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    Is the Prognostic Nutritional Index a Prognostic Marker for the Survival of Patients with Lymph-Node Positive Stage II-III Gastric Cancer Who Receive Adjuvant Chemotherapy?
    (Springer, 2023) Korkmaz, Mustafa; Eryilmaz, Melek Karakurt; Er, Muhammed Muhiddin; Kocak, Mehmet Zahid; Demirkiran, Aykut; Karaagac, Mustafa; Araz, Murat
    Purpose The prognostic nutritional index (PNI), like other systemic inflammatory markers, has been shown to be a prognostic factor in various cancer patients. In this study, we aimed to show whether PNI calculated before adjuvant chemotherapy is a prognostic factor for overall survival (OS) and disease-free survival (DFS) in patients with lymph node-positive stage II-III gastric cancer.Methods The PNI was calculated using the albumin and lymphocyte count. The PNI cut-off value was found to be 39.5. They were divided into two groups as being = 39.5 (PNI low group) and > 39.5 (PNI high group).Results Our study included 168 patients with lymph node-positive stage II-III gastric cancer who received adjuvant chemotherapy. Of the patients, 116 (69.0%) were 65 years or younger, and 52 (31.0%) were over 65 years old. Of the patients, 117 (69.6%) were pT3, 51 (30.4%) were pT4. Seventy-three (43.4%) patients had pN1-2 disease and 95 (56.6%) patients had pN3 disease. The number of stage II patients was 73 (43.5%) and the number of stage III patients was 95 (56.5%). There were 73 patients with PNI = 39.5 and 95 patients with PNI > 39.5. The mOS of the patients with low PNI group was 39.5 months, while the OS of the patients with high PNI group was 96.8 months (p = 0.002). In the group of patients with PNI low group, mDFS 24.4 months was significantly higher than those with PNI high group was 50.7 months (p = 0.021). The PNI score was statistically significant in univariate and multivariate analyzes for both DFS and OS.Conclusion PNI can be used as an independent prognostic factor for both OS and DFS in patients lymph node-positive, stage II-III gastric cancer who will receive adjuvant chemotherapy.
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    Konya ilindeki erişkin çölyak hastalarının epidemiyolojik, klinik ve laboratuvar bulgularının retrospektif olarak değerlendirilmesi
    (Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, 2018) Er, Muhammed Muhiddin; Demir, Ali
    Bu çalışmada erişkin çölyak hastalarının (ÇH) epidemiyolojik ve klinik özelliklerini, diyetten fayda görüp görmediklerini ve laboratuvar parametrelerini değerlendirilmeyi amaçladık. Yöntem: Çalışmamızda 2011-2017 yılları arasında Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Hastanesi, İç Hastalıkları ABD, Gastroenteroloji Bilim Dalı Klinik ve Polikliniğinde çölyak tanısı ile takip edilen 18 yaş ve üzeri hastaların hastane otomasyon sistemi üzerinden retrospektif olarak değerlendirilmesi planlandı. Hastaların laboratuvar kayıtları incelendi ve anamnez kısmındaki bilgilerden tanı anındaki ve en son kontroldeki klinik özellikleri kayıt altına alındı. Bulgular:Çalışmaya toplam 155 çölyak hastası dahil edildi. Hastaların 119'u (%76.8) kadın, 36'sı (%23.2) erkekti ve yaş ortalamaları 37.1±13.7'ti. Ortalama çölyak tanı süresi 5.3±4.6 yıldı. Hastaların 54'ünün (%34.8) ailesinde ÇH tanısı mevcuttu. Hastaların BKİ ortalaması 24±4.4 kg/m2 olarak hesaplandı. Hastaların tanı anında ve son kontrolde en sık şikayeti dispepsiydi (%71.6 ve %20). Konstipasyon tanıda %25'inde mevcuttu. Diyete tam uyum oranı %70.3 olarak hesaplandı. Hipotiroidi en sık eşlik eden hastalıktı (%9.6). Toplam 22 (%14.1) farklı hastada en az bir otoimmün hastalık saptandı. Serolojik testlerin pozitiflik oranı %33.5 ile %63.9 arasındaydı. Hastaların %24'ünde demir eksikliği anemisi, %71'inde vitamin D eksikliği tespit edildi. Sonuç: Çölyak hastalığı hem tanı anında hem de takipte, klinik ve laboratuvar açısından oldukça heterojen bir tablo ile karşımıza çıkmaktadır. Özellikle, oldukça sık eşlik eden immün aracılı hastalıklar konusunda takip eden hekimlerin daha dikkatli olması gerekmektedir. Anahtar Kelimeler: Çölyak hastalığı, atipik çölyak hastalığı, komorbidite, otoimmünite
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    Pazopanib-associated secondary adrenal insufficiency in a patient with malignant solitary fibrous tumor
    (Sage Publications Ltd, 2021) Er, Muhammed Muhiddin; Araz, Murat; Karabacak, Meryem; Ugrakli, Muzaffer; Eryilmaz, Melek Karakurt; Karaagac, Mustafa; Artac, Mehmet
    Introduction Pazopanib is an agent that is being successfully used in soft tissue sarcomas. Some endocrine side effects may develop during pazopanib treatment. Here, we presented a case diagnosed with secondary adrenal insufficiency while being investigated for etiology of hypoglycemia which developed after pazopanib. Case report A 69-year-old male patient was operated in June 2019 due to a lung mass 26 x 18 x 10 cm in size. Pathological diagnosis revealed a solitary fibrous tumor with malignant behavior. The patient received three lines of chemotherapy. After pazopanib treatment, a hypoglycemic attack was reported. Management and outcome: Blood cortisol and ACTH (Adrenocorticotropic hormone) levels were not increased at the time of the hypoglycemic attack, and levels of other pituitary hormones were found to be normal. Electrolyte levels were in normal range. Since the counteracting hormone did not reach a sufficient level, it was considered secondary adrenal insufficiency. Hypoglycemic attacks did not occur during follow-up while taking steroid therapy and pazopanib. Discussion A single case of primary adrenal insufficiency has been reported in the literature. We here present a case who developed hypoglycemia after pazopanib and was diagnosed with drug-associated secondary adrenal insufficiency. When hypoglycemia develops during pazopanib treatment, we must be aware of adrenal insufficiency.