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Bakkaloğlu SA, Delibaş A, Sürmeli Döven S, Taner S, Yavuz S, Erfidan G, Danacı Vatansever E, Aynacı F, Yilmaz K, Taşdemir M, Akacı O, Akıncı N, Güven S, Çiçek N, Dursun I, Keleşoğlu E, Sancaktar M, Alaygut D, Saygılı S, Yavaşcan Ö, Yılmaz A, Gülleroğlu K, Ertan P, Demir BK, Poyrazoğlu H, Pınarbaşı S, Gençler A, Baştuğ F, Günay N, Çeleğen K, Noyan A, Parmaksız G, Avcı B, Çaycı FŞ, Bayrakçı U, Özlü SG, Aksoy ÖY, Yel S, İnal GA, Köse S, Bayazıt AK, Atmış B, Sarıbaş E, Çağlı Ç, Tabel Y, Elmas AT, Zırhlı Selçuk Ş, Demircioğlu Kılıç B, Akbalık Kara M, Büyükçelik M, Balat A, Durucu Tiryaki B, Erdoğdu B, Aksu B, Mahmudova G, Dursun H, Candan C, Göknar N, Mutlubaş F, Çamlar SA, Başaran C, Akbulut BB, Düzova A, Gülhan B, Oruç Ç, Peru H, Alpay H, Türkkan ÖN, Gülmez R, Çelakıl M, Doğan K, Bilge I, Pehlivanoğlu C, Büyükkaragöz B, Leventoğlu E, Alpman N, Zeybek C, Tülpar S, Çiçek Gülşan RY, Kara A, Gürgöze MK, Önder Akyol EN, Özdemir Atikel Y, Pul S, Sönmez F, Yıldız G, Akman S, Elmacı M, Küçük N, Yüksel S, Kavaz A, Nalçacıoğlu H, Alparslan C, Dinçel N, Elhan AH, Sever L. Pediatric kidney care experience after the 2023 Turkey/Syria earthquake. Nephrol Dial Transplant 2024:gfae033. [PMID: 38327222 DOI: 10.1093/ndt/gfae033] [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] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND/AIMS Two earthquakes on February 6th, 2023 destroyed ten cities in Türkiye. We report our experience with pediatric victims during these catastrophes, with a focus on crush syndrome related-acute kidney injury (Crush-AKI) and death. METHOD A web-based software was prepared. Patient demographics, time under rubble (TUR), admission laboratory data, dialysis, and kidney and overall outcomes were asked. RESULTS 903 injured children (median age: 11.62 years) were evaluated. Mean TUR was 13 h (Interquartile range-IQR: 32.5), max 240 h). 31 of 32 patients with a TUR of >120 h survived. The patient who rescued after ten days survived.Two-thirds of the patients were given 50 mEq/L sodium-bicarbonate in 0.45% sodium-chloride solution on admission day. 58% of patients were given intravenous fluid (IVF) at a volume of 2000-3000 mL/m2 body surface area (BSA), 40% of 3000-4000 mL/m2 BSA, and only 2% of >4000 mL/m2 BSA. 425 patients had surgeries, 48 suffered from major bleeding. Amputations were recorded in 96 patients. Eighty-two and 66 patients required ventilator and inotropic support, respectively.Crush-AKI developed in 314 patients (36% of all patients). 189 patients were dialyzed. Age > 15 years, creatine phosphokinase (CK)≥20 950 U/L, TUR≥10 h, and the first-day IVF volume < 3000-4000 mL/m2 BSA were associated with Crush-AKI development. 22 deaths were recorded, 20 of 22 occurred in patients with Crush-AKI and within the first 4 days of admission. All patients admitted after 7 days survived. CONCLUSIONS This is the most extensive pediatric kidney disaster data after an earthquake. Serum CK level was significantly associated with Crush-AKI at the levels of >20 950 U/L, but not with death. Adolescent age and initial IVF of less than 3000-4000 mL/m2 BSA were also asscoiated with Crush-AKI. Given that mildly injured victims can survive longer periods in the disaster field, we suggest uninterrupted rescue activity for at least 10 days.
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Affiliation(s)
- Sevcan A Bakkaloğlu
- Gazi University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Ali Delibaş
- Mersin University, Faculty of Medicine, Department of Pediatric Nephrology, Mersin, Türkiye
| | - Serra Sürmeli Döven
- Mersin University, Faculty of Medicine, Department of Pediatric Nephrology, Mersin, Türkiye
| | - Sevgin Taner
- Adana City Hospital, Pediatric Nephrology Unit, Adana, Türkiye
| | - Sevgi Yavuz
- Başakşehir Çam ve Sakura City Hospital, Pediatric Nephrology Unit, İstanbul, Türkiye
| | - Gökçen Erfidan
- Diyarbakır Gazi Yaşargil Hospital, Pediatric Nephrology Unit, Diyarbakır, Türkiye
| | | | - Fatma Aynacı
- Mersin City Hospital, Pediatric Nephrology Unit, Mersin, Türkiye
| | - Kenan Yilmaz
- Şanlıurfa Training Hospital, Pediatric Nephrology Unit, Şanlıurfa, Türkiye
| | - Mehmet Taşdemir
- İstinye University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Okan Akacı
- Bursa Yüksek İhtisas Hospital, Pediatric Nephrology Unit, Bursa, Türkiye
| | | | - Serçin Güven
- Marmara University Faculty of Medicine, Department of Pediatric Nephrology Pendik Hospital, İstanbul, Türkiye
| | - Neslihan Çiçek
- Marmara University Faculty of Medicine, Department of Pediatric Nephrology Pendik Hospital, İstanbul, Türkiye
| | - Ismail Dursun
- Erciyes University, Faculty of Medicine, Department of Pediatric Nephrology, Kayseri, Türkiye
| | - Emre Keleşoğlu
- İstanbul Medeniyet University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | | | - Demet Alaygut
- SBÜ İzmir Tepecik Hospital, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Seha Saygılı
- İstanbul University - Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Önder Yavaşcan
- İstanbul Medipol University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Alev Yılmaz
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Kaan Gülleroğlu
- Başkent University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Pelin Ertan
- Manisa Celal Bayar University, Faculty of Medicine, Department of Pediatric Nephrology, Manisa, Türkiye
| | - Belde Kasap Demir
- İzmir Katip Çelebi University, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Hakan Poyrazoğlu
- Erciyes University, Faculty of Medicine, Department of Pediatric Nephrology, Kayseri, Türkiye
| | - Seda Pınarbaşı
- Diyarbakır Children's Hospital, Pediatric Nephrology Unit, Diyarbakır, Türkiye
| | - Aylin Gençler
- Harran University, Faculty of Medicine, Department of Pediatric Nephrology, Şanlıurfa, Türkiye
| | - Funda Baştuğ
- Kayseri City Hospital, Pediatric Nephrology Unit, Kayseri, Türkiye
| | - Neslihan Günay
- Kayseri City Hospital, Pediatric Nephrology Unit, Kayseri, Türkiye
| | - Kübra Çeleğen
- Kayseri City Hospital, Pediatric Nephrology Unit, Kayseri, Türkiye
| | - Aytül Noyan
- Başkent University, Adana Dr Turgut Noyan Training and Research Center, Department of Pediatric Nephrology, Adana, Türkiye
| | - Gönül Parmaksız
- Başkent University, Adana Dr Turgut Noyan Training and Research Center, Department of Pediatric Nephrology, Adana, Türkiye
| | - Begüm Avcı
- Başkent University, Adana Dr Turgut Noyan Training and Research Center, Department of Pediatric Nephrology, Adana, Türkiye
| | | | - Umut Bayrakçı
- Bilkent City Hospital, Pediatric Nephrology Unit, Ankara, Türkiye
| | - Sare Gülfem Özlü
- Bilkent City Hospital, Pediatric Nephrology Unit, Ankara, Türkiye
| | | | - Sibel Yel
- Erciyes University, Faculty of Medicine, Department of Pediatric Nephrology, Kayseri, Türkiye
| | - Güldane Aylin İnal
- Erciyes University, Faculty of Medicine, Department of Pediatric Nephrology, Kayseri, Türkiye
| | - Seçil Köse
- Erciyes University, Faculty of Medicine, Department of Pediatric Nephrology, Kayseri, Türkiye
| | - Aysun Karabay Bayazıt
- Çukurova University, Faculty of Medicine, Department of Pediatric Nephrology, Adana, Türkiye
| | - Bahriye Atmış
- Çukurova University, Faculty of Medicine, Department of Pediatric Nephrology, Adana, Türkiye
| | - Emel Sarıbaş
- Çukurova University, Faculty of Medicine, Department of Pediatric Nephrology, Adana, Türkiye
| | - Çağla Çağlı
- Çukurova University, Faculty of Medicine, Department of Pediatric Nephrology, Adana, Türkiye
| | - Yılmaz Tabel
- İnönü University, Faculty of Medicine, Department of Pediatric Nephrology, Malatya, Türkiye
| | - Ahmet Taner Elmas
- İnönü University, Faculty of Medicine, Department of Pediatric Nephrology, Malatya, Türkiye
| | - Şenay Zırhlı Selçuk
- İnönü University, Faculty of Medicine, Department of Pediatric Nephrology, Malatya, Türkiye
| | | | - Mehtap Akbalık Kara
- Gaziantep University, Faculty of Medicine, Department of Pediatric Nephrology, Gaziantep, Türkiye
| | - Mithat Büyükçelik
- Gaziantep University, Faculty of Medicine, Department of Pediatric Nephrology, Gaziantep, Türkiye
| | - Ayşe Balat
- Gaziantep University, Faculty of Medicine, Department of Pediatric Nephrology, Gaziantep, Türkiye
| | - Betül Durucu Tiryaki
- Gaziantep University, Faculty of Medicine, Department of Pediatric Nephrology, Gaziantep, Türkiye
| | - Bilge Erdoğdu
- Gaziantep University, Faculty of Medicine, Department of Pediatric Nephrology, Gaziantep, Türkiye
| | - Bağdagül Aksu
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Günay Mahmudova
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Hasan Dursun
- SBÜ Prof. Dr Cemil Taşçıoğlu City Hospital, Pediatric Nephrology Unit, İstanbul, Türkiye
| | - Cengiz Candan
- İstanbul Medeniyet University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Nilüfer Göknar
- İstanbul Medeniyet University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Fatma Mutlubaş
- SBÜ İzmir Tepecik Hospital, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Seçil Arslansoyu Çamlar
- SBÜ İzmir Tepecik Hospital, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Cemaliye Başaran
- İzmir Tepecik Hospital, Pediatric Nephrology Unit, İzmir, Türkiye
| | - Burcu Bulum Akbulut
- Acıbadem University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Ali Düzova
- Hacettepe University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Bora Gülhan
- Hacettepe University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Çiğdem Oruç
- Hacettepe University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Harun Peru
- Selçuk University, Faculty of Medicine, Department of Pediatric Nephrology, Konya, Türkiye
| | - Harika Alpay
- Marmara University Faculty of Medicine, Department of Pediatric Nephrology Pendik Hospital, İstanbul, Türkiye
| | - Özde Nisa Türkkan
- Marmara University Faculty of Medicine, Department of Pediatric Nephrology Pendik Hospital, İstanbul, Türkiye
| | - Rüveyda Gülmez
- İstanbul University - Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Mehtap Çelakıl
- Sakarya University, Faculty of Medicine, Department of Pediatric Nephrology, Sakarya, Türkiye
| | - Kenan Doğan
- Kocaeli University, Faculty of Medicine, Department of Pediatric Nephrology, Kocaeli, Türkiye
| | - Ilmay Bilge
- Koç University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Cemile Pehlivanoğlu
- Koç University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Bahar Büyükkaragöz
- Gazi University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Emre Leventoğlu
- Gazi University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Nuray Alpman
- Gülhane Hospital, Pediatric Nephrology Unit, Ankara, Türkiye
| | - Cengiz Zeybek
- SBÜ Gülhane Hospital, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Sebahat Tülpar
- Bakırköy Dr Sadi Konuk Hospital, Pediatric Nephrology Unit, İstanbul, Türkiye
| | | | - Aslıhan Kara
- Fırat University, Faculty of Medicine, Department of Pediatric Nephrology, Elazığ, Türkiye
| | - Metin Kaya Gürgöze
- Fırat University, Faculty of Medicine, Department of Pediatric Nephrology, Elazığ, Türkiye
| | | | | | - Serim Pul
- Ümraniye Training and Research Hospital, Pediatric Nephrology Unit, İstanbul, Türkiye
| | - Ferah Sönmez
- Bezm-i Alem University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Gizem Yıldız
- Dokuz Eylül University, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Sema Akman
- Akdeniz University, Faculty of Medicine, Department of Pediatric Nephrology, Antalya, Türkiye
| | - Midhat Elmacı
- Karamanoğlu Mehmetbey University, Faculty of Medicine, Department of Pediatric Nephrology, Karaman, Türkiye
| | - Nuran Küçük
- Kartal Dr Lütfi Kırdar City Hospital, Pediatric Nephrology Unit, İstanbul, Türkiye
| | - Selçuk Yüksel
- Çanakkale Onsekiz Mart University, Faculty of Medicine, Department of Pediatric Nephrology, Çanakkale, Türkiye
| | - Aslı Kavaz
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Pediatric Nephrology, Eskişehir, Türkiye
| | - Hülya Nalçacıoğlu
- Ondokuz Mayıs University, Faculty of Medicine, Department of Pediatric Nephrology, Samsun, Türkiye
| | - Caner Alparslan
- İzmir Demokrasi University, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Nida Dinçel
- SBÜ İzmir Dr Behçet Uz Hospital, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Atilla H Elhan
