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Öğe Abnormal flotation of separator gel in blood test tubes in the hemodialysis patients(2019) Demir, Meltem; Özdem, Sebahat; Sarıer, MehmetObjectives: Serum-separating tubes (SST) are used in medical clinical chemistry tests requiring blood serum. Blood density is mainly dependent on the total protein concentration. Aim of this study to investigate, whether high protein content due to dehydration during hemodialysis can cause laboratory error with the abnormal flotation in blood tubes. Methods: After examining post hemodialysis (HD) blood samples of three cases with ESRD we investigated the effect of adding bovine albumin to the test tubes to determine whether an increment in protein concentration result in abnormal flotation of separator gel in blood samples obtained from healthy volunteers. Results: Serum total protein levels were markedly increased in blood samples of all 3 cases. In tests using blood samples from healthy volunteers supplemented with bovine albumin to increase the protein load, the test tubes having an albumin concentration greater than 16 g/dl displayed an abnormal flotation of separator gel similar to those we observed in post-HD samples from our cases. Conclusion: Increased protein load, probably caused by Intradialytic hypotension due to dehydration, induces the observed abnormal flotation of separator gel in serum tubes in these cases. Our findings emphasize the importance of visual control of serum tubes to prevent abnormal flotation in blood samples.Öğe Association between selective serotonin and serotonin-noradrenaline reuptake inhibitor therapy and hematuria(2022) Sarıer, Mehmet; Demir, Meltem; Emek, Mestan; Özgen, Ali; Turgut, Hasan; Özdemir, CandanBackground: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) are used as first-line treatment for many psychiatric diseases, especially major depressive disorder. However, an important side effect of these drugs is the risk of bleeding due to platelet dysfunction. The aim of this study was to determine the frequency of hematuria in patients using SSRI/SNRIs and to compare with a control group. Methods: This study included patients who were followed up and treated with SSRI/SNRI in the psychiatric outpatient clinic of the Antalya Medical Park Hospital between 1 January 2021 and 31 March 2021 and a control group comprising patients who presented to the medical check-up outpatient clinic between the same dates. Complete urinalysis was performed for all patients and the results were compared between the groups. Results: Each group included 100 patients with a female/male ratio of 1. The mean age was 41.45 ± 13.47 (16-74) years in the study group and 40.51 ± 13.75 (20-70) years in the control group (p = 0.519). Mean duration of SSRI/SNRI use in the study group was 13.35 ± 1.32 (1-64) months. The prevalence of hematuria was 17% in the SSRI/SNRI group and 6% in the control group (p = 0.015). All cases of hematuria were microscopic hematuria. Conclusion: Hematuria is significantly more common in patients receiving SSRI/SNRI treatment. The use of SSRI/SNRI should also be taken into account when investigating the etiology of hematuria.Öğe Comparative results of transurethral incision with transurethral resection of the prostate in renal transplant recipients with benign prostate hyperplasia(Urol & Nephrol Res Ctr-Unrc, 2018) Sarıer, Mehmet; Duman, Ibrahim; Kılıç, Süleyman Sırrı; Yüksel, Yücel; Demir, Meltem; Aslan, Mesut; Yucetin, L.; Tekin, S.; Yavuz, A.H.; Emek, M.Purpose: The aim of this study is to compare the results of transurethral incision of the prostate (TUIP) and transurethral resection of the prostate (TURP) for the surgical treatment of benign prostate hyperplasia (BPH) in patients with renal transplantation. Materials and Methods: Between April 2009 and May 2016, BPH patients with renal transplants whose prostate volumes were less than 30 cm(3) were treated surgically. Forty-seven patients received TURP and 32 received TUIP. The patients' age, duration of dialysis, duration between transplant and TURP/TUIP, preoperative and postoperative serum creatinine (SCr), International Prostate Symptom Score (IPSS), maximum flow rate (Qmax) and postvoid residual volume (PVR) were recorded. At 1-,6- and 12-month follow-up, early and long-term complications were assessed. Results were evaluated retrospectively. Results: In both groups, SCr, PVR and IPSS decreased significantly after the operation, while Qmax increased significantly (P < .001). There was no difference between the two groups in terms of increase in Qmax and decrease in IPSS, SCr and PVR (P = .89, P = .27, P = .08, and P = .27). Among postoperative complications, urinary tract infection (UTIs) and retrograde ejaculation (RE) rates were higher in the TURP group than the TUIP group (12.7% versus 6.2% and 68.1% versus 25%,respectively), whereas urethral strictures were more prevalent in the TUIP group (12.5% versus 6.3%). Conclusion: For the treatment of BPH in renal transplant patients with a prostate volume less than 30 cm(3) , both TUIP and TURP are safe and effective.