Publications by authors named "Demet Yildiz"

16 Publications

  • Page 1 of 1

Epicardial Adipose Thickness and Neutrophil Lymphocyte Ratio in Acute Occlusive Cerebrovascular Diseases.

J Stroke Cerebrovasc Dis 2020 Nov 11;29(11):105203. Epub 2020 Aug 11.

Department of Biostatistics, Uludag University Faculty of Medicine, Bursa; Turkey. Electronic address:

Objectives: We investigate the relationship between the severity of vascular disease and epicardial adipose tissue thickness(EAT-t) and the neutrophil/lymphocyte (NEU/LY) ratio in acute stroke patients.

Methods: Seventy-six patients and 38 healthy controls were included in the study. Strokes were divided into three groups: lacunar infarction, middle cerebral artery infarction (MCA), and other arterial infarcts. Patients were assessed using the GCS (Glasgow coma scale) and NIHSS (National Institutes of Health Stroke Scale) scales. In addition to laboratory measurements, EAT-t was evaluated in all patients by using echocardiography.

Results: The EAT-t value and NEU/LY ratio were higher in the patient group than in the control group. The MCA group was found to have a significantly higher NEU/LY ratio than the lacuna group (p = 0.017) as well as the other patient (p = 0.025) group. There was a positive correlation of NIHSS score with EAT-t (r = 0.291; p = 0.013), and NEU/LY ratio (r = 0.289; p = 0.014).

Conclusion: The EAT-t and NEU/LY ratio were high in patients with acute ischemic stroke patients. The higher ratio of NEU/LY compared to other infarcts in the MCA group. These findings support the relationship between acute ischemic stroke severity and inflammation .
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105203DOI Listing
November 2020

Stereotactic body radiotherapy in patients with early-stage non-small cell lung cancer: Does beam-on time matter?

Jpn J Clin Oncol 2020 Sep;50(10):1182-1187

Radiation Oncology, Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Purpose: Stereotactic body radiotherapy (SBRT) is an effective treatment option for patients with early-stage non-small cell lung cancer (NSCLC). In this study, we evaluated the treatment results using two different SBRT techniques and the effect of beam-on time (BOT) on treatment outcomes.

Methods: Between July 2007 and January 2018, 142 patients underwent SBRT for primary NSCLC. We have delivered SBRT using either respiratory tracking system (RTS) or internal-target-volume (ITV)-based motion management techniques. The effect of age, tumor size, pretreatment tumor SUVmax value, presence of tissue diagnosis, histopathological subtype, operability status, tumor location, motion management technique, BED10 value, BOT on overall survival (OS), loco-regional control (LRC), event-free survival (EFS) and primary tumor control (PTC) were evaluated.

Results: Median age of the patients was 70 years (range, 39-91 years). Most of the patients were inoperable (90%) at the time of SBRT. Median BED10 value was 112.5 Gy. With a median follow-up of 25 months, PTC was achieved in 91.5% of the patients. Two-year estimated OS, LRC, PTC and EFS rates were 68, 63, 63 and 53%, respectively. For the entire group, OS was associated with BOT (P = 0.027), and EFS was associated with BOT (P = 0.027) and tumor size (P = 0.015). For RTS group, OS was associated with age (P = 0.016), EFS with BOT (P = 0.05) and tumor size (P = 0.024), LRC with BOT (P = 0.008) and PTC with BOT (P = 0.028). The treatment was well tolerated in general.

Conclusion: SBRT is an effective and safe treatment with high OS, LRC, EFS and PTC rates in patients with primary NSCLC. Protracted BOT might deteriorate SBRT outcomes.
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http://dx.doi.org/10.1093/jjco/hyaa093DOI Listing
September 2020

Assessment of Neurodegeneration by Optical Coherence Tomography and Mini-Mental Test in Parkinson's Disease.

Ann Indian Acad Neurol 2019 Apr-Jun;22(2):212-216

Department of Biostatistics, Uludag University Faculty of Medicine, Bursa, Turkey.

Background: Parkinson's disease is a neurodegenerative disease. Cognitive disorders and retinal degeneration may occur during the early stages of the disease. Retinal degeneration and cognitive findings can be assessed easily with optical coherence tomography and mini-mental test, respectively.

