Gaziantep Tarihi Kent Merkezindeki Hanlar Bölgesinin Sorunlarının ve İşlevsel İhtiyaçlarının Belirlenmesi

Gaziantep is a city with many civilizations and cultural architectural heritage from past to present. There are historical buildings and inns area along the axis, which is declared as a cultural route, starting from the vicinity of the castle in the city centre of Gaziantep. Historical inns, which were used for accommodation and trade in the past, have lost their function over time. These inns, which cannot be used in today's conditions, were left to disappear as idle areas as the city centre lost its charm. In this study, it is aimed to identify the problems experienced in the district of inns and determine their missing functions and needs. In addition, it is desired to emphasize that the user types who use the region differ in their interpretations of the region. In line with the identified problems, suggestions were made for the revitalization of the region and the refunctioning of the inns. In order to achieve these goals, questionnaires were created in line with the interviews with the temporary and stationary users in the region and the literature review. As the scope of the study, the inns area on the Gaziantep cultural road has been examined. The questionnaires were applied to the participants in this area, by face to face interview method and the answers of the participants were noted on site. The obtained data were statistically analyzed. As a result of the research, it was concluded that the historical value of the region should be understood by the users, and in this context, the inns and other historical structures in the region should be regularly repaired and the idle areas should be re-functioned. It is thought that the revitalization of historically important buildings and the region and their sustainability are possible by determining the existing problems.Gaziantep geçmişten günümüze birçok medeniyete ve kültürel mimari mirasa ev sahipliği yapmıştır. Kent merkezinde bulunan kalenin çevresinden başlayarak kültür yolu ilan edilen aks boyunca tarihi yapılar ve hanlar yer almaktadır. Geçmişte konaklama ve ticaret amaçlı kullanılan bu hanlar zamanla işlevini kaybetmiştir. Günümüz şartlarında kullanılamayan bu hanlar kent merkezinin de cazibesini yitirmesiyle atıl alanlar olarak yok olmaya terkedilmiştir. Bu çalışmada hanlar bölgesinde bulunan sorunları tespit etmek ve eksik işlevleri, ihtiyaçları belirlemek amaçlanmıştır. Ayrıca bölgeyi kullanan kullanıcı tiplerinin bölgeyle ilgili yorumlarının farklılık gösterdiği vurgulanmak istenmiştir. Belirlenen problemler doğrultusunda, bölgenin canlanması ve hanların tekrardan kullanılması için önerilerde bulunulmuştur. Bu amaçlara ulaşmak için bölgede bulunan geçici ve sabit kullanıcılar ile yapılan görüşmelere ve literatür taramasına yönelik anket formları oluşturulmuştur. Çalışma kapsamı olarak Gaziantep kültür yolu üzeri hanlar bölgesi ele alınmıştır. Anketler bu bölgede katılımcılara yüz yüze yapılmış ve sorular tek tek kullanıcılara sorularak yanıtlar not alınmıştır. Elden edilen veriler istatiksel olarak analiz edilmiştir. Araştırma sonucunda bölgenin tarihi değerinin kullanıcılar tarafından kavranması gerektiği, bu bağlamda bölgedeki hanlar ve diğer tarihi yapıların düzenli olarak onarımlarının yapılıp, atıl alanların yeniden işlevlendirilmesi gerektiği sonucuna ulaşılmıştır. Tarihi önemi olan yapılar ile bölgenin canlandırılması ve sürdürülebilirliğinin, mevcut problemlerin tespiti ile mümkün olduğu düşünülmektedir

Current barriers and recommendations on the diagnosis of transthyretin amyloid cardiomyopathy: a Delphi study

ObjectivesThis study has been conducted to investigate the non-invasive diagnostic journey of patients with a transthyretin amyloid cardiomyopathy (aTTR-CM) in Turkey, identify the challenges and uncertainties encountered on the path to diagnosis from the perspectives of expert physicians, and develop recommendations that can be applied in such cases.MethodsThis study employed a three-round modified Delphi method and included 10 cardiologists and five nuclear medicine specialists. Two hematologists also shared their expert opinions on the survey results related to hematological tests during a final face-to-face discussion. A consensus was reached when 80% or more of the panel members marked the “agree/strongly agree” or “disagree/strongly disagree” option.ResultsThe panelists unanimously agreed that the aTTR-CM diagnosis could be established through scintigraphy (using either 99mTc-PYP, 99mTc-DPD, or 99mTc-HMPD) in a patient with suspected cardiac amyloidosis (CA) without a further investigation if AL amyloidosis is ruled out (by sFLC, SPIE and UPIE). In addition, scintigraphy imaging performed by SPECT or SPECT-CT should reveal a myocardial uptake of Grade ≥2 with a heart-to-contralateral (H/CL) ratio of ≥1.5. The cardiology panelists recommended using cardiovascular magnetic resonance (CMR) and a detailed echocardiographic scoring as a last resort before considering an endomyocardial biopsy in patients with suspected CA whose scintigraphy results were discordant/inconclusive or negative but still carried a high clinical suspicion of aTTR-CM.ConclusionThe diagnostic approach for aTTR-CM should be customized based on the availability of diagnostic tools/methods in each expert clinic to achieve a timely and definitive diagnosis

