Person: AKDENİZ, ESRA
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AKDENİZ
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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 Metadata only Correlation of Ultrasonically Determined Bladder Wall Thickness and Prostatic Calcification With the Urinary, Psychosocial Dysfunction, Organ Specific, Infection and Neurological/Systemic Symptoms, and Tenderness Scoring System(ELSEVIER SCIENCE INC, 2019) AKDENİZ, ESRA; Arda, Ersan; Cakiroglu, Basri; Akdeniz, Esra; Akdere, Hakan; Yuksel, Ilkan; Senturk, Aykut B.OBJECTIVE To evaluate ultrasonically determined bladder wall thickness (BWT) and prostatic calcification presence, in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and to correlate the findings with patient characteristics and the urinary, psychosocial dysfunction, organ specific, infection and neurological/systemic symptoms, and tenderness (UPOINT) classification system. MATERIAL AND METHODS Between January 2008 and December 2017, data of 1294 patients diagnosed with chronic prostatitis, in a single urology clinic, meeting a number of selective inclusion/exclusion criteria, were retrospectively analyzed. Patients, compliant to fill out all requested questionnaires, between the ages of 21-65 years were included to the study. Exclusion criteria were noncompliance of filling out required questionnaires, acute and/or chronic bacterial prostatitis, history of genitourinary cancer, history of recent prostate surgery, and diagnosis of neurological diseases affecting the bladder. RESULTS The median patient age and UPOINT subdomain was determined as 37 (IQR = 13, range 21-65) and 2 (IQR = 1, range 0-5), respectively. Median values for BWT, National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), and International Index of Erectile Function were 3 (IQR = 1, range 2-6, 7), 4 (IQR = 6, range 1-23), and 25 (IQR = 10, range 1-30), respectively. The presence of calcification demonstrated a significant association with total NIH-CPSI score and BWT, whereas its relation with age and total UPOINT score was insignificant. However in contrast to calcification status, BWT >= 3.3 showed a strong and statistically significant relation to all the described measurements. CONCLUSION Measurement of BWT can be used as an accessible and objective method for the diagnose of CP/CPPS according to UPOINT scoring system. (C) 2018 Elsevier Inc.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 Metadata only A new difference-based weighted mixed Liu estimator in partially linear models(TAYLOR & FRANCIS LTD, 2018) AKDENİZ, ESRA; Akdeniz, Esra; Akdeniz, Fikri; Roozbeh, MahdiIn this paper, a generalized difference-based estimator is introduced for the vector parameter beta in the partially linear model when the errors are correlated. A generalized difference-based Liu estimator is defined for the vector parameter beta. Under the linear stochastic constraint r = R beta + e, a new generalized difference-based weighted mixed Liu estimator is introduced. The performance of this estimator over the generalized difference-based weighted mixed estimator and the generalized difference-based Liu estimator in terms of the mean squared error matrix criterion is investigated. Then, a method to select the biasing parameter d and non-stochastic weight. is considered. The efficiency properties of the newestimator are illustrated by a simulation study. Finally, the performance of the new estimator is evaluated for a real data set.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 Metadata only Otolog Doku ve İmplant ile Meme Rekonstrüksiyonunda Hasta Memnuniyetinin BREAST-Q Sonuçları ile Karşılaştırılması(2021-10-10) AKDENİZ DOĞAN, ZEYNEP DENİZ; AKDENİZ, ESRA; UĞURLU, MUSTAFA ÜMİT; SAÇAK, BÜLENT; Saraç Ö., AKDENİZ DOĞAN Z. D., Önal M., AKDENİZ E., UĞURLU M. Ü., SAÇAK B.Amaç: Son yıllarda meme rekonstrüksiyonuna yönelik talep gittikçe artmaktadır. Hastaların beklentilerinin de artması sonucu meme cerrahisinde onkoplastik ve rekonstrüktif tekniklerin gelişimi hız kazanmıştır. Mastektomi sonrası meme rekonstrüksiyonunda başarıyı değerlendirmede hasta memnuniyeti ve yaşam kalitesi en önemli iki değişkendir. Bu çalışmanın amacı; meme rekonstrüksiyonu sonrası onarım