Materials And Methods: Twenty-two patients who are being followed-up with Parkinson's disease and 22 healthy controls have been included in the study. The Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn-Yahr staging of the patients have been conducted at the time of admission. Retinal nerve fiber layer analysis and ganglion cell thickness (ganglion cell complexes [GCCs]) were evaluated through optical coherence tomography (OCT). And at the same time, we aimed to compare the stage of the disease, the UPDRS score and the duration of the disease with OCT and cognitive functions by mini-mental test.

Results: Mini-mental test total score value ( = 0.025) and language value ( = 0.021) were lower in the patient group compared to the control group. In patients, there is a reverse significant correlation between UPDRS-T and GCC-left-superior ( = -0.495; = 0.026), GCC-left-inferior ( = -0.517; = 0.019), and GCC-left-to ( = -0.508; = 0.022). There is a significant parallel relation between recall and RFNL-right-mean ( = 0.626; = 0.039).

Conclusion: Our findings indicate that the neurodegeneration continues multisystemically and neurodegeneration increases simultaneously with the disease. OCT, which is a noninvasive method, can be used as an indicator of neurodegeneration in patients with Parkinson's disease.
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http://dx.doi.org/10.4103/aian.AIAN_424_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6472223PMC
April 2019

Associations Between Olfactory Impairment and Cognitive Functions in Patients with Parkinson Disease.

Noro Psikiyatr Ars 2020 Sep 5;57(3):216-221. Epub 2019 Feb 5.

Department of Biostatistics, University of Uludağ, School of Medicine, Bursa, Turkey.

Introduction: Olfactory impairment and cognitive impairment are common non-motor symptoms in Parkinson's disease (PD). Olfactory impairment may be present even many years before the main symptoms of the disease develop. The associations between olfactory loss and cognition in PD are evaluated in this study.

Methods: 31 patients with PD and 31 healthy subjects were included in this study. The Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn and Yahr Scale (H&Y Scale) were administered to all subjects. Butanol threshold test and Sniffin'Sticks test were used to assess olfaction. The Mini Mental State Examination (MMSE) and Clock Drawing Test (CDT) and Stroop Color Word Test (SCWT) were used to assess cognition.

Results: The Sniffin'Sticks test scores were significantly lower in the Parkinson group in comparison to the control group (p<0.001). The rate of anosmia was 90% in the PD group while this rate was found to be 54.8% in control group (p=0.005). A significant correlation was found between butanol test scores and stoop 5 and 5 errors. Significant correlations were found between the Sniffin'Sticks scores and MMSE scores (p=0.047) and orientation (p=0.041) and language (p=0.003) functions of the MMSE test. Worse olfaction was associated with worse memory.

Conclusions: In PD, olfactory impairment correlates with cognitive impairment and olfactory tests may be used to predict the likelihood of developing dementia in this patient population.
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http://dx.doi.org/10.29399/npa.23070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7481972PMC
September 2020

Evaluation of olfaction and taste function in type 2 diabetic patients with and without peripheral neuropathy.

Diabetes Metab Res Rev 2018 03 11;34(3). Epub 2018 Jan 11.

Bursa Yüksek İhtisas Training and Research Hospital, Department of Otorhinolaryngology, University of Health Sciences, Bursa, Turkey.

Aims: Olfaction and gustation in patients with diabetes mellitus have great significance on quality of life, and their impairment may result in possible hazards. A limited number of studies have been performed to determine the alteration of both gustatory and olfactory function in type 2 diabetic patients with diabetic peripheral neuropathy (DPN). The aim of this study was to determine whether type 2 diabetic patients, with and without DPN, exhibit major olfactory and gustatory dysfunction using validated and dependable techniques.

Methods: An observational-analytical case-control study was conducted. Sixty patients with type 2 diabetes mellitus (T2DM) and 30 healthy control subjects with a mean age of 57.1 ± 8.4 were included in the study. Patients with T2DM were recruited from the endocrinology outpatient clinic. After clinical evaluation and electromyography examination, patients with T2DM were divided into the 2 groups, with and without DPN. After a 10-hour fasting period, blood samples were taken for the measurement of serum creatinine, lipids, and HbA1c. For the quantitative assessment of olfactory function, all participants underwent butanol threshold test and odour identification test. Gustatory function was tested administering a whole-mouth above-threshold test using sucrose solutions.