Öğe Comparison of spermiograms of infertile men before and during the COVID-19 pandemic(2022) Sarıer, Mehmet; Demir, Meltem; Emek, Mestan; Sürmen Usta, Sibel; Soylu, Ahmet; Yenidunya Konuk, Elcin; Turgut, HasanObjective: Since the start of the COVID-19 pandemic, there has been interest in the impact of both SARS-CoV-2 infection and pandemic-induced social restrictions on male reproductive health. This study aimed to evaluate the spermiogram values of men who presented for infertility during the pandemic compared with the previous 2 years. Methods: Patients who presented to a urology outpatient clinic for the first time due to infertility were included. The patients' age, semen volume, and spermiogram results were recorded. Based on the presentation date, the patients were divided into prepandemic group 1 (March 2018-February 2019), prepandemic group 2 (March 2019-February 2020), and pandemic group (March 2020-February 2021) for comparison. Results: A total of 594 patients were included. There was no significant difference between the three groups in terms of the number of patients who presented for infertility (207, 190, and 197 patients, respectively; p=0.691). The mean age was 36.6±7.2 in the prepandemic group 1, 35.5±7.1 in the prepandemic group 2, and 33.1±6.3 in the pandemic group. Patients who presented during the pandemic were significantly younger (p<0.001). There were no differences between the groups in terms of semen volume (p=0.910) or rates of normospermia and pathological spermiogram findings (p=0.222). Conclusions: In the first year of the COVID-19 pandemic, there was no significant difference in the number of patients who presented for infertility or in their spermiogram results compared with 2018 and 2019. However, it is noteworthy that the patients were significantly younger during the pandemic than in the previous 2 years.Öğe Developing necrotizing enterocolitis: retrospective analysis of 1428 preterm infants at a level-III neonatal intensive care unit over a four years period(Sociedad Argentina de Pediatria, 2020) Ongun, Hakan; Demirezen, Selim; Demir, MeltemAim. To investigate NEC frequency in premature infants and assess risk factors associated with disease-onset and progression to intestinal perforation. Methods. Retrospective cohort in preterm neonates hospitalized between 2015 and 2018. Perinatal characteristics, clinical features, nutritional data and laboratory outcome were analyzed using SPSS-23 statistical package. Logistic regression was performed to analyze associated risk factors. Results. In 1428 neonates, the rate of developing NEC was 18.28 %. Conception with assisted reproductive technology, cesearean section and postnatal-steroids were associated with NEC (OR: 4.056, 95 % CI: 2.810-5.854, OR: 1.961, 95 % CI: 1.321-2.910, OR: 6.422; 95 % CI: 4.327-9.530). Timing of first enteral feeding was associated to developing NEC, but not to intestinal perforation (p < 0.001, p = 0.604). Forty-seven of 261 NEC patients (18 %) have developed intestinal perforation. Antenatal steroids showed to reduce severe consequences (p = 0.001). Timing of first enteral feeding and hemodynamically significant PDA were predisposing factors for NEC and low 5-minutes Apgar score for intestinal perforation. (OR: 6.515; 95 % CI: 5.011-8.470; OR: 4.715; 95 % CI: 2.717-8.183; OR: 2.748; 95 % CI: 1.100-6.866). Mortality was 9 %. Developing NEC increased risk of mortality by 2.192 times (95 % CI: 1.469- 3.271); in intestinal perforation, mortality risk increased to 11.527 (95 % CI: 6.293-21.115). Conclusion. NEC frequency was 18.28 %. Intestinal perforation occurred in 18 % of NEC patients. PDA and delay in first enteral nutrition were predisposing factors for acquiring NEC and low 5-minutes Apgar scores for intestinal perforation.