Publications by authors named "Murat Kara"

252 Publications

Late Onset of an Overlooked Follicular Thyroid Carcinoma Presenting as a Chest Wall Tumor 10 Years Following Thyroidectomy.

AACE Clin Case Rep 2021 Jul-Aug;7(4):268-272. Epub 2021 Mar 5.

Department of General Surgery, Istanbul University Faculty of Medicine, Istanbul, Turkey.

Objective: Metastatic chest wall tumors resulting from thyroid carcinomas are not unusual; however, the late onset of metastasis of a follicular thyroid carcinoma (FTC) is extremely rare. We aim to present a report of a case with chest wall metastasis of an FTC 10 years following thyroidectomy.

Methods: Among the studies performed were chest wall tumor imaging, serum thyroid stimulating hormone determination, and histopathology of the chest wall tumor and thyroid tissue examination.

Results: An asymptomatic 28-year-old woman was noted to have a left-sided chest wall mass on a chest X-ray performed for a job application. She had a history of right hemithyroidectomy 10 years prior to her admission, which had been reported as a thyroid follicular adenoma. Computed tomography showed a tumor measuring 75 × 50 mm in diameter localized at the left paravertebral region. The maximum standardized uptake value of the tumor was seven in positron emission tomography. Histopathologic finding of the trucut biopsy of the chest wall tumor revealed metastasis of a differentiated thyroid carcinoma. The patient underwent a completion left hemithyroidectomy with chest wall resection and reconstruction. Previous right hemithyroidectomy material was examined and diagnosed as minimally invasive FTC. Histopathologic finding of the resected chest wall tumor was consistent with metastasis of an FTC.

Conclusions: Although extremely rare, the late metastasis of a thyroid carcinoma should be considered in the differential diagnosis of patients with chest wall tumors who have a previous history of thyroidectomy even with a diagnosis of benign tumor.
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http://dx.doi.org/10.1016/j.aace.2021.02.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8282525PMC
March 2021

Analysis of 1430 hand fractures and identifying the 'Red Flags' for cases requiring surgery: Head: Hand Fracture Treatment.

J Plast Reconstr Aesthet Surg 2021 Jun 23. Epub 2021 Jun 23.

Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Research and Training Hospital, Ankara, Turkey.

Background: Hand fractures constitute 20% of hand injury patients who apply to emergency services. Conservative approaches are satisfactory in the majority of the cases. However, the minority group in need of surgery reaches a serious number of patients considering the frequency of these injuries. Retrospective questioning of the indications of the performed surgeries is a proper way of understanding the decisional process for surgery.

Patients/methods: Patients treated for hand fractures were retrospectively reviewed. Patient gender, age, finger/fingers involved, soft tissue involvement, treatment method (conservative/surgery) and if operated, devices used for fixation were noted. Plain radiographs of the patient were evaluated. Descriptive statistics of these variables and the effect of each variable on the decision for surgery were analyzed.

Results: The study involved 1430 fractures of 1303 patients (1016 male and 287 female). Fifth finger was the most commonly injured digit (31%). Comminuted fractures (29%) followed by transverse fractures (29%) and spiral/oblique fractures (22%) were commonly diagnosed fracture types. Thirteen percent (13%) of the study group needed tendon/nerve/vessel repairs. Male patients, cases with soft tissue involvement, second, third and fourth finger fractures, fractures involving multiple digits, fractures with an intra-articular component, fractures with dislocation more than 4 mm and angulation more than 15° had a significantly higher rate of surgery.

Conclusion: Less than half of the hand fractures require surgery, and conservative treatment is usually preferred. Certain variables that indicate surgical treatment were identified with our study. These findings may help to weigh the options and choose the right path in doubtful conditions.

Level Of Evidence: Level 4, Case-control study.
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http://dx.doi.org/10.1016/j.bjps.2021.06.011DOI Listing
June 2021

A Challenging Period After Repair: Etiology and Follow-Up Rates of the Patients With Cleft Lip and Palate in Intensive Care Unit.

J Craniofac Surg 2021 Jul 7. Epub 2021 Jul 7.

Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Cleft Lip and Palate and Craniomaxillofacial Disorders Treatment and Research Center Department of Pediatrics, Hacettepe University Faculty of Medicine, Pediatric Intensive Care Unit Department of Anesthesiology and Reanimation, Hacettepe University Faculty of Medicine, Cleft Lip and Palate and Craniomaxillofacial Disorders Treatment and Research Center, Ankara, Turkey.

