Person: AKDENİZ, ESRA
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AKDENİZ
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ESRA
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Publication Open Access Evaluating the Safety of Sodium Hypochlorite Usage as an Irrigation Solution in Acute Osteomyelitis: an Experimental Study in Rat Tibia via a Renewed Osteomyelitis Model(2020-06-01) AKDENİZ, ESRA; Kürşad AYTEKİN;Aslıhan DUMAN;İlkay ÇINAR;Feyza Yıldız AYTEKİN;Şahin DİREKEL;Esra AKDENİZ;Selçuk TAKIR;Cem Zeki ESENYELObjective: The ideal irrigation solution for osteomyelitis surgery has not yet been clarified. The aim of this study is to evaluate the therapeuticeffect and the optimum concentration of sodium hypochlorite (NaOCl) solution for the mechanical treatment of acute osteomyelitis.Methods: Fourty tibias of 20 male Wistar rats were used. The medullas were percutaneously inoculated with Staphylococcus aureus ATCC25923 to induce acute osteomyelitis in tibias. One week later, rats were randomly assigned to 3 treatment groups and irrigated with 0.5%,1% and 5% NaOCl. Irrigation with saline was used at positive control group and any treatment was not given to negative control group. Allrats were sacrificed 24 hours after NaOCl irrigation. The degree of bacterial density, necrosis, inflammation and edema were evaluatedhistologically as; none (0), mild (1), moderate (2) and severe (3). Kruskal-Wallis and Dunn tests were used for statistical evaluations.Results: Acute osteomyelitis developed in all tibias. NaOCl treatment no matter the concentration reduced the bacterial density compared tonegative control group. The decrease in bacterial density and inflammation was significant at 0.5% NaOCl group compared to positive group(respectively; p=0.019, p=0.045), while the pairwise comparisons were statistically insignificant in terms of necrosis and edema. There wasnot any statistically difference between positive and 1%-5% NaOCl groups in terms of bacterial density.Conclusion: In conclusion, irrigation with 0.5% NaOCl was more therapeutic than saline, 1% NaOCl and 5% NaOCl concentrations for acutetibia osteomyelitis at rats while 0.5% NaOCl group was same with saline group in terms of safety to tissue.Publication Open Access Valuation of Neutrophil/Lymphocyte Ratio in Renal Cell Carcinoma Grading and Progression(CUREUS INC, 2018-01-10) AKDENİZ, ESRA; Arda, Ersan; Yuksel, Ilkan; Cakiroglu, Basri; Akdeniz, Esra; Cilesiz, NusretIntroduction We investigated the association of the neutrophil/lymphocyte ratio (NLR) with tumor size and Fuhrman grade in nonmetastatic renal cell carcinoma (RCC) cases. Materials and methods Data of nonmetastatic RCC (T1-4N0M0) cases, operated between 2010 and 2016, were retrospectively reviewed and 103 patients were included in the study. The patients were divided into two groups according to tumor diameter (Group 1 T < 4 cm, Group 2 T >= 4 cm) and into three groups according to Fuhrman grade. Twenty-eight patients with a tumor diameter of 4 cm or less in Group 1 and 75 patients with a tumor diameter greater than 4 cm in Group 2 were compared. In both grouping systems, the NLR, mean platelet volume (MPV), red cell distribution width (RDW), white blood cell (WBC), red blood cell (RBC), platelet (PLT), lymphocyte, and neutrophil values and age were compared. Results There were no differences in age, MPV, RDW, neutrophil, WBC, RBC, PLT counts in groups of tumor diameter (Group 1 T < 4 cm, Group 2 T >= 4 cm). However, the lymphocyte amount was significantly higher in cases with a tumor diameter less than 4 cm compared to the cases with a tumor diameter greater than 4 cm (p = 0.015). It was observed that the NLR had a tendency to increase in patients with tumor size greater than 4 cm compared to patients with tumor size smaller than 4 cm (p = 0.029). There were no differences in age, MPV, RDW, lymphocyte, neutrophil, WBC, RBC, PLT counts, and the NLR in different Fuhrman-graded cases. Conclusions There is a linear relation between the tumor size and the NLR in nonmetastatic RCC cases. Therefore, the NLR is a cheap parameter that can be used to show the tumor size, and thus it can be used to get an idea about the prognosis of the patient.Publication Open Access DNA methylation in hearing-related genes in non-syndromic sensorineural hearing loss patients(2023-12-01) AKDENİZ, ESRA; Eğilmez O. K., Can S., Kalcıoğlu M. T., Tan B. D., Yılmaz S., Yiğit Ö., Durna M. Y., AKDENİZ E., Akalin I.Background: Our understanding of epigenetic modifications in the inner ear is very limited. Although epigenetic regulation of genes related to individual organ- and system-limited pathologies are generally expected to be tissue-specific, DNA methylation patterns in peripheral blood (PB) are found to be associated with the presence of several diseases with no typical hematological involvement. Here, we