Results: The control subjects showed significantly higher Sniffin' sticks and butanol threshold scores than the diabetic patients without DPN (P = .001 and P = .009). No significant difference was found in the gustatory function test between these 2 groups (P = .116). Diabetic patients with DPN had lower Sniffin' sticks scores, butanol threshold scores, and higher sucrose thresholds compared to the controls (P < .001, P < .001, and P = .002). There were no significant differences between diabetic patients with or without DPN regarding Sniffin' sticks scores, butanol threshold, and sucrose thresholds (P = .302, P = .181, and P = .118).

Conclusion: In conclusion, this study demonstrates that T2DM is associated with olfactory and gustatory dysfunction. The fact that there was no difference between the diabetic patients with and without DPN elicits the idea of central neuropathy. This novel finding might facilitate the addition of olfactory and gustatory tests to the methodological spectrum of afferent pathway investigations.
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http://dx.doi.org/10.1002/dmrr.2973DOI Listing
March 2018

Obesity: a possible risk factor for restless legs syndrome.

Neurol Res 2017 Dec 25;39(12):1044-1048. Epub 2017 Sep 25.

d Department of Neurology , Uludag University School of Medicine , Bursa , Turkey.

Aim/background: Restless legs syndrome (RLS) is a frequent neurological and sleep disorder. Metabolic disorders are known to be related to sleep disorders. We prospectively evaluated whether obesity and its possible cofactors were related to the presence of RLS.

Materials And Methods: The study included 143 obese and 94 non-obese individuals. Obese patients had a BMI of 30 and over, while non-obese patients had a BMI lower than 30. Patients with arthritis and pregnancy were excluded but not those with diabetes mellitus. Participants who met diagnostic criteria recommended by the International RLS Study Group were diagnosed as having RLS. Depression, anxiety, daytime sleepiness, insomnia and sleep quality were evaluated in detail.

Results: The mean age of obese patients was 40.52 years and that of non-obese patients was 39.76 years. The mean body mass index was 36.77 in the obese group and 25.71 in the non-obese group. The occurrence of depression, anxiety, sleep quality, and insomnia scores were significantly higher in obese individuals. The evaluations of daytime sleepiness, sleep efficiency and sleep latency were not significantly different between the groups.

Discussion: Although the presence of RLS was correlated with obesity and vascular risk factors at a significant level, it was also shown that depression, anxiety and insomnia were significantly frequent in obese patients (although not daytime sleepiness). Further studies are needed.
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http://dx.doi.org/10.1080/01616412.2017.1376394DOI Listing
December 2017

Attitudes of neurology specialists toward older adults.

Aging Clin Exp Res 2017 Aug 25;29(4):787-792. Epub 2016 Jul 25.

Department of Geriatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Objective: Attitude of healthcare providers toward older people is very important in the aging world. Neurologists contact older adults very frequently. We aimed to investigate the attitudes of neurologists toward older adults.

Measurements: We recorded participants age; sex; duration of clinical practice in neurology; existence of older adult relatives; and history of geriatrics education, nursing home visits, older adult patient density in their clinical practice, and participation in voluntary public activities. UCLA Geriatrics Attitude Scale was used to evaluate participants' attitudes.

Results: A total of 100 neurologists participated in this study. Seventy-seven percent had positive, 3 % had neutral, and 20 % had negative attitudes. Twenty-seven percent of the participants had history of geriatrics education, and these participants tended to have a higher rate of positive attitudes. Neurologists with positive attitudes tended to be older than those with negative attitudes. Participants with history of living with older adult relatives had lower rates of positive attitudes. The most common diagnoses of the patients the participants encountered were stroke and dementia. Independent factors associated with positive attitudes were history of geriatrics education and older age. History of living with older relatives tended to have a negative effect. Most of the negative items of the attitude scale were associated with the natural course and behavior of the common diseases in neurology practice.

Conclusions: Generalization of geriatrics education may translate into a better understanding and improved care for older patients. Development of instruments and implementation of qualitative studies to assess attitudes of neurologists toward older adults are needed.
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http://dx.doi.org/10.1007/s40520-016-0606-6DOI Listing
August 2017

Evaluation of MLC leaf positioning accuracy for static and dynamic IMRT treatments using DAVID in vivo dosimetric system.

