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    Comparison of pirfenidone and corticosteroid treatments at the COVID-19 pneumonia with the guide of artificial intelligence supported thoracic computed tomography
    (Wiley, 2021) Acat, Murat; Gulhan, Pinar Yildiz; Oner, Serkan; Turan, Muhammed Kamil
    Aim We aimed to investigate the effect of short-term pirfenidone treatment on prolonged COVID-19 pneumonia. Method Hospital files of patients hospitalised with a diagnosis of critical COVID-19 pneumonia from November 2020 to March 2021 were retrospectively reviewed. Chest computed tomography images taken both before treatment and 2 months after treatment, demographic characteristics and laboratory parameters of patients receiving pirfenidone + methylprednisolone (n = 13) and only methylprednisolones (n = 9) were recorded. Pulmonary function tests were performed after the second month of the treatment. CT involvement rates were determined by machine learning. Results A total of 22 patients, 13 of whom (59.1%) were using methylprednisolone + pirfenidone and 9 of whom (40.9%) were using only methylprednisolone were included. When the blood gas parameters and pulmonary function tests of the patients were compared at the end of the second month, it was found that the FEV1, FEV1%, FVC and FVC% values were statistically significantly higher in the methylprednisolone + pirfenidone group compared with the methylprednisolone group (P = .025, P = .012, P = .026 and P = .017, respectively). When the rates of change in CT scans at diagnosis and second month of treatment were examined, it was found that the involvement rates in the methylprednisolone + pirfenidone group were statistically significantly decreased (P < .001). Conclusion Antifibrotic agents can reduce fibrosis that may develop in the future. These can also help dose reduction and/or non-use strategy for methylprednisolone therapy, which has many side effects. Further large series and randomised controlled studies are needed on this subject.
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    Comparison of Tocilizumab and Anakinra in the Treatment of COVID-19: A Single-Center Experience
    (2022) Acat, Bengisu Pınar; Tezce, Ahmet; Acat, Murat; Çavdar, Özben
    Aim: The aim of this study was to examine whether a difference between endotracheal intubation, non-invasive mechanical ventilation, high flow oxygen therapy requirements and 28-day mortality rate in severe and critical coronavirus disease 2019 (COVID-19) patients receiving anakinra and tocilizumab treatment. Material and Methods: A total of 70 patients infected with COVID-19, who were treated with tocilizumab and anakinra from April 2020 to March 2021 at Karabük Training and Research Hospital, were recruited in this retrospective study. Data on patient demographics, comorbidities, treatments, clinical outcomes of the patients’ and hemogram findings were retrieved from hospital records. Results: The mean age of the patients was 61.34±11.8 years. Of the 70 patients, 12 (17.1%) were female and 58 (82.9%) were male. Severe and critical COVID-19 cases were evident in 48 (68.6%), and 22 (31.4%) patients, respectively. The mortality rate in 28 days was not statistically significantly different between the tocilizumab and anakinra groups (p=0.999). Both the necessity of high flow oxygen therapy and non-invasive mechanical ventilation were lower in the tocilizumab group than in the anakinra group (p<0.001, and p=0.002, respectively), while there was no statistically significant difference in the necessity of intubation between the two groups (p=0.999). The length of stay was also significantly shorter in the tocilizumab group (p=0.027). Conclusion: High flow oxygen therapy, non-invasive mechanical ventilation requirements, and length of stay were significantly lower than anakinra in the tocilizumab group. Excessive inflammatory response with cytokine storm features causes severe disease course and worsens prognosis in COVID-19.
