Diskapi Training and Research Hospital

Ankara, Turkey

Diskapi Training and Research Hospital

Ankara, Turkey
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Bajin M.D.,Diskapi Training and Research Hospital | Cingi C.,Eskiehir Osmangazi University | Oghan F.,Dumlupinar University | Gurbuz M.K.,Eskiehir Osmangazi University
European Archives of Oto-Rhino-Laryngology | Year: 2013

The earth is warming, and it is warming quickly. Epidemiological studies have demonstrated that global warming is correlated with the frequency of pollen-induced respiratory allergy and allergic diseases. There is a body of evidence suggesting that the prevalence of allergic diseases induced by pollens is increasing in developed countries, a trend that is also evident in the Mediterranean area. Because of its mild winters and sunny days with dry summers, the Mediterranean area is different from the areas of central and northern Europe. Classical examples of allergenic pollen-producing plants of the Mediterranean climate include Parietaria, Olea and Cupressaceae. Asia Minor is a Mediterranean region that connects Asia and Europe, and it includes considerable coastal areas. Gramineae pollens are the major cause of seasonal allergic rhinitis in Asia Minor, affecting 1.3-6.4 % of the population, in accordance with other European regions. This article emphasizes the importance of global climate change and anticipated increases in the prevalence and severity of allergic disease in Asia Minor, mediated through worsening air pollution and altered local and regional pollen production, from an otolaryngologic perspective. © 2012 Springer-Verlag.


Kirkpantur A.,Nephrology | Gulbay M.,Radiology | Gurbuz O.A.,Diskapi Training and Research Hospital
Hemodialysis International | Year: 2010

Fibroblast growth factor-23 (FGF-23) has been suggested to play a role in vascular calcification in chronic kidney disease. Common carotid artery intima-media thickness (CIMT) assessment and common carotid artery (CCA) plaque identification using ultrasound are well-recognized tools for identification and monitoring of atherosclerosis. The aim of this study was to test that elevated FGF-23 levels might be associated with carotid artery atherosclerosis in maintenance hemodialysis (HD) patients. In this cross-sectional study, plasma FGF-23 concentrations were measured using a C-terminal human enzyme-linked immunosorbent assay kit. Carotid artery intima-media thickness was measured and CCA plaques were identified by B-Mode Doppler ultrasound. One hundred twenty-eight maintenance HD patients (65 women and 63 men, mean age: 55.5 ± 13 years, mean HD vintage: 52 ± 10 months, all patients are on HD thrice a week) were involved. The mean CIMT were higher with increasing tertiles of plasma FGF-23 levels (0.66 ± 0.14 vs. 0.75 ± 0.05 vs. 0.86 ± 0.20 mm, P<0.0001). Log plasma FGF-23 were higher in patients with plaques in CCA than patients free of plaques (3.0 ± 0.17 vs. 2.7 ± 0.23, P<0.0001). Significant correlation was recorded between log plasma FGF-23 and CIMT (r=0,497, P=0.0001). In multiple regression analysis, a high log FGF-23 concentration was a significant independent risk factor of an increased CIMT. Further studies are needed to clarify whether an increased plasma FGF-23 level is a marker or a potential mechanism for atherosclerosis in patients with end-stage renal disease. © 2010 The Author. Hemodialysis International © 2010 International Society for Hemodialysis.


London E.D.,University of California at Los Angeles | Berman S.M.,University of California at Los Angeles | Chakrapani S.,University of California at Los Angeles | Delibasi T.,Diskapi Training and Research Hospital | And 5 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2011

Context: Leptin affects neurogenesis, neuronal growth, and viability. We previously reported that leptin supplementation increased gray matter (GM) concentration in the anterior cingulate gyrus (ACG), cerebellum, and inferior parietal lobule, areas that are also involved in food intake. Objective: The aim of this study was to report the changes in brain structure at different states of leptin supplementation. Design: We conducted a nonrandomized trial. Setting and Patients: We studied three adults with congenital leptin deficiency due to a mutation in the leptin gene. Intervention: Patients received treatment with recombinant methionyl human leptin, with annual 11- to 36-d periods of treatment withholding followed by treatment restoration over 3 yr. Main Outcome Measures: GM concentration (by voxel-based morphometry analysis of magnetic resonance scans) was correlated with body mass index (BMI) and leptin supplementation. Results: Annually withholding leptin supplementation for several weeks increased BMI and reversed the original effects of leptin in the cerebellum and ACG. The changes in the ACG were consistent with an indirect effect of leptin mediated through increased BMI. In the cerebellum, where leptin receptors are most dense,GMchanges appeared to be direct effects of leptin. Leptin restoration did not lead to recovery of GM in the short term but did lead to an unexpected GM increase in the posterior half of the left thalamus, particularly the pulvinar nucleus. Conclusion: These findings provide the first in vivo evidence of remarkably plastic, reversible, and regionally specific effects of leptin onhumanbrain morphology. They suggest that leptinmayhave therapeutic value in modulating plasticity-dependent brain functions. Copyright © 2011 by The Endocrine Society.


