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    Emphysematous pyelonephritis with left renal vein thrombosis-case report successfully treated by conservative methods
    (Türkiye Klinikleri, 2022) Demir, Esra; Erol, Vedat Buğra; Arslan Taşkın, Zeliha; Boz, Mustafa Yücel; Mert, Ali
    Presently emphysematous pyelonephritis is a rare but life-threatening disease, mostly seen in patients with urinary tract obstr uc- tion and diabetes mellitus. It is characterized by the production of gas and necrosis in the renal parenchyma, collecting systems, and perinephritic tissue. Radiologically, the Huang and Tseng classification is used to categorize the severity of the disease. Our case was 49 years old female pre- senting with unconsciousness, fever and bilateral Grade 3 lower extremity eodema one week after left percutaneous nephrolithotomy procedure because of urinary tract stone. Abdominal computerized tomography scan showed renal parenchymal and perinephritic tissue necrosis with the production of gas and renal vein thrombosis which was in accordance with Huang and Tseng classification Grade 3A. We treated our patient with the appropriate antibiotic, enoxaparin sodium, strict glycemic control, and supportive treatment without any surgical intervention or nephrectomy.
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    Maternal serum preptin levels in the pathogenesis and diagnosis of gestational diabetes mellitus
    (Society of Medical Biochemists of Serbia, 2023) Kıraç Utku, İrem; Demir, Esra; Özkan, Hanişe; Sahtiyancı, Berrak; Uzun, Hafize; Ekinci, İskender; Büyükkaba, Mitat; Durmuş, Sinem; Akarsu, Murat; Gelisgen, Remise; Tabak, Ömür
    Background: Gestational diabetes mellitus (GDM) is a metabolic disorder that occurs during pregnancy that increases both maternal and fetal mortality and morbidity. It was investigated whether there is a change in circulating levels of preptin, a new peptide secreted from pancreatic beta cells, due to GDM in pregnant women. The relationship between serum preptin levels with insulin and other metabolic parameters was also evaluated in these subjects. Methods: Eighty-five patients diagnosed as GDM and 89 healthy pregnant women with 75 mg oral glucose tolerance test (OGTT) was assessed in terms of serum preptin levels. Results: The serum preptin levels of the GDM group were significantly higher than those of the control group (p=0.001; p < 0.01). For the cut-off value of preptin measurement of 335.3 ng/L, the sensitivity was 97.65%, specificity was 87.64%, positive predictive value was 88.3% and negative predictive value was 97.5%. The risk of developing the disease is 294.273 times higher in patients with preptin level of 335.3 and above. Conclusions: We think that the reason for the increase in serum preptin levels in GDM is probably the response to glucose. The current results indicate that preptin plays an important role in elucidating the pathology of GDM. In addition, the search for a practical marker for the diagnosis of GDM suggests that the measurement of preptin level is promising.
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    Prematür akut koroner sendrom hastalarında yüksek serum interlökin-17A düzeyi
    (Turkiye Klinikleri, 2015) Demir, Bülent; Ünğan, İsmail; Oflar, Ersan; Khankishiyev, Vüsal; Pirhan, Osman; Demir, Esra; Özbek, Hanefi; Karakaya, Osman
    Amaç: Prematür akut koroner sendrom geçiren hastalarda serum interlökin (IL)-17A düzeyinin değerlendirilmesidir. Gereç ve Yöntemler: Aralık 2013-Ocak 2015 tarihleri arasında hastanemiz acil servisine başvuran ve akut koroner sendrom tanısı alan 45 yaş altında, ardışık seçilen 45 (35 erkek, 10 kadın, ortalama yaş; 39,6±3,85 yıl) hasta, prematür akut koroner sendrom hasta grubu olarak alındı. Koroner anjiyografi sonucu normal koroner arter olarak saptanan ve ardışık seçilen 35 (19 erkek, 16 kadın, ortalama yaş 40,1±3,37 yıl) hasta ise kontol grubu olarak belirlendi. Prematür hasta grubunda koroner lezyonların yaygınlığını belirlemek için ise Syntax skoru hesaplandı. Serum IL-17A düzeyleri ELISA yöntemi ile belirlendi. Bulgular: Hasta grubunda erkek cinsiyet ve sigara içiciliği kontrol grubuna göre daha yüksek idi (Her ikisi için; p<0,05). Koroner arter hastalığı için aile öyküsü varlığı kontrol grubunda hasta grubuna göre istatistiksel anlamlı olarak daha yüksek bulundu (p=0,003). Plazma trigliserid düzeyi, beyaz küre sayısı, nötrofil sayısı, nötrofil/lenfosit oranı hasta grubunda kontrol grubuna göre istatistiksel anlamlı olarak yüksek saptandı (hepsi için p<0,05). Fakat plazma HDL düzeyi, hasta grubunda kontrol grubuna göre düşüktü (p=0,001). Serum IL-17A düzeyi hasta grubunda kontrol grubuna göre daha yüksekti (sırasıyla; 2,0±1,88 pg/mL, 0,9±1,86 pg/mL, p=0,0001). Fakat hs-CRP düzeyi açısından iki grup arasında istatistiksel anlamlılık saptanmadı (sırasıyla; 4,4±5,61 mg/L, 2,7±6,19 mg/L, p=0,050). Sonuç: IL-17A proinflamatuar özelliği ile prematür akut koroner sendrom gelişiminde rol oynuyor olabilir.