J Appl Clin Med Phys 2016 03 8;17(2):14-23. Epub 2016 Mar 8.

Hacettepe University.

Accuracy and precision of leaf positioning in multileaf collimators (MLCs) are significant factors for the accuracy of IMRT treatments. This study aimed to inves-tigate the accuracy and repeatability of the MLC leaf positioning via the DAVID invivo dosimetric system for dynamic and static MLC systems. The DAVID system was designed as multiwire transmission ionization chamber which is placed in accessory holder of linear accelerators. Each wire of DAVID system corresponds to a MLC leaf-pair to verify the leaf positioning accuracy during IMRT treatment and QA. In this study, verifications of IMRT plans of five head and neck (H&N) and five prostate patients treated in a Varian DHX linear accelerator with 80-leaf MLC were performed using DAVID system. Before DAVID-based dosimetry, Electronics Portal Imaging Device (EPID) and PTW 2D ARRAY dosimetry system were used for 2D verification of each plan. The measurements taken by DAVID system in the first day of the treatments were used as reference for the following measurements taken over the next four weeks. The deviations in leaf positioning were evaluated by "Total Deviation (TD)" parameter calculated by DAVID software. The delivered IMRT plans were originally prepared using dynamic MLC method. The same plans were subsequently calculated based on static MLC method with three different intensity levels of five (IL5), 10 (IL10) and 20 (IL20) in order to compare the performances of MLC leaf positioning repeatability for dynamic and static IMRT plans. The leaf positioning accuracy is also evaluated by analyzing DynaLog files based on error histograms and root mean square (RMS) errors of leaf pairs' positions. Moreover, a correlation analysis between simultaneously taken DAVID and EPID measurements and DynaLog file recordings was subsequently performed. In the analysis of DAVID outputs, the overall deviations of dynamic MLC-based IMRT calculated from the deviations of the four weeks were found as 0.55% ± 0.57% and 1.48% ± 0.57% for prostate and H&N patients, respectively. The prostate IMRT plans based on static MLC method had the overall deviations of 1.23% ± 0.69%, 3.07% ± 1.07%, and 3.13% ± 1.29% for intensity levels of IL5, IL10, and IL20, respectively. Moreover, the overall deviations for H&N patients were found as 1.87% ± 0.86%, 3.11% ± 1.24%, and 2.78% ± 1.31% for the static MLC-based IMRT plans with intensity levels of IL5, IL10 and IL20, respectively. Similar with the DAVID results, the error rates in DynaLog files showed upward movement comparing the dynamic IMRT with static IMRT with high intensity levels. In respect to positioning errors higher than 0.005 cm, static prostate IMRT plans with intensity levels of IL10 and IL20 had 1.5 and 2.6 times higher error ratios than dynamic prostate IMRT plans, respectively, while these values stepped up to 8.4 and 12.0 for H&N cases. On the other hand, according to the leaf pair readings, reconstructed dose values from DynaLog files had significant correlation (r = 0.80) with DAVID and EPID readings while a stronger relationship (r = 0.98) was found between the two dosimetric systems. The correlation coefficients for deviations from reference plan readings were found in the interval of -0.21-0.16 for all three systems. The dynamic MLC method showed higher performance in repeatability of leaf positioning than static MLC methods with higher intensity levels even though the deviations in the MLC leaf positioning were found to be under the acceptance threshold for all MLC methods. The high intensity levels increased the position-ing deviations along with the delivery complexity of the static MLC-based IMRT plans. Moreover, DAVID and EPID readings and DynaLog recordings showed mutually strong correlation, while no significant relationship was found between deviations from reference values.
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http://dx.doi.org/10.1120/jacmp.v17i2.5474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5875553PMC
March 2016

Impaired cognitive performance and hippocampal atrophy in Parkinson disease.

Turk J Med Sci 2015 ;45(5):1173-7

Background/aim: Dementia is common in Parkinson disease (PD). Since magnetic resonance imaging has been used, hippocampal atrophy has been shown in PD patients with or without dementia. In this study we sought the correlation of cognitive decline with bilateral hippocampal volume in PD patients.

Materials And Methods: Thirty-three patients with diagnosis of idiopathic PD and 16 healthy subjects were included in this study. PD patients were divided into two groups as normal cognitive function and mild cognitive impairment (MCI). The Mini-Mental State Examination and detailed cognitive assessment tests were performed for all patients for cognitive analyses. Depression was excluded by the Geriatric Depression Scale.

