foam. This study presents a number of case series where an abdominal NPWT (ABThera, KCI, US) has been used to treat other vital organs, helping to prevent complications such as organ rupture and fatal bleeding.
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Affiliation(s)
- Fatma Nihal Durmus Kocaaslan
- Marmara University School of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey
| | - Melekber Cavus Ozkan
- Marmara University School of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey
| | - Zeynep Akdeniz
- Marmara University School of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey
| | - Bulent Sacak
- Marmara University School of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey
| | - Bulent Erol
- Professor, Marmara University School of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
| | - Mustafa Yuksel
- Professor, Marmara University School of Medicine, Department of Thorax Surgery, Istanbul, Turkey
| | - Ozhan Celebiler
- Professor, Marmara University School of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey
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20
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Saracoglu A, Ermerak O, Sirzai EYS, Yuksel M, Aykac Z, Yildizeli B. Anesthesia Management for a Patient Undergoing Pulmonary Endarterctomy without Cardiopulmonary Bypass. Braz J Cardiovasc Surg 2019; 34:783-787. [PMID: 31793258 PMCID: PMC6894026 DOI: 10.21470/1678-9741-2018-0245] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Pulmonary endarterectomy is a curative procedure for chronic thromboembolic Pulmonary Hypertension. As usual, cardiopulmonary bypass circuit is required. However, there are several complications attributed to extracorporeal circulation. Hemodilution, systemic inflammatory response syndrome and leukocyte sequestration are circulation related complications. The severe forms include Acute Respiratory Distress Syndrome, Acute Lung Injury, myocardial stunning, dysfunction of the right ventricle, coagulopathy, postoperative stroke or renal dysfunction. In this case report, we aimed to give information about perioperative anesthesia and surgical management of pulmonary endarterectomy which was successfully managed without Cardiopulmonary Bypass.
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Affiliation(s)
- Ayten Saracoglu
- Marmara University Medical School Department of Anesthesiology and Intensive Care Istanbul Turkey Department of Anesthesiology and Intensive Care, Marmara University Medical School, Istanbul, Turkey
| | - Onur Ermerak
- Marmara University Medical School Department of Thoracic Surgery Istanbul Turkey Department of Thoracic Surgery, Marmara University Medical School, Istanbul, Turkey
| | - Esra Yaman Savci Sirzai
- Marmara University Medical School Department of Thoracic Surgery Istanbul Turkey Department of Thoracic Surgery, Marmara University Medical School, Istanbul, Turkey
| | - Mustafa Yuksel
- Marmara University Medical School Department of Thoracic Surgery Istanbul Turkey Department of Thoracic Surgery, Marmara University Medical School, Istanbul, Turkey
| | - Zuhal Aykac
- Marmara University Medical School Department of Anesthesiology and Intensive Care Istanbul Turkey Department of Anesthesiology and Intensive Care, Marmara University Medical School, Istanbul, Turkey
| | - Bedrettin Yildizeli
- Marmara University Medical School Department of Thoracic Surgery Istanbul Turkey Department of Thoracic Surgery, Marmara University Medical School, Istanbul, Turkey
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21
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Bostanci K, Ozyurtkan MO, Polat MO, Batirel H, Lacin T, Yuksel M, Stamenovic D. Variations in pulmonary fissural anatomy: a medicolegal autopsy study of 256 cases. ANZ J Surg 2019; 90:608-611. [DOI: 10.1111/ans.15553] [Citation(s) in RCA: 3] [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] [Received: 09/17/2018] [Revised: 09/27/2019] [Accepted: 10/02/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Korkut Bostanci
- Department of Thoracic SurgeryMarmara University Faculty of Medicine Istanbul Turkey
| | | | - Mehmet Oguz Polat
- Department of Forensic MedicineAcibadem Mehmet Ali Aydinlar University Faculty of Medicine Istanbul Turkey
| | - Hasan Batirel
- Department of Thoracic SurgeryMarmara University Faculty of Medicine Istanbul Turkey
| | - Tunc Lacin
- Department of Thoracic SurgeryMarmara University Faculty of Medicine Istanbul Turkey
| | - Mustafa Yuksel
- Department of Thoracic SurgeryMarmara University Faculty of Medicine Istanbul Turkey
| | - Davor Stamenovic
- Department of Thoracic SurgerySt Vincentius Kliniken Karlsruhe Germany
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22
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Atilgan A, Yuksel M, Ciprut A. Cochlear Implantation in a Case of Auditory Neuropathy Spectrum Disorder with CAPOS Syndrome. Medeni Med J 2019; 34:318-323. [PMID: 32821455 PMCID: PMC7433731 DOI: 10.5222/mmj.2019.53503] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 08/14/2019] [Indexed: 11/29/2022] Open
Abstract
Auditory neuropathy spectrum disorder (ANSD) is a hearing disorder which characterized with normal outer hair cell function but disrupted neural synchrony in the afferent auditory pathway. CAPOS (cerebellar ataxia, areflexia, pes cavus, optic atrophy, and sensorineural hearing loss) syndrome can manifest itself with ANSD and this rare situation and audiological rehabilitation outcomes have not well documented in the literature. We aim to present a cochlear implant user subject with CAPOS syndrome and ANSD. A 14-year-old girl diagnosed with ANSD and CAPOS syndrome. She received unilateral cochlear implant (CI). Her hearing sensitivity and speech perception abilities have been improved with CI. Also, she has a good music perception ability measured with the Turkish version of Clinical Assessment of Music Perception Test. After detailed audiological evaluations, CI could be a good option for patients who have ANSD and CAPOS syndrome.
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Affiliation(s)
- Atılım Atilgan
- Marmara University, Department of Audiology, Istanbul, Turkey
| | - Mustafa Yuksel
- Marmara University, Department of Audiology, İstanbul, Turkey
| | - Ayca Ciprut
- Marmara University, Department of Audiology, İstanbul, Turkey
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23
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Baskaya M, Yuksel M, Erturkmen GBL, Cunningham M, Cunningham P. Health4Afrika - Implementing HL7 FHIR Based Interoperability. Stud Health Technol Inform 2019; 264:20-24. [PMID: 31437877 DOI: 10.3233/shti190175] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Supported by the European Commission under Horizon 2020, mHealth4Afrika is co-designing and validating a modular, multilingual, state-of-the-art health information system addressing primary healthcare requirements in resource constrained environments. mHealth4Afrika has co-designed a comprehensive range of functionality and medical programs in partnership with Ministries of Health, district health officers, clinic managers and primary healthcare workers from urban, rural and deep rural health facilities in Ethiopia, Kenya, Malawi and South Africa. This paper provides insights into how mHealth4Afrika is leveraging HL7 FHIR to support standards-based data exchange and interoperability between Electronic Medical Records and DHIS2. This work is currently being validated in the field.