- Ankara University, School of Medicine Department of Biostatistics, Ankara, Turkey
| | - Lale Sever
- İstanbul University - Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
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2
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Duman S, Kuru D, Gumussoy M, Kiremitci S, Gokcan H, Ulas B, Ellik Z, Ozercan M, Er RE, Karakaya F, Bodakci E, Erden A, Elhan AH, Savas B, Loomba R, Idilman R. A combination of non-invasive tests for the detection of significant fibrosis in patients with metabolic dysfunction-associated steatotic liver disease is not superior to magnetic resonance elastography alone. Eur Radiol 2023:10.1007/s00330-023-10441-5. [PMID: 37987833 DOI: 10.1007/s00330-023-10441-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/04/2023] [Revised: 09/04/2023] [Accepted: 10/05/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES The aims of the present study were to investigate a combination of magnetic resonance elastography (MRE) and vibration-controlled transient elastography (VCTE) or MRE and fibrosis score 4 (FIB-4) in the detection of significant fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). METHODS Between November 5, 2021, and March 4, 2022, a total of 119 consecutive patients with MASLD were included. Liver stiffness was measured using liver biopsy, MRE, VCTE, and FIB-4. Data were collected from outpatient visit charts. Significant fibrosis was defined as ≥ stage 2 fibrosis. RESULTS All 119 MASLD patients were Caucasian, and their median age was 55 years. MRE, VCTE, and FIB-4 demonstrated significant accuracy in the detection of significant fibrosis with an area under the ROC curve (AUC) of 0.848 ± 0.036 (p < 0.001), 0.632 ± 0.052 (p = 0.012), and 0.664 ± 0.051 (p = 0.001), respectively. However, the diagnostic performance of MRE was superior compared to that of VCTE (AUC difference: 0.216 ± 0.053, p < 0.001) and FIB-4 (AUC difference: 0.184 ± 0.058, p = 0.001). With logistic regression analysis, it was determined that when compared to MRE alone, a combination of MRE and TE (p = 0.880) or MRE and FIB-4 (p = 0.455) were not superior for detecting significant fibrosis. CONCLUSIONS MRE alone is an accurate and non-invasive method for the identification of MASLD patients with significant fibrosis. CLINICAL RELEVANCE STATEMENT Magnetic resonance elastography alone accurately detects significant fibrosis in patients with metabolic dysfunction-associated steatotic liver disease. KEY POINTS • In routine clinical practice, several non-invasive biochemical-based biomarkers and imaging methods are widely used to assess liver fibrosis in patients with metabolic dysfunction-associated steatotic liver disease. • Magnetic resonance elastography (MRE) is more accurate than vibration-controlled transient elastography (VCTE) or fibrosis score 4 (FIB-4) for assessing liver fibrosis and identifying significant fibrosis in patients with metabolic dysfunction-associated steatotic liver disease. • The combination of MRE and VCTE or MRE and FIB-4 was not superior to MRE alone.
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Affiliation(s)
- Serkan Duman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey.
| | - Digdem Kuru
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Mesut Gumussoy
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Saba Kiremitci
- Department of Pathology, Ankara University School of Medicine, Ankara, Turkey
| | - Hale Gokcan
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Bahar Ulas
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Zeynep Ellik
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Mubin Ozercan
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Ramazan Erdem Er
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Fatih Karakaya
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Emin Bodakci
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Ayse Erden
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Atilla H Elhan
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
| | - Berna Savas
- Department of Pathology, Ankara University School of Medicine, Ankara, Turkey
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, CA, USA
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey.
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Melekoglu Ellik Z, S. Idilman I, Kartal A, Balaban Y, H. Elhan A, Karcaaltincaba M, Ozkan H, Idilman R. Evaluation of Magnetic Resonance Elastography and Transient Elastography for Liver Fibrosis and Steatosis Assessments in the Liver Transplant Setting. Turk J Gastroenterol 2022; 33:153-160. [PMID: 35238782 PMCID: PMC9128353 DOI: 10.5152/tjg.2022.21705] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/02/2021] [Indexed: 08/10/2023]
Abstract
BACKGROUND Liver graft fibrosis affects long-term graft and patient survival in liver transplant recipients. Transient elastography and magnetic resonance elastography are widely used for the assessment of liver fibrosis in routine clinical practice, but are limited in liver transplant settings. The aims of the present study were to evaluate the accuracy of magnetic resonance elastography and transient elastograph in the assessment of liver fibrosis in liver transplant recipients, and to determine the recurrence rates of post-transplant hepatic steatosis and liver fibrosis. METHODS A total of 126 consecutive liver transplant recipients were included. Magnetic resonance elastography and transient elastography were performed for to measure liver stiffness. RESULTS The most common cause of liver transplantation was hepatitis B virus-induced cirrhosis (50%). The mean liver stiffness value with transient elastography was 6.1 ± 3.0 kPa, and the mean magnetic resonance elastography value was 2.7 ± 1.0 kPa. A significant positive correlation was found between magnetic resonance elastography and transient elastography in terms of liver stiffness measurement (r = 0.61, P < .001). Obesity and the underlying etiology of liver diseases did not have any significant negative effect on magnetic resonance elastography and transient elastography measurements. During the follow-up, the post-transplant recurrence rates of hepatic steatosis and hepatic fibrosis were 26% and 37%, respectively. The recurrence rates of post-transplant hepatic steatosis and liver fibrosis were slightly higher in recipients with non-alcoholic fatty liver disease-related cirrhosis than those with viral hepatitisrelated etiologies (44% vs 27%, P = .43; 44% vs 30%, P = .45, respectively). CONCLUSION Magnetic resonance elastography and transient elastography are accurate in assessing liver fibrosis in the liver transplant setting. Obesity and the underlying etiology of primary liver disease do not influence the measurements.
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Affiliation(s)
| | - Ilkay S. Idilman
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Aysun Kartal
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Yasemin Balaban
- />Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Atilla H. Elhan
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
| | | | - Hasan Ozkan
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
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4
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Küçükdeveci AA, Elhan AH, Erdoğan BD, Kutlay Ş, Gökmen D, Ateş C, Yüksel S, Lundgren-Nilsson A, Escorpizo R, Stucki G, Tennant A, Conaghan PG. Use and detailed metric properties of patient-reported outcome measures for rheumatoid arthritis: a systematic review covering two decades. RMD Open 2021; 7:rmdopen-2021-001707. [PMID: 34376556 PMCID: PMC8356163 DOI: 10.1136/rmdopen-2021-001707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/20/2021] [Accepted: 07/26/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction The importance of patient-reported outcome measures (PROMs) for rheumatoid arthritis (RA) clinical studies has been recognised for many years. The current study aims to describe the RA PROMs used over the past 20 years, and their performance metrics, to underpin appropriate tool selection. Methods The study included a systematic search for PROMs that have been in use over the period 2000–2019, with detailed documentation of their psychometric properties, and a user-friendly presentation of the extensive evidence base. Results 125 PROMs were identified with psychometric evidence available. The domains of pain, fatigue, emotional functions, mobility, physical functioning and work dominated, with self-efficacy and coping as personal factors. Domains such as stiffness and sleep were poorly served. The most frequently used PROMs included the Health Assessment Questionnaire Disability Index (HAQ), the Short Form 36 (SF-36), the EuroQoL and the Modified HAQ which, between them, appeared in more than 3500 papers. Strong psychometric evidence was found for the HAQ, and the SF-36 Physical Functioning and Vitality (fatigue) domains. Otherwise, all domains except stiffness, sleep, education and health utility, had at least one PROM with moderate level of psychometric evidence. Conclusion There is a broad range of PROMs for measuring RA outcomes, but the quality of psychometric evidence varies widely. This work identifies gaps in key RA domains according to the biopsychosocial model.
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Affiliation(s)
- Ayşe A Küçükdeveci
- Department of Physical Medicine and Rehabilitation, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Atilla H Elhan
- Department of Biostatistics, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Beyza D Erdoğan
- Department of Biostatistics, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Şehim Kutlay
- Department of Physical Medicine and Rehabilitation, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Derya Gökmen
- Department of Biostatistics, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Can Ateş
- Department of Biostatistics, Aksaray University, School of Medicine, Aksaray, Turkey
| | - Selcen Yüksel
- Department of Biostatistics, Ankara Yıldırım Beyazıt University, Faculty of Medicine, Ankara, Turkey
| | - Asa Lundgren-Nilsson
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
| | - Gerold Stucki
- Department of Health Sciences and Health Policy, University of Lucerne, Luzern, Switzerland
| | - Alan Tennant
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK
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5
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Prodinger B, Küçükdeveci AA, Kutlay S, Elhan AH, Kreiner S, Tennant A. Cross-diagnostic scale-banking using rasch analysis: Developing a common reference metric for generic and health condition-specific scales in people with rheumatoid arthritis and stroke. J Rehabil Med 2020; 52:jrm00107. [PMID: 32909047 DOI: 10.2340/16501977-2736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/16/2022] Open
Abstract
OBJECTIVES To develop a common reference metric of functioning, incorporating generic and health condition-specific disability instruments, and to test whether this reference metric is invariant across 2 health conditions. DESIGN Psychometric study using secondary data analysis. Firstly, the International Classification of Functioning, Disability and Health (ICF) Linking Rules were used to examine the concept equivalence between the World Health Organization Disability Assessment Schedule (WHODAS 2.0), Health Assessment Questionnaire (HAQ) and Functional Independence Measure (FIMTM). Secondly, a scale-bank was developed using a reference metric approach to test-equating, based on the Rasch measurement model. PARTICIPANTS Secondary analysis was performed on data from 487 people; 61.4% with rheumatoid arthritis and 38.6% with stroke. RESULTS Three sub-domains of the WHODAS 2.0 and all items of the HAQ and FIMTM motor mapped on to the ICF chapters d4 Mobility, d5 Self-care and d6 Domestic life. Test-equating of these scales resulted in good model fit, indicating that a scale bank and associated reference metric across these 3 instruments could be created. CONCLUSION This study provides a transformation table to enable direct comparisons among instruments measuring physical functioning commonly used in rheumatoid arthritis (HAQ) and stroke (FIMTM motor scale), as well as in people with disability in general (WHODAS 2.0).