Results: The mean onset age of disease was 55 years for PD patients without dementia and 59 for PD patients with MCI. According to the Hoehn-Yahr scales, 24% of patients had grade 1, 58% had grade 2, and 18% had grade 3 disease. Right and left hippocampal volumes decreased along with cognitive test scores in PD patients. Increased right hippocampal volume was correlated with forward number test in the MCI-PD group.

Conclusion: These findings suggest that memory deficit is associated with hippocampal atrophy in PD patients.
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http://dx.doi.org/10.3906/sag-1408-68DOI Listing
February 2016

Malnutrition is associated with dementia severity and geriatric syndromes in patients with Alzheimer disease.

Turk J Med Sci 2015 ;45(5):1078-81

Background/aim: Malnutrition is associated with increased morbidity and mortality in patients with Alzheimer disease (AD). In this study, we aimed to screen for malnutrition and geriatric syndromes and seek their associations in patients with AD.

Materials And Methods: The Mini Mental State Examination (MMSE), Mini Nutritional Assessment (MNA), Katz Activities of Daily Living (ADL), and Lawton Instrumental Activities of Daily Living (IADL) tests were applied. Mean daily oral fluid intake was assessed according to patients' and relatives' declarations.

Results: Seventy-six patients with a mean age of 79 ± 7.4 years were included. Most of the patients had mild or moderate dementia. Malnutrition was associated with increased rates of hospitalization and falls, dysphagia, insomnia, agitation, delusions, hallucinations, immobility, and incontinence. A daily fluid intake of < 1100 mL was associated with malnutrition risk. Multivariate linear regression analysis revealed independent correlations of lower MNA score with lower ADL score, lower daily oral fluid intake, lower MMSE score, and female sex.

Conclusion: Dependency, inadequate fluid intake, advanced dementia stage, and female sex were independently associated with malnutrition. Malnutrition also seemed to be associated with sleep disturbances, psychological problems, immobility, falls, and increased hospitalization risk in these patients. Daily oral fluid intake may be a practical tool in the screening of malnutrition.
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http://dx.doi.org/10.3906/sag-1406-76DOI Listing
February 2016

Restless-legs syndrome and insomnia in hemodialysis patients.

Ren Fail 2016 10;38(2):194-7. Epub 2015 Nov 10.

e Department of Geriatrics , Istanbul School of Medicine, Istanbul University , Istanbul , Turkey.

Aim/background: Restless legs syndrome (RLS) is a common neurological movement disorder which is commonly seen in hemodialysis (HD) patients. Insomnia, depression, and anxiety disorders frequently show concurrence. In this study, we aimed to investigate RLS and insomnia prevalence and related factors in HD patients.

Subjects And Methods: Patients who were under HD treatment and healthy controls with similar mean age, sex ratio, and hypertension and diabetes mellitus frequency were included in this study. Depression, insomnia, and daytime sleepiness assessments were performed by using Beck Depression Inventory, Insomnia Severity Index, and Epworth Sleepiness Scale. The diagnosis of RLS was made using the International RLS Study Group consensus criteria.

Results: About 156 HD patients and 35 controls were enrolled. The mean age was 50.6 in the HD group and 49.7 in the control group. Female sex was 43.9% in the HD group and 57.1% in the control group. RLS was significantly more frequent in HD patients compared with controls. The rate of sub-threshold insomnia and insomnia with moderate severity was higher in HD patients. While insomnia severity score and diabetes mellitus were significantly associated with the presence of RLS, depression, RLS, older age, and being under HD treatment were independently associated with insomnia severity.

Conclusions: HD patients commonly have RLS and insomnia. Insomnia and diabetes mellitus seem to be major factors underlying RLS in HD patients. Furthermore, depression and RLS seem to be closely related to insomnia in these patients. Treatment of depression, insomnia, and RLS may be beneficial to improve quality of life in HD patients.
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http://dx.doi.org/10.3109/0886022X.2015.1111118DOI Listing
December 2016

Effect of Renal Transplantation in Restless Legs Syndrome.

Exp Clin Transplant 2016 Feb 11;14(1):45-9. Epub 2014 Dec 11.