Abstract: The perioperative period is quite challenging because of the featured anatomical and clinical properties of the babies with cleft lip and palate (CLP). Therefore follow-up in the intensive care unit (ICU) is a crucial parameter for managing these patients. Although various studies in cleft literature, limited studies have analyzed the ICU admission rate and its etiology in the cleft population. At this point, the present study aims to reveal the etiology and rate of ICU admission of babies with an orofacial cleft to contribute to taking preventive precautions.The rate of primary CLP patients was 69.5% (937 of 1348 patients). Intensive care unit admission rate of primary CLP patients was 6.2% (n = 58). The expected and unexpected ICU admission rate was 4.8% and 1.4%, respectively. Of the patients admitted to the ICU, 53.4% (n = 31) were boys and 46.6% (n = 27) were girls. There was no statistically significant association between gender and ICU admission (P = 0.896). However, the association between cleft type and ICU follow-up was statistically significant (P < 0.001).The findings of the present study reveal the high ICU admission rate of cleft patients within all patients admitted to ICU. Due to many unique statuses of cleft babies, attentive assessment in the preoperative period and determining the postoperative need for ICU follow-up would contribute to preventing postoperative complications.
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http://dx.doi.org/10.1097/SCS.0000000000007797DOI Listing
July 2021

Sarcopenia: if it looks/walks like a duck, it must be a duck.

Eur J Clin Nutr 2021 Jul 6. Epub 2021 Jul 6.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1038/s41430-021-00965-8DOI Listing
July 2021

Grip strength as a predictor of disease severity in hospitalized COVID-19 patients.

Heart Lung 2021 Jun 11;50(6):743-747. Epub 2021 Jun 11.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

Background: Grip strength is one of the main components for the physical functioning in sarcopenia and physical frailty.

Objectives: To explore the role of grip strength measurement at admission for predicting disease severity in COVID-19.

Methods: Demographic data, smoking status, comorbidities, COVID-19 related symptoms, grip strength, laboratory and computed tomography (CT) findings at admission were all noted. Using a Smedley hand dynamometer, the maximum grip strength value (kg) after three measurements on the dominant side was recorded. Low grip strength was defined as two standard deviations below the gender-specific peak mean value of the healthy young adults (<32 kg for males, <19 kg for females). Patients were categorized into three groups according to clinical and CT findings. Severe illness group had pneumonia with a respiratory rate >30/min, oxygen saturation ≤90%, or extensive lung involvement in CT. Moderate illness group had pneumonia with CT score ≤11. Mild illness group had normal CT findings.

Results: The study population included 312 patients (140 F, 172 M). The distribution of mild, moderate and severe disease groups were 36.9%, 51.0% and 12.2%, respectively. Cough, fever, dyspnea, hypertension, obesity, cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) were most frequent, and C-reactive protein (CRP), ferritin, D-dimer, and neutrophil levels were highest in the severe group (all p<.05). Absolute grip strength values were lowest and the frequency of having low grip strength were highest in the severe group (both p<.01). Since we found that the significant differences were stemming from the severe group, we combined the mild and moderate group as non-severe, and compared severe vs. non-severe groups with binary logistic regression analyses. When age, gender, body mass index, smoking status, presence of comorbidities and low grip strength, and abnormal laboratory findings were taken into analyses; age (odds ratio [OR]: 1.054 [95% confidence interval (CI): 1.020-1.089]), obesity (OR: 2.822 [95% CI: 1.143-6.966]), COPD (OR: 5.699 [95 %CI: 1.231-26.383]), CRP level (OR: 1.023 [95% CI: 1.010-1.036]) and low grip strength (OR: 3.047 [95% CI: 1.146-8.103]) were observed to be independent predictors for severe COVID-19 disease (all p<.05).

Conclusions: In addition to the well-known independent risk factors (i.e. age, obesity, COPD, and CRP level), low grip strength independently increased (about three times) the severity of COVID-19.
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http://dx.doi.org/10.1016/j.hrtlng.2021.06.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192888PMC
June 2021

Is sarcopenia a predictive factor in colorectal cancer? Better understanding the status quo.