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Bakkaloglu SA, Buyan N, Funahashi T, Pasaoglu H, Elhan AH, Hasanoglu E, Soylemezoglu O. Adiponectin Levels and Atherosclerotic Risk Factors in Pediatric Chronic Peritoneal Dialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080502500410] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Atherosclerotic vascular diseases are the major cause of mortality in patients with end-stage renal disease (ESRD) treated with chronic peritoneal dialysis (CPD), even in children. Adiponectin (ADPN) is a recently discovered adipocyte-derived plasma protein having anti-atherogenic properties. ADPN levels are elevated in ESRD but it has been reported that ESRD patients with low plasma ADPN levels have a high risk of cardiovascular death. Objective To clarify the atherosclerotic risk and especially the significance of ADPN levels in pediatric patients on CPD. Design Cross-sectional study in the pediatric peritoneal dialysis unit of a university hospital. Patients 18 children, aged 12.6 ± 5.6 years, being treated with CPD and 20 healthy age- and sex-matched control subjects were enrolled in this study. Methods Serum ADPN levels and other risk factors, including blood pressure, blood glucose, serum lipid/lipoprotein fractions, apolipoprotein B, C-reactive protein (CRP), lipoprotein(a), and homocysteine levels, were studied in CPD patients and compared to the controls. Results Serum ADPN levels were three times higher in the CPD group compared to the control subjects, as was previously reported. Apolipoprotein B and CRP levels were also high in the CPD group. No significant difference was found in other atherosclerotic parameters, including lipoprotein(a) and homocysteine levels. Interestingly, we found a negative correlation between log ADPN and creatinine levels among the CPD patients ( r = –0.54, p < 0.05). There was no correlation between log ADPN and duration of CPD. Creatinine and low-density lipoprotein levels could account for 54% of the total variation in ADPN levels. Conclusion Among pediatric CPD patients, serum levels of the anti-atherogenic protein, ADPN, were inversely associated with creatinine. ADPN level might be a novel marker to predict prognosis in pediatric CPD patients.
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Affiliation(s)
| | - Necla Buyan
- Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
| | - Tohru Funahashi
- Department of Internal Medicine & Molecular Science, Osaka University, Osaka, Japan
| | | | - Atilla H. Elhan
- Department of Biostatistics, Ankara University, Ankara, Turkey
| | - Enver Hasanoglu
- Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
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Kurt-Sukur ED, Özçakar ZB, Haznedar-Karakaya P, Yılmaz S, Elhan AH, Çakar N, Yalçınkaya F. Clinical characteristics and outcome of childhood vesicoureteral reflux. ARCH ARGENT PEDIATR 2020; 118:e16-e21. [PMID: 31984697 DOI: 10.5546/aap.2020.eng.e16] [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: 02/16/2018] [Accepted: 08/14/2019] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The aim of the study was to assess the clinical features and outcome parameters of children with vesicoureteral reflux (VUR) based on gender and VUR grade. POPULATION AND METHODS Patients with VUR who were seen during routine follow-up visits at Ankara University Children's Hospital between January 2014-January 2015 were included in this retrospective study. Patient demographics, clinical course, laboratory investigations, imaging were noted. RESULTS Two hundred and twenty patients were recruited. Mean age at the time of diagnosis was 3,17 ± 3,08 years. Boys were diagnosed at younger ages as compared to girls (2.00 ± 2,59 vs. 3,81 ± 3.15, p < 0.001). Urinary tract infection (UTI) was the most common presentation. The second presentation form was antenatal hydronephrosis (AHN) which was more common in males (25.6 %, p < 0.001). Twenty-two percent of the patients had grade 1-2, 51 % grade 3 and 27 % grade 4-5 reflux. Patients with grade 4-5 reflux had more abnormal ultrasound (US) and Tech 99m dimercaptosuccinic acid scintigraphy (DMSA) findings and surgery was performed more frequently in this group (p < 0.001). In males, grade 4-5 reflux (43.6 % vs. 18.3 %), abnormal US (77 % vs. 54 %) and DMSA (77 % vs. 59 %) findings were more frequent (p < 0.05). In girls higher rates of UTIs, lower urinary tract dysfunction (LUTD) and spontaneous reflux resolution were seen (p < 0.05). CONCLUSIONS Despite younger age at diagnosis, spontaneous resolution was found lower in boys and they had more frequent AHN, more severe reflux, and radiological abnormalities.
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Affiliation(s)
- Eda D Kurt-Sukur
- Ankara University School of Medicine, Department of Pediatrics, Division of Nephrology.
| | - Zeynep B Özçakar
- Ankara University School of Medicine, Department of Pediatrics, Division of Nephrology
| | | | - Songül Yılmaz
- Ankara University School of Medicine, Department of Pediatrics, Division of Nephrology
| | - Atilla H Elhan
- Ankara University School of Medicine, Department of Biostatistics
| | - Nilgün Çakar
- Ankara University School of Medicine, Department of Pediatrics, Division of Nephrology
| | - Fatoş Yalçınkaya
- Ankara University School of Medicine, Department of Pediatrics, Division of Nephrology
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8
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Aydın F, Çakar N, Özçakar ZB, Uncu N, Başaran Ö, Özdel S, Çelikel E, Elhan AH, Yalçınkaya F. Clinical features and disease severity of Turkish FMF children carrying E148Q mutation. J Clin Lab Anal 2019; 33:e22852. [PMID: 30714637 PMCID: PMC6528560 DOI: 10.1002/jcla.22852] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 11/14/2022] Open
Abstract
Background Familial Mediterranean fever (FMF) is the most common hereditary monogenic autoinflammatory disease caused by mutations in the MEFV gene. It is controversial whether E148Q alteration is an insignificant variant or a disease‐causing mutation. The aim of this study was to evaluate the clinical features and disease severity of FMF patients carrying E148Q mutation. Methods Files of FMF patients were retrospectively evaluated. Patients with at least one E148Q mutation were included to the study. The clinical characteristics and disease severity of the patients who were carrying only E148Q mutation were compared with the patients who were compound heterozygous for E148Q and homozygous for M694V mutation. Results The study group comprised 33 patients who were homozygous or heterozygous for E148Q; 34 with compound heterozygous E148Q mutations and 86 patients who had homozygous M694V mutation. Patients who had only E148Q mutation were found to have the oldest mean age of disease onset and lowest mean disease severity score. Attack frequency and colchicine doses were lower in patients with only E148Q mutation as compared with the other two groups. The frequency of clinical findings such as fever, abdominal pain, arthralgia, and arthritis among the three groups was similar. Conclusion Familial Mediterranean fever patients with only E148Q mutation are presenting with late‐onset and milder disease course despite having similar clinical findings as compared with patients who had other mutations. Finally, we imply that E148Q is a mutation and colchicine treatment should be given.
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Affiliation(s)
- Fatma Aydın
- Department of Pediatric Rheumatology, Ankara University School of Medicine, Ankara, Turkey
| | - Nilgün Çakar
- Department of Pediatric Rheumatology and Nephrology, Ankara University School of Medicine, Ankara, Turkey
| | - Zeynep Birsin Özçakar
- Department of Pediatric Rheumatology and Nephrology, Ankara University School of Medicine, Ankara, Turkey
| | - Nermin Uncu
- Department of Pediatric Rheumatology and Nephrology, Ankara, Child Health, Hematology and Oncology Education and Research Hospital, Ankara, Turkey
| | - Özge Başaran
- Department of Pediatric Rheumatology, Ankara, Child Health, Hematology and Oncology Education and Research Hospital, Ankara, Turkey
| | - Semanur Özdel
- Department of Pediatric Rheumatology, Ankara University School of Medicine, Ankara, Turkey
| | - Elif Çelikel
- Department of Pediatric Rheumatology, Ankara University School of Medicine, Ankara, Turkey
| | - Atilla H Elhan
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
| | - Fatoş Yalçınkaya
- Department of Pediatric Rheumatology and Nephrology, Ankara University School of Medicine, Ankara, Turkey
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9
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Lundgren-Nilsson Å, Dencker A, Palstam A, Person G, Horton MC, Escorpizo R, Küçükdeveci AA, Kutlay S, Elhan AH, Stucki G, Tennant A, Conaghan PG. Patient-reported outcome measures in osteoarthritis: a systematic search and review of their use and psychometric properties. RMD Open 2018; 4:e000715. [PMID: 30622735 PMCID: PMC6307597 DOI: 10.1136/rmdopen-2018-000715] [Citation(s) in RCA: 17] [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: 04/26/2018] [Revised: 10/31/2018] [Accepted: 11/04/2018] [Indexed: 01/11/2023] Open
Abstract
Introduction Patient-reported outcome measures (PROM) or self-completed questionnaires have been used to report outcomes in osteoarthritis (OA) for over 35 years. Choices will always need to be made about what should be measured and, if relevant, what would be the most appropriate PROM to use. The current study aims to describe the available PROMs used in OA and their performance quality, so that informed choices can be made about the most appropriate PROM for a particular task. Methods The study included a systematic search for PROMs that have been in use over 17 years (period 2000–2016), and to catalogue their psychometric properties, and to present the evidence in a user-friendly fashion. Results 78 PROMs were identified with psychometric evidence available. The domains of pain, self-care, mobility and work dominated, whereas domains such as cleaning and laundry and leisure, together with psychological and contextual factors, were poorly served. The most frequently used PROMs included the Western Ontario McMaster Osteoarthritis Index, the Short Form 36 and the Knee Disability and Osteoarthritis Outcome Score which, between them, appeared in more than 4000 papers. Most domains had at least one PROM with the highest level of psychometric evidence. Conclusion A broad range of PROMs are available for measuring OA outcomes. Some have good psychometric evidence, others not so. Some important psychological areas such as self-efficacy were poorly served. The study provides a current baseline for what is available, and identifies the shortfall in key domains if the full biopsychosocial model is to be explored.
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Affiliation(s)
- Åsa Lundgren-Nilsson
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Dencker
- Centre for Person-Centred Care (GPCC), Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annie Palstam
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Mike C Horton
- Psychometric Laboratory for Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Ayse A Küçükdeveci
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Sehim Kutlay
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Atilla H Elhan
- Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Gerold Stucki
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Alan Tennant
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Özdel S, Özçakar ZB, Cakar N, Aydın F, Çelikel E, Elhan AH, Yalçınkaya F. Fatigue in pediatric patients with familial Mediterranean fever. Mod Rheumatol 2018; 28:1016-1020. [DOI: 10.1080/14397595.2018.1427459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Semanur Özdel
- Department of Pediatrics, Division of Pediatric Rheumatology, Ankara University School of Medicine, Ankara, Turkey
| | - Z. Birsin Özçakar
- Department of Pediatrics, Division of Pediatric Rheumatology, Ankara University School of Medicine, Ankara, Turkey
| | - Nilgün Cakar
- Department of Pediatrics, Division of Pediatric Rheumatology, Ankara University School of Medicine, Ankara, Turkey
| | - Fatma Aydın
- Department of Pediatrics, Division of Pediatric Rheumatology, Ankara University School of Medicine, Ankara, Turkey
| | - Elif Çelikel
- Department of Pediatrics, Division of Pediatric Rheumatology, Ankara University School of Medicine, Ankara, Turkey
| | - Atilla H. Elhan
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
| | - Fatoş Yalçınkaya
- Department of Pediatrics, Division of Pediatric Rheumatology, Ankara University School of Medicine, Ankara, Turkey
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Abstract
Purpose To compare the results of viscocanalostomy with and without mitomycin-C (MMC). Methods Retrospective results of 15 standard viscocanalostomy (VCO) operations (Group 1) were compared with the prospective results of 15 VCO operations performed with intraoperative adjunctive MMC (Group 2). MMC (0.2 mg/mL) was applied over and under the superficial scleral flap for 3 minutes in Group 2 before the deep flap was prepared. Each patient was followed up for at least 1 year, and results of examinations in the first 12 months were used in the statistical comparison of the two groups. Surgical success was defined as intraocular pressure (IOP) ≤ 18 mmHg. Results Pr eoperative mean intraocular pressures (IOP) in Group 1 and Group 2 wer e 35.3±11.0 and 39.1±8.9, respectively. Mean IOP levels at the 12th month were 14.4±2.6 and 11.9±4.0, respectively, showing a significant decrease in both groups (p<0.001). Postoperative IOP course appeared to be lower in the MMC group, however, the difference was not statistically significant (p=0.554). Complete success rates without medications were 40% in Group 1 and 67% in Group 2. No significant difference was found between the two groups in terms of early and late postoperative complications, pre- and postoperative number of antiglaucoma medications, and surgical success rates at the end of the study period (p>0.05 for all). A significant difference was verified between the two groups of eyes considering the conjunctival bleb types, as low-lying, localized blebs were the most frequent type in Group 1 and thin-walled, avascular blebs were more predominant in the MMC group (p=0.004). Conclusions Intraoperative adjunctive MMC use might improve the long-term results of viscocanalostomy by facilitating subconjunctival filtration and might widen the indication range of the technique.