metodu, tek veya iki taraflı onarım uygulanması ve radyoterapi (RT) gibi etmenlere bağlı yaşam kalitesini ve hasta memnuniyetini karşılaştırmaktır. Gereç-Yöntem: 2013-2020 yılları arasında kliniğimizde mastektomi sonrası eşzamanlı implant bazlı veya otolog rekonstrüksiyonunu tamamlamış hastalar arasından preoperatif ve postoperatif 1.yıllarında Breast-Q (Rekonstrüksiyon Modülü) formu dolduran hastalar çalışmaya dahil edildi. Breast-Q formunu doldurmayan hastalar, takipten çıkmış hastalar, gecikmiş onarımlar ve doku genişletici uygulanan hastalar çalışma dışı bırakıldı. Hastaların yaşları, BMİ, sigara kullanım durumları, komorbiditeleri, mastektomi endikasyonları, mastektomi tipleri, rekonstrüksiyon tipleri ve adjuvan radyoterapi alma durumları hasta dosyalarından ve hastane verilerinden alınarak karşılaştırıldı. Tüm olgularda tümör rezeksiyonu Genel Cerrahi ekibi tarafından yapıldı. Bulgular: Toplam 128 hastanın ortalama yaşı 45.6, ortalama VKİ’si 26.08 olarak tespit edildi. 106(%82.8) hasta sigara içmiyorken, 106 (%82.8) hastanın da eşlik eden başka bir hastalığı bulunmamaktadır. Mastektomi operasyonları 115 (%89.8) hastada terapötik, 13(%10.2) hastada da profilaktik endikasyonlar ile gerçekleştirilmiştir. 103(%80.5) hastaya meme koruyucu mastektomi (MKM), 21(%16,4) hastaya deri koruyucu mastektomi (DKM) ve 1 (%0.8) hastanın tek memesine MKM, diğer memesine DKM uygulandığı ve 3(%2.3) hastaya da segmenter mastektomi operasyonu uygulandığı tespit edildi. 71 hastada tek taraflı (%55,5), 57 hastada iki taraflı (%44,5) onarım uygulandı. Mastektomi sonrası meme rekonstrüksiyonu; 72 (%56.2) hastanın otolog doku ile, 56 (%43.8) hastanın da implant ile yapıldı. 41 (%32) hasta rekonstrüksiyon sonrasında adjuvan RT alırken, rekonstrüksiyon sonrası flep veya implant kaybı da 8(%6.3) hastada tespit edildi. Hastaların preoperatif ve postoperatif BREAST-Q rekonstrüksiyon modülündeki alt başlıklardaki cevaplarına göre karşılaştırılmalar yapıldı. Hastaların, otolog onarımda preoperatif ile postoperatif karın görünümlerinden anlamlı derecede (p= 0.002) daha memnun olduğu; bilateral otolog onarım uygulanan hastalarda, postoperatif RT almayan hastaların RT alan hastalara göre nipple görünümünde (p= 0.117) memnuniyet farkı istatistiksel olarak anlamlı değilken; bilateral implant ile onarım uygulanan hastalarda, postoperatif RT almayan hastaların RT alan hastalara göre nipple görünümünden anlamlı derecede (p = 0.043) daha memnun oldukları görülmüştür. Bu bulgular dışında unilateral/bilateral, otolog onarım/implant ile onarım ve RT alan/RT almayan şeklinde sınıflandırılan hastalar arasında postoperatif memnuniyet açısından istatiksel olarak anlamlı derecede fark saptanmamıştır. Tartışma: Mastektomi sonrası RT alan hastalarda, her iki rekonstrüksiyon yöntemi için de oldukça yüksek komplikasyon oranları olduğu bilinmektedir. İmplant temelli rekonstrüksiyon, otolog rekonstrüksiyon ile karşılaştırıldığında; rekonstrüksiyon başarısızlığı gelişme riskinin daha yüksek ve postoperatif hasta memnuniyetinin de daha düşük olduğu bilinmektedir1.Çalışmamızda otolog onarım ve implant ile onarım arasında, hasta memnuniyeti açısından anlamlı derecede bir farklılık görülmemesi; göreceli olarak kısıtlı hasta sayısına bağlanabilir. Bizim verilerimize göre RT alan hastalar ile RT almayan hastalar, BREAST-Q bulgularından genel meme görünümüyle alakalı memnuniyet hususunda karşılaştırıldığında; anlamlı derecede farklılık tespit edilmemiştir. RT alan hastaların RT sonrası dönemde implant ile onarımlıların otolog doku ile onarımlılara göre nipple pozisyonu ile ilgili memnuniyetinin daha az olduğu gözlemlendi. RT’nin cilt ve cilt altı dokuda olduğu gibi kas ve kapsül dokusu üzerinde de etkilerine bağlı kas dokusunun kontraksiyonu sonucu oluşan kas-cilt yapışıklıları nedenli kliniğimizde subpektoral planda konulan implantların daha fazla nipple pozisyonda değişikliğe yol açtığını düşünüyoruz. Otolog doku ile onarımlı hastalarda pektoral adele veya kapsülün radyoterapiye bağlı değişimleri cilde yansımadığı için nipple pozisyonundaki değişimlerin daha az yaşandığı varsayılabilir. Bu veriler preoperatif planlama sırasında hastaların ayrıntılı bir şekilde bilgilendirilmesinin ve postoperatif dönemde özellikle implant ile onarımlılarda nipple’a yönelik ek prosedürlerin gerekebileceğinin anlatılmasının önemine işaret etmektedir. Sonuç: Sonuçlarımız, otolog doku ve implant ile rekonstrüksiyonun hastaların psikososyal ve cinsel açıdan memnun olma durumları ile meme görünümünden memnun olma durumlarını benzer derecede iyileştirdiğini gösterdi. Postoperatif RT alan hastalarda nipple görünümünden memnuniyetin azaldığı ve bu hastaların özellikle preoperatif dönemde nipple pozisyonu ile alakalı ayrıntılı bilgilendirilmesi gerektiği tespit edildi.