aimed to investigate whether there is a correlation between hearing-related genes’ promoter region methylation in the PB samples with the presence of non-syndromic sensorineural hearing loss (NSSHL) with an aim of future utilization of DNA methylation as biomarkers in hearing loss. The study included 26 patients with NSSHL and a control group of 20 healthy individuals. CpG islands in the promoter regions of the GJB-2, GJB-6, and SLC24A genes were analyzed using bisulfite sequencing, and methylation percentages were analyzed. Results: Methylation levels at the 1st region of GJB-6 and the 1st and the 4th regions of SLC26A4 were found to differ significantly (p = 0.039, p = 0.042, and p = 0.029, respectively) between the patients and the control group. There was no statistically significant difference in methylation percentages of GJB-2 promoters. We also found that parents’ consanguinity determines the methylation levels in patients’ families. Conclusions: According to our knowledge, this is the first study that investigates epigenetic changes in the PB of patients with NSSHL. Despite the small sample size, our findings indicate that DNA methylation patterns in the PB could be of use for understanding epigenetic changes in the inner ear and the clinical management of NSSHL.Publication Open Access Medical Expulsive Therapy for Distal Ureteral Stones: Tamsulosin Versus Silodosin in the Turkish Population(CUREUS INC, 2017-11-15) AKDENİZ, ESRA; Arda, Ersan; Cakiroglu, Basri; Yuksel, Ilkan; Akdeniz, Esra; Cetin, GizemIntroduction Our aim was to contribute a study that includes a higher patient population to the limited number of studies comparing tamsulosin and silodosin in the treatment of distal ureteral stones. Material and methods Patients who presented with renal colic to the urology emergency clinic and were diagnosed with ureteral stones and followed-up with conservative treatment between January 2010 and January 2016 were retrospectively screened. According to the inclusion-exclusion criteria, the patients were divided into three groups. Group 1: 150 patients followed with watchful waiting (WW), Group 2: 156 patients who received 0.4 mg of tamsulosin daily, and Group 3: 159 patients who received 8 mg of silodosin daily. The side effects of the used drugs, duration of stone reduction, and expulsion rates were evaluated and compared separately. Results A total of 465 patients were included in the study. No statistically significant difference was found in terms of age, gender, and stone size among the groups. The patient characteristics and results are shown in Table 1. The differences in stone expulsion rate between the groups in the first week were calculated using the Chi-square test and found to be non-significant (p = 0.155); whereas, the stone expulsion rates between Group 1 versus Group 2 and Group 1 versus Group 3 were found to be significantly different after the second and third week. Conclusion According to our results, no statistically significant superiority between tamsulosin and silodosin was shown in the treatment of distal ureteral stones in the Turkish population.Publication Open Access Evaluation of Necrotic, Edematous and Inflammatory Changes in Bone Marrow and Soft Tissue After Irrigation with Different Concentrations of NaOCl Solution: An Experimental Study in Rat Tibia(AVES, 2020-10-28) AKDENİZ, ESRA; Aytekin, Kursad; Duman, Aslihan; Aytekin, Feyza Yildiz; Cinar, Ilkay; Akdeniz, Esra; Takir, Selcuk; Esenyel, Cem ZekiObjective: We aimed to investigate effects of different concentrations (0.5-5%) of Sodium Hypochlorite (NaOCl) solution on healthy tissues, and determine the optimal concentration that does not harm to tissue. Materials and Methods: 30 tibias of 15 male Wistar albino rats were used. The tibias were randomly divided into 5 groups (Salin, 0.5%, 1%, 2.5%, and 5% NaOCl). Tibias were reamed intramedullary, and irrigated with 20 ml of saline or increasing concentrations of (0.5-5%) NaOCl. The tibias were embedded in paraffin and the sections were stained with hematoxylin-eosin. All sections were assessed for edema, acute inflammation, or necrosis according to their density, in bone marrow and soft tissues. Results: Pairwise comparisons revealed that irrigation of tibia with saline or 0.5% NaOCl solutions was not statistically significant in terms of necrosis in the bone marrows (p=0.320). However, irrigation of rat tibia with saline caused less necrosis in the bone marrows compared to high concentrations (1%, 2.5%, and 5%) of NaOCl (saline and 1% NaOCl, p=0.017; saline and 2.5% NaOCl, p=0.0007; saline and 5% NaOCl, p=0.001). Conclusion: As an irrigation solution, the effects of 0.5% NaOCl are similar to those of saline in terms of edema, inflammation, and necrosis. There is a need for evaluation of necrosis for extended periods such as one week or one month by immunohistochemical