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Affiliation(s)
- Mert Baskaya
- SRDC Software Research Development & Consultancy Corp, Ankara, Turkey
| | - Mustafa Yuksel
- SRDC Software Research Development & Consultancy Corp, Ankara, Turkey
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24
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Halefoglu YZ, Oglakci M, Yuksel M, Canimoglu A, Topaksu M, Can N. Structural and spectroscopic properties of LaAlBO 3 doped with Eu 3+ ions. Appl Radiat Isot 2019; 154:108876. [PMID: 31470191 DOI: 10.1016/j.apradiso.2019.108876] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 06/19/2019] [Revised: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 11/19/2022]
Abstract
In this study, we performed X-ray diffraction (XRD) and environmental scanning electron microscope (ESEM) techniques to examine the structure and morphological observation of the samples and thermoluminescence (TL) experiments to extract the trapping parameters and dosimetric properties of LaAlBO3 phosphors doped with Eu at various doping concentrations. Diffraction patterns of obtained sample were well consistent JCPDS card No 98-009-7945, indicating the formation of pure phase. The TL kinetic parameters were estimated by CGCD software. TL glow curves of LaAlBO3:Eu3+ consist of 12 trap levels and exhibited dominantly first order kinetics. Photoluminescence (PL) emission was observed in the range 400-800 nm for LaAlBO3 phosphor doped with Eu3+. The dominant emission of Eu3+ corresponding to the electric dipole transition 5D0 → 7F2 is located at 616 nm. The sharp emission properties exhibited demonstrate that the LaAlBO3 is a suitable host for rare-earth ion doped phosphor material. It is observed that for the variable concentration of Eu3+ on PL studies, the PL intensity augments with increase in the dopant concentration and the concentration quenching was found after 1 mass% of Eu3+. The PL experimental results reveal that LaAlBO3:Eu3+ phosphor as an red emitting phosphor may be promising luminescence materials for the optoelectronic applications.
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Affiliation(s)
- Yusuf Ziya Halefoglu
- Cukurova University, Faculty of Arts, Department of Ceramic, 01330, Adana, Turkey
| | - M Oglakci
- Physics Department, Cukurova University, Arts-Sciences Faculty, 01330, Adana, Turkey
| | - M Yuksel
- Physics Department, Cukurova University, Arts-Sciences Faculty, 01330, Adana, Turkey
| | - A Canimoglu
- Omer Halisdemir University, Faculty of Arts and Sciences, Physics Department, Nigde, Turkey
| | - M Topaksu
- Physics Department, Cukurova University, Arts-Sciences Faculty, 01330, Adana, Turkey
| | - N Can
- Department of Physics, Manisa Celal Bayar University, Faculty of Arts and Sciences, Muradiye, Manisa, 45010, Turkey; Physics Department, Jazan University, P.O. Box 114, 45142, Jazan, Saudi Arabia.
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25
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Traore L, Assele-Kama A, Keung SNLC, Karni L, Klein GO, Lilja M, Scandurra I, Verdoy D, Yuksel M, Arvanitis TN, Tsopra R, Jaulent MC. User-Centered Design of the C3-Cloud Platform for Elderly with Multiple Diseases - Functional Requirements and Application Testing. Stud Health Technol Inform 2019; 264:843-847. [PMID: 31438043 DOI: 10.3233/shti190342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The number of patients with multimorbidity has been steadily increasing in the modern aging societies. The European C3-Cloud project provides a multidisciplinary and patient-centered "Collaborative Care and Cure-system" for the management of elderly with multimorbidity, enabling continuous coordination of care activities between multidisciplinary care teams (MDTs), patients and informal caregivers (ICG). In this study various components of the infrastructure were tested to fulfill the functional requirements and the entire system was subjected to an early application testing involving different groups of end-users. MDTs from participating European regions were involved in requirement elicitation and test formulation, resulting in 57 questions, distributed via an internet platform to 48 test participants (22 MDTs, 26 patients) from three pilot sites. The results indicate a high level of satisfaction with all components. Early testing also provided feedback for technical improvement of the entire system, and the paper points out useful evaluation methods.
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Affiliation(s)
- Lamine Traore
- Inserm, Sorbonne Université, Univ Paris 13, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, F-75011 Paris, France
| | - Ariane Assele-Kama
- Inserm, Sorbonne Université, Univ Paris 13, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, F-75011 Paris, France
| | | | - Liran Karni
- Örebro University School of Business, Informatics, Örebro, Sweden
| | - Gunnar O Klein
- Örebro University School of Business, Informatics, Örebro, Sweden
| | - Mikael Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education, and Development Östersund Hospital, Umeå University, Umeå, Sweden
| | | | - Dolores Verdoy
- Asociacion Centro De Excelencia Internacional En Investigacion Sobre Cronicidad - Kronikgune, Spain
| | - Mustafa Yuksel
- SRDC Software Research Development & Consultancy Corp, Ankara, Turkey
| | | | - Rosy Tsopra
- Inserm, Sorbonne Université, Univ Paris 13, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, F-75011 Paris, France.,AP-HP, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Marie-Christine Jaulent
- Inserm, Sorbonne Université, Univ Paris 13, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, F-75011 Paris, France
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26
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Despotou G, Yuksel M, Sarigul B, Arvanitis TN. Drug Interaction Advisory Service for Clinical Decision Support of Multimordity Patient Centric Care Plans in the C3-Cloud System. Stud Health Technol Inform 2019; 262:388-391. [PMID: 31349249 DOI: 10.3233/shti190100] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
C3-Cloud is a project aiming to provide an ICT infrastructure, which will allow patient centric and integrated care, based on best practice guideline, for patients with multi-morbidity. Clinical Decision Support, by checking the patient's record for known adverse interactions when the medication changes. The drug interaction advisory service provides recommendations in the three languages used in the project's pilot sites, for over 1000 substances, based on the UK's NICE BNF body of knowledge.
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Affiliation(s)
- George Despotou
- Institute of Digital Healthcare, WMG, University of Warwick, UK
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27
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Laleci Erturkmen GB, Yuksel M, Sarigul B, Arvanitis TN, Lindman P, Chen R, Zhao L, Sadou E, Bouaud J, Traore L, Teoman A, Lim Choi Keung SN, Despotou G, de Manuel E, Verdoy D, de Blas A, Gonzalez N, Lilja M, von Tottleben M, Beach M, Marguerie C, Klein GO, Kalra D. A Collaborative Platform for Management of Chronic Diseases via Guideline-Driven Individualized Care Plans. Comput Struct Biotechnol J 2019; 17:869-885. [PMID: 31333814 PMCID: PMC6614507 DOI: 10.1016/j.csbj.2019.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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] [Received: 12/20/2018] [Revised: 03/18/2019] [Accepted: 06/04/2019] [Indexed: 11/19/2022] Open
Abstract
Older age is associated with an increased accumulation of multiple chronic conditions. The clinical management of patients suffering from multiple chronic conditions is very complex, disconnected and time-consuming with the traditional care settings. Integrated care is a means to address the growing demand for improved patient experience and health outcomes of multimorbid and long-term care patients. Care planning is a prevalent approach of integrated care, where the aim is to deliver more personalized and targeted care creating shared care plans by clearly articulating the role of each provider and patient in the care process. In this paper, we present a method and corresponding implementation of a semi-automatic care plan management tool, integrated with clinical decision support services which can seamlessly access and assess the electronic health records (EHRs) of the patient in comparison with evidence based clinical guidelines to suggest personalized recommendations for goals and interventions to be added to the individualized care plans. We also report the results of usability studies carried out in four pilot sites by patients and clinicians.