Öğe Does inflammation play a pole in the pathophysiology of tinnitus?(2021) Demir, MeltemObjective: The present study aimed to investigate the potential of neutrophil/ lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and mean platelet volume (MPV) as prognostic markers in tinnitus patients at inflammatory process. Methods:This study consisted of 216 subjects (124 males and 92 females), Routine laboratory CBC test results were calculated in this study. All the patients were divided into three groups according to their hearing thresholds: a high frequency hearing loss?tinnitus group (HFHL?TN) consisted of 55 subjects, an hearing loss in all frequencies tinnitus group (AFHL?TN) consisted of 53 subjects and a normal hearing?tinnitus group (NH?TN) consisted of 51 subjects. The control group (CNT) included 57 age?and sex?matched healthy subjects. Results: NLR, PLR and MPV were observed in the HFHL?TN group when compared to AFHL? TN, NH?TN and CNT group (P < 0.001). An increase in NLR was observed in the AFHL?TN group compared with the CNT group (P = 0.004). The PLR value of the HFHL?TN group was significantly higher than that of the AFHL?TN (P = 0.028) and NH?TN,CNTgroup (P < 0001). The PLR value of the HFHL?TN group was significantly higher than that of the AFHL?TN (p=0.028) and NH?TN, CNT group (P < 0001). MPV values in HFHL?TN group was slightly higher AFHL?TN group and significantly higher than NH?TN (P = 0.025) and CNT (P < 0.001) group. Conclusion: Our results confirm that elevated NLR, PLR and MPV values has been suggested to be a useful inflammatuar prognostic biomarker of tinnitus patients.Öğe Does ß-glucan can have a protective role against oxidative stress in the experimental sepsis model in rats?(Turkish Association of Trauma and Emergency Surgery, 2020) Demir, Meltem; Köse, Kader; Yazıcı, Cevat; Sözüer, Erdoğan MütevelliBACKGROUND: Very high mortality rate in sepsis may be related to oxidative stress. This study was conducted on the rats to investigate the presence of oxidative stress and also the potential protective effects of the ß-glucan in the intra-abdominal sepsis model formed by cecal ligation-perforation (CLP). METHODS: In this study, 30 Male rats were equally divided into three groups as “Sham”, “Sepsis” and “ß-Glucan”. Only laparotomy was performed in the Sham group, and sepsis was induced by CLP in Sepsis and ß-Glucan groups. Following CLP, a single dose of 4 mg ß-glucan/kg was also intraperitoneally administered to the ?-Glucan group. Blood and tissue (liver, lung and kidney) samples were taken from Sepsis and ß-Glucan groups after sepsis development determined at the end of the 48th hour, also from the Sham group. The levels of myeloperoxidase (MPO) and advanced oxidation protein products (AOPP) were determined in plasma samples, and the malondialdehyde (MDA) was measured in plasma and tissues. RESULTS: MPO and AOPP were higher in both the Sepsis and ß-Glucan groups; however, plasma and tissue MDA levels were higher only in the Sepsis group than the Sham group (p<0.05). However, when compared to the Sepsis group, all parameters measured, except kidney MDA, were significantly lower in the ß-Glucan group (p<0.05). CONCLUSION: To our knowledge, this is the first study to investigate the AOPP levels in the CLP sepsis model, ROS produced by the reaction of MPO derived from neutrophils may form oxidative damage to the proteins, compared to the lipids, and ß-glucan may be used as an alternative agent for sepsis treatment. © 2020 Turkish Association of Trauma and Emergency Surgery.Öğe Family-centered lactation counseling and breastfeeding in preterm infants upon neonatal intensive care discharge(WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2021) Ongun, Hakan; Demir, MeltemBackground: There is great variability in breastfeeding implications upon neonatal intensive care unit discharge for preterm infants. Aims and Objectives: To examine the breastfeeding rates and the impact of lactation-counseling on the nutrition following hospital discharge in preterm infants. Materials and Methods: A three-page survey was applied to the families of infants of gestational age <= 34 weeks who were hospitalized between 2016-2(118. Exclusion criteria were family reluctance to consent, foster-care placement, acquiring enteral feeding by orogastric tube/gastrostomy. The group categorization was based on lactation-counselling that involved both parents and elderly relatives who would assist the mother at neonatal care. Statistics were