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Öğe Allergic Diseases as a Clinical Phenotype Marker in Patients with Common Variable Immunodeficiency(Karger, 2023) Yildiz, Eray; Colkesen, Fatih; Arslan, Sevket; Evcen, Recep; Aykan, Filiz Sadi; Kilinc, MehmetIntroduction: Patients with common variable immunodeficiency (CVID) have been shown to be more predisposed to develop allergic diseases because of mucosal immune defects and immune dysregulation. The aim of this study was to determine the prevalence, and clinical and laboratory characteristics of various allergic diseases in patients with CVID. Methods: The study included patients aged & GE;18 years who were followed up for a diagnosis of CVID. Patients were separated into 5 groups according to the clinical phenotypic characteristics of lymphoproliferation, autoimmunity, gastrointestinal diseases, allergic diseases, and malignancy. Atopic dermatitis (AD), drug hypersensitivity reaction (DHR), allergic rhinitis (AR), and asthma were accepted as allergic diseases. Results: The most commonly seen clinical phenotypes were lymphoproliferation in 41 (48.8%) patients and allergic diseases in 31 (37%). AD was determined in 2 (2.4%) patient, DHR in 5 (6%), AR in 7 (8.3%), and asthma in 21 (25%). The delay in diagnosis of patients with allergic disease was determined to be shorter compared to those without allergic disease (p = 0.042). Serum total immunoglobulin E level, CD19(+) B cell, switched memory B cell, and natural killer cell counts were determined to be higher in the CVID patients with allergic disease compared to those without (p = 0.007, p = 0.022, p = 0.023, p = 0.017, respectively). Conclusion: Allergic diseases should be considered as a marker of clinical phenotype in CVID because of the clinical and immunological differences. Early diagnosis and treatment of allergic diseases in patients with CVID can improve quality of life.Öğe Allergic diseases in the elderly population: a single-center experience(Tubitak Scientific & Technological Research Council Turkey, 2021) Yildiz, Eray; Colkesen, Fatih; Arslan, Sevket; Evcen, Recep; Sadi Aykan, Filiz; Kilinc, Mehmet; Aytekin, GokhanBackground/aim: Although allergic diseases are generally considered to be diseases of childhood and youth, the first symptoms of allergic diseases can be seen in old age sometimes. The aim of this study was to determine the prevalence and characteristics of allergic diseases in the elderly population admitted to the allergy unit on an outpatient basis. Materials and methods: The files of the patients who applied to our clinic's allergy unit during the 8-year period were retrospectively analyzed. The data of patients aged >_ 65 years were obtained from the files of our allergy unit archive. Results: A total of 1272 patients aged >_ 65 years old were included in the study. The mean age was 70 years (range: 65-97 years). Most of the patients were female (n = 704, 55.3%). Of the patients, 887 (69.8%) presented with cutaneous symptoms, and urticaria was identified in 500 of them (56.3%). Drug hypersensitivity reactions were detected in 175 (13.7%) patients. A total of 71 (5.6%) patients had asthma, 65 (5.1%) had anaphylaxis, 48 (3.8%) had allergic rhinitis, 24 (1.9%) had hymenoptera venom allergy, and 18 (1.4%) had food allergies. Atopy history (OR = 2.323, 95% CI = 1.590-3.393, p < 0.001) and comorbidity (OR = 1.631, 95% CI = 1.050-2.533, p = 0.029) were found to be risk factors for drug hypersensitivity reactions. Male sex (OR = 3.462, 95% CI = 1.097-10.933, p = 0.034) and atopy history (OR = 14.877, 95% CI = 6.081-36.393, p < 0.001) were found to be risk factors for hymenoptera venom allergy. Conclusion: Diagnosis becomes difficult due to the perception that allergic diseases mainly affect young people. Clinical symptoms are not evident in the elderly and age-related difficulties are encountered in diagnostic tests. There is a need to develop specific guidelines for the diagnosis of allergic diseases in the elderly.