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Affiliation(s)
| | - Mustafa Yuksel
- SRDC Software Research Development and Consultancy Corp, Ankara, Turkey
| | - Bunyamin Sarigul
- SRDC Software Research Development and Consultancy Corp, Ankara, Turkey
| | | | | | - Rong Chen
- Cambio Healthcare Systems, Sweden
- Health Informatics Center, Karolinska Institutet, Sweden
| | - Lei Zhao
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | - Eric Sadou
- Inserm, Sorbonne Université, Univ Paris 13, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, F-75011 Paris, France
| | - Jacques Bouaud
- AP-HP, Delegation for Clinical Research and Innovation, Paris, France
- Inserm, Sorbonne Université, Univ Paris 13, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, F-75011 Paris, France
| | - Lamine Traore
- Inserm, Sorbonne Université, Univ Paris 13, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, F-75011 Paris, France
| | - Alper Teoman
- SRDC Software Research Development and Consultancy Corp, Ankara, Turkey
| | | | - George Despotou
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | | | | | | | | | - Mikael Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education, and Development, Östersund Hospital, Umeå University, Umeå, Sweden
| | - Malte von Tottleben
- empirica Gesellschaft fÜr Kommunikations- und Technologieforschung mbH, Bonn, Germany
| | | | | | - Gunnar O. Klein
- Örebro University School of Business, Informatics, Örebro, Sweden
| | - Dipak Kalra
- European Institute for Innovation through Health Data, Belgium
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28
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Baskaya M, Yuksel M, Laleci Erturkmen GB, Cunningham M, Cunningham P. mHealth4Afrika: Supporting Standards Based Integration of Medical Sensor Data. Stud Health Technol Inform 2019; 258:259-260. [PMID: 30942766] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
mHealth4Afrika has introduced the use of CE approved medical sensors at the point of care in primary healthcare facilities in Africa as part of an integrated platform supporting primary health care services. This paper shares insights into the standards-based architecture and HL7 FHIR service developed to support data transfer from sensors with proprietary standards to populate the mHealth4Afrika electronic patient record via custom Android and Windows applications. The current iteration is being validated in healthcare facilities in Ethiopia, Kenya, Malawi and South Africa.
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Affiliation(s)
- Mert Baskaya
- SRDC Software Research Development & Consultancy Corp, Turkey
| | - Mustafa Yuksel
- SRDC Software Research Development & Consultancy Corp, Turkey
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29
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Batirel HF, Metintas M, Caglar HB, Ak G, Yumuk PF, Ahiskali R, Bozkurtlar E, Bekiroglu N, Lacin T, Yildizeli B, Yuksel M. Macroscopic complete resection is not associated with improved survival in patients with malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2018; 155:2724-2733. [DOI: 10.1016/j.jtcvs.2017.12.131] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 11/15/2017] [Accepted: 12/23/2017] [Indexed: 01/10/2023]
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30
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Ocakcıoglu I, Ermerak NO, Yuksel M. Total Rib Resection Via Uniportal Thoracoscopic Approach. Ann Thorac Surg 2018; 106:e185-e187. [PMID: 29733823 DOI: 10.1016/j.athoracsur.2018.03.082] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 03/26/2018] [Accepted: 03/30/2018] [Indexed: 10/17/2022]
Abstract
In this report, we present a case specifying the availability of uniportal thoracoscopic resection of a total rib safely without the need for conventional thoracotomy. The favorable outcome of this case suggests that the uniportal thoracoscopic technique described here is a safe and successful approach for resection of costal lesions with good cosmetic results. To our knowledge, this is the first case reporting the entire rib resection via uniportal thoracoscopic approach.
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Affiliation(s)
- Ilhan Ocakcıoglu
- Department of Thoracic Surgery, Marmara University Istanbul Pendik Training and Research Hospital, Istanbul, Turkey.
| | - Nezih Onur Ermerak
- Department of Thoracic Surgery, Marmara University Istanbul Pendik Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Yuksel
- Department of Thoracic Surgery, Marmara University Istanbul Pendik Training and Research Hospital, Istanbul, Turkey
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31
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Pacaci A, Gonul S, Sinaci AA, Yuksel M, Laleci Erturkmen GB. A Semantic Transformation Methodology for the Secondary Use of Observational Healthcare Data in Postmarketing Safety Studies. Front Pharmacol 2018; 9:435. [PMID: 29760661 PMCID: PMC5937227 DOI: 10.3389/fphar.2018.00435] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Received: 12/14/2017] [Accepted: 04/12/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Utilization of the available observational healthcare datasets is key to complement and strengthen the postmarketing safety studies. Use of common data models (CDM) is the predominant approach in order to enable large scale systematic analyses on disparate data models and vocabularies. Current CDM transformation practices depend on proprietarily developed Extract-Transform-Load (ETL) procedures, which require knowledge both on the semantics and technical characteristics of the source datasets and target CDM. Purpose: In this study, our aim is to develop a modular but coordinated transformation approach in order to separate semantic and technical steps of transformation processes, which do not have a strict separation in traditional ETL approaches. Such an approach would discretize the operations to extract data from source electronic health record systems, alignment of the source, and target models on the semantic level and the operations to populate target common data repositories. Approach: In order to separate the activities that are required to transform heterogeneous data sources to a target CDM, we introduce a semantic transformation approach composed of three steps: (1) transformation of source datasets to Resource Description Framework (RDF) format, (2) application of semantic conversion rules to get the data as instances of ontological model of the target CDM, and (3) population of repositories, which comply with the specifications of the CDM, by processing the RDF instances from step 2. The proposed approach has been implemented on real healthcare settings where Observational Medical Outcomes Partnership (OMOP) CDM has been chosen as the common data model and a comprehensive comparative analysis between the native and transformed data has been conducted. Results: Health records of ~1 million patients have been successfully transformed to an OMOP CDM based database from the source database. Descriptive statistics obtained from the source and target databases present analogous and consistent results. Discussion and Conclusion: Our method goes beyond the traditional ETL approaches by being more declarative and rigorous. Declarative because the use of RDF based mapping rules makes each mapping more transparent and understandable to humans while retaining logic-based computability. Rigorous because the mappings would be based on computer readable semantics which are amenable to validation through logic-based inference methods.
