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    A case of malignant melonoma presenting with upper gastrointestinal bleeding.
    (Ramazan AKDEMİR, 2019) Altun, Gulsah; Önmez, Attila; Öneç, Kürşad; Kurtoğlu, Burak; Torun, Serkan; Eşbah, Onur
    Malignant melanoma can metastasize to the gastrointestinal tract as it can metastasize to many parts of the body. Small bowel is the most common involvement in gastrointestinal tract, while gastric involvement is rare. A 82-year-old male patient who presented to the emergency department with complaints of hematemesis and melena had a large number of black polypoid masses in the gastric corpus and antrum in his gastroscopic  examination. And the result of the biopsy taken from that part, was malignant melanoma. In this way, it is very rare that a patient who is not known to have malignant melanoma, presents with upper gastrointestinal bleeding.
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    Etanercept-Induced Thrombocytopenia In A Patient With Ankylosing Spondylitis
    (DAHUDER, 2022) Önmez, Attlla; Altun, Gulsah; Akbaş, Türkay; Öneç, Birgül
    Tumor necrosis factor-alpha (TNF-?), which is produced by macrophages and activated T lymphocyte cells, plays a main role in inducing further stimulation of other inflammatory cells. Anti-TNF-? drugs are used for induction and preservation of remission in patients with Ankylosing spondylitis. Etanercept, which is one of the most used Anti-TNF-? drugs, has side effects such as cytopenia but isolated thrombocytopenia is an uncommon adverse event. We report the case of a 40-year-old man diagnosed with Ankylosing spondylitis who developed Etanercept-induced isolated thrombocytopenia.
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    Factors Affecting Influenza and Pneumococcal Vaccination Rates in Hemodialysis Patients: A Multicenter Study
    (Dove Medical Press Ltd, 2025) Selen, Tamer; Merhametsiz, Ozgur; Onec, Kuersad; Ercan, Zafer; Islam, Mahmud; Altun, Gulsah; Pinar, Musa
    Purpose: In patients with end-stage renal disease (ESRD), infections, particularly pneumonias, are the most common cause of hospital admissions and death after cardiovascular diseases. It is recommended that dialysis patients receive the pneumococcal vaccine every five years and the influenza vaccine annually. Our study aims to determine the awareness and factors affecting influenza and pneumococcal vaccination rates in hemodialysis patients. Patients and Methods: This cross-sectional study was conducted on patients undergoing regular hemodialysis treatment in 10 different hemodialysis centers across 4 cities. After excluding patients with less than one year of hemodialysis duration and those under 18 years of age, 548 patients were included in the study. Patients were administered a 20-item survey via face-to-face interview and electronic medical records. Results: Out of the 548 patients, only 19 (3.5%) had knowledge about the pneumococcal vaccine, while 238 (43.4%) had knowledge about the influenza vaccine. There were 220 patients (20.1%) who had knowledge about both vaccines. Among the patients, 95 (17.3%) had received the pneumococcal vaccine, with 41.1% of them having received it five years ago or more. A significant proportion (33.7%) of the patients could not recall the timing of their vaccination. While 183 (33.4%) patients had not received the influenza vaccine, only 140 (25.5%) had been vaccinated regularly every year. The reasons for not receiving the influenza and pneumococcal vaccines were stated as I do not feel the need because I do not get the flu (25%) and I do not know about the pneumonia vaccine (36.7%), respectively. The ROC curve analysis for the influenza questionnaire score showed an AUC of 0.822 (95% CI 0.787-0.856), with a p-value of <0.001. The statistically significant cutoff value for predicting influenza vaccination was determined to be 2.5. In the univariate analysis, dialysis duration (HD duration), diabetes mellitus (DM), and vascular access type were found to be statistically significant. In the multivariate logistic regression analysis, dialysis duration and DM were identified as independent factors predicting a higher level of knowledge about the influenza vaccine (p=0.009, 0.003, and p=0.041). The ROC curve analysis for the pneumococcal questionnaire score showed an AUC of 0.920 (95% CI 0.886-0.955), with a p-value of <0.001. The statistically significant cutoff value for predicting pneumococcal vaccination was determined to be 3.5. In the univariate analysis, residence, dialysis duration, and education level were found to be statistically significant. In the multivariate logistic regression analysis, dialysis duration and education level were identified as independent factors predicting a higher level of knowledge about the pneumococcal vaccine (p=0.038, 0.040, and p=0.010). physicians, nurses and nephrologists on this issue will increase vaccination rates.