performed using SPSS-22 for covariates of neonatal intensive care interventions and post-discharge nutrition. Results: Exclusive breastfeeding was 49.2% at hospital-discharge and declined to 31.3% at six months. Early introduction of complementary foods was 51.1%. Total duration of breastfeeding was 7.38 +/- 3.98 months. Lactation-counseling prolonged breastfeeding duration to 8.47 +/- 3.87 months. The program presented the highest odds of extending breastfeeding interventions beyond six months (OR: 2.183, 95% CI: 1.354-3.520). It favored the outcomes by reducing the introduction of formulas and complementary foods before six months (P = 0.044, P = 0.018). The physical contribution of the father towards nutrition was the most significant benefit claimed by the participants. (71.6 versus 51.8%). Conclusion: Family-centered peer lactation-counseling by the medical staff and increasing awareness for infant nutrition are promising local strategies in reaching the goals of national nutrition policies guided by the international recommendations in preterm infants.Öğe Is there any association between urothelial carcinoma of the bladder and human papillomavirus? A case-control study(Karger, 2020) Sarıer, Mehmet; Sepin, Nevgun; Keles, Yildiz; Imir, Levent; Emek, Mestan; Demir, Meltem; Kukul, Erdal; Soylu, AhmetObjectives: Human papillomavirus (HPV) is a well-known oncogenic virus associated with anogenital carcinomas. Despite the anatomical proximity of the bladder and the anogenital region, the relationship between HPV and urothelial carcinoma of the bladder (UCB) is still a controversial issue. This study aimed to test the urethral swabs and first-void urine samples of patients with UCB for HPV-Deoxyribonucleic acid (DNA) using polymerase chain reaction (PCR) assay and to compare the results with a control group. Materials and Methods: Sixty-nine patients who were diagnosed with UCB between January and December 2018 were included in this case-control study. Sixty-nine patients who visited the urology outpatient clinic for non-oncological reasons within the study period were designated as the control group. Urethral swab and first-void morning urine samples were collected from each patient. HPV-DNA presence was investigated using a PCR kit that can detect a total of 22 HPV genotypes, of which 18 are high-risk and 3 are low-risk genotypes. Results: The mean age of the patients included in the study was 63.2 +/- 12.6 years and the male to female ratio was 5.3. HPV-DNA was detected in 28.9% (20/69) of the patients in the case group and in 8.7% (6/69) of the patients in the control group. HPV-DNA positivity was significantly higher in the case group (OR 4.24; 95% CI 1.63-12.34). No statistically significant relationship was found between HPV-DNA positivity and tumor grade (p = 0.36). Conclusion: A statistically significant relationship exists between HPV infection and UCB, regardless of the tumor grade.Öğe Mortality caused by late-onset sepsis in very low birth weight infants: risk analysis and the performance of diagnostic tools(Coll Physicians & Surgeons Pakistan, 2020) Ongun, Hakan; Demir, MeltemObjective: To assess the risk on late-onset sepsis attributed mortality in very low birth weight (VLBW) infants. Study Design: Observational study. Place and Duration of Study: Level-III Neonatal Intensive Care Unit, Istinye University, Antalya Medical Park Hospital, Turkey, between January 2014 and December 2018. Methodology: Perinatal characteristics and clinical features of 198 septic preterm neonates were evaluated to predict sepsis-attributed mortality. ROC analysis was employed to drive optimal-cutoffs for laboratory parameters and logistic regression to calculate mortality risk factors using SPSS version-22 and MedCalc software. Results: Mean gestational age was 28.91 +/- 2.67 weeks. Umbilical catheterisation was the principal risk factor for culture-positive sepsis (OR 2.860, 95%CI: 1.232-6.639). Outborn infants were more likely to deliver surfactant and longer intubation (p=0.013, and p=0.005, respectively), manifested frequent BPD (p=0.014), and at greater risk of proven sepsis and mortality (OR: 1.796, 95%CI: 1.011-3.191; OR: 1.950, 95%CI: 1.002-3.794). Low Apgar scores necrotising enterocolitis (NEC) and prolonged intubation were independent risk factors for mortality (OR: 13.840, 95%CI: 6.384-30.005; OR: 5.410, 95%CI: 2.113-13.849; OR: 10.037, 95%CI: 4.700-21.434). An increase in high-sensitivity C-reactive protein (hsCRP)-ratio >6.08-fold afforded good sensitivity and specificity (AUC: 0.914; sensitivity: 89.36%, specificity: 86.09%). Logistic regression of various combinations has shown a >6.08-fold change in hsCRP-ratio over 24-hours and platelet counts <88x10(9)/L optimally predicted mortality (OR: 27.983, 95%CI: 9.704-80.697). Conclusion: Low Apgar scores, NEC and prolonged intubation are independent risk factors for mortality of VLBW infants. Birth in level III-IV NICUs featuring special neonatal care, avoidance of prolonged intubation, and timely prediction of fatal sepsis using hsCRP ratio and platelets could prevent sepsis-related mortality.