methods and flow cytometry.Publication Open Access Why some pregnant women refuse glucose challenge test? Turkish pregnant women's perspectives for gestational diabetes mellitus screening(KARE PUBL, 2018) AKDENİZ, ESRA; Hocaoglu, Meryem; Turgut, Abdulkadir; Guzin, Kadir; Yardimci, Oguz Devrim; Gunay, Taner; Bor, Ergul Demircivi; Akdeniz, Esra; Karateke, AtesOBJECTIVE: Diabetes in pregnancy is associated with several adverse outcomes for both mother and baby. Awareness is the first step toward identifying pregnant women with diabetes. The purpose of this study was to assess Turkish pregnant women's opinion and practice about 50-g glucose challenge test (GCT) and to assess the reasons why some of them refuse the test. METHODS: This study was conducted on 312 patients at any age and gestational week in Istanbul, Turkey, by a personal interview using self-created questionnaire. Women were asked about their opinion and practice about 50-g GCT. RESULTS: Among women who were <= 28 weeks of gestation, 42.5% (n = 82/193) exhibited their desire to have a GCT in their ongoing pregnancy, 40.9% (n = 79/193) pointed out their reluctance, and 16.6% (n = 32/193) indicated that they had no opinion about the subject. Women who were <= 28 weeks of gestation and did not want to have GCT, were asked to explain the reasons of their reluctance. The most frequently indicated reason was the belief that GCT is harmful for their babies and themselves (n = 62/79, 78.5%). Of the women who were >28 weeks of gestation, 37.8% (n = 45/119) had GCT in the ongoing pregnancy, while 62.2% (n = 74/119) did not have GCT. The most frequently indicated reason why women did not have a GCT was the belief that GCT is harmful for themselves and the baby (n = 37/74, 50%). CONCLUSION: This study exposes an important problem - misinformation about 50-g GCT - that carries a dangerous potential for missing the diagnosis of gestational diabetes. Study findings put forth the need for raising awareness among pregnant women and training health-care professionals about the subject.Publication Open Access Evaluation on the Practice and Behaviour of Women Applied for Gynecology Outpatient Clinics About Screening Methods for Early Diagnosis of Breast Cancer(AVES, 2017-07-03) AKDENİZ, ESRA; Hocaoglu, Meryem; Ersahin, Aynur Adeviye; Akdeniz, EsraObjective: Breast self-examination (BSE), clinical breast exam (CBE), mammography and ultrasound imaging (UI) are screening methods used for early diagnosis of breast cancer (BC). The purpose of this study is to put forth the utilization frequency of these screening methods among women presenting to the gynecology outpatient clinics and the relation of these data with the socio-demographic characteristics of the women. Materials and Methods: A survey was conducted among 429 women (age, 16-80 years) who were admitted to the gynecology outpatient clinics. The survey inquired about the rate and frequency of the performance of BSE, CBE, mammography and UI; personal and family history of breast cancer and social-demographic characteristics of the women. Results: The mean age was 40.08 (SD: 3.67). More than half of the women above 40 years of age (59.7 %) had never undergone mammography. 99.8 % of the women who had undergone mammography had also received ultrasound imaging. A significant relationship was identified between the BSE performance and having mammography. 57.4% of the women above 40 years of age (117) had UI, 53.9% (110) had CBE and 57.3% (117) performed BSE. There was a significant relationship between the age, education status and regular BSE; positive family history of BC and having CBE and mammography. Conclusion: The results reveal that the rate of BSE performance, having mammography and CBE are at less-than-ideal levels. In this context, it is apparent that breast cancer screening methods are needed to be introduced and guidance about their application frequency should be provided for women in gynecology outpatient clinics.Publication Open Access Adaptation of the professionalism mini-evaluation exercise instrument into Turkish: a validity and reliability study(2023-12-01) AKDENİZ, ESRA; GÜLPINAR, MEHMET ALİ; Taşçı A. İ., AKDENİZ E., GÜLPINAR M. A., Danacıoğlu Y. O., Sarı E. E., Yaşar L., Karandere F., Ferahman S.Background: There is an ongoing search for standardized scales appropriate for each culture to evaluate professionalism, which is one of the basic competencies of a physician. The Professionalism Mini-evaluation Exercise (P-MEX) instrument was originally developed in Canada to meet this need. In this study, it was aimed to adapt the P-MEX to Turkish and to evaluate the validity and reliability of the Turkish version. Methods: A total of 58 residents at Bakirkoy Dr. Sadi Konuk Training and Research Hospital were assessed with the Turkish version of P-MEX by 24 raters consisting of faculty