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    The relationship between elevated plasma zonulin levels and Hashimoto's thyroiditis
    (Tubitak Scientific and Technical Research Council Turkey, 2022) Demir, Esra; Önal, Burak; Özkan, Hanise; Kıraç Utku, İrem; Sahtiyancı, Berrak; Kumbasar, Abdulbaki; Yenmiş, Güven; Demir, Bülent
    Background/aim: Hashimoto thyroiditis (HT) is one of the most prevalent autoimmune diseases. The intestine microbiota is strongly associated with autoimmune diseases. Zonulin, a modulator of tight junctions that controls the selective permeability of the intestine can induce an elevation in gut permeability. We aimed to investigate the association of plasma zonulin levels with HT. Materials and methods: We compared 77 HT patients with 66 age-gender and BMI-matched healthy individuals in the case of plasma zonulin levels. Plasma zonulin levels were measured by ELISA. The statistical analyses were performed using Student's t-test and chi-square tests. The predictive power was investigated using univariate and multivariate logistic regression analysis. Results: We found that the increase in plasma zonulin levels in the HT group was statistically significant compared to the control group (p < 0.001). The regression analysis showed that urea, anti-thyroid peroxidase, aspartate aminotransferase, thyroid-stimulating hormone, free T3, and serum zonulin levels were found to be associated with HT in both univariate and multivariate models (p < 0.05). Conclusion: Zonulin is a possible biomarker candidate that may link intestinal permeability with the etiology of autoimmune diseases.
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    The relationship between hepatic high FIB-4 score and COVID-19 pneumonia
    (Clinical Laboratory Publication, 2022) Demir, Esra; Erol, Vedat Buğra; Olmuşçelik, Oktay; Koryürek, Özgül M.; Tabak, Ömür; Demir, Bülent
    Background: We aimed to compare the level of hepatic FIB-4 scores between COVID-19 patients who had pneu-monia and COVID-19 patients who had no pneumonia in an attempt to develop a risk assessment after the treat-ment and recovery of active COVID-19 infection. Methods: The study included 80 patients who were consecutively selected and admitted to an internal medicine outpatient clinic for a control examination after COVID-19 infection. Chest tomography was performed on all pa-tients during the COVID-19 infection. Patients were divided into two groups as those with and without lung in-volvement on CT. COVID-19 infection was diagnosed using real-time reverse transcription-polymerase chain re-action (RT-PCR). The hepatic fibrosis 4 (FIB-4) index score was calculated for each patient. The statistical ana-lyses were performed using Student's t-test and chi-squared tests. Results: We found that the increased hepatic FIB-4 index score in patients with pneumonia group was statistically significant compared to the control group (p < 0.001). The regression analysis showed that the hepatic FIB-4 index has significant prognostic efficiencies in both uni-and multivariate models (p < 0.05). Conclusions: The hepatic FIB-4 index appears to be a simple parameter with a good prognostic value in patients with COVID-19 infection.