Öğe Anaphylaxis in older adult patients: a 10-year retrospective experience(Elsevier, 2022) Yildiz, Eray; Arslan, Sevket; Coelkesen, Fatih; Evcen, Recep; Aykan, Filiz Sadi; Kilinc, MehmetBackground: Despite the worldwide increase in life expectancy and the elderly population, very little is known about the characteristics of anaphylaxis in older adults.Methods: A retrospective scan was made of the files of patients who presented at the Allergy Unit of our clinic between October 2011 and October 2021. The study included 971 patients aged >18 years who met the criteria for diagnosis of anaphylaxis. The patients were separated into 2 groups of adults (18-64 years) and older adults (>65 years).Results: The adult group included 887 (91.3%) patients and the older adult group, 84 (8.7%) patients. Comorbid diseases were seen more frequently in the older adults than in the adult group (p < 0.001). Drugs were seen to be the most common trigger of anaphylaxis in both groups, and this was more common in the older adult group (p = 0.039). Food was a more common trigger of anaphylaxis in the adult group than in the older adult group (p = 0.017). In both groups, the skin was the organ most affected, and was less affected in the older adults than in the adults (p = 0.020). Cardiovascular symptoms were seen significantly more and respiratory symptoms significantly less in the older adult group (p < 0.001, p = 0.002, respectively). Admission to the hospital and the intensive care unit was more frequent in the older adult group and rates of adrenalin administration were higher compared to the adult group (p < 0.001 for all).Conclusion: Anaphylaxis in the older adults is generally caused by drugs. Older adults were found to have more cardiovascular symptoms and more frequent adrenalin injections, hospitalizations and intensive care unit admissions.Öğe Aromatase deficiency in an adolescent girl misdiagnosed as congenital adrenal hyperplasia in infancy and childhood(Walter De Gruyter Gmbh, 2014) Eklioglu, Beray Selver; Atabek, Mehmet Emre; Akyurek, Nesibe; Piskin, Mehmet M.; Kilinc, Mehmet[Abstract Not Availabe]Öğe Aromatase deficiency in an adolescent girl misdiagnosed as congenital adrenal hyperplasia in infancy and childhood(Walter De Gruyter Gmbh, 2014) Eklioglu, Beray Selver; Atabek, Mehmet Emre; Akyurek, Nesibe; Piskin, Mehmet M.; Kilinc, Mehmet[Abstract Not Availabe]Öğe Comparison of Non-Hilar Clamping Simple Enucleation and Enucleo-Resection of Exophytic Renal Tumors(Urol & Nephrol Res Ctr-Unrc, 2015) Balasar, Mehmet; Durmus, Emrullah; Piskin, Mehmet Mesut; Karalezli, Giray; Gurbuz, Recai; Kilinc, MehmetPurpose: To retrospectively evaluate our institutional experience with non-hilar-clamping simple enucleation (SE) and enucleoresection (ER) for the treatment of exophytic renal tumors regarding their oncological outcomes. Materials and Methods: We retrospectively evaluated patients treated between 2006 and 2013 for clinical exophytic T1-T2a renal tumors using open nephron-sparing surgery. Results: A total of 33 patients underwent SE and 39 underwent ER. The mean tumor size was 38.7 mm. None of the patients had positive surgical margins. No local recurrences were observed during the postoperative follow-up period (mean 40.7 +/- 23.4 months); however, ipsilateral adrenal and contralateral kidney metastasis was detected in one of the patients. There was no statistically significant difference in the R.E.N.A.L Nephrometry Score, operative time, or intraoperative blood loss in the non-hilar-clamping SE and ER groups (P > .05). During the third postoperative month, the estimated glomerular filtration rate (eGFR) levels in the SE group were significantly reduced compared with the preoperative eGFR levels (P = .046). Conclusion: SE and ER with non-hilar clamping are safe, acceptable approaches for treating exophytic renal tumors.