ANZ J Surg 2021 06;91(6):1317

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1111/ans.16790DOI Listing
June 2021

Diagnosing sarcopenia: Functional perspectives and a new algorithm from the ISarcoPRM.

J Rehabil Med 2021 Jun 21;53(6):jrm00209. Epub 2021 Jun 21.

Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey. E-mail:

Sarcopenia is an important public health problem, characterized by age-related loss of muscle mass and muscle function. It is a precursor of physical frailty, mobility limitation, and premature death. Muscle loss is mainly due to the loss of type II muscle fibres, and progressive loss of motor neurones is thought to be the primary underlying factor. Anterior thigh muscles undergo atrophy earlier, and the loss of anterior thigh muscle function may therefore be an antecedent finding. The aim of this review is to provide an in-depth (and holistic) neuromusculoskeletal approach to sarcopenia. In addition, under the umbrella of the International Society of Physical and Rehabilitation Medicine (ISPRM), a novel diagnostic algorithm is proposed, developed with the consensus of experts in the special interest group on sarcopenia (ISarcoPRM). The advantages of this algorithm over the others are: special caution concerning disorders related to the renin-angiotensin system at the case finding stage; emphasis on anterior thigh muscle mass and function loss; incorporation of ultrasound for the first time to measure the anterior thigh muscle; and addition of a chair stand test as a power/performance test to assess anterior thigh muscle function. Refining and testing the algorithm remains a priority for future research.
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http://dx.doi.org/10.2340/16501977-2851DOI Listing
June 2021

Measure grip strength, gait speed and quadriceps muscle in cirrhosis. Comment to "Frailty, sarcopenia and mortality in cirrhosis: What is the best assessment, how to interpret the data correctly and what interventions are possible?"

Clin Res Hepatol Gastroenterol 2021 Jun 2;45(5):101727. Epub 2021 Jun 2.

Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Ankara, Turkey.

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http://dx.doi.org/10.1016/j.clinre.2021.101727DOI Listing
June 2021

Grip strength assessment before cancer surgery: 'Shaking Hands' for long-term outcome.

Surg Today 2021 May 19. Epub 2021 May 19.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Zemin Kat FTR AD, Sıhhiye, Ankara, Turkey.

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http://dx.doi.org/10.1007/s00595-021-02307-4DOI Listing
May 2021

Disputing the use of static one-leg standing balance test for screening low muscle mass.

Aging Clin Exp Res 2021 Aug 17;33(8):2309-2310. Epub 2021 May 17.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1007/s40520-021-01872-5DOI Listing
August 2021

Photobiomodulation combined with adipose-derived stem cells encapsulated in methacrylated gelatin hydrogels enhances in vivo bone regeneration.

Lasers Med Sci 2021 Apr 11. Epub 2021 Apr 11.

Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Reconstruction of bone defects is still a significant challenge. The aim of this study was to evaluate the effect of application of photobiomodulation (PBM) to enhance in vivo bone regeneration and osteogenic differentiation potential of adipose-derived stem cells (ADSCs) encapsulated in methacrylated gelatin (GEL-MA) hydrogels. Thirty-six Sprague-Dawley rats were randomly separated into 3 experimental groups (n = 12 each). The groups were control/blank defect (I), GEL-MA hydrogel (II), and ADSC-loaded GEL-MA (GEL-MA+ADSC) hydrogel (III). Biparietal critical sized bone defects (6 mm in size) are created in each animal. Half of the animals from each group (n = 6 each) were randomly selected for PBM application using polychromatic light in the near infrared region, 600-1200 nm. PBM was administered from 10 cm distance cranially in 48 h interval. The calvaria were harvested at the 20th week, and macroscopic, microtomographic, and histologic evaluation were performed for further analysis. Microtomographic evaluation demonstrated the highest result for mineralized matrix formation (MMF) in group III. PBM receiving samples of group III showed mean MMF of 79.93±3.41%, whereas the non-PBM receiving samples revealed mean MMF of 60.62±6.34 % (p=0.002). In terms of histologic evaluation of bone defect repair, the higher scores were obtained in the groups II and III when compared to the control group (2.0 for both PBM receiving and non-receiving specimens; p<0.001). ADSC-loaded microwave-induced GEL-MA hydrogels and periodic application of photobiomodulation with polychromatic light appear to have beneficial effect on bone regeneration and can stimulate ADSCs for osteogenic differentiation.
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http://dx.doi.org/10.1007/s10103-021-03308-yDOI Listing
April 2021

SARC-F as a case-finding tool in sarcopenia: valid or unnecessary?