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Affiliation(s)
- A Yarangümeli
- Ankara Numune Training and Research Hospital, 1st Eye Clinic, Ankara, Turkey.
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Aktürk S, Erdoğmuş Ş, Kumru G, Elhan AH, Şengül Ş, Tüzüner A, Keven K. Average Tacrolimus Trough Level in the First Month After Transplantation May Predict Acute Rejection. Transplant Proc 2017; 49:430-435. [PMID: 28340806 DOI: 10.1016/j.transproceed.2017.02.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although tacrolimus is one of the essential drugs used for the prevention of rejection in kidney recipients, target trough levels are not well established. In this study, we aimed to investigate the association between average tacrolimus trough levels (TTLs) of the first month after transplantation and biopsy-proven acute rejection (BPAR) during the first 12 months after transplant. METHODS A total of 274 patients who underwent kidney-alone transplantation between 2002 and 2014 were enrolled in the study. Average TTLs of the first month were assessed by means of receiver operating characteristic (ROC) curve analysis to discriminate patients with and those without BPAR. Univariate and multivariate Cox proportional hazards models were used to determine the effect of average TTLs of the first month on BPAR. RESULTS According to ROC curve analysis, the highest area under the curve (AUC) was obtained from 8 ng/mL (AUC = 0.73 ± 0.11; 95% confidence interval [CI], 0.62-0.84). Forty-two (31.8%) of the 132 patients with average TTLs <8 ng/mL and 13 (9.1%) of 142 patients with ≥8 ng/mL had BPAR during the first 12 months after transplant (P < .001). In univariable analysis, average TTLs of the first month <8 ng/mL were associated with higher risk of BPAR (P < .001), and the significance remained in Cox multivariable analysis (hazard ratio, 2.79; 95% CI, 1.76-3.82; P = .001). No significant differences were observed in the glomerular filtration rate, cytomegalovirus, BK viremia, or BK nephropathy between groups at post-transplant month 12. CONCLUSIONS Keeping the average TTLs of the first month after transplantation at ≥8 ng/mL not only prevents BPAR occurrence but also minimizes the toxic effects of the use of a single-trough level.
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Affiliation(s)
- S Aktürk
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey.
| | - Ş Erdoğmuş
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey
| | - G Kumru
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey
| | - A H Elhan
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
| | - Ş Şengül
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey
| | - A Tüzüner
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - K Keven
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey
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Yılmaz S, Özçakar ZB, Kurt Şükür ED, Bulum B, Kavaz A, Elhan AH, Yalçınkaya F. Vesicoureteral Reflux and Renal Scarring Risk in Children after the First Febrile Urinary Tract Infection. Nephron Clin Pract 2016; 132:175-80. [DOI: 10.1159/000443536] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/19/2015] [Indexed: 11/19/2022] Open
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Özdel S, Özçakar Z, Kunt SŞ, Elhan AH, Yalçınkaya F. Late-onset disease is associated with a mild phenotype in children with familial Mediterranean fever. Clin Rheumatol 2016; 35:1837-40. [DOI: 10.1007/s10067-016-3196-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/22/2016] [Accepted: 01/25/2016] [Indexed: 01/01/2023]
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Idilman R, Gunsar F, Koruk M, Keskin O, Meral CE, Gulsen M, Elhan AH, Akarca US, Yurdaydin C. Long-term entecavir or tenofovir disoproxil fumarate therapy in treatment-naïve chronic hepatitis B patients in the real-world setting. J Viral Hepat 2015; 22:504-10. [PMID: 25431108 DOI: 10.1111/jvh.12358] [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: 07/14/2014] [Accepted: 09/30/2014] [Indexed: 12/12/2022]
Abstract
The aim of this study was to determine the long-term efficacy of entecavir (ETV) and tenofovir disoproxil fumarate (TDF) on the natural course of disease in chronic hepatitis B patients (CHB) with/without cirrhosis in clinical practice. A total of 355 treatment-naïve CHB patients were enrolled into the study. The primary outcome measure was viral suppression as defined by serum HBV DNA level <20 IU/mL. A secondary outcome measure was to determine the development of Hepatocellular carcinoma (HCC). Virological and biochemical responses were similar between the two treatment groups over time. The presence of cirrhosis and hepatitis B e antigen (HBeAg) positivity did not appear to impact viral suppression. The cumulative probability of HBeAg loss was 41% at 4 years of therapy. Hepatitis B surface antigen (HBsAg) loss occurred in four patients. Model for End-Stage Liver Disease score was significantly improved from baseline to week 48 and 96 under antiviral therapy (P = 0.013, P = 0.01). HCC was diagnosed in 17 patients (4.8%). The cumulative probability of the development of HCC was 3.3% at 1 year and 7.3% at 4 years of therapy. The development of HCC was independently associated with older age (P = 0.031) and the presence of cirrhosis (P = 0.004). Serum creatinine levels and creatinine clearance remained stable over time. ETV and TDF effectively maintained virological and biochemical responses in long-term follow-up of CHB patients with/without cirrhosis. HCC may still develop, although at a lower rate, and is more likely to develop in patients with cirrhosis, especially in older patients.
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Affiliation(s)
- R Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
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16
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Kapuağası A, Özcan A, Şencan İ, Aydın MA, Öztürk M, Uzundurukan Z, Elhan AH, Başar H, Kaymak Ç. OUTCOME OF LIVING KIDNEY DONORS ACCORDING TO NATIONAL DATA OF TURKISH ORGAN AND TISSUE INFORMATION SYSTEM. Intensive Care Med Exp 2015. [PMCID: PMC4797084 DOI: 10.1186/2197-425x-3-s1-a901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Aribal-Ayral P, Özelçi-Kavas G, Elhan AH. Pycnogenol® supplementation and its beneficial effects in healthy rats. Saudi Med J 2014; 35:195-197. [PMID: 24562522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Affiliation(s)
- Pelin Aribal-Ayral
- Pathophysiology Division, Department of Internal Medicine, Faculty of Medicine, Ankara University, Sihhiye 06100, Ankara, Turkey. Tel. +90 (312) 5958230. Fax. 90 (312) 3106370. E-mail:
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Özçakar ZB, Elhan AH, Yalcinkaya F. P01-002 – Comparison between different colchicines responders. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952106 DOI: 10.1186/1546-0096-11-s1-a6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Özçakar ZB, Erdogan BD, Elhan AH, Yalçinkaya F. Familial Mediterranean fever in siblings. J Rheumatol 2012; 39:2170-4. [PMID: 23027888 DOI: 10.3899/jrheum.120530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Genetic and environmental factors have been implicated in disease severity and development of amyloidosis in familial Mediterranean fever (FMF). We investigated similarities in clinical characteristics, disease severity, and treatment response within siblings with FMF. METHODS The study group consisted of 2 or more siblings who were followed in our center with the diagnosis of FMF. Siblings were evaluated for demographic data, clinical and laboratory disease features, genetic analysis of MEFV mutations, and disease severity score. The intraclass correlation coefficient (ICC), which can be interpreted as the expected correlation between 2 siblings, was used to reflect within-family similarity. RESULTS The study included 67 pediatric patients from 31 different families. When we investigated the similarity of siblings after adjusting for genetic effects, we found very low ICC with p > 0.05 in the majority of clinical features, disease severity, and colchicine dosages. However, age at disease onset, age at onset of therapy, attack-free acute-phase reactant levels, and presence of amyloidosis were found to be similar within siblings (relatively high ICC with p < 0.05). CONCLUSION Siblings with FMF had different clinical findings and disease severity. They had similar amyloidogenic potential, proven by both similar presence of amyloid and increased levels of acute-phase reactants between attacks. Our findings strongly support that genetic factors may be more dominant in the development of amyloidosis.
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Affiliation(s)
- Z Birsin Özçakar
- Department of Pediatric Nephrology and Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
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Küçükdeveci AA, Kutlay Ş, Yıldızlar D, Öztuna D, Elhan AH, Tennant A. The reliability and validity of the World Health Organization Disability Assessment Schedule (WHODAS-II) in stroke. Disabil Rehabil 2012; 35:214-20. [PMID: 22671861 DOI: 10.3109/09638288.2012.690817] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE Psychometric properties of the World Health Organization Disability Assessment Schedule (WHODAS-II) in stroke have received some attention recently, mostly using classical approaches, but there is still an absence of investigation from a modern psychometric perspective. This study aimed to test the reliability and validity of the WHODAS-II in stroke, using modern psychometric analysis. METHODS A total of 188 community-dwelling poststroke patients were recruited. Internal construct validity was assessed by Rasch analysis, reliability by internal consistency and person separation index (PSI), and external construct validity by associations with Functional Independence Measure (FIM(™)). RESULTS Rasch analysis indicated that total score (based upon 32 items, omitting the work-related items) was satisfactory, after adjustment for local dependency. The proposed "activities" and "participation" components also satisfied Rasch model expectations. An existing short form was problematic due to inclusion of a work-related item, but an alternative 10-item version was acceptable. Cronbach's α for the WHODAS-II, its domains and components varied between 0.83 and 0.99 and PSI between 0.70 and 0.95. External construct validity was confirmed by expected correlations with FIM(™). CONCLUSIONS WHODAS-II provides a reliable and valid instrument for measuring disability and components of "activities" and "participation" in stroke survivors. Various combinations of the item set may provide a range of scales to suit most research needs.
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Affiliation(s)
- Ayşe A Küçükdeveci
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Ankara University, Ankara, Turkey.
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Özdemir SK, Güloğlu D, Sin BA, Elhan AH, Ikincioğulları A, Mısırlıgil Z. Reliability of basophil activation test using CD203c expression in diagnosis of pollen allergy. Am J Rhinol Allergy 2012; 25:e225-31. [PMID: 22185730 DOI: 10.2500/ajra.2011.25.3723] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND CD203c is a basophil surface marker and its expression is rapidly up-regulated after cross-linking of high-affinity immunoglobulin E (IgE) receptor (FcepsilonR1) by an allergen. CD203c basophil activation tests have been studied for the in vitro diagnosis of several allergic conditions. However, there is limited data about its diagnostic usefulness. The optimum allergen concentrations for stimulation and allergen specific cutoff values remain unknown for a number of allergens. This study was designed to investigate the efficacy of basophil activation test via CD203c in the diagnosis of pollen allergy. METHODS The CD203c basophil activation was determined in 31 allergic rhinitis patients with pollen allergy and 9 healthy nonatopic controls during the off-season. CD203c expression was evaluated using three-color staining protocol by flow cytometry. RESULTS After an in vitro stimulation with grass pollen extract, the CD203c assay clearly discriminated pollen-allergic patients from controls (p < 0.001). A dose-dependent increase in the percentages of CD203c-activated basophils was shown in rhinitis patients with pollen allergy (p < 0.001). The sensitivity and specificity was 100% and optimal cutoff values were 14.05 and 10.05% with 45.1 and 4.5 μg/mL Phl p 5 stimulation, respectively. Although the specificity was also 100%, the sensitivity was 93 and 87% and the cutoff values were 5.40 and 5.35% with 4.5 × 10(-4) and 4.5 × 10(-5) micrograms/mL Phl p 5 stimulation, respectively. CONCLUSION The CD203c basophil activation test seems to be a reliable tool in the diagnosis of grass pollen allergy. It could be used when conventional diagnostic tests fail or can not be performed.