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Affiliation(s)
- Anil Pacaci
- Software Research & Development and Consultancy Corp., Ankara, Turkey.,David R. Cheriton School of Computer Science, University of Waterloo, Waterloo, ON, Canada
| | - Suat Gonul
- Software Research & Development and Consultancy Corp., Ankara, Turkey.,Department of Computer Engineering, Middle East Technical University, Ankara, Turkey
| | - A Anil Sinaci
- Software Research & Development and Consultancy Corp., Ankara, Turkey
| | - Mustafa Yuksel
- Software Research & Development and Consultancy Corp., Ankara, Turkey
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32
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Yuksel M, Lacin T, Ermerak NO, Sirzai EY, Sayan B. Minimally Invasive Repair of Pectus Carinatum. Ann Thorac Surg 2018; 105:915-923. [DOI: 10.1016/j.athoracsur.2017.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/12/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
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33
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Laleci Erturkmen GB, Yuksel M, Sarigul B, Lilja M, Chen R, Arvanitis TN. Personalised Care Plan Management Utilizing Guideline-Driven Clinical Decision Support Systems. Stud Health Technol Inform 2018; 247:750-754. [PMID: 29678061] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Older age is associated with an increased accumulation of multiple chronic conditions. The clinical management of patients suffering from multiple chronic conditions is very complex, disconnected and time-consuming with the traditional care settings. Integrated care is a means to address the growing demand for improved patient experience and health outcomes of multimorbid and long-term care patients. Care planning is a prevalent approach of integrated care, where the aim is to deliver more personalized and targeted care creating shared care plans by clearly articulating the role of each provider and patient in the care process. In this paper, we present a method and corresponding implementation of a semi-automatic care plan management tool, integrated with clinical decision support services which can seamlessly access and assess the electronic health records (EHRs) of the patient in comparison with evidence based clinical guidelines to suggest personalized recommendations for goals and interventions to be added to the individualized care plans.
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Affiliation(s)
| | - Mustafa Yuksel
- SRDC Software Research Development & Consultancy Corp, Ankara, Turkey
| | - Bunyamin Sarigul
- SRDC Software Research Development & Consultancy Corp, Ankara, Turkey
| | | | - Rong Chen
- Health Informatics Center, Karolinska Institutet, Sweden
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34
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Yuksel M, Unay-Demirel Ö, Pelin Z. Nucleated red blood cell count in obstructive sleep apnea patients. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.1060] [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: 11/26/2022]
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35
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Kolgazi M, Ozdemir-Kumral ZN, Cantali-Ozturk C, Demirci EK, Yuksel M, Sirvanci S, Yegen BC. Anti-inflammatory effects of nesfatin-1 on acetic acid-induced gastric ulcer in rats: involvement of cyclo-oxygenase pathway. J Physiol Pharmacol 2017; 68:765-777. [PMID: 29375052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 10/25/2017] [Indexed: 06/07/2023]
Abstract
In order to elucidate the contribution of cycloxygenase (COX) enzymes in the anti-oxidant and anti-inflammatory mechanisms of nesfatin-1, which improves the healing process of chronic gastric ulcers, either acetic acid (80%; ulcer groups; n = 40) or saline (control groups; n = 40) was applied to the serosal surface of male Sprague Dawley rats' stomachs for 1 min. Both the control and ulcer groups were treated daily with either i.p. saline or nesfatin-1 (0.3 μg/kg; for 3 days). Nesfatin-1-treatment was preceded with i.p. saline, COX-2 inhibitor NS-398 (2 mg/kg), COX-1 inhibitor ketorolac (3 mg/kg) or non-selective COX inhibitor indomethacin (5 mg/kg) for 3 days. The rats were decapitated at the end of the third day, and their trunk blood was collected for the measurements of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and IL-10 using ELISA. The induction of ulcers resulted in increased macroscopic scores, along with elevated gastric malondialdehyde, luminol- and lucigenin-enhanced chemiluminescence levels and myeloperoxidase activity. On the other hand, nesfatin-1 treatment abolished these elevations. Depleted glutathione, superoxide dismutase and catalase activity levels in the saline-treated ulcer group were preserved in the nesfatin-1-treated ulcer group. Increased levels of serum TNF-α, IL-1β, IL-10 in the saline-treated ulcer group, as compared to control group, were significantly decreased in the nesfatin-1-treated ulcer group. The inhibition of COX-1, and/or COX-2 reversed most of the alterations induced with nesfatin-1, but COX-2-blockade was consistently more effective to abolish all nesfatin-1-induced changes. Our results suggest that nesfatin-1 ameliorates ulcer-induced inflammatory response through the modulation of oxidant-antioxidant balance. As selective pharmacological inhibition of COX-1 or COX-2 suppresses the antioxidant/anti-inflammatory effects of nesfatin-1, it appears that nesfatin-1 decreases inflammatory mediators and neutrophil migration by a COX-dependent mechanism, especially by a COX-2- dependent mechanism, during the ulcer healing stage.
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Affiliation(s)
- M Kolgazi
- Department of Physiology, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Z N Ozdemir-Kumral
- Department of Physiology, Marmara University, School of Medicine, Istanbul, Turkey.
| | - C Cantali-Ozturk
- Department of Physiology, Marmara University, School of Medicine, Istanbul, Turkey.
| | - E K Demirci
- Department of Histology and Embryology, Marmara University, School of Medicine, Istanbul, Turkey
| | - M Yuksel
- Department of Medical Laboratory, Marmara University, Vocational School of Health-Related Professions, Istanbul, Turkey
| | - S Sirvanci
- Department of Histology and Embryology, Marmara University, School of Medicine, Istanbul, Turkey
| | - B C Yegen
- Department of Physiology, Marmara University, School of Medicine, Istanbul, Turkey.
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36
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Ates I, Arikan MF, Erdogan K, Kaplan M, Yuksel M, Topcuoglu C, Yilmaz N, Guler S. Factors associated with increased irisin levels in the type 1 diabetes mellitus. Endocr Regul 2017; 51:1-7. [PMID: 28222023 DOI: 10.1515/enr-2017-0001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The aim of the present study was to determine the irisin levels in patients with the type 1 diabetes mellitus (T1DM) and to examine the relation of irisin levels with the inflammation and autoimmunity. METHODS This study included 35 cases diagnosed with T1DM and 36 healthy volunteers. Antiglutamic acid decarboxylase (anti-GAD), islet cell antibody (ICA), and insulin autoantibody levels were measured in patients at the time when they were included into the study and recorded from the patient files. Serum irisin levels were measured by ELISA kit. RESULTS The median irisin levels were determined higher in T1DM group compared to the control one (6.8 ng/ml vs. 4.8 ng/ml, p=0.022; respectively). Median irisin levels were higher in anti-GAD (p=0.022) and ICA (p=0.044) positive groups compared to negative groups. In T1DM group, irisin levels displayed positive correlation with glycosylated hemoglobin (HbA1c) (r=0.377, p<0.001) and anti-GAD (r=0.392, p=0.020) and negative correlation with creatinine (r=-0390, p=0.021). In multivariate regression model, HbA1c (B±SE: 2.76±17683, p<0.001), and anti-GAD (B±SE: 2.311±0.610, p=0.001) were determined as independent predictors for predicting the irisin levels. CONCLUSION In patients with T1DM, which chronic inflammation and autoimmunity take part in their etiopathogenesis, anti-GAD levels were an independent risk factor for the irisin. Th is may suggest that factors such as inflammation and autoimmunity can be effective in the synthesis of irisin.