Aging Clin Exp Res 2021 Aug 29;33(8):2305-2306. Epub 2021 Mar 29.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1007/s40520-021-01838-7DOI Listing
August 2021

Ad Hoc Measurements of the Anterior Thigh Muscle (Mass and Function) in Sarcopenia.

J Ultrasound Med 2021 Mar 24. Epub 2021 Mar 24.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1002/jum.15698DOI Listing
March 2021

Letter to the editor concerning "Handgrip strength correlates with walking in lumbar spinal stenosis" by Inoue H, et al. (Eur Spine J 2020; 29: 2198-204).

Eur Spine J 2021 04 22;30(4):1077. Epub 2021 Mar 22.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1007/s00586-021-06735-1DOI Listing
April 2021

Comment on: Sarcopenia is a prognostic outcome marker in children with high-risk hepatoblastoma: Sarcopenia in children. A misnomer for muscle wasting or atrophy?

Pediatr Blood Cancer 2021 Jun 11;68(6):e28956. Epub 2021 Mar 11.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1002/pbc.28956DOI Listing
June 2021

Measure What Matters Most in Sarcopenia: Regional vs. Appendicular Muscle Mass?

J Am Med Dir Assoc 2021 04 8;22(4):883-884. Epub 2021 Mar 8.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1016/j.jamda.2021.02.006DOI Listing
April 2021

Sarcopenia in Pediatrics? To Be Reconsidered.

Liver Transpl 2021 Jul 20;27(7):1071-1072. Epub 2021 Apr 20.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1002/lt.26044DOI Listing
July 2021

SARC-F to screen or diagnose sarcopenia in cancer? A point-blank refusal.

Cancer 2021 Jun 23;127(12):2158. Epub 2021 Feb 23.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1002/cncr.33464DOI Listing
June 2021

Ultrasound imaging/measurements for skeletal muscles in sarcopenia: an aide memoire.

Eur Geriatr Med 2021 Apr 11;12(2):425-426. Epub 2021 Feb 11.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1007/s41999-021-00461-zDOI Listing
April 2021

Comparison of speech outcomes using type 2b intravelar veloplasty or furlow double-opposing Z plasty for soft palate repair of patients with unilateral cleft lip and palate.

J Craniomaxillofac Surg 2021 Mar 8;49(3):215-222. Epub 2021 Jan 8.

Hacettepe University Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Cleft Lip and Palate and Craniomaxillofacial Disorders Treatment and Research Center, Ankara, Turkey.

Background: The aim of this study is to compare speech outcomes, fistula rates, and rates of secondary speech surgeries after palatoplasty using Furlow palatoplasty or type 2b intravelar veloplasty for soft palate repair.

Patients And Methods: Patients with unilateral cleft lip and palate who had either Furlow palatoplasty or intravelar veloplasty for soft palate repair were retrospectively evaluated for demographic and perioperative variables and speech outcomes. Fistula rate, secondary surgical intervention for improved speech results, and findings of speech assessment were further reviewed for the patients who met the inclusion criteria.

Results: A total of 76 patients, 36 in the Furlow palatoplasty group and 40 in the intravelar veloplasty group, were included in the study. In the speech assessment, nasalance values were statistically similar between the two groups. Also, there was no statistically significant difference between the groups in velopharyngeal motility (p = 0.103). The total rates of secondary surgeries and fistula were statistically similar between the groups (p = 0.347 and 0.105, respectively).

Conclusion: The similar outcomes of speech and surgical evaluation between the two groups make the surgeon's preference determinant in the selection of the surgical technique for soft palate repair.
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http://dx.doi.org/10.1016/j.jcms.2021.01.003DOI Listing
March 2021

Rewinding sarcopenia: a narrative review on the renin-angiotensin system.

Aging Clin Exp Res 2021 Jan 4. Epub 2021 Jan 4.

Department of Physical Medicine and Rehabilitation, Hacettepe University Medical School, Ankara, Turkey.

Background And Aims: The purpose of this review was two-fold. First, we aimed to provide an in-depth glance on the relationship between renin-angiotensin system (RAS) dysregulation and sarcopenia. Second, we aimed to touch upon potential treatments of sarcopenia (including RAS blockers, vitamin D, and exercise) in light of the pertinent literature.

