Araştırma Çıktıları
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Item Factors Affecting Inadequate Empirical Antimicrobial Therapy and the Clinical Course of Upper Urinary Tract Infections in Elderly Patients: A Multicenter Study(GALENOS YAYINCILIK, 2020-01-01) Korkmaz, Pinar; Kurtaran, Behice; Ozdemir Armagan, Sule; Turan Ozden, Hale; Kacar, Fatma; Ates, Selma; Durmus, Gul; Bayindir Bilman, Fulya; Uygun Kizmaz, Yesim; Hamidi, Aziz Ahmad; Ozdemir, Burcu; Burcu Yikilgan, Aslihan; Firat, Pinar; Inan, Asuman; Okay, Gulay; Isik, Mehmet Emirhan; But, Ayse; Ugurlu, Kenan; Harman, Rezan; Ergut Sezer, Busra; Doyuk Kartal, Elif; Kuscu, Ferit; Sener, Alper; Mistanoglu Ozatag, Duru; Tukenmez Tigen, Elif; Dagli, Ozgur; Kocak, Funda; Kusoglu, Hulya; Erturk Sengel, Buket; Demirel, Aslihan; Naz, Hasan; Agalar, Canan; Ozturk Engin, Derya; Dokmetas, Ilyas; Cancan Gursul, Nur; Yilmaz Karadag, Fatma; Cayiroz, Mehmet Umut; Kurekci, Yesim; Kadanali, Ayten; Cakar, Zeynep Sule; Savasci, Umit; Erdem, Ilknur; Cagan Aktas, SabahatIntroduction: In this study, we aimed to determine the risk factors associated with inadequate empirical antibiotherapy (IEAT) and hospital-related mortality in elderly patients being treated for upper urinary tract infections (UTI). Materials and Methods: This study included individuals aged 65 years and over who were hospitalized after being diagnosed of community-acquired UTI or community-onset healthcare-associated UTI and followed-up in clinics and/or intensive care units (ICU) of 33 hospitals between March and September 2017. Results: A total of 525 patients (48\% malesItem Are surgical and non-operating room intervention safe in the COVID-19 pandemic? A retrospective study(CAMBRIDGE UNIV PRESS, 2021-01-01) Yildirim, Serap Aktas; Sarikaya, Zeynep Tugce; Ulugol, Halim; Ozata, Sanem; Aksu, Ugur; Toraman, Fevzi; Grp, C. O. V. I. D.-19 StudyLittle is known about the impact of COVID-19 on the outcomes of patients undergoing surgery and intervention. This study was conducted between 20 March and 20 May 2020 in six hospitals in Istanbul, and aimed to investigate the effects of surgery and intervention on COVID-19 disease progression, intensive care (ICU) need, mortality and virus transmission to patients and healthcare workers. Patients were examined in three groups: group I underwent emergency surgery, group II had an emergency non-operating room intervention, and group III received inpatient COVID-19 treatment but did not have surgery or undergo intervention. Mortality rates, mechanical ventilation needs and rates of admission to the ICU were compared between the three groups. During this period, patient and healthcare worker transmissions were recorded. In total, 1273 surgical, 476 non-operating room intervention patients and 1884 COVID-19 inpatients were examined. The rate of ICU requirement among patients who had surgery was nearly twice that for inpatients and intervention patients, but there was no difference in mortality between the groups. The overall mortality rates were 2.3\% in surgical patients, 3.3\% in intervention patients and 3\% in inpatients. COVID-19 polymerase chain reaction positivity among hospital workers was 2.4\%. Only 3.3\% of infected frontline healthcare workers were anaesthesiologists. No deaths occurred among infected healthcare workers. We conclude that emergency surgery and non-operating room interventions during the pandemic period do not increase postoperative mortality and can be performed with low transmission rates.Item Serum Vitamin D Level at ICU Admission and Mortality(AVES, 2017-01-01) Atalan, Hakan Korkut; Gucyetmez, BulentObjective: Vitamin D is a fat-soluble vitamin that plays a major role in the regulation of bone and calcium metabolism and has effects on the immune and cardiovascular systems. Vitamin D deficiency is commonly seen in the general population as well as in critically ill patients and is reported to be associated with increased mortality and morbidity. Our aim was to determine the relationship between vitamin D level at ICU admission and mortality. Methods: A total of 491 patients admitted to the ICU between January 2014 and January 2015 were evaluated retrospectively. The patients who were under 18 years old, had elective surgery, or whose serum vitamin D levels and outcomes were unknown were excluded. The patient's age, gender, APACHE II score, number of organ dysfunction, serum vitamin D level at ICU admission and outcomes were recorded. Results: Vitamin D level was low (<25 ng dL(-1)) in 166 (77.1\%) of the patients. In non-survivor patients, APACHE II score and the number of organ dysfunction were significantly higher than the survivor patients (p<0.001 and p<0.001). There was a negative correlation between vitamin D level and APACHE II score (r(2)=0.04, p=0.006). In multivariate analyses, the likelihood of mortality was increased 9.8-fold (range 4.2-17.6) and 8.9-fold (range 3.9-14.1) with an APACHE II score >= 24 and the number of organ dysfunction >= 2, respectively (p<0.001 and p<0.001). Conclusion: Vitamin D deficiency is commonly seen in intensive care patients. Although it is not an independently decisive factor for mortality, it might be related with poor clinical status at ICU admission. The APACHE II score and number of organ dysfunction are still important parameters for increased mortality.Item Obesity might be a good prognosis factor for COPD patients using domiciliary noninvasive mechanical ventilation(DOVE MEDICAL PRESS LTD, 2016-01-01) Altinoz, Hilal; Adiguzel, Nalan; Salturk, Cuneyt; Gungor, Gokay; Mocin, Ozlem; Takir, Huriye Berk; Kargin, Feyza; Balci, Merih; Dikensoy, Oner; Karakurt, ZuhalCachexia is