From the Sevket Yilmaz Training and Research Hospital, Department of Nephrology, Bursa, Turkey.

Objectives: Restless legs syndrome is a disorder in which patients have irresistible urge to move legs during rest. Restless legs syndrome seems to be common in end-stage renal disease. After a successful renal transplant, symptoms ameliorate with renal function improvement and restless legs syndrome is seen less in this population. Here, we aimed to investigate restless legs syndrome frequency and associated factors in renal transplant patients.

Materials And Methods: In a cross-sectional study with 193 patients (116 hemodialysis patients, 45 transplant patients, and 32 controls), the presence of restless legs syndrome was assessed using the Restless Legs Syndrome Questionnaire. Medical history, demographic, and laboratory data were collected from the patients' medical records. Patients were questioned about the presence of restless legs syndrome using the Restless Legs Syndrome Questionnaire. Patients were evaluated with Beck Depression Scale for depression and Pittsburgh tests for sleep disturbances.

Results: While the rate of restless legs syndrome was similar between transplants and controls, it was significantly greater in hemodialysis patients. Hemodialysis patients and controls had similar depression scores that were higher compared with transplant patients. Pittsburgh score was similar in transplant patients and controls and significantly increased in the hemodialysis patients. The rate of insomnia was significantly higher in the hemodialysis patients compared with the other 2 groups. Logistic regression analysis revealed independent correlates of restless legs syndrome as insomnia, Beck depression score, and being on hemodialysis. Linear regression analysis showed that independent correlates of higher Pittsburgh score were higher depression score, higher age, and presence of restless legs syndrome.

Conclusions: The prevalence of restless legs syndrome is significantly lower in transplant patients than it is in patients on maintenance dialysis. In renal transplant patients, restless legs syndrome frequency was found to be lower because of improved renal functions (normalization of uremia), psychological symptoms, and sleep disturbances.
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http://dx.doi.org/10.6002/ect.2014.0163DOI Listing
February 2016

Urea to creatinine ratio: a forgotten marker of poor nutritional state in patients undergoing hemodialysis treatment.

Aging Male 2015 Mar 7;18(1):49-53. Epub 2014 Apr 7.

Geriatrics Unit, Şevket Yılmaz Training and Research Hospital , Bursa , Turkey .

Background: Malnutrition is common in subjects undergoing hemodialysis and is associated with increased morbidity and mortality. Studies investigating factors associated with malnutrition and effect of various interventions to treat these patients are needed. We aimed to screen older and young patients undergoing chronic hemodialysis, for malnutrition, and seek its association with clinical factors including anxiety and depression and laboratory variables including urea/creatinine ratio (UCR).

Methods: Duration of hemodialysis treatment, medications taken, anthropometric measurements and routine laboratory results were recorded. Mini nutritional assessment and Beck anxiety and Beck depression inventories were applied. Study variables between subjects with malnutrition, malnutrition risk and normal nutritional states were compared. Older and younger patients were also compared regarding malnutrition and laboratory results. Linear regression analysis was performed to seek independent factors associated with malnutrition score.

Results: Clinical and laboratory data except for UCR were found to be similar among young and older patients. UCR increased, while albumin, body mass index and weight circumference decreased along with worse nutritional state. Low albumin level, body mass index and UCR and higher hemoglobin level and depression score were independent factors associated with malnutrition.

Conclusion: In addition to routinely used markers of malnutrition UCR may provide additional information regarding malnutrition in this population.
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http://dx.doi.org/10.3109/13685538.2014.908281DOI Listing
March 2015

Robotic stereotactic body radiotherapy in the treatment of sinonasal mucosal melanoma: report of four cases.

Head Neck 2013 Mar 11;35(3):E69-73. Epub 2011 Nov 11.

Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey.

Background: Sinonasal mucosal melanoma (SNMM) is a rare entity originating from melanocytes of the sinonasal mucosa. Postoperative radiotherapy is recommended in all cases to increase local control. However, external radiotherapy is rarely used as a definitive treatment modality. In this report, we present 4 cases of SNMM treated with CyberKnife (Accuray, Sunnyvale, CA).

Methods: All patients were immobilized with a thermoplastic mask. A planning CT scan with 1-mm thickness was obtained, and these images were fused with MRI for the contouring procedure. Multiplan (Accuray) inverse planning software was used for treatment planning. Robotic stereotactic body radiotherapy (SBRT) was delivered with CyberKnife.