Kardiyovasküler İşlemlerde Görüntüleme

Doğum sırasındaki fizyolojik değişimlerle kapanması öngörülen foramen ovale erişkin populasyonun yaklaşık %75’inde tamamen kapanmış olarak izlenirken, %25’inde ise kapanmaz ve patent foramen ovale (PFO) olarak varlığını sürdürür.1 PFO, serebrovasküler olay dahil birçok patoloji (auralı migren, dalgıçlarda dekompresyon hastalığı vs.) ile ilişkilendirilmiştir. İskemik inmelerin %25’inde standart tanısal değerlendirmeye rağmen bir neden bulunamaz ve bu grup kriptojenik inme olarak adlandırılır. PFO ve kriptojenik inme arasındaki patofizyolojik ilişki paradoksal embolizm, PFO içerisinde meydana gelen trombüs, sol atriyal disfonksiyon ve atriyal aritmiler gibi nedenlere bağlı olabilir. Epidemiyolik veriler ve klinik gözlemsel çalışmalar, PFO kapatılmasıyla inme rekürrenslerinin azaldığını gösteren randomize kontrollü çalışmalar tarafından kuvvetle desteklenmektedir.2 PFO’nun tanısında ve perkütan tedavisinde çoklu görüntüleme yöntemleri önem arz etmektedir

Datasheet1_Current barriers and recommendations on the diagnosis of transthyretin amyloid cardiomyopathy: a Delphi study.docx

ObjectivesThis study has been conducted to investigate the non-invasive diagnostic journey of patients with a transthyretin amyloid cardiomyopathy (aTTR-CM) in Turkey, identify the challenges and uncertainties encountered on the path to diagnosis from the perspectives of expert physicians, and develop recommendations that can be applied in such cases.MethodsThis study employed a three-round modified Delphi method and included 10 cardiologists and five nuclear medicine specialists. Two hematologists also shared their expert opinions on the survey results related to hematological tests during a final face-to-face discussion. A consensus was reached when 80% or more of the panel members marked the “agree/strongly agree” or “disagree/strongly disagree” option.ResultsThe panelists unanimously agreed that the aTTR-CM diagnosis could be established through scintigraphy (using either 99mTc-PYP, 99mTc-DPD, or 99mTc-HMPD) in a patient with suspected cardiac amyloidosis (CA) without a further investigation if AL amyloidosis is ruled out (by sFLC, SPIE and UPIE). In addition, scintigraphy imaging performed by SPECT or SPECT-CT should reveal a myocardial uptake of Grade ≥2 with a heart-to-contralateral (H/CL) ratio of ≥1.5. The cardiology panelists recommended using cardiovascular magnetic resonance (CMR) and a detailed echocardiographic scoring as a last resort before considering an endomyocardial biopsy in patients with suspected CA whose scintigraphy results were discordant/inconclusive or negative but still carried a high clinical suspicion of aTTR-CM.ConclusionThe diagnostic approach for aTTR-CM should be customized based on the availability of diagnostic tools/methods in each expert clinic to achieve a timely and definitive diagnosis.</p

Comparing the efficacy of regorafenib and 5-fluorouracil-based rechallenge chemotherapy in the third-line treatment of metastatic colorectal cancer

Abstract Background The optimal treatment for metastatic colorectal cancer (mCRC) after the second line is still controversial. Regorafenib has been the standard of care in this setting as it improved overall survival (OS) compared to placebo. In real-world practice chemotherapy rechallenge is also a preferred option even though supporting evidence is not enough. We aim to compare the efficacy of regorafenib and 5-fluorouracil-based (5-FU) rechallenge treatment in the third line setting of mCRC. Methods In this retrospective multi-institutional trial, mCRC patients from 21 oncology centers who progressed after 2 lines of chemotherapy were analyzed. Patients who were treated with regorafenib or rechallenge therapy in the third-line setting were eligible. Rechallenge chemotherapy was identified as the re-use of the 5-FU based regimen which was administered in one of the previous treatment lines. OS, disease control rate (DCR), progression free survival (PFS) and toxicity were analyzed. Results Three hundred ninety-four mCRC patients were included in the study. 128 (32.5%) were in the rechallenge, and 266 (67.5%) were in the regorafenib group. Median PFS was 5.82 months in rechallenge and 4 months in regorafenib arms (hazard ratio:1.45,95% CI, p = 0.167). DCR was higher in the rechallenge group than regorafenib (77% vs 49.5%, respectively, p =  < 0.001). Median OS after the third-line treatment was 11.99 (95% CI, 9.49–14.49) and 8.08 months (95% CI, 6.88–9.29) for rechallenge and regorafenib groups, respectively (hazard ratio:1.51, 95% CI, p < 0.001). More adverse effects and discontinuation were seen with regorafenib treatment. Conclusion Our study revealed that higher disease control and OS rates were achieved with rechallenge treatment compared to regorafenib, especially in patients who achieved disease control in one of the first two lines of therapy

