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Öğe Apoptosis-induced T-cell lymphopenia is related to COVID-19 severity(Wiley, 2021) Cizmecioglu, Ahmet; Cizmecioglu, Hilal Akay; Goktepe, Mevlut Hakan; Emsen, Ayca; Korkmaz, Celalettin; Tasbent, Fatma Esenkaya; Consultant, Fatma ColkesenIncreased levels of acute-phase reactants and lymphopenia are predictors of disease severity in coronavirus disease 2019 (COVID-19). This study aimed to investigate the role of apoptosis in the etiology of lymphopenia in patients with COVID-19. This multicentered, prospective, and case-control study was conducted with polymerase chain reaction (+) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients, and an age-gender-matched control group. Samples were taken at the time of diagnosis and analyzed via flow cytometry within 24 h. The participants' demographic data and initial laboratory tests were also recorded. In total, 33 patients with COVID-19 (mean age = 45.4 +/- 17.2) and 25 controls (mean age = 43.4 +/- 17.4) participated in the study. All patients were identified as having mild (16), moderate (5), or severe (12) disease severity. Both early and late apoptotic cells in B and T lymphocytes were increased in all patients with COVID-19 (p < .05). Early apoptotic (EA) B and T lymphocytes were also higher in severe cases compared to mild cases (p = .026). There was no significant difference between lymphopenia and apoptosis in patients with COVID-19. However, patients with lymphopenia (n = 14) and severe COVID-19 (p = .013) had increased EA T lymphocytes. This study's results show that B and T lymphocytes' apoptosis increases in patients with COVID-19. In addition, enhanced T lymphocyte apoptosis is associated with disease severity in lymphopenic patients with COVID-19.Öğe Drug Dose Adjustment in Dialysis Patients Admitted in Clinics Other Than Internal Medicine(Lippincott Williams & Wilkins, 2016) Solak, Yalcin; Biyik, Zeynep; Gaipov, Abduzhappar; Kayrak, Mehmet; Ciray, Hilal; Cizmecioglu, Ahmet; Tonbul, Halil ZekiMany drugs that are administered during hospitalization are metabolized or excreted through kidneys, consequently require dosage adjustment. We aimed to investigate inappropriate prescription of drugs requiring renal dose adjustment (RDA) in various surgical and medical inpatient clinics. We retrospectively determined dialysis patients hospitalized between January 2007 and December 2010. Inpatient clinics, including cardiology, pulmonary medicine, neurology, infectious diseases (medical clinics) and cardiovascular surgery, orthopedics, general surgery, obstetrics and gynecology, and neurosurgery (surgical clinics), were screened via electronic database. Total and RDA medications were determined. RDA drugs correctly adjusted to creatinine clearance were labeled as RDA-A (appropriate), otherwise as RDA-I (inappropriate). Renal doses of RDA medications were based on the American College of Physicians Drug Prescribing in Renal Failure, fifth Edition. Two hundred seventeen hospitalization records of 172 dialysis patients (92 men and 80 women) were included in the analysis. Mean age of patients was 59.4 +/- 14.6 years, and the mean hospitalization duration was 8.5 +/- 7.8 days. In total, 247 (84.3%, percentage in drugs requiring dose adjustment) and 175 (46.2%) drugs have been inadequately dosed in surgical and medical clinics, respectively. The percentage of patients to whom at least 1 RDA-I drug was ordered was 92% and 91.4% for surgical and medical clinics, respectively (P > 0.05). Nephrology consultation numbers were 8 (7.1%) in surgical and 32 (30.4%) in medical clinics. The most common RDA-I drugs were aspirin and famotidine. A significant portion of RDA drugs was ordered inappropriately both in surgical and medical clinics. Nephrology consultation rate was very low. Measures to increase physician awareness are required to improve results.