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Affiliation(s)
- Seçil Kepil Özdemir
- Division of Immunology and Allergy Diseases, Ankara University School of Medicine, Ankara, Turkey.
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Özçakar ZB, Yalçınkaya F, Kavaz A, Kadıoğlu G, Elhan AH, Aysev D, Güriz H, Ekim M. Urinary tract infections owing to ESBL-producing bacteria: microorganisms change--clinical pattern does not. Acta Paediatr 2011; 100:e61-4. [PMID: 21392102 DOI: 10.1111/j.1651-2227.2011.02262.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM Urinary tract infections (UTIs) caused by extended-spectrum beta lactamase (ESBL)-producing bacteria have become a growing problem worldwide. The aim of this study was to investigate the clinical and radiological findings in patients with community-acquired UTIs owing to ESBL-producing bacteria. METHODS Files of the patients that had UTI owing to ESBL-producing bacteria, between January 2008 and December 2009, were retrospectively evaluated. RESULTS One hundred and eleven UTI episodes in 94 patients were included. Seventy-five per cent of the patients had recurrent UTIs. Ultrasound, dimercaptosuccinic acid (DMSA) scintigraphy and voiding cystourethrography (VCUG) were found abnormal in 36%, 46% and 31% of the patients, respectively. Overall, 68% of the patients had ≥1 underlying predisposing factor for UTI. Male patients and acute pyelonephritis (APN) episodes were more frequent at small ages. The rate of female patients and cystitis episodes predominated with increasing age. Ultrasound, DMSA scintigraphy, VSUG and UT abnormalities were more frequent in patients with APN, and lower UT disturbances were more frequent in patients with cystitis. CONCLUSION UTIs owing to ESBL-producing bacteria begin to replace UTIs owing to non-ESBL-producing bacteria. However, the clinical pattern of these infections does not seem to be different. Thus, our aim should be to correct underlying predisposing factors in general in order to prevent infections owing to ESBL-producing bacteria.
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Affiliation(s)
- Zeynep Birsin Özçakar
- Department of Pediatric Nephrology, Ankara University School of Medicine, Ankara, Turkey.
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Abstract
AIM This prospective study was conducted to compare changes in the health-related quality of life (HRQoL) and religious practices of patients who underwent surgery for rectal cancer. METHOD We prospectively followed 93 Muslim patients after surgery for colorectal carcinoma: abdominoperineal excision (APE, n = 50), sphincter-saving resection (LAR, n = 22) or anterior resection including sigmoid colectomy (AR, n = 1). The HRQoL was measured pre- and postoperatively at 15-18 months with the Medical Outcomes Study Short Form 36 Health Survey (SF-36) and a modified version of the American Society of Colorectal Surgeons (ASCRS) Fecal Incontinence questionnaire. Life standards, including religious practice, were measured using the Ankara University Life Standard Questionnaire. RESULTS No difference was detected in any SF-36 Health Survey HRQoL domain among the groups, although there were differences within groups before and after surgery. The ASCRS Fecal Incontinence questionnaire scales of lifestyle, coping/behaviour and depression/self-perception were similar in the APE and AR groups and were significantly worse than in the AR group (P ≤ 0.004). The embarrassment scale was worse in the APE than in the LAR and AR groups (P < 0.001). Religious worship (praying alone, praying in mosques, fasting during Ramadan and purifying alms) was not significantly different among the groups. CONCLUSION HRQoL measured by the SF-36 questionnaire and religious practices were not significantly different after APE compared with AR. Ostomy support and pre- and postoperative health-related and religious counselling may have had beneficial effects.
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Affiliation(s)
- H Celasin
- Department of Surgery, University of Ankara, Ankara, Turkey
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Yalcinkaya F, Ozcakar ZB, Tanyildiz M, Elhan AH. Familial Mediterranean fever in small children in Turkey. Clin Exp Rheumatol 2011; 29:S87-S90. [PMID: 21813071] [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: 12/21/2010] [Accepted: 03/07/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Familial Mediterranean fever (FMF) is an autosomal recessive disease, characterised by recurrent, self limited attacks of fever with serositis. The aim of our study was to describe the demographic, clinical and genetic features of FMF patients who had early disease onset and to compare them with late onset patients. Our second aim was to investigate the factors associated with delay in diagnosis. METHODS The study group consisted of recently diagnosed FMF patients who came to routine follow-up visits between January and July 2009. Patients were divided into two groups according to age of disease onset (Group I: ≤ 3 years of age; Group II: >3 years of age). In the second part, patients were analysed according to the duration of delay in diagnosis. RESULTS There were 83 patients in group I and 73 patients in Group II. Median delay in diagnosis was 4 years in Group I and 2 years in Group II (p<0.001). The presence of M694V mutation was more frequent in Group I (81%) as compared to Group II (65%), (p=0.034). Mean attack Hb was lower (p<0.01) and mean attack leukocyte count was higher (p=0.017) in Group I. Final colchicine dosages were higher in Group I as compared to Group II. There was a statistically significant negative correlation between the age at disease onset and period of delay in diagnosis (p<0.001). CONCLUSIONS This study suggests that FMF patients with early disease onset have more severe disease. Moreover, the smaller the age of disease onset, the more likely their diagnoses are delayed.
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Affiliation(s)
- Fatos Yalcinkaya
- Ankara University School of Medicine, Department of Pediatric Nephrology, Ankara, Turkey.
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Halisdemir N, Colak C, Camurdan AD, Ergocen S, Sahin F, Elhan AH. Body mass index percentile curves for predominantly breastfed children aged 0-2 years from Ankara, Turkey. BRATISL MED J 2011; 112:517-520. [PMID: 21954531] [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] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The percentiles of weight, height and body mass index (BMI) change markedly from one country to another and also from one city to another, particularly in childhood. The aim of the present study is to construct BMI percentile curves for predominantly breastfed Turkish children aged 0-2 years from Ankara, Turkey. METHODS The study population consisted of healthy boys and girls aged 0-2 years from the middle-high socioeconomic status between 2002 and 2004 in well child clinic of Gazi University School of Medicine, Ankara, Turkey. The BMI values for boys and girls were calculated from the height and weight measurements, and BMI percentile values and curves were obtained separately for boys and girls by the LMS method. RESULTS The current findings indicate that the BMI percentile values for boys are higher than those for girls in general. The estimated curves for BMI showed that there was a constant increase in BMI values towards 7th or 8th month and a slight decrease until 24th month in both boys and girls. CONCLUSIONS The current study presents percentile curves for BMI values in predominantly breastfed Turkish children aged 0 to 2 years living in Ankara, Turkey. To our knowledge, this is the first study considering BMI percentiles for predominantly breastfed Turkish children aged 0-2 years. However, WHO multicenter growth reference study curves can be used until constructing multicenter BMI reference curves representing Turkey (Fig. 2, Tab. 3, Ref. 19).
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Affiliation(s)
- N Halisdemir
- Firat University, Department of Statistics, Elazig, Turkey.
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Aydinli B, Eke H, Demir A, Sengul EP, Elhan AH, Ozgok A. Anesthetic Management in Geriatric Patients for Urologic Surgery: A Descriptive Retrospective Study. Turk J Anaesthesiol Reanim 2010. [DOI: 10.5222/jtaics.2010.412] [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: 11/05/2022] Open
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Felek SA, Celik H, Islam A, Elhan AH, Demirci M, Samim E. Type 2 ossiculoplasty: prognostic determination of hearing results by middle ear risk index. Am J Otolaryngol 2010; 31:325-31. [PMID: 20015772 DOI: 10.1016/j.amjoto.2009.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 03/04/2009] [Accepted: 03/10/2009] [Indexed: 11/28/2022]
Abstract
PURPOSE The aims of this study were to investigate the prognostic impact of middle ear risk index on the postoperative hearing results in cases with type 2 ossiculoplasty; to compare the middle ear risk index results among primary, staged, and revision cases; and to compare the results of the prostheses used in ossicular reconstruction. MATERIAL AND METHODS Records of 293 patients who had canal wall up tympanomasteidectomy and type 2 ossiculoplasty due to chronic otitis media between November 1995 and November 2007 were reviewed retrospectively. RESULTS The mean preoperative air-bone gap was 32.6 dB, and it decreased to 15.2 dB after a mean follow-up period of 26.8 months postoperatively. The mean change of air-bone gap was 17.4 dB. Postoperative air-bone gap was 20 dB or less in 79% of the cases. The patients with dry perforations were in the low-risk group, and 91% of them had an air-bone gap of 20 dB or less. This value was 86% in the ones with intact malleus. The patients who had primary surgery were found in moderate risk group, whereas staged and revision groups were in the high-risk group. The air-bone gap was 20 dB or less in 84%, 78%, and 59%, respectively, of those groups. The difference between the primary and the revision groups reached a statistical significance. CONCLUSIONS We had the best ossicular reconstruction results with glass ionomer cement, whereas the worst results were obtained with allograft partial ossicular replacement prostheses. We determined that risk-reducing factors such as dry ear, minimal ossicular chain defect, and intact malleus were important to have successful results. The middle ear risk index is a valuable tool for the surgeon to judge the risks and the probability success of the procedure as well as to make a good patient selection.
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Affiliation(s)
- Sevim Aslan Felek
- Ministry of Health Ankara Training and Research Hospital, 2nd E.N.T. Department, Ankara, Turkey.
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Kutlay S, Küçükdeveci AA, Elhan AH, Oztuna D, Koç N, Tennant A. Validation of the World Health Organization disability assessment schedule II (WHODAS-II) in patients with osteoarthritis. Rheumatol Int 2009; 31:339-46. [PMID: 20020133 DOI: 10.1007/s00296-009-1306-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 11/29/2009] [Indexed: 12/26/2022]
Abstract
The objective of this study is to test the reliability and validity of WHODAS-II (Turkish version) for the assessment of disability in patients with osteoarthritis. This study is designed as follows: the internal construct validity of WHODAS-II in patients with knee osteoarthritis was assessed by Rasch analysis, and external construct validity by association with the Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) and the Nottingham Health Profile (NHP); reliability was tested by internal consistency, intra-class correlation coefficient (ICC) and test-retest ICC. Our study presents the results of 225 outpatients assessed with mean age 58.4 years (SD 11.1) of whom 80.9% were female. Cronbach's α, ICC, and test-retest ICC values for the six subscales of WHODAS-II varied between 0.71 and 0.94, 0.71 and 0.94, and 0.87 and 0.97, respectively. Rasch analysis of WHODAS-II indicated that after adjustment for local dependency, satisfactory fit was achieved. Two separate 'activities' and 'participation' components could also be identified. External construct validity of the scale was confirmed with expected correlations with WOMAC and NHP. This study concludes that WHODAS-II provides a reliable and valid health status instrument for measuring disability and components of 'activities' and 'participation' in patients with osteoarthritis. Thus, it provides the opportunity to model the consequences of disease according to the International Classification of Functioning, Disability and Health framework.
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Affiliation(s)
- Sehim Kutlay
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Ankara, Ankara, Turkey.