Real-world data on efficacy and safety of first-line alectinib treatment in advanced-stage, ALK-positive non-small-cell lung cancer patients: A Turkish Oncology Group study

Aims: In this multicenter study, the authors aimed to determine the real-life efficacy and safety of first-line alectinib. Materials & methods: This retrospective trial included advanced-stage, ALK-positive non-small-cell lung cancer patients who were treated with first-line alectinib in terms of ALK-tyrosine kinase inhibitors, regardless of previous chemotherapy. The co-primary end points were progression-free survival both for all patients and for the treatment-naive population. The secondary end points were overall response rate, overall survival, rate of CNS progression and safety. Results & conclusion: A total of 274 patients (n = 177 for treatment-naive patients) were enrolled in the study. The median progression-free survival was 26 and 28.8 months for all patients and the treatment-naive group, respectively. The overall response rate, CNS progression rate and 1-year overall survival ratio were 77.9, 12.4 and 77%. Alectinib is a highly effective therapy with a favorable safety profile

Mortality Risk Factors among Critically Ill Children with Acute COVID-19 in PICUs: A Multicenter Study from Turkish Pediatric Critical COVID-19 and MIS-C Study Group

© 2022 Lippincott Williams and Wilkins. All rights reserved.Background: During the coronavirus disease 2019 (COVID-19) pandemic, the world has a large number of reported COVID-19 cases and deaths. Information on characteristics and mortality rate of pediatric intensive care unit (PICU) cases with COVID-19 remains limited. This study aims to identify the risk factors for mortality related to COVID-19 in children admitted to PICU. Methods: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 44 PICUs in Turkey. Children who were 1 month-18-year of age with confirmed COVID-19 admitted to PICU were included in the study. Children with multisystem inflammatory syndrome and asymptomatic for COVID-19 were excluded. Results: Of 335 patients with COVID-19, the median age was 6.8 years (IQR: 1.2-14) and 180 (53.7 %) were male, 215 (64.2 %) had at least one comorbidity. Age and gender were not related to mortality. Among 335 patients, 166 (49.5%) received mechanical ventilation, 17 (5.1%) received renal replacement therapy and 44 (13.1 %) died. Children with medical complexity, congenital heart disease, immunosuppression and malignancy had significantly higher mortality. On multivariable logistic regression analysis, organ failure index [odds ratio (OR): 2.1, 95 confidence interval (CI): 1.55-2.85], and having congenital heart disease (OR: 2.65, 95 CI: 1.03-6.80), were associated with mortality. Conclusions: This study presents detailed data on clinical characteristics and outcomes of patients with COVID-19 admitted to PICU in the first pandemic year in Turkey. Our study shows that having congenital heart disease is associated with mortality. In addition, the high organ failure score in follow-up predict mortality

The longitudinal evolution of post-COVID-19 outcomes among hemodialysis patients in Turkey

Introduction: Hemodialysis (HD) patients have increased risk for short-term adverse outcomes of COVID-19. However, complications and survival at the post-COVID-19 period have not been published extensively.Methods: We conducted a national, multicenter observational study that included adult maintenance HD patients recovered from confirmed COVID-19. A control HD group without COVID-19 was selected from patients in the same center. We investigated the characteristics and outcomes in the follow-up of HD patients and compare them with the non-COVID-19 group.Results: A total of 1223 patients (635 patients in COVID-19 group, 588 patients in non-COVID-19 group) from 47 centers were included in the study. The patients' baseline and HD characteristics were almost similar. The 28th-day mortality and mortality between 28th day and 90th day were higher in the COVID-19 group than non-COVID-19 group (19 [3.0%] patients vs. none [0%]; 15 [2.4%] patients vs. 4 [0.7%] patients, respectively). The presence of respiratory symptoms, rehospitalization, need for home oxygen therapy, lower respiratory tract infection, and arteriovenous (AV) fistula thrombosis was significantly higher in the COVID-19 group in both the first 28 days and between 28 and 90 days. In the multivariable analysis, age (odds ratio [OR] [95% CI]: 1.029 [1.004-1.056]), group (COVID-19 group vs. non-COVID-19 group) (OR [95% CI]: 7.258 [2.538-20.751]), and vascular access type (tunneled catheter/AV fistula) (OR [95% CI]: 2.512 [1.249-5.051]) were found as independent parameters related to 90-day mortality.Conclusion: In the post-COVID-19 period, maintenance HD patients who have had COVID-19 have increased rehospitalization, respiratory problems, vascular access problems, and high mortality compared with the non-COVID-19 HD patients