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Yuksel M, Karamık K, Anıl H, Islamoglu E, Ates M, Savas M. Factors affecting surgical margin positivity in robotic assisted radical prostatectomy. ACTA ACUST UNITED AC 2017; 89:71-74. [PMID: 28403595 DOI: 10.4081/aiua.2017.1.71] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/11/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES After radical prostatectomy, surgical margin positivity is an important indicator of biochemical recurrence and progression. In our study we want to compare the surgical margin positivity rates for retropubic radical prostatectomy (RRP) and robotic assisted radical prostatectomy (RALP) and investigate the factors affecting surgical margin positivity in RALP. MATERIALS AND METHODS Data from 78 RRP and 62 RALP patients operated from 2011 May to 2016 March were retrospectively screened. Patients in both groups were compared in terms of age, postop hematocrit reduction, hospital stay, duration of follow-up, surgical margin positivity, biochemical recurrence and oncologic parameters. In RALP group it was searched the relationship between the surgical margin positivity and prostate specific antigen (PSA), positive biopsy core, biopsy Gleason scoring, pathologic stage and Gleason scoring, lymph node positivity, lymphovascular and perineural invasion, extracapsular extension, seminal vesicle invasion, prostate weight. RESULTS Patients in the RALP group had lower postop hematocrit reduction and shorter hospital stay (p < 0.001). There was no difference in surgical margin positivity between RALP and RRP groups (37.1% vs. 29.5%, p = 0.341). In RALP group there was a correlation between surgical margin positivity and positive biopsy core number (p = 0.011), pathologic stage (p < 0.001) and Gleason score (p < 0.001), EAU risk classification (p = 0.001), seminal vesicle invasion (p = 0.045), extraprostatic extension (p < 0.001). There was no correlation between prostate weight (p = 0.896), PSA (p = 0.220), biopsy Gleason score (p = 0.266), lymph node positivity (p = 0.140), perineural (p = 0.103) and lymphovascular invasion (p = 0.92) with surgical margin positivity. CONCLUSIONS Positive biopsy core number, pathological stage and Gleason score, EAU risk classification, seminal vesicle invasion and extraprostatic extension are correlated with surgical margin positivity in RALP.
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Yalcinkaya S, Ates N, Yuksel M, Islamoglu E, Tokgoz H, Ates EU, Yildız A, Yilmaz S, Savas M. The evaluation of renal parenchymal scarring using static renal scintigraphy after percutaneous nephrolithotomy operations. Niger J Clin Pract 2017; 20:376-381. [PMID: 28256495 DOI: 10.4103/1119-3077.187318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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]
Abstract
OBJECTIVE To analyze whether operative techniques and other variables related to patient and renal stone characteristics affect potential renal parenchymal damage. MATERIALS AND METHODS The study population comprised 64 patients who underwent percutaneous nephrolithotomy operations (PCNL). Data of the operated renal units, renal stone burden, route and number of entries, dilation techniques, duration of surgery, preoperative and postoperative glomerular filtration rate (GFR) and relative dimercaptosuccinic acid (DMSA) uptakes, as well as the changes in hemoglobin values, were recorded and analyzed for all patients. RESULTS The mean age of the patients was 44 years. In 11 (17.1%) cases, renal cortical defects in the 3rd month were detected on DMSA scintigraphy. When the patients with and without renal cortical defect were compared regarding their preoperative and postoperative GFR values, no statistically significant difference was noticed between the groups (P > 0.05). Similarly, when postoperative relative DMSA uptakes were compared with preoperative relative DMSA uptakes of the same kidneys, no statistical significance was seen. When preoperative relative DMSA uptake values between groups with and without renal scarring were compared, no statistically significant difference was observed (P > 0.05). CONCLUSION We did not observe any significant difference in scintigraphic parameters and GFR values. Hence, in the current trial, significant loss in renal function after PCNL operations was not observed. Thus, PCNL operations should be regarded as safe, but still, the risk of loss of kidney function should always be considered.
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Affiliation(s)
- S Yalcinkaya
- Department of Urology, Antalya Training and Research Hospital, Antalya, Turkey
| | - N Ates
- Department of Urology, Antalya Training and Research Hospital, Antalya, Turkey
| | - M Yuksel
- Department of Urology, Antalya Training and Research Hospital, Antalya, Turkey
| | - E Islamoglu
- Department of Urology, Antalya Training and Research Hospital, Antalya, Turkey
| | - H Tokgoz
- Department of Urology, Antalya Training and Research Hospital, Antalya, Turkey
| | - E U Ates
- Department of Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - A Yildız
- Department of Urology, Antalya Training and Research Hospital, Antalya, Turkey
| | - S Yilmaz
- Department of Urology, Antalya Training and Research Hospital, Antalya, Turkey
| | - M Savas
- Department of Urology, Antalya Training and Research Hospital, Antalya, Turkey
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Abstract
Introduction Obesity is an important modifiable etiological factor associated with several diseases. There is strong evidence that urinary incontinence (UI) is positively correlated with body mass index (BMI). Aim One of the many benefits experienced by obese patients after bariatric surgery is decrease in UI. To investigate this correlation, we aimed to examine the effects of weight loss on UI in female patients who had undergone laparoscopic sleeve gastrectomy (LSG). Materials and methods Obese female patients (n=120), ≥18 years of age, and planning to undergo LSG were included in this prospective study. We administered the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) and Incontinence Impact Questionnaire (IIQ-7) to the patients prior to surgery and 6 months after the surgery. Using the collected data, we determined the incidence of UI and examined the relationship between the preoperative and postoperative BMI and UI values. Results The mean age of the patients was 39.19 (standard deviation [SD] =9.94) years and the mean preoperative BMI was 46.17 (SD =5.35). Of the 120 patients, 72 (60%) complained of UI preoperatively. Among these 72 patients, 23 (31.95%) described urge incontinence, 18 (25%) stress incontinence, and 31 (43.05%) mixed-type incontinence. At 6 months postoperatively, the percentage of excess weight loss was 70.33% (SD =14.84%). For all three UI subtypes, the 6-month postoperative ICIQ-UI-SF and IIQ-7 scores decreased significantly compared to the preoperative scores (P<0.05). Conclusion LSG results in a clinically significant improvement in most common types of UI, regardless of patient reproductive history, existence of comorbid conditions, and smoking status.
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Affiliation(s)
- Nurullah Bulbuller
- General Surgery Department, Antalya Training and Research Hospital, Antalya
| | - Mani Habibi
- General Surgery Department, Antalya Training and Research Hospital, Antalya; General Surgery Department, Esenler Maternity and Child Health Hospital, Istanbul
| | - Mustafa Yuksel
- Urology Department, Antalya Training and Research Hospital, Antalya, Turkey
| | - Onur Ozener
- General Surgery Department, Antalya Training and Research Hospital, Antalya
| | - Mehmet Tahir Oruc
- General Surgery Department, Antalya Training and Research Hospital, Antalya
| | - Osman Zekai Oner
- General Surgery Department, Antalya Training and Research Hospital, Antalya
| | - Mehmet Altug Kazak
- General Surgery Department, Antalya Training and Research Hospital, Antalya
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Gumus NM, Gumus M, Unsal S, Yuksel M, Gunduz M. Examination of Insert Ear Interaural Attenuation (IA)Values in Audiological Evaluations. CLIN INVEST MED 2016. [DOI: 10.25011/cim.v39i6.27507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Purpose: The purpose of this study was to evaluate Interaural Attenuation (IA) in frequency base in the insert earphones that are used in audiological assessments.