Öğe Efficacy of convalescent plasma therapy in severe COVID-19 patients(Pergamon-Elsevier Science Ltd, 2021) Cizmecioglu, Hilal Akay; Goktepe, Mevlut Hakan; Demircioglu, Sinan; Tekinalp, Atakan; Cizmecioglu, Ahmet; Tuna, Ali Kursat; Ozer, HuseyinIntroduction: The use of convalescent plasma (CP) transfusions is very valuable in the current COVID-19 outbreak, given that there are no specific preventive and therapeutic options. Materials and methods: 50 patients with severe COVID-19 disease treated with convalescent plasma transfusion were included in the study. The efficacy of CP and in which situations it was effective were investigated. Conclusion: 80 % of the patients recovered, and 20 % died in our study. The mean age of the patients who died was found to be higher than the patients who recovered. CRP, ferritin, D-dimer, neutrophil, MPV, and NLR counts were found to be higher, and lymphocyte and platelet counts were lower in the deceased group after CP. It was determined that patients who received CP within the first five days were hospitalized for a shorter period. Discussion: Administration of CP transfusion within the first five days in severe COVID-19 patients has been shown to reduce hospital stay length.Öğe Predicting gestational diabetes mellitus during the first trimester using anthropometric measurements and HOMA-IR(Springer, 2016) Alptekin, Husnu; Cizmecioglu, Ahmet; Isik, Hatice; Cengiz, Turkan; Yildiz, Murat; Iyisoy, Mehmet SinanPurpose To determine the predictability of gestational diabetes mellitus (GDM) during the first trimester using the degree of insulin resistance and anthropometric measurements and to assign the risk of developing GDM by weight gained during pregnancy (WGDP). Methods A total of 250 singleton pregnancies at 7-12 gestational weeks were studied. Body mass index (BMI), waist/hip ratio (WHR), quantitative insulin sensitivity check index (QUICKI), homeostasis model assessment-insulin resistance (HOMA-IR) scores and WGDP were determined. The backward stepwise method was applied to estimate possible associations with GDM. Cutoff points were estimated using receiver operating characteristic curve analysis. Results GDM was found in 20 of 227 singleton pregnancies (8.8 %). The calculated HOMA-IR, QUICKI, BMI, WHR, WGDP, and parity were significantly associated with GDM. Logistic regression analyses showed that three covariates (HOMA-IR, BMI, WGDP) remained independently associated with GDM. It was calculated as OR 1.254 (95 % CI 1.006-1.563), AUC 0.809, sensitivity 90 %, specificity 61 % with cutoff = 2.08 for HOMA-IR; OR 1.157 (CI 1.045-1.281), AUC 0.723, sensitivity 80 %, specificity 58 % with cutoff = 25.95 for BMI; OR 1.221, (CI 1.085-1.374), AUC 0.654, sensitivity 80 %, specificity 46 % with cutoff = 4.7 for WGDP. Despite a HOMA-IR score of > 3.1 in pregnant women, GDM was detected in only three of 29 patients (10.3 %) if WGDP was < 4.7 kg at weeks 24-28. Conclusions First trimester screening for GDM can be achieved based on maternal anthropometric measurements and HOMA-IR. In particular, if BMI is > 25.95 kg/m(2) and the HOMA-IR score > 2.08, controlling weight gain may protect against GDM.Öğe Reduced Monocyte Subsets, Their HLA-DR Expressions, and Relations to Acute Phase Reactants in Severe COVID-19 Cases(Mary Ann Liebert, Inc, 2022) Cizmecioglu, Ahmet; Emsen, Ayca; Sumer, Sua; Ergun, Dilek; Akay Cizmecioglu, Hilal; Turk Dagi, Hatice; Artac, HasibeMonocytes are one of the principal immune defense cells that encounter infectious agents. However, an essential role of monocytes has been shown in the spread of viruses throughout the human body. Considering this dilemma, this study aimed to evaluate monocyte subsets and Human Leukocyte Antigen-DR isotype (HLA-DR) expressions in clinical coronavirus disease 2019 (COVID-19) cases. This prospective, multicenter, case-control study was conducted with COVID-19 patients and healthy controls. The patient group was divided into two subgroups according to disease severity (severe and non-severe). Three monocyte subsets (classical, CL; intermediate, INT; non-classical, NC) were analyzed with flow cytometry upon the patients' hospital admission. A total of 42 patients with COVID-19 and 30 controls participated in this study. The patients' conditions were either severe (n = 23) or non-severe (n = 19). All patients' monocyte and HLA-DR expressions were decreased compared with the controls (p < 0.05). Per disease severity, all monocyte subsets were not significant with disease severity; however, the HLA-DR expressions of CL monocytes (p = 0.002) and INT monocytes (p = 0.025) were more decreased in the severe patient group. In patients with various clinical features, NC monocytes were more affected. Based on these results, NC monocytes were more decreased in acute COVID-19 cases, though related various clinics decreased all monocyte subsets in these patients. Decreased monocyte HLA expressions may be a sign of immune suppression in severe patients, even when the percentage of monocyte levels has not decreased yet.