known to be a deteriorating factor for survival of patients with chronic obstructive pulmonary disease (COPD), but data related to obesity are limited. We observed that obese patients with COPD prescribed long-term noninvasive mechanical ventilation (NIMV) had better survival rate compared to nonobese patients. Therefore, we conducted a retrospective observational cohort study. Archives of Thoracic Diseases Training Hospital were sought between 2008 and 2013. All the subjects were prescribed domiciliary NIMV for chronic respiratory failure secondary to COPD. Subjects were grouped according to their body mass index (BMI). The first group consisted of subjects with BMI between 20 and 30 kg/m(2), and the second group consisted of subjects with BMI >30 kg/m(2). Data obtained at the first month's visit for the following parameters were recorded: age, sex, comorbid diseases, smoking history, pulmonary function test, 6-minute walk test (6-MWT), and arterial blood gas analysis. Hospital admissions were recorded before and after the domiciliary NIMV usage. Mortality rate was searched from the electronic database. Overall, 118 subjects were enrolled. Thirty-eight subjects had BMI between 20 and 30 kg/m(2), while 80 subjects had BMI >30 kg/m(2). The mean age was 65.8+/-9.4 years, and 81\% were male. The median follow-up time was 26 months and mortality rates were 32\% and 34\% for obese and nonobese subjects (P=0.67). Improvement in 6-MWT was protective against mortality. In conclusion, survival of obese patients with COPD using domiciliary NIMV was found to be better than those of nonobese patients, and the improvement in 6-MWT in such patients was found to be related to a better survival.Item Graft and Patient Survival in Kidney Transplant Recipients Over the Age of Sixty-Five(CUREUS INC, 2022-01-01) Yilmaz, Gulay; Ozdemir, Ebru; Yildar, Murat; Karayagiz, Hamit; Berber, Ibrahim; Cakir, UlkemIntroduction: Elderly patients have increased morbidity and mortality compared to younger patients due to existing comorbid diseases and chronic immunosuppression. Therefore, the option of kidney transplantation for renal replacement therapy in elderly patients is still being controversial. Our aim in this study was to evaluate graft function, graft and patient survival, and associated factors in kidney transplant recipients over 65 years of age, at 11 years of follow-up. Methods: The study included 53 patients aged 65-76 years, out of a total of 1319 patients who underwent live kidney transplantation in the Organ Transplant Center of Acibadem International Hospital between October 2010 and July 2021. Demographic characteristics and creatinine values were recorded. Graft survival rates and patient survival rates at one, three, and five years were analyzed. Results: Fifty-three patients, 14 female, 39 male, aged 65-76 years were included in the study. The follow-up period of the patients was 7-125 months. During the follow-up, 20 patients died. Graft loss occurred in two of 20 patients who died, and 18 patients died with working grafts. Graft loss developed in two of the 33 surviving patients. In the whole group, one-, three-, and five-year patient survival rates were 94\%, 81\%, and 76\%, respectively. Conclusion: These results emphasize that kidney transplantation is a viable treatment option in elderly patients who have been well evaluated before kidney transplantation.Item Assessment of clinical outcomes in renal transplant recipients with COVID-19(WILEY, 2021-01-01) Yilmaz, Gulay; Ebru, Ozdemir; Ibrahim, Berber; Ulkem, CakirThe coronavirus disease 2019 (COVID-19) has affected more than a hundred million individuals and caused more than three million deaths worldwide. Specific risk groups were defined for increased risk of mortality and morbidity in COVID-19, and renal transplant recipients are at a significantly increased risk regarding outcomes due to their immunosuppressed conditions. This study evaluated the general characteristics of kidney transplant recipients with COVID-19 infection. Among 1257 transplant cases, 56 had COVID-19 infection, and 23 (41\%) were hospitalized during the 9-month study period. Among all COVID-19 cases, 58\% were male with a mean age of 45.5 (+/- 13.2, 19-71) years, and the most frequent comorbidities were hypertension (70.9\%) and diabetes (23.6\%). Hospitalized patients were older (p = 0.03) and had higher rates of hypertension (p = 0.008), diabetes (p = 0.002), and ischemic heart disease (p = 0.03). Therapeutic management included antimetabolite withdrawal and prednisolone increase in 71\%, calcineurin inhibitor withdrawal in 8\% and decrease in 58\%, hydroxychloroquine in 17\%, tocilizumab in 3\%, and antivirals in 67\% of patients. Acute kidney injury and respiratory failure developed in 34\% and 85\%, respectively. The mortality rate was 23\%. These results emphasized that the COVID-19 infection in renal transplant recipients significantly increases the risk of morbidity and mortality. Therefore, these patients should be intervened earlier and monitored closely to prevent poor outcomes.Item Did blood transfusion increase mortality in patients with diabetes undergoing isolated coronary artery bypass graft surgery? A propensity score-matched analysis of 816 patients(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2020-01-01) Kocyigit, Muharrem; Ulugol, Halim; Kiran, Seher Irem; Alhan, Cem; Toraman, FevziBackground: The aim of this study was to compare clinical outcomes of blood transfusion in patients with diabetes mellitus undergoing isolated on-pump coronary artery bypass grafting. Methods: The medical records of a total of 1,912 patients (1,300 males, 612 females