Methods: Currently available research regarding the effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers on knee extensor strength, grip strength, chair stand test, gate speed together with the effects of exercise on muscle mass, strength, physical performance, blood pressure and cognitive tests (particularly in older adults) was reviewed.

Results: Although some studies have shown favorable effects of ACEIs on muscle strength and/or physical function tests, some studies have reported no/negative association in between. The favorable impact of exercise on reducing blood pressure is shown, and exercise treatment is widely recommended in the relevant literature. Different types of exercises (aerobic, resistance, dancing, music movement, water-based, golf, knitting activities or multicomponent exercises) have shown improvement in cognitive functions as well.

Conclusion: Classical RAS activity results in deleterious effects not only on the cardiovascular but also on the neuromusculoskeletal system. Therefore, treatments targeting inhibition of the classical RAS activity seem to be important in the management of several age-related pathologies, including sarcopenia. As such, ACEIs, vitamin D, exercise, and healthy diet can have prominent effects not only on the modulation of RAS but also on physical and cognitive functions and sarcopenia as well.
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http://dx.doi.org/10.1007/s40520-020-01761-3DOI Listing
January 2021

Letter Regarding: Regional Muscle Measurements/Adjustments Amidst Others in the Diagnosis of Sarcopenia.

J Surg Res 2021 Apr 17;260:520-521. Epub 2020 Dec 17.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1016/j.jss.2020.09.043DOI Listing
April 2021

Impact of COVID-19 outbreak on plastic surgery: Taken precautions, distribution of surgical procedures and changes in admissions to outpatient clinic.

J Plast Reconstr Aesthet Surg 2021 04 8;74(4):890-930. Epub 2020 Nov 8.

Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Training and Research Hospital, Ankara 06230, Turkey.

The COVID-19 outbreak is a global problem affecting the world in many respects. In the medical field, its impact on surgical branches as well as clinical branches is inevitable. From the plastic surgery perspective, the COVID-19 outbreak affects the number and distribution of surgeries, patient admissions and educational activities. Although these impacts are predictable, it is beneficial to document these data that would contribute to the proper response to a similar crisis in the future. From this standpoint, the present study aims to analyze the effect of the COVID-19 pandemic on plastic surgery practice in some aspects. Epidemiologic data of the two-time frames, routine period, and pandemic period of plastic surgery were reviewed retrospectively. The ratios of the listed data were compared between the two periods; admissions to the outpatient clinic, surgeries, consultations, anesthesia type, hospitalizations, and demographic data. While the number of outpatient clinic patients was 3511 in the routine period, it was 490 in the pandemic period. Compared to the routine period, the number of surgical interventions was decreased from 793 to 129 during the pandemic period. In particular, a statistically significant increase was observed in the rate of hand trauma and maxillofacial trauma cases during the pandemic period compared with the routine period (p < 0.001, and p = 0.032, respectively). Therefore, high rates of hand trauma and maxillofacial trauma should be taken into consideration when making arrangements such as personnel distribution, use of medical resources, and regulation of hospital infrastructure in extraordinary situations like COVID-19 pandemics.
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http://dx.doi.org/10.1016/j.bjps.2020.10.073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7649027PMC
April 2021

Saporin, a Polynucleotide-Adenosine Nucleosidase, May Be an Efficacious Therapeutic Agent for SARS-CoV-2 Infection.

SLAS Discov 2021 03 6;26(3):330-335. Epub 2020 Nov 6.

Graduate School of Natural and Applied Sciences, Nanotechnology Engineeing, Bulent Ecevit University, Incivez, Zonguldak, Turkey.

Saporin, a type I ribosome-inactivating protein from soapwort plant, is a potent protein synthesis inhibitor. Catalytically, saporin is a characteristic -glycosidase, and it depurinates a specific adenine residue from a universally conserved loop of the major ribosomal RNA (rRNA) of eukaryotic cells. It is well-known that saporin induces apoptosis through different pathways, including ribotoxic stress response, cell signal transduction, genomic DNA fragmentation and RNA abasic lyase (RAlyase) activity, and NAD depletion by poly-(ADP)-ribose polymerase hyperactivation. Saporin's high enzymatic activity, high stability, and resistance to conjugation procedures make it a well-suited tool for immunotherapy approaches.In the present study, we focus on saporin-based targeted toxins that may be efficacious therapeutic agents for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Our discussed points suggest that saporin may be a strategic molecule for therapeutic knockout treatments and a powerful candidate for novel drugs in the struggle against coronavirus 2019 (COVID-19).
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http://dx.doi.org/10.1177/2472555220970911DOI Listing
March 2021

Reassessing Sarcopenia in Hypertension: STAR and ACE Inhibitors Excel.