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    COVID-19 Hastalarında TNF-? Düşüşünü Etkileyen Faktörler
    (2024) Gülhan, Muhammet; Alpay, Merve; Yıldız, Şule; Yaşlı, Nevra Ezgi; Acat, Murat; Kahraman, Gözde; Arbak, Peri
    Amaç: Tümör nekrozis faktör-alfa (TNF-?) hücrenin hayatta kalması, farklılaşması ve çoğalması da dahil çeşitli işlevlere sahiptir. TNF-?, COVID-19 enfeksiyonu sırasında ortaya çıkan sitokin fırtınası sırasında hücre ölümünü etkileyebilir. Bu çalışmada COVID-19 hastalarında TNF-? düşüşüne etki eden faktörleri araştırmak amaçlandı. Gereç ve Yöntemler: Çalışmaya COVID-19 enfeksiyonu olan toplam 44 kişi dahil edildi. Kan sayımı, biyokimyasal incelemeler ve D-dimer incelemeleri yapıldı. Hastaların ek hastalıkları ve başlangıç semptomları kaydedildi. TNF-?, CRP ve ferritin değerleri yatışının 1. ve 7. günlerinde iki kez ölçüldü. Bu değerlerdeki değişim komorbiditelere, başlangıç semptomlarına ve steroid kullanımına göre incelendi. Bulgular: Toplam 44 hastanın %56,8'i erkek (25/44) ve %43,2'si kadındı (19/44). TNF-? düşüşü diyabetik olmayan hastalarda istatistiksel olarak anlamlı bulunurken, diyabetik hastalarda TNF-? düşüşü anlamsız bulundu. CRP düşüşü hem diyabetik hem de diyabetik olmayan hastalarda istatistiksel olarak anlamlı bulunurken, ferritin düşüşü hem diyabetik hem de diyabetik olmayan hastalarda anlamsız bulundu. Akciğer hastalığı olmayanlarda TNF-? ve CRP istatistiksel olarak anlamlı düzeyde düşerken, akciğer hastalığı olanlarda hem TNF-? hem de CRP düşüşlerinin anlamlı olmadığı görüldü. TNF-? ve CRP'deki azalma steroid ile tedavi edilmeyenlerde anlamlı değilken, TNF-? ve CRP'deki azalma steroid tedavisi alanlarda istatistiksel olarak anlamlıydı. Sonuç: Steroidler TNF-? düzeyini düşürürler. Akciğer hastalığı ve diyabeti olanlarda TNF-? düşüşü anlamlı değildir.
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    Evaluation of both expression and serum protein levels of caspase-8 and mitogen-activated protein kinase 1 genes in patients with different severities of COVID-19 infection
    (Springer, 2023) Acat, Murat; Gülhan, Pınar Yıldız; Eröz, Recep; Ertinmaz Özkan, Ayşegul; Koca, Oğuzhan; Çınar, Caner
    AimThe current study aimed to evaluate the effects of caspase-8 (CASP8) and mitogen-activated protein kinase 1 (MAPK1) gene expression levels and their products on preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.MethodsA total of 40 patients (men, 15 [37.5%]; women, 25 [62.5%]) with COVID-19 infection were included in the current study. The patients were divided into four main groups based on disease severity: mild (n = 7), moderate (n = 10), severe (n = 14), and critical (n = 9). Individuals aged < 18 years and pregnant women were excluded. Patients were classified according to the World Health Organization (WHO) classification system (WHO/2019-nCoV/clinical/2021.1).ResultsConsidering all groups, statistically significant differences were detected among all groups for both CASP8(2-Delta Delta Ct) (p = 0.006) and MAPK1 2(-Delta Delta Ct) values (p = 0.015). Moreover, statistically significant differences were detected between mild and moderate (p = 0.013), moderate and critical (p = 0.018), and severe and critical (p = 0.023) groups for lymphocytes.ConclusionThe CASP8/MAPK1 expression levels and/or its products are essential in preventing injury caused by COVID-19 infection. They play crucial roles in maintaining cellular homeostasis and viability. Furthermore, CASP8/MAPK1 levels can provide information about disease severity.
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    EVALUATION OF PRE AND POST-TREATMENT POSITRON EMISSION TOMOGRAPHY FINDINGS IN SMALL CELL LUNG CANCER
    (Wiley-Blackwell, 2014) Özgül, Güler; Toru, Ümran; Özgül, Mehmet Akif; Acat, Murat; Seyhan, Ekrem Cengiz; Annakkaya, Ali Nihat; Çetinkaya, Erdoğan
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