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Abstract
The Functional Independence Measure for Children (WeeFIM) instrument has recently been adapted and validated for non-disabled children in Turkey. The aim of this study was to validate the instrument in children with cerebral palsy (CP). One hundred and thirty-four children with CP were assessed using the WeeFIM. Reliability was tested by internal consistency, intraclass and interrater correlation coefficients (ICCs), internal construct validity by Rasch analysis, and external construct validity by correlation with the Denver II Development Test (Denver II). Mean age of the participants (70 females, 64 males) was 4y 6mo (SD 3y 8mo, range 6mo-16y). CP type was: diplegia in 37.3%, hemiplegia in 20.2%, quadriplegia in 8.2%, 'baby at risk' (i.e. infants who show neuromotor delay but cannot be classified in a CP type) in 29.9%, and other in 4.5%. Reliability of the WeeFIM was excellent with high Cronbach's alpha and ICC values ranging between 0.91 and 0.98 for the motor and cognitive scales. After collapsing response categories, both motor and cognitive scales met Rasch model expectations. Unidimensionality of the motor scale was confirmed after adjustment for local dependency of items. There was no substantive differential item functioning and strict unidimensionality for both scales was shown by analysis of the residuals. External construct validity was supported by expected high correlations with developmental ages determined by the social, fine motor function, language, and gross motor function domains of the Denver II. We conclude that the WeeFIM is a reliable and valid instrument for evaluating the functional status of Turkish children with CP.
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Affiliation(s)
- Birkan Sonel Tur
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Turkey
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Kuzu I, Beksac M, Arat M, Celebi H, Elhan AH, Erekul S. Bone Marrow Microvessel Density (MVD) in Adult Acute Myeloid Leukemia (AML): Therapy Induced Changes and Effects on Survival. Leuk Lymphoma 2009; 45:1185-90. [PMID: 15359999 DOI: 10.1080/1042819032000159915] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Based on the strong evidence in favor of an increase in microvessel density (MVD) in hematological malignancies, we evaluated VEGF immunoreactivity and MVD measurement in bone marrow biopsies of 36 AML patients at diagnosis and following therapy. MVD assessment was based on CD31, CD34 expressing vessels. The values were calculated for only one marker if the other vascular marker was positive on blasts, otherwise both markers were used. VEGF immunoreactivity was also scored. Comparison of MVD values of 36 AML patients with 18 non-malignant controls showed a significantly higher MVD in AML (CD31: P = 0.004, CD34: P < 0.001), which is independent of other variables such as cellularity or blast percentage. Following induction chemotherapy, the responders showed a significant decrease in blast counts (P < 0.001), cellularity (P = 0.001) and MVD (P = 0.050) quantification with CD31. Higher baseline MVD (CD34) values were associated with shorter overall survival (P = 0.0027). These results are encouraging for inclusion of MVD enumeration in bone marrow examinations of AML patients at diagnosis as an additional prognostic factor.
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Affiliation(s)
- Isinsu Kuzu
- Department of Pathology, University of Ankara, School of Medicine, Ankara, Turkey
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Kutlay S, Kuçukdeveci AA, Elhan AH, Yavuzer G, Tennant A. Validation of the Middlesex Elderly Assessment of Mental State (MEAMS) as a cognitive screening test in patients with acquired brain injury in Turkey. Disabil Rehabil 2009; 29:315-21. [PMID: 17364781 DOI: 10.1080/09638280600756612] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Assessment of cognitive impairment with a valid cognitive screening tool is essential in neurorehabilitation. The aim of this study was to test the reliability and validity of the Turkish-adapted version of the Middlesex Elderly Assessment of Mental State (MEAMS) among acquired brain injury patients in Turkey. METHODS Some 155 patients with acquired brain injury admitted for rehabilitation were assessed by the adapted version of MEAMS at admission and discharge. Reliability was tested by internal consistency, intra-class correlation coefficient (ICC) and person separation index; internal construct validity by Rasch analysis; external construct validity by associations with physical and cognitive disability (FIM); and responsiveness by Effect Size. RESULTS Reliability was found to be good with Cronbach's alpha of 0.82 at both admission and discharge; and likewise an ICC of 0.80. Person separation index was 0.813. Internal construct validity was good by fit of the data to the Rasch model (mean item fit -0.178; SD 1.019). Items were substantially free of differential item functioning. External construct validity was confirmed by expected associations with physical and cognitive disability. Effect size was 0.42 compared with 0.22 for cognitive FIM. CONCLUSION The reliability and validity of the Turkish version of MEAMS as a cognitive impairment screening tool in acquired brain injury has been demonstrated.
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Affiliation(s)
- Sehim Kutlay
- Department of Physical Medicine and Rehabilitation, University of Ankara, School of Medicine, Turkey.
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Küçükdeveci AA, Kutlay Ş, Elhan AH, Tennant A. Construct validity and reliability of the rivermead behavioural memory test in the Turkish population. Brain Inj 2009; 22:75-82. [DOI: 10.1080/02699050701809011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ozçakar ZB, Yalçinkaya F, Altas B, Ergün H, Kendirli T, Ateş C, Elhan AH, Ekim M. Application of the new classification criteria of the Acute Kidney Injury Network: a pilot study in a pediatric population. Pediatr Nephrol 2009; 24:1379-84. [PMID: 19308461 DOI: 10.1007/s00467-009-1158-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [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: 11/26/2008] [Revised: 02/12/2009] [Accepted: 02/16/2009] [Indexed: 10/21/2022]
Abstract
The purpose of our study was to apply the new classification criteria proposed by the Acute Kidney Injury Network (AKIN) in a pediatric population and to determine the clinical characteristics, laboratory features and outcomes of acute kidney injury (AKI) in a tertiary pediatric nephrology center in Turkey. Patients' charts from January 2003 to August 2008 were retrospectively evaluated. One hundred patients (55 male; 45 female) were enrolled. Median age at the time of AKI was 7 years (range 1 month-18 years). Patients' AKI was classified according to the staging system as follows: 25% stage 1, 36% stage 2 and 39% stage 3. The etiology of AKI was bone marrow transplantation related in 27%, renal disease in 14%, dehydration in 10%, nephrotoxic medication in 8%, cardiac surgery related in 8%, and congenital anomalies in 2%. Multiple etiologic factors with underlying chronic diseases were present in 31% of the patients. Dialysis was needed in 45% of the patients. Mortality rate was 33%. Dialysis need and mortality rate were higher in stage 2 and stage 3 patients, with a more favorable prognosis in stage 1 patients. Mortality rate was higher in patients that had undergone cardiac surgery and in those with multiple etiologic factors. The proposed AKIN staging successfully reflected the course of patients with AKI. The underlying cause of AKI seemed to be an important risk factor for death.
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Affiliation(s)
- Z Birsin Ozçakar
- Division of Pediatric Nephrology, Ankara University School of Medicine, Ankara, Turkey
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Kanpolat Y, Kahilogullari G, Ugur HC, Elhan AH. Computed tomography-guided percutaneous trigeminal tractotomy-nucleotomy. Neurosurgery 2009; 63:ONS147-53; discussion ONS153-5. [PMID: 18728592 DOI: 10.1227/01.neu.0000335029.85402.89] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The destruction of the descending trigeminal tractus in the medulla is known as trigeminal tractotomy (TR), whereas the lesioning of the nucleus caudalis is known as trigeminal nucleotomy (NC). Trigeminal TR and/or NC procedures can be used in a large group of pain syndromes, such as glossopharyngeal, vagal, and geniculate neuralgias, atypical facial pain, craniofacial cancer pain, postherpetic neuralgias, and atypical forms of trigeminal neuralgia. METHODS In this study, anatomic and technical details of the procedure and the experience gained from 65 patients over the course of 20 years are discussed. Patients' pain scores and Karnofsky Performance Scale scores were evaluated pre- and postoperatively (postoperative Day 1). RESULTS The best results were obtained in the second-largest group (vagoglossopharyngeal neuralgia, n = 17) and in geniculate neuralgia (n = 4). Patients with atypical facial pain (n = 21; 13 women, eight men) accounted for the largest group to undergo computed tomography-guided TR-NC surgery; pain relief was achieved in 19 of these patients. In the third-largest group (craniofacial and oral cancer pain, n = 13), 11 of 13 patients were successfully treated with TR-NC. Four of five patients with failed trigeminal neuralgia were also effectively treated with TR-NC. CONCLUSION We propose that computed tomography-guided TR-NC provides direct visualization of the target-electrode relation and can be considered a first-step procedure in patient management. In view of its high efficacy, low complication rate, and minimal invasiveness, computed tomography-guided trigeminal TR-NC is a safe and effective procedure in the treatment of intractable facial pain syndromes.
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Affiliation(s)
- Yucel Kanpolat
- Department of Neurosurgery, School of Medicine, Ankara University, Sihhiye, Turkey.
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Yalçinkaya F, Ozen S, Ozçakar ZB, Aktay N, Cakar N, Düzova A, Kasapçopur O, Elhan AH, Doganay B, Ekim M, Kara N, Uncu N, Bakkaloglu A. A new set of criteria for the diagnosis of familial Mediterranean fever in childhood. Rheumatology (Oxford) 2009; 48:395-8. [PMID: 19193696 DOI: 10.1093/rheumatology/ken509] [Citation(s) in RCA: 263] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Several sets of criteria mainly for adults have been proposed for the diagnosis of FMF. The aim of the present study is to validate the most widely used diagnostic 'Tel Hashomer' criteria in children and to establish a new set of criteria for use in childhood. METHODS The study group consisted of 170 recently diagnosed FMF patients who had mutations at both alleles. They were interviewed about the presence of 35 features and manifestations of FMF at the time of diagnosis. Controls were consecutive patients without FMF (n = 141) who had episodes of fever and clinical features mimicking that of FMF. The diagnostic performance of the candidate features was assessed by multiple logistic regression analysis. RESULTS The sensitivity and specificity of Tel Hashomer criteria in our study group were 98.8 and 54.6%, respectively. The multiple logistic regression analysis showed that 5 (fever, abdominal pain, chest pain, arthritis and family history of FMF) of the 35 candidate criteria discriminate FMF from controls with a sensitivity and specificity of 88.8 and 92.2%, respectively. The presence of two or more of these five criteria diagnosed FMF with a sensitivity of 86.5% and a specificity of 93.6%. CONCLUSION It was demonstrated that although the Tel Hashomer criteria were successful in diagnosing the FMF patients in childhood, its specificity was definitely low in children. The new set of criteria has a high sensitivity and specificity for the diagnosis of FMF and is practical to use on an everyday basis.
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Affiliation(s)
- Fatos Yalçinkaya
- Department of Pediatric Nephrology, Ankara University School of Medicine, Ankara, Turkey.
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Kutlay S, Küçükdeveci AA, Elhan AH, Tennant A. Validation of the Behavioural Inattention Test (BIT) in patients with acquired brain injury in Turkey. Neuropsychol Rehabil 2008; 19:461-75. [PMID: 19085520 DOI: 10.1080/09602010802445421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this descriptive study was to evaluate the construct validity and reliability of the Behavioural Inattention Test (BIT) in patients with acquired brain injury in Turkey. One hundred and eighteen acquired brain injury patients undergoing rehabilitation were assessed by the BIT. Internal construct validity was tested by Rasch analysis; reliability by internal consistency and the Person Separation Index; and external construct validity by associations with physical and cognitive disability. Analysis of the data revealed that some subtests deviated from Rasch model expectation and the conventional subscale of the BIT had an unsatisfactory reliability for individual use. Consequently, a common 10-item scale (BIT-10) was derived from both the behavioural and conventional subscales of the BIT. Reliability of .87 met expectation for individual use. The BIT-10 correlated at .52 with cognitive disability upon admission. As a conclusion the original BIT adapted for use in Turkey was shown to lack reliability and internal construct validity. A revised 10-item new version, BIT-10, gave a valid unidimensional summed score, with high sensitivity and specificity to the original cut points. Reliability of the BIT-10 was high and external construct validity was as expected.
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Affiliation(s)
- Sehim Kutlay
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey.