Methods: Thirty healthy subjects between 18-65 years of age (14 female and 16 male) participated in our study. Otoscopic examination was performed on all participants. Audiological evaluations were performed using the Interacoustics AC40 clinical audiometer and ER-3A insert earphones. IA value was calculated by subtracting good ear bone conduction hearing thresholds of the worst airway hearing threshold.
Results: In our measuring for 0.125-8.0 kHz frequency were performed in our audiometry device separately for each frequency. IA amount in the results we found in 1000 Hz and below frequencies about 75-110 dB range avarage is 89±5dB, in above 1000 Hz frequencies in 50-95 dB range and avarage it is changed to 69±5dB.
Conclusion: According to the obtained findings the quantity of melting in the transition between the ears are increasing with the insert earphones. The insert earphone should be beside supraaural earphone that is routinely used in clinics. Difficult masking applications due to the increase in the value of IA can be easily done with insert earphones.
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Gumus NM, Gumus M, Unsal S, Yuksel M, Gunduz M. Examination of Insert Ear Interaural Attenuation (IA)Values in Audiological Evaluations. CLIN INVEST MED 2016; 39:27507. [PMID: 27917798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE The purpose of this study was to evaluate Interaural Attenuation (IA) in frequency base in the insert earphones that are used in audiological assessments. METHODS Thirty healthy subjects between 18-65 years of age (14 female and 16 male) participated in our study. Otoscopic examination was performed on all participants. Audiological evaluations were performed using the Interacoustics AC40 clinical audiometer and ER-3A insert earphones. IA value was calculated by subtracting good ear bone conduction hearing thresholds of the worst airway hearing threshold. RESULTS In our measuring for 0.125-8.0 kHz frequency were performed in our audiometry device separately for each frequency. IA amount in the results we found in 1000 Hz and below frequencies about 75-110 dB range avarage is 89±5dB, in above 1000 Hz frequencies in 50-95 dB range and avarage it is changed to 69±5dB. CONCLUSION According to the obtained findings the quantity of melting in the transition between the ears are increasing with the insert earphones. The insert earphone should be beside supraaural earphone that is routinely used in clinics. Difficult masking applications due to the increase in the value of IA can be easily done with insert earphones.
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Yuksel M, Xiao X, Tai N, Vijay M, Gülden E, Beland K, Lapierre P, Alvarez F, Hu Z, Colle I, Ma Y, Wen L. The induction of autoimmune hepatitis in the human leucocyte antigen-DR4 non-obese diabetic mice autoimmune hepatitis mouse model. Clin Exp Immunol 2016; 186:164-176. [PMID: 27414259 DOI: 10.1111/cei.12843] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 12/17/2022] Open
Abstract
Autoimmune hepatitis (AIH) is a chronic liver disease characterized by progressive inflammation, female preponderance and seropositivity for autoantibodies such as anti-smooth muscle actin and/or anti-nuclear, anti-liver kidney microsomal type 1 (anti-LKM1) and anti-liver cytosol type 1 (anti-LC1) in more than 80% of cases. AIH is linked strongly to several major histocompatibility complex (MHC) alleles, including human leucocyte antigen (HLA)-DR3, -DR7 and -DR13. HLA-DR4 has the second strongest association with adult AIH, after HLA-DR3. We investigated the role of HLA-DR4 in the development of AIH by immunization of HLA-DR4 (DR4) transgenic non-obese diabetic (NOD) mice with DNA coding for human CYP2D6/FTCD fusion autoantigen. Immunization of DR4 mice leads to sustained mild liver injury, as assessed biochemically by elevated alanine aminotransferase, histologically by interface hepatitis, plasma cell infiltration and mild fibrosis and immunologically by the development of anti-LKM1/anti-LC1 antibodies. In addition, livers from DR4 mice had fewer regulatory T cells (Tregs ), which had decreased programmed death (PD)-1 expression. Splenic Tregs from these mice also showed impaired inhibitory capacity. Furthermore, DR4 expression enhanced the activation status of CD8+ T cells, macrophages and dendritic cells in naive DR4 mice compared to naive wild-type (WT) NOD mice. Our results demonstrate that HLA-DR4 is a susceptibility factor for the development of AIH. Impaired suppressive function of Tregs and reduced PD-1 expression may result in spontaneous activation of key immune cell subsets, such as antigen-presenting cells and CD8+ T effectors, facilitating the induction of AIH and persistent liver damage.
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Affiliation(s)
- M Yuksel
- Section of Endocrinology, Yale University School of Medicine, New Haven, USA.,Department of Hepatology and Gastroenterology, Ghent University Hospital, Belgium.,Institute of Liver Studies and Transplantation, King's College London Faculty of Life Sciences and Medicine, King's College Hospital, London, UK
| | - X Xiao
- Section of Endocrinology, Yale University School of Medicine, New Haven, USA.,Department of Nephrology, Qilu Hospital, Shandong University, China
| | - N Tai
- Section of Endocrinology, Yale University School of Medicine, New Haven, USA
| | - Manakkat Vijay
- Section of Endocrinology, Yale University School of Medicine, New Haven, USA.,Institute of Liver Studies and Transplantation, King's College London Faculty of Life Sciences and Medicine, King's College Hospital, London, UK
| | - E Gülden
- Section of Endocrinology, Yale University School of Medicine, New Haven, USA
| | - K Beland
- Division of Gastroenterology, Hepatology and Nutrition, Sainte-Justine University Hospital, Montreal, Canada
| | - P Lapierre
- Immunovirology Laboratory, Institut National De La Recherche Scientifique, INRS-Institut Armand-Frappier, Laval, Québec, Canada
| | - F Alvarez
- Division of Gastroenterology, Hepatology and Nutrition, Sainte-Justine University Hospital, Montreal, Canada
| | - Z Hu
- Department of Nephrology, Qilu Hospital, Shandong University, China
| | - I Colle
- Department of Hepatology and Gastroenterology, Ghent University Hospital, Belgium
| | - Y Ma
- Institute of Liver Studies and Transplantation, King's College London Faculty of Life Sciences and Medicine, King's College Hospital, London, UK
| | - L Wen
- Section of Endocrinology, Yale University School of Medicine, New Haven, USA.
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Abstract
Fascioliasis is a zoonotic disease that is acquired by ingestion of the metacercaria form on uncooked aquatic plants, and humans act as an accidental host. Diagnosis is confirmed by the demonstration of the parasites or evidence of them in faeces and serology. In the absence of these data, delays or misdiagnosis may occur since it may mimic many diseases. In this study, we present three cases, among them two were similar to the above-mentioned statement. The first case, to the best of our knowledge, is the first case with adult-type living fluke in the gall bladder, diagnosed by laparoscopic cholecystectomy.
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Affiliation(s)
- E Bulbuloglu
- Department of General Surgery, Faculty of Medicine, School of Medicine, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey.
