Hacettepe Üniversitesi Açık Erişim Sistemi (HÜAES)
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HIV İle Yaşayan Bireylerin 8 Yıllık İzleminde Kırılganlık Ve Sarkopeni Değişimi: 2018 Hacettepe Kohortunun Yeniden Değerlendirilmesi
(Tıp Fakültesi, 2026-06-23) Gamze Saban; İç Hastalıkları
Gamze SABAN, Changes in Frailty and Sarcopenia Over an 8-Year Follow-Up Among People Living with HIV: A Prospective Reassessment of the 2018 Hacettepe Cohort. Hacettepe University Faculty of Medicine, Thesis in Internal Medicine. Ankara, 2026.
Objective: With effective antiretroviral therapy, HIV infection has become a chronic condition, and comorbidity, frailty, sarcopenia, and geriatric syndromes have become increasingly relevant in aging people living with HIV (PLWH). This study aimed to reassess a cohort of PLWH aged ≥40 years evaluated at Hacettepe University in 2018 and to examine 8-year changes in frailty, sarcopenia, comorbidity burden, and geriatric syndromes.
Materials and Methods: This was an ambispective longitudinal cohort study. Of 95 PLWH evaluated in 2018, 56 were reassessed face-to-face in 2026, and 4 deaths were recorded. Demographic characteristics, HIV-related parameters, ART history, comorbidities, Charlson Comorbidity Index, VACS-2, D:A, and FRAX scores were evaluated. Frailty was assessed using the Fried phenotype, Edmonton Frail Scale, and Social Frailty Index. Sarcopenia was evaluated according to the EWGSOP2 algorithm using muscle strength, physical performance, and BIA-based muscle mass parameters. Muscle ultrasonography was performed as a supportive morphologic assessment and was not used as an EWGSOP2 diagnostic criterion. Cognitive status, basic and instrumental activities of daily living, nutritional status, depressive symptoms, falls, and urinary incontinence were assessed within a comprehensive geriatric evaluation.
Results: Median age increased from 48.5 (45.0–54.8) years in 2018 to 56.0 (52.3–62.8) years in 2026; 76.8% were male. The proportion with current HIV RNA <50 copies/mL was 87.5%. CD4 count increased from 684.5 (469–926) to 901.0 (716.8–1139.3) cells/mm³, and the CD4/CD8 ratio increased from 0.74 (0.60–1.02) to 1.03 (0.82–1.37) (p<0.001). Charlson score increased from 0 (0–1) to 2 (1–3), and D:A cardiovascular risk increased from 15.6% (9.4–27.4) to 32.2% (22.7–49.6) (p<0.001). VACS-2 score decreased from 40.09±9.17 to 33.36±9.49 (p<0.001). Fried frailty decreased from 16.1% to 10.7%, whereas pre-frailty increased from 26.8% to 44.6%; the overall categorical change was not statistically significant. According to the Edmonton Frail Scale, the proportion of non-frail participants increased from 73.2% to 82.1% (p=0.039). Social pre-frailty and social frailty were present in 41.1% and 8.9%, respectively. Sarcopenia stages showed significant progression: the normal category decreased from 85.7% to 69.6%, whereas probable sarcopenia increased from 10.7% to 19.6% and confirmed sarcopenia from 3.6% to 10.7% (p=0.016). In the 2026 cross-sectional EWGSOP2 assessment, 26.8% had probable sarcopenia and 3.6% had confirmed sarcopenia; severe sarcopenia was not observed. BMI increased from 26.61±3.38 to 27.93±4.50 kg/m² (p<0.001). Normal bone mineral status decreased from 78.6% to 46.4%, whereas osteopenia increased from 8.9% to 44.6% and osteoporosis from 0% to 8.9% (p<0.001). Independence in basic and instrumental activities of daily living was 91.1%, normal nutritional status according to MNA-SF was 91.1%, and median MMSE score was 29 (28–30). Falls within the previous year and urinary incontinence were reported in 21.4% and 17.9%, respectively. In exploratory regression analyses, male sex was associated with lower odds of sarcopenia progression, whereas previous protease inhibitor exposure was associated with higher odds.