Öğe New approach to microscopy of gram-stained urethral smear: the kissing slide method(2020) Sarıer, Mehmet; Demir, Meltem; Turgut, Hasan; Hizel, Aydan; Emek, Mestan; Kukul, Erdal; Sepin, NevgünBackground: The effectiveness of microscopy of Gram-stained smear (GSS) for the detection of male urethral infection is debatable, especially in cases with low inflammation and no visible urethral discharge. This clinical study compared GSS samples collected with the conventional swab method and our new technique, the kissing slide method, together with polymerase chain reaction results to demonstrate the effectiveness of this new method in men with acute urethritis. Methods: The study included 64 men who presented to the urology outpatient clinic with complaints of acute urethritis between October 2019 and January 2020. Two GSS samples were collected from each patient, first using the kissing slide method (applying the slide directly to the urethral mucosa), followed by the conventional method. The results were compared with polymerase chain reaction findings. Results: The patients' mean age was 37.4 ± 7.8 years, and 68.7% had no visible urethral discharge on physical examination. At a GSS threshold of ?5 polymorphonuclear leukocytes/high-power field, sensitivity values were 60% (95% confidence interval [CI], 42.32%-75.41%) for the kissing slide method and 23.33% (95% CI, 11.79%-40.93%) for the conventional method. At a threshold of ?2 polymorphonuclear leukocytes/high-power field, sensitivity values with the kissing slide and conventional methods were 80% (95% CI, 62.69%-90.5%) and 50% (95% CI, 33.15%-66.85%) in all patients, and 66.67% (95% CI, 41.71%-84.82%) and 20% (95% CI, 7.047%-45.19%) in cases without visible urethral discharge, respectively. Conclusion: The new kissing slide method is a noninvasive alternative method that may have better sensitivity than the conventional GSS sampling method in the diagnosis of male acute urethritis. Randomized studies are needed to verify these findings.Öğe The relationship between frontal QRS-T angle and vitamin d deficiency(MDPI, 2024) Demir, Fulya Avcı; Bingöl, Gülsüm; Ersoy, İbrahim; Arslan, Akif; Ersoy, Pınar; Demir, Meltem; Ünlü, SerkanBackground and Objectives: A deficiency in serum 25-hydroxyvitamin D levels is associated with a number of cardiovascular situations, such as high blood pressure, heart failure, atherosclerotic heart disease, and peripheral artery disease. The frontal QRS-T angle has recently been proposed as a marker of ventricular repolarization. A wider frontal QRS-T angle has been positively correlated with adverse cardiac events. The objective of our study was to examine the association between serum 25-hydroxyvitamin D level and the frontal QRS-T angle. Materials and Methods: A total of 173 consecutive patients aged 18-60 years undergoing routine cardiology check-up evaluation, and not receiving concurrent vitamin D treatment were included in the study. Patients were classified in three groups, depending on their vitamin D levels, and categorized as follows: Group 1-deficient (<20 ng/mL), Group 2-insufficient (20-29 ng/mL), or Group 3-optimal (>= 30 ng/mL). The frontal QRS-T angle was determined using the automated reports generated by the electrocardiography machine. Results: The average age of participants was 45.8 (+/- 12.2) years, and 55.5% of participants were female (p < 0.001). Individuals with low vitamin D concentrations exhibited a wider frontal QRS-T angle. It was determined that vitamin D level is an independent predictive factor for the frontal QRS-T angle. Conclusions: As the levels of 25-hydroxyvitamin D decrease, repolarization time assessed by frontal QRS-T angle is widened. Our findings indicate that lower concentrations of vitamin D may increase the susceptibility to ventricular arrhythmia.