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Yuksel M, Gonul S, Laleci Erturkmen GB, Sinaci AA, Invernizzi P, Facchinetti S, Migliavacca A, Bergvall T, Depraetere K, De Roo J. An Interoperability Platform Enabling Reuse of Electronic Health Records for Signal Verification Studies. Biomed Res Int 2016; 2016:6741418. [PMID: 27123451 PMCID: PMC4830705 DOI: 10.1155/2016/6741418] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 10/04/2015] [Indexed: 01/17/2023]
Abstract
Depending mostly on voluntarily sent spontaneous reports, pharmacovigilance studies are hampered by low quantity and quality of patient data. Our objective is to improve postmarket safety studies by enabling safety analysts to seamlessly access a wide range of EHR sources for collecting deidentified medical data sets of selected patient populations and tracing the reported incidents back to original EHRs. We have developed an ontological framework where EHR sources and target clinical research systems can continue using their own local data models, interfaces, and terminology systems, while structural interoperability and Semantic Interoperability are handled through rule-based reasoning on formal representations of different models and terminology systems maintained in the SALUS Semantic Resource Set. SALUS Common Information Model at the core of this set acts as the common mediator. We demonstrate the capabilities of our framework through one of the SALUS safety analysis tools, namely, the Case Series Characterization Tool, which have been deployed on top of regional EHR Data Warehouse of the Lombardy Region containing about 1 billion records from 16 million patients and validated by several pharmacovigilance researchers with real-life cases. The results confirm significant improvements in signal detection and evaluation compared to traditional methods with the missing background information.
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Affiliation(s)
- Mustafa Yuksel
- SRDC Software Research & Development and Consultancy Ltd., 06800 Ankara, Turkey
| | - Suat Gonul
- SRDC Software Research & Development and Consultancy Ltd., 06800 Ankara, Turkey
- Department of Computer Engineering, Middle East Technical University, 06800 Ankara, Turkey
| | | | - Ali Anil Sinaci
- SRDC Software Research & Development and Consultancy Ltd., 06800 Ankara, Turkey
| | - Paolo Invernizzi
- Lombardia Informatica S.p.A., Via Torquato Taramelli, 26 20124 Milano, Italy
| | - Sara Facchinetti
- Lombardia Informatica S.p.A., Via Torquato Taramelli, 26 20124 Milano, Italy
| | - Andrea Migliavacca
- Lombardia Informatica S.p.A., Via Torquato Taramelli, 26 20124 Milano, Italy
| | - Tomas Bergvall
- WHO Collaborating Centre for International Drug Monitoring, Uppsala Monitoring Centre (UMC), 753 20 Uppsala, Sweden
| | - Kristof Depraetere
- Advanced Clinical Applications Research Group, Agfa HealthCare, 9000 Gent, Belgium
| | - Jos De Roo
- Advanced Clinical Applications Research Group, Agfa HealthCare, 9000 Gent, Belgium
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Abstract
Sternal cleft is a rare chest wall deformity. It can be diagnosed in the intrauterine stage with ultrasonography. Newborn period is the optimal time for the surgical correction of sternal cleft, due to the elasticity of the sternum and minimal compression of underlying structures. Here we reported a newborn patient with sternal cleft which has been operated 5 days after labor. Good surgical outcome and long-term results were accomplished.
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Affiliation(s)
- Mustafa Yuksel
- Department of Thoracic Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Pinar Kuru
- Department of Physiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Nezih Onur Ermerak
- Department of Thoracic Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Gursu Kiyan
- Department of Pediatric Surgery, Marmara University School of Medicine, Istanbul, Turkey
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Kuru P, Cakiroglu A, Er A, Ozbakir H, Cinel AE, Cangut B, Iris M, Canbaz B, Pıçak E, Yuksel M. Pectus Excavatum and Pectus Carinatum: Associated Conditions, Family History, and Postoperative Patient Satisfaction. Korean J Thorac Cardiovasc Surg 2016; 49:29-34. [PMID: 26889443 PMCID: PMC4757394 DOI: 10.5090/kjtcs.2016.49.1.29] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/23/2015] [Accepted: 09/30/2015] [Indexed: 11/23/2022]
Abstract
Background Pectus excavatum (PE) and pectus carinatum (PC) are the most common chest wall deformities. In this study, we aimed to characterize how patients obtained information about these deformities, as well as patients’ family history, associated medical problems, and postoperative satisfaction after the Nuss and Abramson procedures. Methods This cross-sectional retrospective study included patients who were operated by a single surgeon between 2006 and 2013. Follow-up calls were made after approval of our institution’s ethics committee. We reached 207 of the 336 PE patients (61.6%) and 73 of the 96 PC patients (76%). Results The majority of the patients were male (85% of the PE patients and 91.8% of the PC patients). The age of diagnosis of PE was 14.52±0.51 years and the age at the time of operation was 17.89±0.42 years; for PC patients, the corresponding ages were 15.23±0.55 years and 16.77±0.55 years, respectively. A total of 70% of the PE patients and 63.8% of the PC patients obtained information about pectus deformities through the Internet. In 27.1% of the PE patients with an associated anomaly, 57.1% (n=13) had scoliosis, while 41.1% of the PC patients with an associated anomaly had kyphosis (n=5). Postoperative satisfaction, as evaluated on a scale from 0 to 10, was 8.17±0.15 for PE patients and 8.37±0.26 for PC patients. The postoperative pain duration was 51.93±5.18 days for PE patients and 38.5±6.88 days for PC patients. Conclusion In this study, we found that most patients with pectus deformities were male. The Internet was an important resource for patients to learn about their deformities. Family history and associated anomalies were identified as important aspects for consideration in the clinical setting. The patients reported high levels of postoperative satisfaction, and pain management was found to be one of the most important elements of postoperative care.
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Affiliation(s)
- Pinar Kuru
- Department of Physiology, Marmara University School of Medicine
| | | | - Aynur Er
- Marmara University School of Medicine
| | | | | | | | | | | | | | - Mustafa Yuksel
- Department of Thoracic Surgery, Marmara University School of Medicine
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Evman S, Bostanci K, Yuksel M. Infection or Malignancy? Malignant Pulmonary Mass Mimicking Pneumonia. Surg J (N Y) 2016; 2:e11-e13. [PMID: 28824976 PMCID: PMC5553461 DOI: 10.1055/s-0036-1572359] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/04/2016] [Indexed: 11/03/2022] Open
Abstract
A 36-year-old woman, unresponsive to pneumonia antibiotherapy followed by antituberculosis treatment, was referred to our clinic. Thorax computed tomography (CT) and positron emission tomography CT showed cystic mass and mediastinal lymph node with suspicion of malignancy. Fine needle aspiration biopsy and mediastinoscopy showed no malignancy, so the patient underwent an exploratory thoracotomy. A frozen section of wedge-resected mass was reported as adenocarcinoma, leading to right lower lobectomy with mediastinal lymph node dissection. Besides cutting-edge diagnostic techniques, exploratory thoracotomy for cavitary lung lesions can still be necessary, as the last-line choice. The probability of malignancy must always be considered, despite a patient's age or symptoms.