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 Metadata only Association between serum 25-hydroxyvitamin D levels and the presence and severity of striae gravidarum in primigravid women(WILEY, 2020) AKDENİZ, ESRA; Hocaoglu, Emre; Hocaoglu, Meryem; Akdeniz, EsraBackground Striae gravidarum (SG) are a form of scarring on the skin observed during pregnancy and an important cosmetic problem. Vitamin D plays an important role in the skin. Aims To assess the association between serum 25-hydroxyvitamin D (25(OH)D) levels and the presence and severity of SG in primigravid women. Methods The study included 91 primigravid women at the gestational age of 36-41 weeks. Patients were examined and divided into two groups with respect to whether they had SG or not. Striae were scored using the numerical scoring system of Atwal et al. The serum 25(OH)D levels were evaluated. Results While 55 patients (60.5%) had SG, 36 (39.5%) did not. The mean serum 25(OH)D level of women with SG was 17.69 +/- 9.81 ng/mL and of women without SG was 21.18 +/- 11.71 ng/mL. There was no statistically significant difference between two groups (P = .144). Multivariate logistic regression analysis has shown that women who have normal values of serum 25(OH)D (>= 30 ng/mL) have a lower risk of having SG than women who have scarce levels of serum 25(OH)D (<20 ng/mL) after adjusting for confounding factors (adjusted odds ratio = 0.18, 95% confidence interval: 0.04-0.72, P = .015). According to the results of the linear-by-linear test, the association between serum 25(OH)D levels and the severity of SG was not found significant (P = .82). Conclusions This is the first study to show that having normal values of serum 25(OH)D is linked to a lower risk of having SG than scarce levels. Therefore, management of vitamin D deficiency might help prevent SG in primigravid women.Publication Metadata only Stereological and electrophysiological evaluation of autonomic involvement in amyotrophic lateral sclerosis(2022-11-01) AKDENİZ, ESRA; İŞAK, BARIŞ; Ozturk R., Karlsson P., Hu X., AKDENİZ E., Surucu S., İŞAK B.© 2022 Elsevier Masson SASObjective: Previous studies have identified autonomic dysfunction in amyotrophic lateral sclerosis (ALS) using mostly neurophysiological techniques. In this study, stereological evaluation of autonomic fibers and sweat glands has been performed to identify structural evidence of autonomic denervation in patients with ALS. Methods: In this study, 29 ALS patients were compared to 29 controls using COMPASS-31 questionnaire, sympathetic skin response (SSR), and heart rate variability (HRV) at rest. From the same cohorts, 20 ALS patients and 15 controls were further evaluated using staining of autonomic nerve fibers and sweat glands in skin biopsies. SSR and resting HRV were repeated in the ALS patient cohort one year later. Results: COMPASS-31 total score, gastrointestinal- and urinary-sub scores were higher in ALS patients than controls (P = 0.004, P = 0.005, and P = 0.049, respectively). In the ALS patient cohort, SSR amplitudes in hands and feet were lower than in controls (P0.05). While there was no change in nerve fibers innervating sweat glands, their density was lower in ALS patients than controls, and semi-quantitative analysis also showed structural damage (P = 0.02 and P = 0.001, respectively). SSR and resting HRV of ALS patients remained stable during the one-year follow-up period (P>0.05). Discussion: Supporting abnormal neurophysiological tests, stereological analysis revealed direct evidence of autonomic denervation in ALS patients. However, the degenerative process in autonomic nerve fibers is relatively slow, compared to the rate of motor neuron degeneration in this condition.