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Öğe A case of malignant melonoma presenting with upper gastrointestinal bleeding.(Ramazan AKDEMİR, 2019) Altun, Gulsah; Önmez, Attila; Öneç, Kürşad; Kurtoğlu, Burak; Torun, Serkan; Eşbah, OnurMalignant 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.Öğe Baseline Serum Albumin for Long-Term Risk Stratification in Maintenance Hemodialysis Patients: A Retrospective Cohort Study(Mdpi, 2026) Onec, Kursad; Altun, Gulsah; Sav, TansuBackground/Objectives: Mortality among patients receiving maintenance hemodialysis remains high, and biomarkers that allow early risk stratification are needed. Serum albumin reflects nutritional status and systemic inflammation and has been associated with adverse outcomes; however, its long-term prognostic significance remains incompletely defined. This study examined the association between baseline serum albumin and long-term (up to 10-year) all-cause mortality in a large hemodialysis cohort. Methods: This retrospective cohort study included adult patients undergoing maintenance hemodialysis between 2015 and 2025 at a tertiary nephrology center. Individuals with at least three months of stable dialysis and available baseline serum albumin measurements were included. Patients were categorized into two groups according to baseline serum albumin levels (<3.5 g/dL and >= 3.5 g/dL). The primary outcome was long-term (up to 10-year) all-cause mortality, while secondary outcomes included emergency department visits, hospital admissions, cardiovascular events, and infection-related hospitalizations. Survival was assessed using Kaplan-Meier analysis, and predictors of mortality were evaluated using Cox proportional hazards regression. The median follow-up duration was 54 months (interquartile range: 28-92), with a maximum follow-up of 10 years. Results: A total of 412 patients were analyzed, of whom 40.8% had serum albumin levels < 3.5 g/dL. During follow-up, 233 deaths occurred. Lower albumin levels were associated with significantly higher mortality (76.2% vs. 43.4%, p < 0.001), increased healthcare utilization, and a greater incidence of cardiovascular and infectious complications. In multivariate analysis, albumin < 3.5 g/dL remained an independent predictor of mortality (hazard ratio 1.84, 95% confidence interval 1.42-2.38; p < 0.001). Receiver operating characteristic analysis identified 3.4 g/dL as the optimal cutoff for mortality prediction (area under the curve 0.72). Conclusions: Baseline serum albumin is an independent predictor of long-term (up to 10-year) mortality and adverse clinical outcomes in patients receiving maintenance hemodialysis. Although albumin is not a causal determinant, its association with survival likely reflects underlying nutritional and inflammatory burden. Prospective multicenter studies are warranted to validate albumin-based risk stratification and to evaluate the prognostic value of longitudinal changes in serum albumin over time.Öğe Creatinine Decline Rate as a Predictor of Renal Recovery After Acute Kidney Injury: A Retrospective Cohort Study(Mdpi, 2025) Onec, Kursad; Altun, Gulsah; Sav, TansuBackground/Objectives: Acute kidney injury (AKI) is a common complication in hospitalized patients and carries a substantial risk of chronic kidney disease (CKD), dialysis dependence, and mortality. Although novel biomarkers such as NGAL, KIM-1, and cystatin C have shown promise, their high cost and limited availability restrict their use in routine practice, particularly in developing countries where CKD incidence is rising. The trajectory of serum creatinine decline after its peak may provide a simple, low-cost, and universally available prognostic marker for renal recovery. Methods: This retrospective cohort study included 817 adult patients diagnosed with AKI between January 2015 and December 2024. The creatinine decline rate was calculated as the difference between peak and discharge creatinine divided by hospital stay (mg/dL/day). Patients were stratified into rapid or slow decline groups according to the median value (0.19 mg/dL/day). Post-discharge outcomes, including CKD development, readmission, dialysis requirement, and mortality, were evaluated at 3, 6, and 12 months. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cutoff for predicting renal recovery. Results: Patients in the rapid decline group (n = 409) were younger and had fewer comorbidities and shorter hospital stays than those in the slow decline group (n = 408). The ROC analysis yielded an AUC of 0.78 (95% CI 0.73-0.82, p < 0.001) with an optimal cutoff of 0.18 mg/dL/day (sensitivity 76%, specificity 71%). At 12 months, CKD (18.6% vs. 34.3%), dialysis requirement (3.4% vs. 8.8%), readmission (29.8% vs. 41.2%), and mortality (9.3% vs. 14.2%) were all significantly higher in the slow decline group (all p < 0.05). In multivariable analysis, faster creatinine decline independently predicted renal recovery (OR = 1.36 per 0.1 mg/dL/day, 95% CI 1.22-1.53, p < 0.001), along with younger age, higher serum albumin, and shorter hospital stay. In the longitudinal GEE model, both time (p = 0.004) and group effects (p < 0.001) remained significant, with an interaction effect (p = 0.018) indicating greater eGFR improvement over time among patients with rapid creatinine decline. Conclusions: The rate of creatinine decline is an independent predictor of long-term renal recovery following AKI. This simple and inexpensive parameter may complement novel biomarkers and serve as a practical risk-stratification tool in diverse clinical settings, especially where resources are limited. Prospective multicenter studies integrating albuminuria and emerging biomarkers are warranted to validate and expand these findings.Öğe Erythroferrone, Hepcidin, and Erythropoietin in Chronic Kidney Disease: Associations with Hemoglobin and Renal Function(Mdpi, 2025) Onec, Kursad; Altun, Gulsah; Ozdemir Aytekin, Seyma; Davran, Fatih; Onec, BirgulBackground/Objectives: Chronic kidney disease (CKD) is commonly complicated by anemia resulting from impaired erythropoietin (EPO) production, iron dysregulation, and chronic inflammation. Erythroferrone (ERFE) and hepcidin are key regulators of erythropoiesis and iron metabolism, but their interaction in CKD remains incompletely understood. This study aimed to examine the associations among ERFE, hepcidin, EPO, and hemoglobin, and to determine whether these markers independently relate to anemia severity in CKD. Methods: This cross-sectional case-control study included 126 patients with CKD (stages 2-5) and 33 age- and sex-matched healthy controls. Laboratory parameters, including hemoglobin, ferritin, transferrin saturation (TSAT), EPO, ERFE, hepcidin, and renal indices (eGFR, BUN, creatinine), were analyzed. Group differences were assessed using ANOVA or Kruskal-Wallis tests with post hoc analyses, and trends were evaluated using the Jonckheere-Terpstra test. Age- and sex-adjusted correlations and multivariable linear regression identified independent associations with hemoglobin. Results: Patients with CKD were older (61.2 +/- 14.8 vs. 33.4 +/- 10.7 years, p < 0.001) and had lower hemoglobin (11.8 +/- 1.9 vs. 13.5 +/- 1.4 g/dL, p < 0.001) and higher ferritin levels (245 (110-470) vs. 105 (40-240) ng/mL, p = 0.002) compared with controls. eGFR declined progressively across CKD stages (median (IQR): 73 (64-86) to 12 (7-17) mL/min/1.73 m(2), p-trend < 0.001). ERFE and hepcidin showed increasing trends with advancing CKD (p-trend = 0.031 and 0.047, respectively). Hemoglobin correlated negatively with ERFE (r = -0.40, 95% CI: -0.53 to -0.26, p < 0.001) and positively with eGFR (r = 0.42, 95% CI: 0.28-0.54, p < 0.001). In adjusted regression analysis, ERFE (beta = -0.29, 95% CI: -0.41 to -0.18, p < 0.001) and eGFR (beta = 0.25, 95% CI: 0.13-0.37, p < 0.001) remained independently associated variables of hemoglobin (adjusted R-2 = 0.47). Conclusions: Anemia severity in CKD is independently associated with both renal dysfunction and higher ERFE concentrations, suggesting a disrupted ERFE-hepcidin regulatory balance. These findings provide hypothesis-generating insights into the complex interplay between iron metabolism and erythropoiesis in CKD. Validation in larger, multi-center longitudinal studies that include inflammatory markers is warranted.Öğe Etanercept-Induced Thrombocytopenia In A Patient With Ankylosing Spondylitis(DAHUDER, 2022) Önmez, Attlla; Altun, Gulsah; Akbaş, Türkay; Öneç, BirgülTumor 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.Öğe 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, MusaPurpose: 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.Öğe 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 AliObjective: 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.Öğe Treatment of critically ill patients with acute hypercarbic respiratory failure by average volume-assured pressure support mode(Wiley, 2021) Akbas, Turkay; Altun, GulsahObjectives 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.