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    The Relationship of Hepcidin, Soluble Transferrin Receptor, Growth Differentiation Factor-15 And Anemia in Multipl Myeloma
    (Duzce Univ, Fac Medicine, 2023) Onec, Birgul; Kos, Durdu Mehmet; Altun, Gulsah; Sungur, Mehmet Ali
    Objective: Multiple myeloma (MM) is a malignant hematological disease and anemia is observed in the majority of patients. Hepcidin, Growth differentiation factor-15 (GDF-15), soluble transferrin receptor (sTfR) have been investigated in many forms of anemia, especially in chronic diseases and cancers. However, there are few studies investigating their role in MM. We aimed to determine the relationship between hepcidin, sTfR and GDF-15 levels in MM patients and their clinical features such as anemia parameters, disease stage and overall survival.Methods: Hepcidin, sTfR and GDF-15 levels, as well as clinical and anemia-related parameters, were analyzed in newly diagnosed MM patients and healthy volunteers.Results: Although MM patients had significantly lower Hb and Hct levels compared to the control group, none of the GDF-15, hepcidin and sTfR levels showed a significant difference between the groups. Among MM patients, we found that the anemic subgroup had significantly lower hepcidin levels than the non-anemic subgroup. GDF-15, hepcidin and sTfR levels showed weak or moderate, but statistically significant positive correlation with each other, while GDF15 was positively correlated with creatinine and sTfR levels were correlated with many parameters such as LDH, CRP, ferritin, albumin, creatinine, Hb and ISS, all of which weak. None of the levels of GDF-15, hepcidin and sTfR had a significant effect on survival.Conclusions: We suggested that these mediators may play a role in anemia of MM but there is not a clear relashionship as in chronic disease anemia, there may be different mechanisms according to the characteristics of the patient groups.
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    Treatment of critically ill patients with acute hypercarbic respiratory failure by average volume-assured pressure support mode
    (Wiley, 2021) Akbas, Turkay; Altun, Gulsah
    Objectives Average volume-assured pressure support (AVAPS), a dual mode, delivers a set tidal volume (TV) per kg by adjusting the pressure between upper and lower inspiratory positive airway pressures (IPAP). Thus, ventilation is presumed to be happened effectively by sending a guaranteed TV. This study was aimed to evaluate the effectiveness of AVAPS mode in critically ill patients with acute hypercarbic respiratory failure (HRF) and compare the results with bilevel positive airway pressure-spontaneous/timed (BPAP-S/T) mode. Methods Sixty patients were assigned to BPAP-S/T (n = 29) and AVAPS modes (n = 31). Maximum IPAP was started at 20 cmH(2)O and minimum IPAP was set at 5 cmH(2)O higher than expiratory positive airway pressure (EPAP) in AVAPS mode. IPAP was started at 15 cmH(2)O in BPAP-S/T mode. IPAP levels were titrated up to 30 cmH(2)O during noninvasive mechanic ventilation (NIMV) with a targeted TV of 6-8 mL/kg. Patients were followed for 5 days. Results No differences were found in pH, paCO(2), HCO3, TV and EPAP between the two groups when compared separately by days. Maximum IPAP levels were significantly high in AVAPS mode in all times (P < 0.001). The length of stay (LOS) in intensive care unit (ICU) (P = 0.994) and hospital (P = 0.509), hours of NIMV use per day (P = 0.101) and NIMV success rate (P = 0.931) were identical between the two groups. ICU (P = 0.931), hospital (P = 0.800), 6-month (P = 0.919) and 1-year (P = 0.645) mortality rates were also not different between the both groups. Conclusions AVAPS mode had similar efficiency with BPAP-S/T mode regarding the NIMV treatment success in critically ill patients with acute HRF.