Aypak C.,Diskapi Training and Research Hospital | Turedi O.,Diskapi Yildirim Beyazit Training and Research Hospital | Yuce A.,Diskapi Yildirim Beyazit Training and Research Hopital | Gorpelioglu S.,Diskapi Yildirim Beyazit Training and Research Hospital
Journal of Pediatric Endocrinology and Metabolism | Year: 2013

Objective: In recent years, there has been increasing focus on thyroid function in pediatric obese patients. Our aims were to investigate whether there is an association between serum thyroid-stimulating hormone (TSH) within the normal range and body mass index (BMI), and to determine if TSH levels correlate with metabolic risk factors in children. Methods: A retrospective cross-sectional analysis was carried out on 528 euthyroid, age- And sex-matched lean, overweight, or obese children. Anthropometric indices, blood pressure, fasting blood glucose, hepatic enzymes, lipid profiles, TSH, free triiodothyronine (fT3), and free thyroxine (fT4) were assessed from medical records and compared among groups. Subjects with known presence of diabetes, using medications altering blood pressure and glucose or lipid metabolism, with TSH levels > 97.5 or <2.5 percentile, or with autoimmune thyroid disease were excluded. Results: Hypertension, dyslipidemia, and elevated levels of hepatic enzymes were found to be more common in overweight and obese children (p < 0.001), and those metabolic changes were significantly correlated with the increase in BMI (p <0.05). Serum concentrations of TSH and fT3 within the normal range were higher in overweight and obese children (p <0.01), and TSH was positively correlated with total cholesterol, triglycerides, and systolic blood pressure (p < 0.05). Conclusion: Our findings suggest that obese children have higher serum TSH and fT3 levels even within the normal range, and that an increase in TSH is associated with dyslipidemia and higher systolic blood pressure. It remains to be seen whether TSH might serve as a potential marker of metabolic risk factors in obese pediatric patients.


Bedirli N.,Gazi University | Demirtas C.Y.,Gazi University | Akkaya T.,Diskapi Training and Research Hospital | Salman B.,Gazi University | And 3 more authors.
Journal of Surgical Research | Year: 2012

Background: This study aimed to evaluate the differential protective effects of isoflurane or sevoflurane on lung inflammation in a rat model of cecal ligation and puncture (CLP) induced sepsis. Methods: Seventy-two rats were assigned to control, sevoflurane, or isoflurane groups. At 2 and 4 h, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-1β (IL-1β), nitrate/nitrate levels (NO), total antioxidant capacity (TAC), and intercellular cell adhesion molecule-1 (ICAM-1) were determined. At 12 and 24 h, malondialdehyde (MDA), myeloperoxidase (MPO), and histologic changes were evaluated. Survival was monitored for 7 d after CLP. Results: Sevoflurane (75%) and isoflurane (63%) significantly improved survival rate compared with control rats (38%). When sevoflurane and isoflurane groups were compared, sevoflurane pretreatment showed significant decrease in NO at 2 h [1045 (803-1274)/1570 (1174-2239) and 4 h [817 (499-1171)/1493 (794-2080)]; increase in TAC at 4 h [580.0 (387-751)/320 (239-512)]; decrease in MDA at 12 h [2.5 (1.1-4.2)/5.4 (4-73)] and 24 h [10.8 (6.0-14.0)/15.9 (9-28)]; and decrease in MPO at 24 h [145.8 (81-260)/232 (148-346)]. The difference in the ICAM-1 expression of the isoflurane and sevoflurane groups was not significant at both measurement times. The architectural integrity of the alveoli was preserved in all the groups. The injury scores of the three groups at 12 and 24 h did not show any significant difference. Conclusions: Both sevoflurane and isoflurane attenuated inflammatory response, lipid peroxidation, and oxidative stress. Furthermore, sevoflurane was more effective in modulating sepsis induced inflammatory response at the chosen concentration in sepsis model. © 2012 Elsevier Inc. All rights reserved.