Int J Clin Pract 2021 Mar 20;75(3):e13800. Epub 2020 Nov 20.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

Background: Hypertension and sarcopenia are commonly seen in older adults. The renin-angiotensin system and the therapeutic use of angiotensin-converting enzyme (ACE) inhibitors have been on the agenda of sarcopenia in different perspectives. Our aim was to explore the frequency of sarcopenia in patients with hypertension and to investigate the association between the use of ACE inhibitors and sarcopenia.

Methods: A total of 272 community-dwelling adults were recruited. Anterior thigh muscle thickness was measured by ultrasound. Handgrip strength, gait speed, and chair stand test were evaluated. Low muscle mass was diagnosed in the presence of low sonographic thigh adjustment ratio (STAR) values and sarcopenia was diagnosed if low STAR values were coupled with low functional tests.

Results: 136 subjects (50.0%) had no comorbid disease; 102 (37.5%) had one, 21 (7.7%) had two, nine (3.3%) had three and four (1.5%) had four comorbid diseases. Both low muscle mass (41.9% vs 13.2%) and sarcopenia (32.2% vs 7.8%) were more commonly seen in hypertensive when compared with normotensive older adults. Subgroup analysis of older adults with hypertension revealed that sarcopenia was less prevalent (P = .003) in patients using ACE inhibitors (8.7%) than those using angiotensin II receptor blockers (48.7%) and other antihypertensive drugs (46.4%). After binary logistic regression analyses; only the presence of hypertension seemed to independently predict the development of sarcopenia in older adults [OR = 6.5 (95% CI: 2.4-17.8, P < .001)].

Conclusions: Sarcopenia is highly prevalent in hypertensive older adults. Amongst many antihypertensive medications, ACE inhibitors seem to have favourable effects on both disorders.
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http://dx.doi.org/10.1111/ijcp.13800DOI Listing
March 2021

Is sarcopenia primarily an age-related or renin-angiotensin system-related disorder?

Geriatr Gerontol Int 2020 Oct;20(10):997

Department of Physical and Rehabilitation Medicine Ankara, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1111/ggi.13997DOI Listing
October 2020

Does early cleft palate repair make difference? Comparative evaluation of the speech outcomes using objective parameters.

J Craniomaxillofac Surg 2020 Nov 12;48(11):1057-1065. Epub 2020 Sep 12.

Hacettepe University Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Cleft Lip and Palate and Craniomaxillofacial Disorders Treatment and Research Center, Ankara, Turkey.

The present study aims to evaluate the effect of timing of cleft palate repair on speech results by using objective assessment tools, under standardized variables. The patients included in the study were divided into three groups according to their age of palatal repair. Velopharyngeal closure was evaluated anatomically by nasopharyngoscopy, and the nasalance values were recorded and evaluated objectively by nasometer. Also, the rate of secondary surgical intervention and fistula rate was analyzed for each group. Nasalance values and nasopharyngoscopic evaluation results were statistically similar between group 1 and group 2. However, there was a statistically significant difference between these groups compared with group 3 in the nasalance value of all speech samples and terms of the velopharyngeal complete closure (p = 0.022). The rate of fistula and secondary surgical intervention was statistically similar between the groups (p = 0.080). In secondary surgical intervention rates, the difference between group 1 and group 3 was statistically significant (p = 0.016). The present study confirms the importance of the 18th month as a cut-of time in palatal repair for improved speech results by using objective assessment tools.
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http://dx.doi.org/10.1016/j.jcms.2020.09.003DOI Listing
November 2020

Prognostic factors in patients undergoing pulmonary resection for sarcomatoid carcinomas of the lung.

Balkan Med J 2021 03;38(2):104-110

Department of Cardiovascular and Thoracic Surgery, West Virginia University Heart and Vascular Institute, Morgantown, USA.

