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    Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis
    (Wiley, 2022) Efe, Cumali; Lammert, Craig; Tascilar, Koray; Dhanasekaran, Renumathy; Ebik, Berat; Higuera-de la Tijera, Fatima; Caliskan, Ali R.
    Background We investigated associations between baseline use of immunosuppressive drugs and severity of Coronavirus Disease 2019 (COVID-19) in autoimmune hepatitis (AIH). Patients and methods Data of AIH patients with laboratory confirmed COVID-19 were retrospectively collected from 15 countries. The outcomes of AIH patients who were on immunosuppression at the time of COVID-19 were compared to patients who were not on AIH medication. The clinical courses of COVID-19 were classified as (i)-no hospitalization, (ii)-hospitalization without oxygen supplementation, (iii)-hospitalization with oxygen supplementation by nasal cannula or mask, (iv)-intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v)-ICU admission with invasive mechanical ventilation or (vi)-death and analysed using ordinal logistic regression. Results We included 254 AIH patients (79.5%, female) with a median age of 50 (range, 17-85) years. At the onset of COVID-19, 234 patients (92.1%) were on treatment with glucocorticoids (n = 156), thiopurines (n = 151), mycophenolate mofetil (n = 22) or tacrolimus (n = 16), alone or in combinations. Overall, 94 (37%) patients were hospitalized and 18 (7.1%) patients died. Use of systemic glucocorticoids (adjusted odds ratio [aOR] 4.73, 95% CI 1.12-25.89) and thiopurines (aOR 4.78, 95% CI 1.33-23.50) for AIH was associated with worse COVID-19 severity, after adjusting for age-sex, comorbidities and presence of cirrhosis. Baseline treatment with mycophenolate mofetil (aOR 3.56, 95% CI 0.76-20.56) and tacrolimus (aOR 4.09, 95% CI 0.69-27.00) were also associated with more severe COVID-19 courses in a smaller subset of treated patients. Conclusion Baseline treatment with systemic glucocorticoids or thiopurines prior to the onset of COVID-19 was significantly associated with COVID-19 severity in patients with AIH.
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    Evaluation of diagnostic laparoscopy results in Turkish patients with unexplained ascites
    (Baishideng Publishing Group Inc, 2025) Caliskan, Ali R.; Erdogan, Mehmet A.; Baskiran, Adil; Ocal, Ibrahim H.; Kacmaz, Huseyin
    BACKGROUND Diagnostic laparoscopy is a minimally invasive surgical method to diagnose intra-abdominal diseases. AIM To evaluate patients with unexplained ascites who could not be definitively diagnosed via advanced radiological and endoscopic methods and serological, cytological, and microbiological examinations and, therefore, underwent diagnostic laparoscopy. METHODS This retrospective analysis evaluated 82 patients who underwent diagnostic laparoscopy due to unexplained ascites. Patients' medical records were obtained from the hospital database. Their age, sex, complaints at admission, laboratory results, radiological imaging results, diagnostic laparoscopy reports, and pathology reports were analyzed. RESULTS The serum-ascites albumin gradient was < 1.1 in 96.3% of the patients (n = 79). Among patients, 22 (26.8%) had benign diagnoses and 60 (73.2%) had malignant diagnoses. In addition, 55 (67.1%) were deceased, and the median follow-up time from diagnosis to death was four months. The overall follow-up time ranged from 1 to 142 months, with a median of 14 months. Patients' diagnoses were significantly associated with their survival (P < 0.05, chi 2 test). The mortality rate was 86.7% among patients with malignant diagnoses and 13.6% among patients with benign diagnoses. CONCLUSION Diagnostic laparoscopy is minimally invasive, has a low complication rate, and requires a short hospital stay. It can be safely performed to diagnose and treat ascites that remain unexplained after advanced radiological and endoscopic examinations.
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    A mitochondrial neurogastrointestinal encephalomyopathy with intestinal pseudo-obstruction resulted from a novel splice site mutation
    (Lippincott Williams & Wilkins, 2019) Erdogan, Mehmet A.; Seckin, Yuksel; Harputluoglu, Muhsin M.; Karincaoglu, Melih; Aladag, Murat; Caliskan, Ali R.; Bilgic, Yilmaz
    Mitochondrial neurogastrointestinal encephalopathy (MNGIE) is an autosomal recessive disorder characterized by gastrointestinal dysmotility, cachexia, ptosis, peripheral neuropathy and leukoencephalopathy. The diagnosis is often not made until 5-10 years after the onset of symptoms. MNGIE is caused by mutations in thymidine phosphorylase gene TYMP. Here, we present a 19-year-old boy with MNGIE who had a chronic intestinal pseudo-obstruction, and we describe his family history. Genetic analysis revealed a novel homozygous c.765+1G>C intronic mutation which is expected to disrupt splicing of TYMP in the patient. Family screening revealed that the brother was also affected and the mother was a carrier. MNGIE should be considered and genetic testing instigated if individuals with cachexia have neuromuscular complaints or symptoms of chronic intestinal pseudo-obstruction. Copyright (c) 2018 Wolters Kluwer Health, Inc. All rights reserved.