Karakoyun R.,Etlik Ihtisas Training and Research Hospital | Koksoy C.,Ankara University | Yilmaz T.U.,Gazi University | Altun H.,Etlik Ihtisas Training and Research Hospital | And 4 more authors.
European Journal of Vascular and Endovascular Surgery | Year: 2014

Objectives Ischemic conditioning (IC) is a method of angiogenic stimulus for limb ischemia. Here, we aimed to investigate the effects of short-term repeated ischemic stimulus on critical lower limb ischemic injury. Methods Rats were divided into four groups consisting of 40 animals in each group: sham, ischemia, local IC, and remote IC groups. Right-leg critical limb ischemia was achieved through ligation of the iliac artery and vein in male Sprague-Dawley rats except the sham group. Repeated transient ischemia using the tourniquet method was used for IC of lower extremities in the local and remote groups. IC was performed on the right leg for the local group and on the left leg for the remote group. Ten rats in each group were sacrificed for evaluation on days 1, 7, 14, and 30. Endothelial progenitor cell (EPC) counts were measured. Gastrocnemius muscles were evaluated for the degree of ischemia. Laser Doppler blood flow measurements were performed in order to make comparison between the blood flows of the limbs of the groups. Results The blood flow in the right limb of rats in the sham (1.65 perfusion units [PU]) and local IC (1.67 PU) groups was significantly higher than the ischemic group (1.17 PU) (p =.001 and p =.022 respectively). The levels of EPCs in the ischemia (1.09 ± 0.5) and remote IC groups (1.36 ± 0.8) were significantly higher than the sham (0.38 ± 0.2) group on day 7 (p =.026 and p =.002 respectively). Remote IC and local IC groups exhibited increased histopathological ischemia on day 7 when compared with sham group (p =.001, p =.01 respectively). The angiogenic scores on the 7th, 14th and 30th days for local IC and remote IC groups were significantly higher than sham and ischemia groups. Conclusions IC seems to be the potent activator of angiogenesis in ischemic tissue. This study provides preliminary data showing that repeated short ischemic stimuli may reduce critical ischemic injury by promoting angiogenesis.© 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.


Afsar B.,Konya Numune State Hospital | Elsurer R.,Selcuk University | Kirkpantur A.,Diskapi Training and Research Hospital
Nutrition | Year: 2013

Objective: The relationship between various anthropometric parameters and mortality in hemodialysis (HD) patients is conflicting. Recently a new anthropometric parameter emerged, namely, body shape index (BSI). BSI is based on waist circumference (WC) but is independent of height, weight, and body mass index in predicting mortality in the general population. The aim of this study was to determine the relationship between BSI and mortality in HD patients. Methods: This retrospective study evaluated the demographic characteristics and anthropometric measures including BSI, laboratory parameters, and mortality data in HD patients in a single center. Results: There were 142 HD patients enrolled in the study. The median BSI was 0.0816. Because no normal value was defined for BSI, the patients were divided into two groups based on the median BSI: group 1 BSI < 0.0816 and group 2 BSI > 0.0816. During an average follow-up period of 40.1 ± 19.2 mo (range 12-88 mo), 36 (25.4%) patients had died. The Cox regression analysis of independence showed that increased age (hazard ratio [HR], 1.077, 95% confidence interval [CI],1.031-1.125; P = 0.001), presence of diabetes (HR, 2.855, 95% CI, 1.258-6.481; P = 0.012), hemoglobin (HR, 0.629, 95% CI, 0.452-0.875; P = 0.006), and albumin (HR, 0.442, 95% CI, 0.204-0.955; P = 0.038) were independently related with mortality. None of the anthropometric parameters including BSI were related with mortality. Kaplan-Meier analysis showed that there were no differences with respect to mortality among patients in group 1 and group 2 based on median BSI (P = 0.332, log-rank test). Conclusion: In conclusion, BSI is not independently associated with mortality in HD patients. © 2013 Elsevier Inc.


Eker E.,Diskapi Training and Research Hospital
The Journal of craniofacial surgery | Year: 2010

Treatment of open-mouth deformity and augmentation of the upper lip were performed using a combination of double-row V-Y mucosal advancement flaps and a V-Y skin advancement flap in 2 cases with Möbius syndrome. The mucosal V-Y advancement flaps were consisted for 2 rows of flaps. The first row was placed near the labial sulcus, including 3 V-Y advancement flaps. These flaps equally provided 3 directional augmentation for each segment of the upper lip. Second row V-Y mucosal advancement flap was used for the augmentation of the vermilion tubercle. In our cases, V-Y advancement flaps were used as subcutaneous based flaps unlike other distally based V-Y flap techniques for the upper lip. Postoperative complications such as scar formation, sensation problems, severe pain, and edema were decreased because of subcutaneous pedicled V-Y flaps. In addition, the relationship between mucosa and orbicularis oris muscle, which is responsible for the fine balance of the vermilion, was maintained with subcutaneous-based flaps. The skin V-Y advancement flap was used both to lengthen the upper lip and to create philtral columns on the upper lip.