Background: Pulmonary sarcomatoid carcinomas are very rare lung neoplasms, and no consensus exists regarding their optimal treatment. The prognosis of sarcomatoid carcinomas has been reported to be unfavorable compared with non-small-cell lung cancers; however, prognostic factors in patients undergoing surgery for sarcomatoid carcinomas remain unclear.

Aims: To analyze clinicopathologic prognostic factors and survival outcomes in patients who underwent surgery for pulmonary sarcomatoid carcinoma.

Study Design: Retrospective cross-sectional study.

Methods: We designed a retrospective cross-sectional study in patients who underwent surgery for pulmonary sarcomatoid carcinomas and statistically analyzed the prognostic factors regarding clinicopathologic features with respect to survival outcomes.

Results: We had a total of 44 patients with sarcomatoid carcinoma who had pulmonary resection. Sex distribution was 34 (77%) males and 10 (22.7%) females, which was determined by declaration. The mean age of patients was 57.3 ± 16 years with a median of 60 years. The 5-year progression-free survival and overall survival rates were 59% and 58%, respectively. The 5-year survival rates were significantly different for tumors > 5 cm (P = 0.044), tumorstatus (T) (P=0.016), lymph node status (N) (P=0.005), and pathologic tumor-node-metastasis (TNM) stage (P = 0.0001 ). However, histologic subtype (P = 0.628) and adjuvant treatment (P = 0.804) did not have any significant effect on survival. Similarly, the significant prognostic factors in univariate analysis were tumor size (P = 0.085), T status (P = 0.005), N status (P = 0.028), and pathologic TNM stage (P = 0.0001). Multivariate analysis showed only T status (P = 0.058), N status (P = 0.018), and pathologic TNM stage (P = 0.019) as independent prognostic factors, with statistical power of 87%, 43.1% and 21.2%.

Conclusion: Surgery appears to be an optimal treatment with favorable outcomes for patients with pulmonary sarcomatoid carcinoma. Patients with small tumors at earlier stages are very likely to benefit from surgery, regardless of histologic subtype.
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http://dx.doi.org/10.4274/balkanmedj.galenos.2020.2020.7.45DOI Listing
March 2021

STAR-Sonographic Thigh Adjustment Ratio: A Golden Formula for the Diagnosis of Sarcopenia.

Am J Phys Med Rehabil 2020 10;99(10):902-908

From the Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey (MK, BK, AB, LÖ) Department of Physical and Rehabilitation Medicine, Doctor Ayten Bozkaya Spastic Children Hospital and Rehabilitation Center, Bursa, Turkey (AMA); Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey (ÖÖ, ST); Geriatrics Unit, Yenimahalle Training and Research Hospital, Yıldırım Beyazıt University, Ankara, Turkey (ÖK); Department of Geriatrics, Hacettepe University Medical School, Ankara, Turkey (GŞA, MH); Department of Biostatistics, Hacettepe University Medical School, Ankara, Turkey (SK); Department of Biophysics, Hacettepe University Medical School, Ankara, Turkey (ARS); and Department of Public Health, Hacettepe University Medical School, Ankara, Turkey (BÇ).

Objective: The aim of the study was to explore an individualized sonographic muscle thickness ratio and its cutoff values in the diagnosis of sarcopenia.

Design: A total of 326 community-dwelling adults were included in this cross-sectional study. Total skeletal muscle mass was evaluated by bioelectrical impedance analysis, and nine-site muscle thickness measurements using ultrasound. Isometric handgrip and knee extension strengths were assessed. Physical performance was evaluated by usual Gait Speed, Chair Stand Test, and Timed Up and Go Test.

Results: Because the anterior thigh muscle thickness was the most significantly decreasing measurement with aging and the most significantly related value with body mass and height; sonographic thigh adjustment ratio was calculated by dividing it with body mass index. Using the two standard deviation values of our healthy young adults, sonographic thigh adjustment ratio cutoff values were found as 1.4 and 1.0 for male and female subjects, respectively. Sonographic thigh adjustment ratio values were negatively correlated with Chair Stand Test and Timed Up and Go Test in both sexes (all P < 0.05) and positively correlated with gait speed in female subjects and knee extension strength in male subjects (both P < 0.05).

Conclusions: Our results imply that regional (rather than total) muscle mass measurements should be taken into consideration for the diagnosis of sarcopenia.
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http://dx.doi.org/10.1097/PHM.0000000000001439DOI Listing
October 2020
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