Öğe Development of buffalo milk ice-cream by high pressure-homogenisation of mix: Physicochemical, textural and microstructural characterisation(Elsevier, 2021) Sert, Durmus; Mercan, Emin; Kilinc, MehmetThis study aimed to determine the physicochemical, textural, and microstructural characteristics of buffalo milk ice cream produced from high-pressure homogenisation (HPH) treated ice cream mix. Ice cream mix was subjected to 0 (control), 30, 60, 90, 120, or 150 MPa. HPH increased the firmness and consistency value of mixes, whereas it decreased cohesiveness and index of viscosity values. Also, HPH improved the lightness, redness, and yellowness of the mix. The mean particle size of HPH-treated mix samples was lower than the control, except HPH-150. The hardness of ice cream samples was between 14.30 and 77.81 N, in which HPH increased hardness value with the increasing pressure. The overrun of ice cream samples ranged from 19.93 to 45.15%, and HPH decreased it. HPH significantly improved resistance to melting in the ice cream. Scanning electron microscopy images revealed that HPH reduced the size of air bubbles. HPH at 150 MPa resulted in a foamy structure in the ice cream. HPH can alter the hardness, microstructure, and melting characteristics of buffalo milk ice cream. Products with improved properties may be developed by further modifying the formulation and processing parameters.Öğe Evaluation of malnutrition risk and nutrition status in adult patients with common variable immunodeficiency(Wiley, 2022) Yildiz, Eray; Arslan, Sevket; Colkesen, Fatih; Aykan, Filiz Sadi; Evcen, Recep; Kilinc, Mehmet; Aytekin, GokhanBackground The aim of this study is to determine the prevalence of malnutrition in outpatients with common variable immunodeficiency (CVID) and the utility of nutrition screening tools to detect malnutrition in these patients. Methods Fifty outpatients with CVID were included in the study. Nutrition risk for each patient was evaluated using four nutrition screening tools: Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), Short Nutritional Assessment Questionnaire (SNAQ), and Nutritional Risk Screening 2002 (NRS-2002). Results According to MUST, MST, SNAQ, and NRS-2002, malnutrition risk was determined to be 48% (n = 24), 26% (n = 13), 20% (n = 10), and 20% (n = 10), respectively. Malnutrition was detected in 54% (n = 27) of the patients. It was found that MUST showed a better correlation in detecting malnutrition in outpatients with CVID (kappa = 0.482, P = 0.001). MUST has a higher positive and negative predictive value than other nutrition screening tools (79% and 70%, respectively). In the multivariate logistic regression analysis, it was found that low serum immunoglobulin A (IgA) levels at diagnosis increased the risk of malnutrition by similar to 15 times, and low CD19(+) B-cell counts increased the risk by approximately eight times. Conclusion The prevalence of malnutrition in patients with CVID was found to be quite high, and there was a strong correlation between malnutrition and low CD19(+) B-cell counts and low serum IgA levels. Given the high rate of malnutrition in patients with CVID, nutrition assessment is recommended rather than starting with nutrition screening.Öğe Evaluation of Organization and Management Structure of Health Enterprises: Comparison of Public, Private and University Hospitals in Turkey(Springer Int Publishing Ag, 2017) Yuceler, Aydan; Kilinc, Mehmet; Kaya, S. DidemGeneral Assembly of the United Nations adopted Universal Declaration of Human Rights on 10th of December, 1948. It is stated in the 2nd article of this declaration that everyone's right to live will be protected by law. Individual's right to live may become meaningful with the right to health granted to the individual. Existence of right to live depends on the existence of right to health. What the important is not only the life, but a healthy life. Individuals' staying healthy, protection of individual's right to live and right to health is only possible with effective health services. For provision of effective health services, health system should be organized well. According to World Health Organization, health system of a country should be designed in a manner that health services needed by everyone are provided at high quality. This service should be effective, affordable and socially acceptable. It is suggested that each country develops its unique health system by taking these factors into consideration. The reforms made in the health system which has undergone significant changes in recent years in Turkey and its present organization structure was analyzed in this study.