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Abstract
Abstract
Objective:
The destruction of the descending trigeminal tractus in the medulla is known as trigeminal tractotomy (TR), whereas the lesioning of the nucleus caudalis is known as trigeminal nucleotomy (NC). Trigeminal TR and/or NC procedures can be used in a large group of pain syndromes, such as glossopharyngeal, vagal, and geniculate neuralgias, atypical facial pain, craniofacial cancer pain, postherpetic neuralgias, and atypical forms of trigeminal neuralgia.
Methods:
In this study, anatomic and technical details of the procedure and the experience gained from 65 patients over the course of 20 years are discussed. Patients’ pain scores and Karnofsky Performance Scale scores were evaluated pre- and postoperatively (postoperative Day 1).
Results:
The best results were obtained in the second-largest group (vagoglossopharyngeal neuralgia, n = 17) and in geniculate neuralgia (n = 4). Patients with atypical facial pain (n = 21; 13 women, eight men) accounted for the largest group to undergo computed tomography-guided TR-NC surgery; pain relief was achieved in 19 of these patients. In the third-largest group (craniofacial and oral cancer pain, n = 13), 11 of 13 patients were successfully treated with TR-NC. Four of five patients with failed trigeminal neuralgia were also effectively treated with TR-NC.
Conclusion:
We propose that computed tomography-guided TR-NC provides direct visualization of the target-electrode relation and can be considered a first-step procedure in patient management. In view of its high efficacy, low complication rate, and minimal invasiveness, computed tomography-guided trigeminal TR-NC is a safe and effective procedure in the treatment of intractable facial pain syndromes.
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Affiliation(s)
- Yucel Kanpolat
- Department of Neurosurgery, School of Medicine, Ankara University, Sihhiye, Turkey
| | - Gokmen Kahilogullari
- Department of Neurosurgery, School of Medicine, Ankara University, Sihhiye, Turkey
| | - Hasan C. Ugur
- Department of Neurosurgery, School of Medicine, Ankara University, Sihhiye, Turkey
| | - Atilla H. Elhan
- Department of Biostatistics, School of Medicine, Ankara University, Sihhiye, Turkey
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Erkin G, Elhan AH, Aybay C, Sirzai H, Ozel S. Validity and reliability of the Turkish translation of the Pediatric Evaluation of Disability Inventory (PEDI). Disabil Rehabil 2007; 29:1271-9. [PMID: 17654002 DOI: 10.1080/09638280600964307] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the validity and reliability of the Turkish translation of the original Pediatric Evaluation of Disability Inventory (PEDI). METHOD On May 2003, we received permission from Boston University to translate and use the PEDI for Research purposes. PEDI Functional Skills scale and Caregiver Assistance scale was administered by physiatrists to 573 healthy Turkish children (295 males and 278 females; the age range: 7 months to 7(1/2) years) in two different healthcare centres in Ankara. The Turkish translation of the PEDI was again administered to 102 children after five days in order to assess test-retest reliability. Intraclass correlation coefficients (ICC) and Cronbach's alphas (alpha) were calculated. The test-retest reliability was assessed by Spearman's correlation coefficient. Internal construct validity was assessed by using Rasch unidimensional measurement model. RESULTS High Cronbach's alpha coefficients (> or =0.98), high ICC values (> or =0.96) and high Spearman correlation coefficients (> or =0.86) were found. The internal construct validity was confirmed by good fit to the Rasch measurement model. The fit statistics conducted in the study was acceptable, except for some items. CONCLUSIONS The Turkish translation of the PEDI is valid and reliable for the Turkish child population. We believe that PEDI is a detailed and useful instrument for the evaluation of efficiency of pediatric rehabilitation programme.
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Affiliation(s)
- Gulten Erkin
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey.
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Abstract
OBJECTIVE To evaluate the WeeFIM instrument's reliability and internal construct validity for the Turkish child population. DESIGN License was taken from UDSmr to use the WeeFIM instrument. For the reliability and validity studies of the Turkish translation of the WeeFIM instrument, 573 Turkish nondisabled children were included in the study. The reliability of the instrument was assessed by Cronbach's alpha coefficient, intraclass correlation coefficient (ICC), and test-retest reliability. Internal construct validity was assessed by both using Rasch unidimensional measurement model and testing for differential item functioning for age and gender. RESULTS Cronbach alpha value was 0.99 for motor WeeFIM rating and 0.99 for cognitive WeeFIM rating. ICC was 0.81 for motor WeeFIM rating and 0.92 for cognitive WeeFIM rating. The internal construct validity of the Turkish translation of the WeeFIM instrument was confirmed by excellent fit to the Rasch measurement model. Two subscales were found from the principal component analysis of standardized residual correlation for items. Among the items, bowel management, bladder management, eating, and comprehension showed considerable levels of misfit. CONCLUSIONS The Turkish translation of the WeeFIM instrument is valid, reliable, and practical for the Turkish child population. Further studies are required to determine the cross-cultural validity of the instrument.
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Affiliation(s)
- Canan Aybay
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey
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Gümüş-Akay G, Unal AE, Bayar S, Karadayi K, Elhan AH, Sunguroĝlu A, Tükün A. Telomerase activity could be used as a marker for neoplastic transformation in gastric adenocarcinoma: but it does not have a prognostic significance. Genet Mol Res 2007; 6:41-9. [PMID: 17469053] [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] [Indexed: 05/15/2023]
Abstract
Telomerase activity is responsible for telomere maintenance and is believed to be crucial in most immortal cells and cancer cells; however, its clinicopathological significance in gastric cancer remains to be clarified. The aim of the present study was to assess whether malignant progression of gastric adenocarcinoma correlates with telomerase activity. We also investigated the correlation between telomerase activity and histopathological findings. We examined telomerase activity in tumor specimens and adjacent normal tissues from 43 patients with gastric adenocarcinoma. Telomerase activity was measured quantitatively by the TRAPEZE Gel Based Telomerase Detection Kit. Approximately 98% of the tumor tissues were telomerase positive, but telomerase activity was detected not only in tumor tissues but also in normal gastric mucosa. Although telomerase activity was found to be higher in tumor samples than normal tissue for each subject, we could not find a general cut-off level for telomerase activity in gastric adenocarcinoma. In addition, telomerase activity was not correlated with tumor invasion, lymph node involvement and histological stage. Our results support the idea that telomerase reactivation is a common event in gastric adenocarcinoma and it is not related to histopathological parameters. Since it is difficult to set a cut-off level for this type of cancer, we suggest that the prognostic utility of telomerase assay has not yet reached the clinic in terms of predicting outcome for patients with gastric adenocarcinoma. For the assessment of gastric carcinoma, telomerase activity should be evaluated in both tumor and normal tissues, because normal gastric mucosa samples show appreciable telomerase activity.
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Affiliation(s)
- G Gümüş-Akay
- Department of Medical Biology, Ankara University School of Medicine, Ankara, Turkey.
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Yalçinkaya F, Cakar N, Acar B, Tutar E, Güriz H, Elhan AH, Oztürk S, Kansu A, Ince E, Atalay S, Girgin N, Doğru U, Aysev D, Ekim M. The value of the levels of acute phase reactants for the prediction of familial Mediterranean fever associated amyloidosis: a case control study. Rheumatol Int 2006; 27:517-22. [PMID: 17103173 DOI: 10.1007/s00296-006-0265-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2006] [Accepted: 10/18/2006] [Indexed: 11/26/2022]
Abstract
In order to determine the role of levels of acute phase proteins (APPs) for the development of amyloidosis in familial Mediterranean fever (FMF) patients, the levels of serum amyloid A (SAA), C reactive protein (CRP), fibrinogen and erythrocyte sedimentation rate were measured in paired sera of 36 FMF patients during and in between acute attacks, 39 of their healthy parents (obligate heterozgotes), and 15 patients with FMF associated amyloidosis. To compare the levels of APPs, 39 patients with chronic infections or inflammatory diseases who may develop secondary amyloidosis, 20 patients with acute infections who are known to have elevated acute phase response but will never develop amyloidosis and 19 healthy controls were included. The median levels of all APPs are increased in the patients with FMF during attacks and a significant decrease was observed after the attack was over. The level of SAA was above reference range in all FMF patients during the attack free period and the level of at least one other APP was also above normal in 64% of the patients. Both CRP and SAA levels were found to be higher in obligate heterozygotes compared to controls. The levels of SAA in patients with FMF during the attack-free period, obligate heterozygotes and patients with FMF-amyloidosis were found to be similar. The levels in each group were found to be higher than SAA levels found in healthy controls yet lower than the levels measured in the patients with acute infections and patients with chronic inflammation or chronic infections. In conclusion, our results show that SAA level reflects subclinical inflammation with high sensitivity but its value for the prediction of amyloid formation process seems to be low.
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Affiliation(s)
- F Yalçinkaya
- Department of Pediatric Nephrology, Ankara University Faculty of Medicine, 38. Cadde, Mehmet Cakir Apt. 5/20, Cukurambar, Ankara, Turkey
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Abstract
It is suggested that leptin may be involved in inflammation. Although relation between leptin levels and active pulmonary tuberculosis has been studied, there is no information about relation between leptin levels and tuberculous pleural effusions (TPE). We evaluated the diagnostic value of pleural fluid and serum leptin levels in TPE and compared them with adenosine deaminase (ADA). Forty-five patients, 17 tuberculous effusion and 28 nontuberculous effusion, with exudative pleural effusions were included. Leptin and ADA levels were measured from serum and pleural fluid in all patients. There were no statistically significant differences between tuberculous and nontuberculous groups with respect to the serum ADA activity and pleural fluid/serum leptin ratio. On the contrary, pleural fluid leptin level, pleural fluid ADA activity, serum leptin level and pleural fluid/serum ADA activity ratio were statistically different between tuberculous and nontuberculous groups. When leptin levels were corrected for body mass index, serum leptin levels did not reach statistical significance. Cut-off points to predict tuberculosis were calculated as 9.85 ng/ml and 35.55 U/l for pleural fluid leptin level and pleural fluid ADA activity, respectively. Sensitivity, specificity and area under the curve +/- standard error were 82.4%, 82.1%, 0.83 +/- 0.07 for pleural fluid leptin levels and 100%, 100%, 1.00 +/- 0.00 for pleural fluid ADA activity, respectively; the difference between these curves was significant (p = 0.01). Pleural fluid leptin levels were lower in tuberculous effusions than in other exudates. Pleural fluid leptin has a diagnostic value for TPE but not as good as that of ADA.
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Affiliation(s)
- G Celik
- Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey.
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Kuzu MA, Terzioğlu H, Genç V, Erkek AB, Ozban M, Sonyürek P, Elhan AH, Torun N. Preoperative nutritional risk assessment in predicting postoperative outcome in patients undergoing major surgery. World J Surg 2006; 30:378-90. [PMID: 16479353 DOI: 10.1007/s00268-005-0163-1] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Although a variety of nutritional indices have been found to be valuable in predicting patient outcome when used alone, there is no consensus on the best method for assessing the nutritional status of hospitalized patients. Therefore, the aim of this study was to assess the nutritional status of a cohort of patients who underwent major elective surgery using the Nutritional Risk Index (NRI), Maastricht Index (MI), Subjective Global Assessment (SGA), and Mini Nutritional Assessment (MNA) to determine the best possible nutrition screening system in surgical practice. METHODS The study population consisted of 460 patients who underwent major elective surgery between December 1999 and March 2002. Each patient had a complete set of the three nutritional assessment techniques (NRI, MI, SGA); in addition, the MNA was performed in patients older than 59 years of age. One of the coauthors who was unaware of the nutritional assessments assessed the patients for postoperative morbidity and mortality. Complications were classified as major or minor and as infectious or noninfectious. To assess the predictive value of the assessment techniques, likelihood ratios were calculated for the various strata of each method. The odds ratio and receiver operating characteristic (ROC) curves were also calculated to describe and compare the diagnostic value of each of the four nutrition indices. RESULTS Twenty patients died during the study period. No complications occurred in 329 of the 460 patients; 42 patients suffered from two or more complications. The frequency of malnutrition was found to be 58.3%, 63.5%, and 67.4% as assessed by the SGA, NRI, and MI, respectively. Morbidity rates, especially severe infectious and noninfectious complications, were significantly higher in malnourished patients in all nutritional indices. The likelihood ratio was well correlated with the risk categories of every nutritional index. The area under the ROC curves revealed that each scoring system proved to be significantly powerful in predicting the morbidity (infectious and noninfectious severe morbidity) and mortality. However, no differences were detected among the nutritional indices in 460 patients. The odds ratio for morbidity between the well nourished and malnourished patients was 3.09 [95% confidence interval (CI), 1.96-4.88], 3.47 (95% CI, 2.12-5.68), 2.30 (95% CI, 1.43-3.71), and 2.81 (95% CI, 0.79-9.95) for the SGA, NRI, MI, and MNA, respectively. All indices except the MNA were significantly predictive for morbidity. The odds ratios were not statistically different among the indices. CONCLUSIONS Our findings revealed that all nutritional assessment techniques can be safely applied to the clinical setting with no significant difference in predictive value. We therefore strongly recommend the use of any of these techniques to improve the outcome of surgical care. Meanwhile, further investigations are needed, and much effort must be given to find the best method for assessing nutritional status.