members, attending physicians, peer residents, and nurses during patient room visits, outpatient clinic and group practices. For construct validity, the confirmatory factor analysis was performed. For reliability, Cronbach’s alpha scores were calculated. Generalizibility and decision studies were undertaken to predict the reliability of the validated tool under different conditions. After the administration of P-MEX was completed, the participants were asked to provide feedback on the acceptability, feasibility, and educational impact of the instrument. Results: A total of 696 forms were obtained from the administration of P-MEX. The content validity of P-MEX was found to be appropriate by the faculty members. In the confirmatory factor analysis of the original structure of the 24-item Turkish scale, the goodness-of-fit parameters were calculated as follows: CFI = 0.675, TLI = 0.604, and RMSEA = 0.089. In the second stage, the factors on which the items loaded were changed without removing any item, and the model was modified. For the modified model, the CFI, TLI, and RMSEA values were calculated as 0.857, 0.834, and 0.057, respectively. The decision study on the results obtained from the use of P-MEX in a Turkish population revealed the necessity to perform this evaluation 18 times to correctly evaluate professionalism with this instrument. Cronbach’s alpha score was 0.844. All the faculty members provided positive feedback on the acceptability, feasibility, and educational impact of the adapted P-MEX. Conclusion: The findings of this study showed that the Turkish version of P-MEX had sufficient validity and reliability in assessing professionalism among residents. Similarly, the acceptability and feasibility of the instrument were found to be high, and it had a positive impact on education. Trial registration: 2020/249, Bakirkoy Dr. Sadi Konuk Training and Research Hospital.Publication Open Access Orthopedic trauma or surgery does not effect on cognitive_x000D_ or behavioral capability of rats(2020) AKDENİZ, ESRA; Kürşad AYTEKİN;Murat UYSAL;Esra AKDENİZ;Selçuk TAKIRAim: The aim of this study is to investigate the probable effects of orthopedic trauma/surgery on anxiety, memory and learningcapability in rats.Material and Methods: Twenty-one Wistar albino rats grouped into three as control, sham operated, and tibia fracture. In controlgroup, any surgery or fracture was done whereas in sham group the tibia of rats was fixed with intramedullar Kischner wire. In tibiafracture group, a closed fracture was occurred with Bonnarens and Einhorn's guillotine device then intramedullar Kischner wiresends to tibia. All rats were evaluated for memory, anxiety, and learning via behavioral tests respectively; water-maze test, elevatedplus arm test and shuttle box test.Results: One month after the fractures were done and the bone healing was seen on X-ray at all rats. According to the behavioraltests results, there was not any statistically difference between groups in terms of anxiety, learning capability, locomotor activity andmemory (p>0.05).Conclusion: Our results showed that, the orthopedic trauma or surgery itself does not affect the anxiety, learning capability, locomotoractivity and memory in rats.Publication Open Access Neutrophil and lymphocyte ratio in craniocervical artery dissection and prognostic correlations of the blood biomarkers(2022-03-01) AKDENİZ, ESRA; ÖMERCİKOĞLU ÖZDEN, HATİCE; BALTACIOĞLU, FEYYAZ; MİDİ, İPEK; MİDİ İ., Ciftci A. C., Ekincikli B. T., AKDENİZ E., ÖMERCİKOĞLU ÖZDEN H., Babashova L., BALTACIOĞLU F.Background & Objective: The aim of this study was to investigate the relationship of neutrophil to lymphocyte ratio (NLR) and other blood cells markers in craniocervical artery dissection patients and the dynamic changes of these biomarkers during the disease course, and effects on prognosis of the patients. Method: Cranial MR imaging, cranial and cervical MR angiography and DSA were examined, and diffusion weighted imaging (DWI) was performed to show the acute lesion(s). Results: Forty-six patients with craniocervical artery dissection were included in this study; they had a mean age of 42 years. Almost 60% of the patients (n=27) were admitted during acute state. Almost 2/3 of cases had extracranial dissection (n=31) and nearly 40% of the patients (n=18) had trauma. Neutrophil to lymphocyte ratio (NLR) was observed to be higher in the acute phase of the disease while the ratio decreased in the chronic phase. Low hemoglobin, high lymphocyte and a high NLR were found to have a negative correlation with the National Institutes of Health Stroke Scale (NIHSS). Conclusion: Elevation of neutrophil was higher in acute craniocervical artery dissection as a marker of acute inflammatory response. High NLR, low hemoglobin and high eosinophil levels were associated with worse prognosis and functional outcomes.