Öğe Evaluation of the Effectiveness of the 6 Warning Signs of the European Society for Immunodeficiencies for Primary Immunodeficiencies in Older Adults(Karger, 2024) Yildiz, Eray; Colkesen, Fatih; Evcen, Recep; Aykan, Filiz Sadi; Kilinc, Mehmet; Arslan, SevketIntroduction: Diagnostic delay in cases of primary immunodeficiency (PID) is a significant problem for clinicians, and most do not have sufficient awareness of this uncommon disorder. The European Society for Immunodeficiencies (ESID) has developed 6 warning signs to increase awareness of adult PIDs. The aim of this study was to determine the prevalence of PID in older adults regardless of the reason for presentation and to evaluate the effectiveness of the 6 warning signs of ESID in the diagnosis of PIDs. Methods: The study included 1,331 patients aged >= 65 years who presented at our clinic for any reason and were questioned about the ESID 6 warning signs for PIDs. After the exclusion of reasons for secondary immunodeficiency (SID), all the patients underwent immunological evaluation for the diagnosis of potential underlying PIDs. Results: After excluding 6 patients diagnosed with SID, PID was diagnosed in 16 (1.2%) of 1,325 older adults using ESID warning signs. The most common reasons for presentation were infection (69%) in the PID group and urticaria and/or angioedema (41.5%) in the non-PID group. The most common PID subgroup was common variable immunodeficiency (50%). In 12 of the patients diagnosed with PID, there was at least 1 positive ESID warning sign. In 4 patients, PID was determined despite negative ESID warning signs. The patients diagnosed with PID showed a significant, minimal level of agreement with questions 1 and 4 of the ESID warning signs (p < 0.001, kappa = 0.204, p = 0.005, kappa = 0.208, respectively). Conclusion: The ESID warning signs do not encompass all the symptoms and findings of PIDs. There is a need for more infection-centered questions to determine PIDs in older adults. Therefore, the ESID warning signs should be further developed.Öğe Examining Pediatric Cases From the Clinical Research Office of the Endourological Society Ureteroscopy Global Study(Elsevier Science Inc, 2017) Guven, Selcuk; Basiri, Abbas; Varshney, Anil Kumar; Aridogan, Ibrahim Atilla; Miura, Hiroyasu; White, Mark; Kilinc, MehmetOBJECTIVE To evaluate the characteristics and outcomes of ureteroscopy (URS) in children treated in several hospitals participating in the Clinical Research Office of the Endourological Society (CROES) Study, and to present the overall results of pediatric URS compared with adults. PATIENTS AND METHODS The CROES Study collected data on consecutive patients treated with URS for urolithiasis at each participating center over a 1-year period. The collected prospective global database includes data for 11,885 patients who received URS at 114 centers in 32 countries. Of these URStreated patients, 192 were <= 18 years old. RESULTS Of the 114 centers participating in the study, 42% had conducted pediatric URS. Among the pediatric cases, 7 were infants, 53 were small children, 59 were school-aged children, and 73 were adolescents. A considerable number (37%) of the pediatric cases had previously undergone URS treatment. No differences in the surgical outcomes of the adults and children were reported. The URS-treated children had a greater number of positive preoperative urine cultures when compared with adult cases treated. A semirigid scope was used in the vast majority of pediatric cases (85%). According to the present data, within the group of URS-treated children, the younger the child, the more readmissions occurred. CONCLUSION URS is as efficient and safe in children as it is in adults. The data suggest that readmissions among URS-treated children are associated with age, with the likelihood of readmissions greater among younger age groups. (C) 2016 Elsevier Inc.