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Affiliation(s)
- Serdar Evman
- Department of Thoracic Surgery, Sureyyapasa Training and Research Hospital, Istanbul, Turkey
| | - Korkut Bostanci
- Department of Thoracic Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Mustafa Yuksel
- Department of Thoracic Surgery, Marmara University School of Medicine, Istanbul, Turkey
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48
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Aydin M, Yuksel M, Yildiz A, Polat N, Bilik MZ, Akil MA, Acet H, Demir M, Inci U, Toprak N. Association between the neutrophil to lymphocyte ratio and prehypertension. ACTA ACUST UNITED AC 2015; 116:475-9. [PMID: 26350086 DOI: 10.4149/bll_2015_090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To explore the neutrophil-lymphocyte ratio (NLR) in patients with prehypertension (PHT). BACKGROUND Inflammation plays an important role in the development of cardiovascular diseases. A pathophysiological link also exists between inflammation and PHT. NLR is a simple marker for the assessment of inflammatory status. There is a lack of data regarding the association between NLR and pre-hypertensive state. METHODS The present cross-sectional study included 33 newly diagnosed PHT patients and 35 normotensive control subjects. Prehypertension was defined as a systolic blood pressure (BP) of 120-139 mm Hg and/or a diastolic BP of 80-89 mm Hg. RESULTS Patients were divided into tertiles based on NLR values: 1.17 (0.9-1.42) in tertile 1; 1.57 (1.43-1.78) in tertile 2; and 2.40 (1.82-4.5) in tertile 3. The frequency of PHT was significantly higher for patients in the upper NLR tertile compared to the middle and lower NLR tertiles (21 (91.3%), 7 (30.4%), and 5 (22.7%), respectively; p<0.001). Systolic BP and diastolic BP were significantly higher among patients in the upper NLR tertile than among those in the other NLR tertiles. CONCLUSION An association exists between PHT and NLR. NLR measurement, as well as monocyte count, may be used to indicate increased risk of prehypertension (Tab. 2, Ref. 48).
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49
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Yuksel M, Yilmaz S, Tokgoz H, Yalcinkaya S, Baş S, Ipekci T, Yildiz A, Ates N, Savas M. Efficacy of silodosin in the treatment of distal ureteral stones 4 to 10 mm in diameter. Int J Clin Exp Med 2015; 8:19086-92. [PMID: 26770537 PMCID: PMC4694437] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 10/06/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE Few studies have investigated the efficacy of silodosin, a recently introduced selective alpha 1-A adrenoceptor antagonist, in medical expulsive therapy (MET) for ureteral calculi. The results of these studies, which all evaluated the efficacy of 8 mg/day, indicate that silodosin is a potential treatment for ureteral calculi. This study investigated the efficacy of 4 mg/day of silodosin for MET of distal ureteral stones 4 to 10 mm in diameter. MATERIAL AND METHOD After 70 patients had been randomized into 2 groups of 35 patients each, both the control and experimental groups (groups 1 and 2, respectively) were advised to take 75 mg/day of diclofenacsodiumas needed for pain relief but only the experimental group to take 4 mg/day of silodosin. After 21 days, the groups were compared regarding the stone expulsion rate and duration, number of renalcolicepisodes, and analgesicdosage. RESULTS The median expulsion rates were 71.4% and 91.4% in groups 1 and 2, respectively, and the difference between them was significant (P=0.031). The median expulsion durations were 12.91±6.14 and 8.03±4.99 days, respectively, and the difference between them was significant (P<0.001). No significant differences were found regarding the median number of renal colic episodes or median analgesic dosage. While no patients in group 1 experienced side effects, 5 patients (14%) in group 2 experienced retrograde ejaculation. CONCLUSION These results indicate that 4 mg/day of silodos in facilitates the expulsion of distal ureteral stones 4 to 10 mm in diameter but does not significantly reduce the number of renal colic episodes or analgesic dosage.
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Affiliation(s)
- Mustafa Yuksel
- Department of Urology, Antalya Training and Research HospitalAntalya, Turkey
| | - Serdar Yilmaz
- Department of Urology, Konya Training and Research HospitalKonya, Turkey
| | - Husnu Tokgoz
- Department of Urology, Antalya Training and Research HospitalAntalya, Turkey
| | - Soner Yalcinkaya
- Department of Urology, Antalya Training and Research HospitalAntalya, Turkey
| | - Serkan Baş
- Department of Urology, Babaeski State HospitalAntalya, Turkey
| | - Tümay Ipekci
- Department of Urology, Baskent University Medical Faculty, Alanya Practice and Research CenterAntalya, Turkey
| | - Ali Yildiz
- Department of Urology, Antalya Training and Research HospitalAntalya, Turkey
| | - Nihat Ates
- Department of Urology, Antalya State HospitalAntalya, Turkey
| | - Murat Savas
- Department of Urology, Antalya Training and Research HospitalAntalya, Turkey
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Batirel HF, Metintas M, Caglar HB, Ak G, Yumuk PF, Yildizeli B, Yuksel M. Adoption of pleurectomy and decortication for malignant mesothelioma leads to similar survival as extrapleural pneumonectomy. J Thorac Cardiovasc Surg 2015; 151:478-84. [PMID: 26611742 DOI: 10.1016/j.jtcvs.2015.09.121] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 09/03/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We changed our surgical approach to malignant pleural mesothelioma (MPM) in August 2011 and adopted pleurectomy and decortication (PD) instead of extrapleural pneumonectomy (EPP). In this study, we analyzed our perioperative and survival results during the 2 periods. METHODS All patients who underwent surgical intervention for MPM during 2003-2014 were included. Data were retrospectively analyzed from a prospective database. Before August 2011, patients underwent evaluation for EPP and adjuvant chemoradiation (group 1). After August 2011, patients were evaluated for PD and adjuvant chemotherapy and/or radiation (group 2). Demographic characteristics, surgical technique, histology, side, completeness of resection, and types of treatments were recorded. Statistics was performed using Student t test, χ(2) tests, uni- and multivariate regression, and Kaplan-Meier survival analysis. RESULTS The same surgical team operated on 130 patients. Median age was 55.7 years (range, 26-80 years) and 76 were men. EPP and extended PD was performed in 72 patients. Ninety-day mortality was 10%. Median survival was 17.8 months with a 5-year survival rate of 14%. Uni- and multivariate analyses showed that epithelioid histology, stage N0, and trimodality treatment were associated with better survival (P = .039, P = .012, and P < .001, respectively). Demographic variables and overall survival (15.6 vs 19.6 months, respectively) were similar between the groups, whereas nonepithelioid histology, use of preoperative chemotherapy, and incomplete resections were more frequent in group 2 (P < .001, P < .001, and P = .006, respectively). Follow-up was shorter in group 2 (22.5 ± 20.6 vs 16.4 ± 10.9 months; P < .001). CONCLUSIONS Adoption of PD as the main surgical approach is not associated with survival disadvantage in the surgical treatment of MPM.
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Affiliation(s)
- Hasan Fevzi Batirel
- Department of Thoracic Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey.
| | - Muzaffer Metintas
- Lung and Pleural Cancers Research and Clinical Center, Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Hale Basak Caglar
- Department of Radiation Oncology, Medipol University, Istanbul, Turkey
| | - Guntulu Ak
- Lung and Pleural Cancers Research and Clinical Center, Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Perran Fulden Yumuk
- Division of Medical Oncology, Department of Internal Medicine, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Bedrettin Yildizeli
- Department of Thoracic Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Mustafa Yuksel
- Department of Thoracic Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey
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