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Affiliation(s)
- Mehmet A Kuzu
- Department of Surgery, Ankara University School of Medicine, Dekanlik Binasi, Sihhiye, Ankara, 06100, Turkey.
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Abstract
PURPOSE To evaluate the corneal sensitivity and nerve morphology in dry eyes. METHODS A total of 32 eyes of 16 patients (10 Sjogren's syndrome and six non-Sjogren's syndrome) and 19 eyes of 10 age-matched controls were studied. Sensitivity of the central cornea was measured by the Cochet-Bonnet aesthesiometer. The morphology of corneal nerves was studied by in vivo confocal microscopy (ConfoScan 2.0, Fortune Technologies Srl, Vigonza (PD), Italy). Sub-basal epithelial nerve plexus, subepithelial nerve plexus, and stromal nerves were localized and evaluated for the number of nerves, thickness, reflectivity, and tortuosity for each frame. RESULTS The mean corneal sensitivity of dry eye patients (5.6 mm/grs/S) was found significantly lower than that of the control (5.0 mm/grs/S) group (P<0.01). Although the subepithelial nerves were thicker in dry eyes (mean: 6.38+/-1.18 microm) than control eyes (mean: 5.72+/-1.27 microm), this difference was not significant (P>0.05). CONCLUSION Decreased corneal sensitivity is not associated with morphological changes of corneal nerves in dry eyes.
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Affiliation(s)
- B M Hoşal
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Mamak, Ankara, Turkey
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Tennant A, Küçükdeveci AA, Kutlay S, Elhan AH. Assessing normative cut points through differential item functioning analysis: an example from the adaptation of the Middlesex Elderly Assessment of Mental State (MEAMS) for use as a cognitive screening test in Turkey. Health Qual Life Outcomes 2006; 4:18. [PMID: 16556299 PMCID: PMC1479316 DOI: 10.1186/1477-7525-4-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Accepted: 03/23/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Middlesex Elderly Assessment of Mental State (MEAMS) was developed as a screening test to detect cognitive impairment in the elderly. It includes 12 subtests, each having a 'pass score'. A series of tasks were undertaken to adapt the measure for use in the adult population in Turkey and to determine the validity of existing cut points for passing subtests, given the wide range of educational level in the Turkish population. This study focuses on identifying and validating the scoring system of the MEAMS for Turkish adult population. METHODS After the translation procedure, 350 normal subjects and 158 acquired brain injury patients were assessed by the Turkish version of MEAMS. Initially, appropriate pass scores for the normal population were determined through ANOVA post-hoc tests according to age, gender and education. Rasch analysis was then used to test the internal construct validity of the scale and the validity of the cut points for pass scores on the pooled data by using Differential Item Functioning (DIF) analysis within the framework of the Rasch model. RESULTS Data with the initially modified pass scores were analyzed. DIF was found for certain subtests by age and education, but not for gender. Following this, pass scores were further adjusted and data re-fitted to the model. All subtests were found to fit the Rasch model (mean item fit 0.184, SD 0.319; person fit -0.224, SD 0.557) and DIF was then found to be absent. Thus the final pass scores for all subtests were determined. CONCLUSION The MEAMS offers a valid assessment of cognitive state for the adult Turkish population, and the revised cut points accommodate for age and education. Further studies are required to ascertain the validity in different diagnostic groups.
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Affiliation(s)
- Alan Tennant
- Academic Unit of Musculoskeletal Disease, University of Leeds, UK
| | - Ayse A Küçükdeveci
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Ankara, Turkey
| | - Sehim Kutlay
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Ankara, Turkey
| | - Atilla H Elhan
- Department of Biostatistics, School of Medicine, University of Ankara, Turkey
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Bakkaloglu SA, Soylemezoglu O, Buyan N, Oktar SO, Funahashi T, Pasaoglu H, Elhan AH, Peru H, Hasanoglu E. Adiponectin levels and arteriosclerotic risk factors in pediatric renal transplant recipients. Pediatr Transplant 2006; 10:187-92. [PMID: 16573605 DOI: 10.1111/j.1399-3046.2005.00422.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
ADPN, a recently discovered adipocytokine, has attracted great attention because of its anti-atherogenic properties. It was suggested as a protective factor for the cardiovascular system because of its close correlation with several risk factors. Our aim was to investigate serum ADPN levels in pediatric RTR and to document possible relationships between ADPN and arteriosclerotic risk factors. Twenty-one RTR, aged 16.3 +/- 4.0 yr, and 23 healthy age and sex-matched control subjects were enrolled in this study. Serum lipid/lipoprotein fractions, homocysteine and ADPN levels as well as intima-media thickness of the cIMT were determined in both groups. Significantly higher serum ADPN (p < 0.001) and homocysteine (p < 0.05) levels as well as higher cIMT (p < 0.001) were found in RTR compared with the control subjects, whereas apolipoprotein B and lipoprotein (a) levels were not significantly different. HDL cholesterol was positively correlated with log ADPN (r = 0.585, p < 0.01). There were inverse correlations between log time post-transplantation and log ADPN as well as HDL cholesterol (r = -0.438, p < 0.05 and r = -0.578, p < 0.05, respectively). There were no correlation between log ADPN, log homocysteine, log apolipoprotein B, lipoprotein (a), creatinine clearance and cumulative steroid dose. Despite reasonable lipid profiles and remarkably elevated ADPN levels, our pediatric RTR with stable graft function displayed a risk for arteriosclerosis because of increased cIMT and mild hyperhomocysteinemia. Regarding the close positive correlation between ADPN and HDL cholesterol, it could be speculated that ADPN is a novel negative surrogate marker of arteriosclerosis. To our knowledge, this is the only report investigating levels and diverse correlates of ADPN in a pediatric RTR group. Further studies in larger groups of recipients are needed to clarify the interaction between arteriosclerotic risk factors and ADPN.
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Abstract
AIM To determine the effect of sildenafil citrate on the nocturnal penile erections (i.e. time to onset, the duration of erection, and the interval between first and second erections) of healthy young men. METHODS Twenty-two potent men, 23-29 years old, were recruited for the study. All subjects completed three sessions over consecutive nights using the RigiScan monitoring device (Dacomed, Minneapolis, USA). After a first night of adaptation, night 2 records were their baseline values, and on night 3 they received 100 mg of sildenafil citrate. Statistical comparisons were done between the second and third night data. RESULTS The mean time to onset of the first erection with sildenafil citrate was (34+/-18) min, whereas it was (74+/-24) min (P 0.0001) without sildenafil citrate. The number of erections observed during the first 5 h after sildenafil citrate medication was 3.6+/-0.5 in contrast to 2.4+/-0.5 with no medication (P=0.001). The interval between first and second erections was shorter with sildenafil citrate: (52+/-26) min vs. (85+/-34) min (P = 0.01). The duration of the last erection was statistically significantly longer with the sildenafil citrate: (64 +/-33) min vs. (42 +/-28) min (P 0.001). CONCLUSION Healthy young men achieved erection within 34 min after sildenafil citrate administration, which is shorter than the 1 h interval proposed by the manufacturer. The interval between the first and second erections was shorter and the duration of the last nocturnal erection was longer.
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Affiliation(s)
- Onder Yaman
- Department of Urology, University of Ankara, School of Medicine, Ankara, Turkey.
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Yarangümeli A, Davutluoglu B, Köz OG, Elhan AH, Yaylaci M, Kural G. Glaucomatous damage in normotensive fellow eyes of patients with unilateral hypertensive pseudoexfoliation glaucoma: normotensive pseudoexfoliation glaucoma? Clin Exp Ophthalmol 2006; 34:15-9. [PMID: 16451253 DOI: 10.1111/j.1442-9071.2006.01140.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The objective of the study was to investigate the prevalence of glaucomatous damage in normotensive fellow eyes of patients with unilateral high-tension pseudoexfoliation (PX) glaucoma. METHODS Initial examination records of 111 patients with unilateral PX glaucoma with intraocular pressure (IOP) > or = 22 mmHg in the hypertensive eye and IOP < or = 21 mmHg in the normotensive fellow eye without any prior antiglaucomatous treatment were retrospectively studied. Visual field and optic disc examination results were evaluated for glaucomatous damage in the normotensive eyes. RESULTS Glaucomatous changes were detected in 45 of the 111 fellow eyes (40%). The damage was mild in 25 eyes (22%), moderate in 18 eyes (16%), and severe in 2 (2%). The factors significantly associated with glaucomatous findings in the normotensive eyes were clinical detection of PX, higher age (> or =70 years), higher maximal IOP (> or =18 mmHg) and wider IOP fluctuation (> or =6 mmHg) in the univariate analyses. In the multivariate analysis, associated factors remained as higher maximal IOP (odds ratio = 7.92, confidence interval = 2.82-22.23, P < 0.001) and wider IOP fluctuation (odds ratio = 5.67, confidence interval = 2.05-15.74, P = 0.001). CONCLUSION Normotensive fellow eyes of patients with unilateral high-tension PX glaucoma are under significant risk of glaucomatous damage, related with the level and the fluctuation range of IOP.
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Affiliation(s)
- Alper Yarangümeli
- Eye Clinic I, Ankara Numune Training and Research Hospital, A. Ayranci 06540, Ankara, Turkey.
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Elhan AH, Kutlay S, Küçükdeveci AA, Cotuk C, Oztürk G, Tesio L, Tennant A. Psychometric properties of the Mini-Mental State Examination in patients with acquired brain injury in Turkey. J Rehabil Med 2005; 37:306-11. [PMID: 16203619 DOI: 10.1080/16501970510037573] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To evaluate the psychometric properties of Mini-Mental State Examination (MMSE) in patients with acquired brain injury in Turkey. METHODS A total of 207 patients with acquired brain injury were assessed. Reliability was tested by internal consistency and the person separation index; internal construct validity by Rasch analysis; external construct validity by correlation with cognitive disability; and cross-cultural validity by differential item functioning analysis compared with Italian MMSE data. RESULTS Reliability was adequate with a Cronbach's alpha of 0.75 and person separation index of 0.76. After collapsing some categories, and adjustment for differential item functioning, internal construct validity was supported by fit of the data to Rasch model. Differential item functioning for culture was found in 2 items and after adjustment, data could be pooled between Turkey and Italy. External construct validity was supported by expected associations. CONCLUSION The Turkish version of the Mini-Mental State Examination can be used as a cognitive screening tool in acquired brain injury. Cross-cultural validity between Italy and Turkey is supported, given appropriate adjustment for differential item functioning. However, shortfalls in reliability at the individual level, as well as the presence of differential item functioning suggest that a better instrument should be developed to screen for cognitive deficits following acquired brain injury.
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Affiliation(s)
- Atilla H Elhan
- Department of Biostatistics, School of Medicine, Anakara University, Turkey
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