Öğe High digit ratio (2D:4D) is associated with attack frequency and severity in hereditary angioedema patients(Elsevier Ireland Ltd, 2023) Evcen, Recep; Colkesen, Fatih; Saygin, Duygu Akin; Aykan, Filiz Sadi; Kilinc, Mehmet; Ergun, Ummugulsum Yilmaz; Akkus, Fatma ArzuBackground: Hereditary angioedema (HAE) caused by a deficiency or dysfunction of the plasma protease C1inhibitor is a rare autosomal-dominant disorder. We explored a possible correlation between the ratio of the second and fourth finger lengths (2D:4D) and the frequency of HEA attacks, and whether the ratio might predict laryngeal attack. Method: We evaluated 35 HEA patients aged 19 to 66 years; 3 were subsequently excluded. The 2D:4D ratio was calculated by dividing the length of the second finger by that of the fourth finger of both hands. A structured clinical questionnaire exploring HAE course and treatment over the prior year was administered.Results: Of the 32 participants, 56.25 % (n = 18) were female. Of them, those with high 2D:4D ratios suffered significantly more laryngeal attacks than others; 93.3% of patients with high 2D:4D ratios experienced >= 5 attacks annually, significantly more than those with low ratios. Among type 2 HEA patients, 75 % of those experiencing >= 5 attacks annually had high 2D:4D ratios; all patients with low 2D:4D ratios reported <5 attacks annually. These significant effects were found for right-hand 2D:4D ratios and not left-hand 2D:4D ratios.Conclusion: The data suggest that intrauterine sex hormone exposure, which affects the 2D:4D ratio, is significantly associated with HEA attack frequency and severity, and laryngeal edema.Öğe Increasing Prevalence of Sensitization to Cat/Dog Allergens in the COVID-19 Pandemic(Karger, 2024) Evcen, Recep; Colkesen, Fatih; Yildiz, Eray; Aykan, Filiz Sadi; Kilinc, Mehmet; Akkus, Fatma Arzu; Arslan, SevketIntroduction: Cat and dog allergens are common indoor triggers for respiratory allergies such as allergic rhinitis and asthma. This study aims to evaluate the prevalence of cat and dog allergies in adults and analyze changes during the COVID-19 pandemic.Methods: We retrospectively analyzed the medical records of 8,102 patients who visited an allergy clinic and underwent skin prick testing (SPT) from March 2018 to March 2022: 2 years before and 2 years during the pandemic. Demographic information, clinical attributes, and laboratory results were examined based on patient records.Results: Of 8,102 SPTs performed, 400 (4.9%) were sensitized to cat allergen and 289 (3.6%) to dog allergen. Allergic rhinitis was the predominant clinical diagnosis in both groups. Of the 400 subjects exposed to cats, 240 (60%) experienced allergic symptoms, while of the 289 subjects exposed to dogs, 65 (22.5%) experienced allergic symptoms during exposure. Within the cat-sensitized group, anaphylaxis was observed in 5 patients (1.3%), while no cases of anaphylaxis were reported in the dog-sensitized group. Compared to the pre-pandemic period, patients presenting during the pandemic had higher rates of cat and dog sensitization (5.7% vs. 4.1%; p < 0.05, 5.2% vs. 1.7%; p < 0.05).Conclusion: During the COVID-19 pandemic, there was an increase in cat and dog allergies among adults. Increased exposure to pet antigens, both directly and indirectly, has resulted in more people becoming sensitized to cats or dogs.Öğe Powder flow behaviour, functional characteristics and microstructure of whole milk powder produced from cow and buffalo milk mixtures(Elsevier Sci Ltd, 2022) Sert, Durmus; Mercan, Emin; Kilinc, MehmetThe effects of cow and buffalo milk mixtures on powder flow behaviour, functional characteristics and microstructure of whole milk powder was investigated. Milk powder was produced from 100% cow milk (G1), 100% buffalo milk (G2), 75% cow/25% buffalo milk (G3), 50% cow/50% buffalo milk (G4) and 25% cow/75% buffalo milk (G5). A higher proportion of buffalo milk increased the hydroxymethylfurfural, thiobarbituric acid reactive substances and free fatty acid contents in powders, but decreased dis-persibility and wettability. The lowest and highest mean particle size values were obtained in G3 and G2 samples. Milk powder containing a higher level of buffalo milk increased caking ability and compaction coefficients of milk powder. All samples had remarkably cohesive characteristics. A higher proportion of cow milk can improve the flow behaviour of milk powder containing cow and buffalo milk mixtures in terms of caking, cohesion, and powder speed flow dependency.