Cakir E.,Diskapi Training and Research Hospital | Dogan M.,Diskapi Training and Research Hospital | Topaloglu O.,Diskapi Training and Research Hospital | Ozbek M.,Diskapi Training and Research Hospital | And 4 more authors.
Atherosclerosis | Year: 2013

Objective: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders affecting reproductive-age women and is reported to be associated with an increased risk of cardiovascular disease and early atherosclerosis. Epicardial fat thickness (EF) is clinically related to subclinical atherosclerosis and visceral fat changes. Therefore, the objective of this study is to compare the carotid artery intima-media thickness (CIMT), EF and cardiometabolic risk factors in patients with PCOS, patients with idiopathic hirsutism (IH) and healthy controls. Methods: This cross-sectional controlled study was conducted in a training and research hospital. The study population consisted of 50 reproductive-age PCOS women, 34 women with IH and 39 control subjects. We evaluated anthropometric, hormonal and metabolic parameters as well as CIMT and EF measurements in PCOS patients, IH patients and controls. Results: The mean fasting insulin, HOMA-IR, hsCRP, GGT, CIMT, and EF levels were significantly higher in patients with PCOS and IH (p < 0.05). A significant positive correlation was found between EF and age, BMI, WHR, Ferriman Gallwey score (FG), fasting insulin, HOMA-IR, triglyceride, total cholesterol, LDL-C, 17 OH progesterone, free testosterone, CIMT, hsCRP, and GGT, whereas a significant negative correlation was observed between EF and HDL-C (p < 0.05). In the multiple linear regression analyses, EF was found to be associated with the FG (β coefficient: 0.389, p < 0.001), CIMT (β coefficient: 0.376, p < 0.001) and free testosterone levels (β coefficient: 0.173, p < 0.038). Conclusion: EF appears to be a marker that will enable the detection of the cardiometabolic response in patients with PCOS and IH, even at an early stage. © 2012 Elsevier Ireland Ltd.


Afsar B.,Zonguldak Ataturk State Hospital | Elsurer R.,Zonguldak Ataturk State Hospital | Guner E.,Zonguldak Ataturk State Hospital | Kirkpantur A.,Diskapi Training and Research Hospital
Journal of Renal Nutrition | Year: 2011

Objective: We analyzed the relationships between body mass index (BMI), waist circumference (WC), waist-to-hip ratio, and conicity index and 24-hour urinary albumin excretion rate (UAER) and creatinine clearance. Design: Cross-sectional study. Setting: Patients presenting to a state hospital. Patients: Study involved patients with type 2 diabetes. Methods: Study participants underwent medical history examination, measurement of office blood pressure (BP), measurement of anthropometric factors and calculations (including BMI, WC, waist-to-hip ratio, and conicity index), physical examination, biochemical analysis, and 24-hour urine specimen collection to determine creatinine clearance and UAER. Results: In all, 202 patients with type 2 diabetes (male/female: 91/111, aged: 58.4 ± 10.1 years) were included. It was found that 24-hour UAER correlated with WC (rho: +0.176, P = .012), serum albumin (rho: -0.324, P < .0001), and systolic BP (rho: +0.153, P = .029), whereas creatinine clearance correlated with age (rho: -0.152, P = .031), BMI (rho: +0.191, P = .007), albumin level (rho: +0.365, P < .0001), and uric acid level (rho: -0.369, P < .0001). The stepwise linear regression analysis revealed that WC (P = .012), glycosylated hemoglobin (P = .018), and systolic BP (P = .043) were found to be independently related to logarithmically converted 24-hour UAER, whereas creatinine clearance was found to be related to duration of diabetes (P = .001), BMI (P = .008), presence of peripheral arterial disease (P = .021), fasting serum glucose level (P = .003), and uric acid level (P < .0001). However, after correction for body surface area, BMI was no longer associated with creatinine clearance. Conclusion: Among the anthropometric parameters, only an increase in WC was found to be independently related to 24-hour UAER. Although BMI was associated with creatinine clearance, this association was lost after creatinine clearance was corrected for body surface area. © 2011 National Kidney Foundation, Inc.

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