Results: Median follow-up was 26 months. Three patients had complete response to CyberKnife, and 1 patient had partial response.

Conclusion: Robotic SBRT seems to be an appealing treatment option for local control. Effective systemic treatment is required to prevent distant metastases.
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http://dx.doi.org/10.1002/hed.21895DOI Listing
March 2013

A retrospective comparison of robotic stereotactic body radiotherapy and three-dimensional conformal radiotherapy for the reirradiation of locally recurrent nasopharyngeal carcinoma.

Int J Radiat Oncol Biol Phys 2011 Nov 22;81(4):e263-8. Epub 2011 Apr 22.

Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey.

Purpose: We assessed therapeutic outcomes of reirradiation with robotic stereotactic radiotherapy (SBRT) for locally recurrent nasopharyngeal carcinoma (LRNPC) patients and compared those results with three-dimensional conformal radiotherapy (CRT) with or without brachytherapy (BRT).

Methods And Materials: Treatment outcomes were evaluated retrospectively in 51 LRNPC patients receiving either robotic SBRT (24 patients) or CRT with or without BRT (27 patients) in our department. CRT was delivered with a 6-MV linear accelerator, and a median total reirradiation dose of 57 Gy in 2 Gy/day was given. Robotic SBRT was delivered with CyberKnife (Accuray, Sunnyvale, CA). Patients in the SBRT arm received 30 Gy over 5 consecutive days. We calculated actuarial local control and cancer-specific survival rates for the comparison of treatment outcomes in SBRT and CRT arms. The Common Terminology Criteria for Adverse Events v3.0 was used for toxicity evaluation.

Results: The median follow-up was 24 months for all patients. Two-year actuarial local control rates were 82% and 80% for SBRT and CRT arms, respectively (p = 0.6). Two-year cancer-specific survival rates were 64% and 47% for the SBRT and CRT arms, respectively (p = 0.4). Serious late toxicities (Grade 3 and above) were observed in 21% of patients in the SBRT arm, whereas 48% of patients had serious toxicity in the CRT arm (p = 0.04). Fatal complications occurred in three patients (12.5%) of the SBRT arm, and four patients (14.8%) of the CRT arm (p = 0.8). T stage at recurrence was the only independent predictor for local control and survival.

Conclusion: Our robotic SBRT protocol seems to be feasible and less toxic in terms of late effects compared with CRT arm for the reirradiation of LRNPC patients.
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http://dx.doi.org/10.1016/j.ijrobp.2011.02.054DOI Listing
November 2011

The prevalence and clinical features of restless legs syndrome: a door to door population study in Orhangazi, Bursa in Turkey.

Neurol India 2009 Nov-Dec;57(6):729-33

Department of Neurology, Uludag University School of Medicine, 16059 Bursa, Turkey.

Background: Restless leg syndrome (RLS) has negative effects on the quality of life of the patients. Epidemiological studies on RLS are limited.

Aim: To determine the prevalence of RLS among people aged 40 years and above in Orhangazi district of Bursa, Turkey.

Materials And Methods: The study was carried out between 2004 and 2005. This population-based study was conducted in two phases. In the phase 1, residents conducted door-to-door interviews using a short questionnaire to determine the possible cases of RLS. In the phase 2, physicians ascertained the suspected cases of RLS. Diagnosis of RLS was made using the criteria proposed by the International Restless Legs Syndrome Study Group (IRLSSG) and also the rating scale for RLS.

Results: Out of 1, 256 subjects screened in phase 1, 1,124 (89.6%) were included in the study. Also, 161 cases with suspected symptoms of RLS were detected in phase 1, 49 of the suspected cases could not be evaluated in phase 2. A diagnosis of RLS was also made in 60 cases during phase 2.

Conclusions: We defined the prevalence of RLS as 9.71% among 40 years of age and older population. The prevalence of RLS did not differ by age and was 2.6 times more in women. None of the patients were diagnosed as RLS sought medical care for the symptoms, possibly due to lack of knowledge of patients and physicians about RLS. Prevalence studies help to provide knowledge on morbidity, which is essential for diagnosis and early treatment.
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http://dx.doi.org/10.4103/0028-3886.59467DOI Listing
April 2010