(c) 2022 Elsevier Ltd. All rights reserved.Öğe PRELIMINARY EXPERIENCE WITH MICROPERC IN KIDNEY AND BLADDER STONES: AS FINE AS POSSIBLE(Mary Ann Liebert, Inc, 2012) Piskin, Mesut; Guven, Selcuk; Kilinc, Mehmet; Arslan, Mehmet; Goger, Emre; Ozturk, Ahmet[Abstract Not Availabe]Öğe Preliminary, Favorable Experience with Microperc in Kidney and Bladder Stones(Mary Ann Liebert Inc, 2012) Piskin, Mehmet Mesut; Guven, Selcuk; Kilinc, Mehmet; Arslan, Mehmet; Goger, Emre; Ozturk, AhmetPurpose: In this study, we report our initial experience using microperc for treatment of kidney stones and the implications of the microperc system in bladder stone management. Patients and Methods: Microperc was performed with a 4.85F all-seeing needle in 11 patients with stone disease; 9 of the patients had kidney stones and 2 had bladder stones. Access to the renal collecting system was achieved under fluoroscopic control in eight patients, while ultrasonography was used in one. Fluoroscopy was not used in any of the patients with bladder stones for bladder access. Results: The mean stone burden was 12.8mm (range 7-18 mm). The stone locations were pelvis in three, upper calix in one, middle calix in two, and lower calix in three. The mean age for kidney stones was 20.8 years (range 3-47 years). Single access was sufficient in all cases. In two patients, although the procedure was progressing without complication, conversion to miniperc was needed because of operator-related system errors. There were no intraoperative complications. The stone-free rate in the postoperative first month was 85%. Conclusion: The least invasive microperc with an optical puncture system appears to be a safe and effective treatment modality in patients with different kinds of stone disease with respect to various features. Although the initial cases were patients with single stones of less than 20 mm, the combined use of this system with other minimally invasive treatment modalities for the management of larger stones is promising.Öğe Primary results of transurethral prostate ethanol injection(Springer, 2014) Arslan, Mehmet; Ozturk, Ahmet; Goger, Yunus Emre; Aslan, Erkan; Kilinc, MehmetMinimally invasive methods, especially the novel techniques, gain more and more popularity in benign prostate hyperplasia (BPH) treatment. Transurethral ethanol injection is one of these novel methods as it is easy to apply for BPH treatment and quite successful. The present study evaluates the results of a single-year transurethral ethanol injection prostate (TUEP) follow-up employed for the first time in our country. Fifty-two patients with lower urinary tract symptoms underwent TUEP. It was performed in ten patients under local anesthesia and in 42 patients under sedation. Dehydrated ethanol with a concentration of 95-98 % was injected using transurethral approach with a rigid cystoscope. Forty-two patients were followed for 1 year. At the end of the first year, the average patients' IPSS scores decreased from 22.6 to 12.8 and prostate volume from 49.5 to 38.8 cc. Q-average increased from 3.3 to 7.1 ml/s and Qmax from 6.4 to 9.7 ml/s. Residual urine decreased from 160.1 ml to 68 cc. There were not any dire postoperative complications. In 77.8 % of the patients, TUEP succeeded. In 13.8 % of the patients, alternative treatment methods were to be employed. TUEP, an effective minimally invasive treatment option, can be performed with medically high-risk BPH patients under regional anesthesia. The procedure is easy, inexpensive, safe, and rapid to us. Yet, long-term and multi-centered studies with larger patient series are needed to define further benefits.