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    The relationship of elevated hepatic fibrosis-4 index score with pneumonia severity index and in hospital mortality among COVID-19 patients admitted to intensive care unit
    (Yerküre Tanıtım ve Yayıncılık A.Ş., 2022) Demir, Esra; Güngör, Hande; Erdoğan, Cem; Olmuşçelik, Oktay; Çakmak, Rümeysa; Yıldırım, Ayşegül
    Objective: We investigated the relationship hepatic fibrosis-4 (FIB-4) index score calculated in the early period and pneumonia severity index (PSI) and in-hospital mortality in patients hospitalized in the intensive care unit (ICU) due to new severe acute respiratory syndrome coronavirus-2 infection. Methods: Seventy six consecutive patients diagnosed with coronavirus disease-2019 (COVID-19), hospitalized in the ICU due to hypoxemia, and selected consecutively were included. COVID-19 infection was diagnosed using real-time reverse transcription-polymerase chain reaction (RT-PCR) in nose and throat swab samples. The diagnosis of pneumonia was confirmed by showing typical ground-glass opacities and areas of subsegmental consolidation in lung computed tomography examinations of patients previously diagnosed with COVID-19 by RT-PCR. Hepatic FIB-4 index score and PSI score was calculated separately for each patient. In the statistical method, the independent samples t-test and MannWhitney U test were used to compare quantitative data. A chi-square test was used to compare qualitative data. Results: The FIB-4 value and PSI value were significantly higher (p<0.05) in the mortality group than in the non-mortality group. Also, there was no significant statistical difference between the two groups in terms of the other laboratory parameters (p>0.05) FIB-4 value was significantly predictive [under the curve 0.835 (0.742-0.929)] in differentiating patients with and without mortality. For a cut-off value of 5.4, FIB-4 had a sensitivity of 60.6%, positive predictive of 95.2%, specificity of 97.6%, and negative predictive value of 75.9% Conclusion: High FIB-4 index and PSI score detected in the early period in patients admitted to the ICU due to COVID-19 seem to be predictors of in-hospital mortality.
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    Yüksek hepatik Fibrozis – 4 (FİB-4) indeksi ile asemptomatik tiroid nodülleri arasındaki ilişki
    (Dicle Üniversitesi, 2022) Demir, Esra; Tanrıkulu, Onur; Demir, Bülent
    Amaç: Asemptomatik hastalarda yapılan tiroid ultrasonu sırasında rastlanan insidental tiroid nodüllerinin karaciğer fibrozis skoruolan hepatik Fibrozis – 4 (FİB-4) indeksi ile ilişkisinin araştırılmasıdir. . Yöntemler: Hastanemiz iç hastalıkları polikliniğine genel kontrol amaçlı başvurmuş, herhangi bir semptomu olmayan ve yapılan tiroid ultrasonunda tiroid nodülü tesbit edilen veardışık seçilen100 hasta ile tiroid nodülü olmayan ardışık seçilen 100 kontrol hastası retrospektif olarak taranarak toplam 200 hastaçalışmaya dahil edildi. Hastaların yaşları, cinsiyetleri, Tiroid USG sonuçları , Abdominal USG sonuçları her bir hasta için ayrı ayrı kaydedildi. Tüm hastalar içinhepatik FİB-4 indeks skorlarıhesaplandı.Tek değişkenli ve çok değişkenli analizler için Spearman'ın korelasyon analizi ve ikili lojistik modeli kullanıldı. Bulgular: Hasta grubunun yaş ortalaması, hepatosteatoz derecesi, kreatinin duzeyive FİB-4dahayüksekti (p<0.05).. Yapilan Spearman'skorelasyon analizi sonucunda;tiroid nodülü ilecinsiyet (r=-0.331; p<0.01), yaş (r=0.344; p<0.01), kreatinin (r=-0.259; p<0.01)arasinda anlamli pozitif korelasyon olduğu gösterildi. (r=-0.154; p<0.05) ve FİB-4 (r=0.227; p<0.01). İkili lojistik regresyon analizi sonuçları, cinsiyetin (B=1,351; p<0,01) ve FIB-4'ün (B=1,603; p<0,01) tiroid nodülü üzerinde anlamlı etkisi olduğunu gösterdi. Sonuç: Hepatik FİB-4indeksi kolay hesaplanan ve ucuz bir parametre olması nedeniyle, asemptomatik hastalarda tiroid USG yapılacak hastaları belirlemede bir tarama testi olarak kullanılabilir.