Conclusion: This study provides longitudinal data from Türkiye on 8-year changes in frailty, sarcopenia, comorbidity burden, and comprehensive geriatric assessment in the same PLWH cohort. Despite sustained virologic suppression and immunologic improvement, comorbidity burden, cardiovascular risk, bone mineral disorders, and sarcopenia increased over time. These findings support the integration of muscle and bone health, frailty, physical function, cognition, nutrition, falls, medication burden, and social vulnerability into routine geriatric-oriented HIV care.
Aralıklı Oruç Diyeti Uygulayanların Uyku Kalitelerinin ve Bedenlerini Beğenme Durumlarının Değerlendirilmesi: Tanımlayıcı Kesitsel Çalışma
(Tıp Fakültesi, 2026-08-11) Feray Atilla; Aile Hekimliği
Intermittent fasting has become an increasingly popular dietary approach and a common topic of consultation in family medicine. This study aimed to determine the sociodemographic characteristics, sleep quality, and body appreciation of individuals practicing intermittent fasting in Türkiye. This descriptive cross-sectional study was conducted using face-to-face questionnaires. A total of 201 individuals aged 18 years and older who had been practicing intermittent fasting for at least one month and had a body mass index below 30 kg/m² were included (75.1% female; median age: 30 years). Data were collected between May 1, 2025, and August 1, 2025, and analyzed using IBM SPSS Statistics version 23.0.
No statistically significant association was found between the intermittent fasting model and either the total Pittsburgh Sleep Quality Index score (p=0.211) or the good/poor sleep quality categories (p=0.098). Poor sleep quality was numerically more frequent among participants following alternate-day fasting (66.7%) or the 5:2 model (100.0%) compared with those practicing time-restricted eating (44.8%); however, given the very small number of participants in the alternate-day fasting and 5:2 groups (n=6 and n=3, respectively), this difference should be interpreted with caution. The mean total Body Appreciation Scale score was 38.5±8.3; this score was significantly higher in participants practicing intermittent fasting for the first time (39.8) than in those who had practiced it more than once (37.9) (p=0.045). In contrast, no significant association was found between the total Pittsburgh Sleep Quality Index score and the total Body Appreciation Scale score (p=0.942). This study evaluated the relationship between intermittent fasting, sleep quality, and body appreciation, and its findings may contribute to future studies with larger and more diverse populations.
Abdominal ve Torasik Aort Anevrizma Olgularında Endovasküler Onarım Sırasındaki Anestezi Yaklaşımının Klinik Sonuçlar Üzerine Etkilerinin Retrospektif Olarak İncelenmesi
(Tıp Fakültesi, 2026) Şeyda Zirek; Anesteziyoloji ve Reanimasyon
Zirek Ş. A Retrospective Analysis of the Impact of Anesthetic Techniques
on Clinical Outcomes During Endovascular Repair of Abdominal and Thoracic
Aortic Aneurysms, Hacettepe University, Department of Anesthesiology and
Reanimation, Residency Thesis, Ankara, 2026. The aim of this study was to
retrospectively evaluate the effects of different anesthetic techniques used during
endovascular aortic repair procedures, including EVAR (Endovascular Aortic Repair)
and TEVAR (Thoracic Endovascular Aortic Repair), on perioperative and
postoperative clinical outcomes in patients with abdominal and thoracic aortic
aneurysms. General anesthesia, regional anesthesia, and local anesthesia with sedation
were compared. Patients who underwent endovascular aortic repair at the Vascular
Interventional Radiology Unit of Hacettepe University Hospital between January 1,
2004 and September 30, 2024 were screened. A total of 276 patients who underwent
EVAR or TEVAR during the study period were screened. Of these, 118 patients were
excluded because their anesthesia records were unavailable. The remaining 158
patients with complete anesthesia records were included in the final analysis. The
patients were categorized according to the anesthesia technique used: general
anesthesia, regional anesthesia, and local anesthesia with sedation. Demographic
characteristics, ASA classification, comorbidities, procedural features, intraoperative
hemodynamic parameters, administered fluid volume, blood transfusion requirement,
antihypertensive and vasopressor use, operation time, length of hospital and intensive
care unit stay, laboratory parameters, complications, endoleak, and 30-day mortality
were evaluated.
The mean age of the patients was 65.45±11.83 years, and 88% were male.
EVAR was performed in 74.1% of the patients and TEVAR in 25.9%. Regarding
anesthesia technique, 43% of the patients received general anesthesia, 15.8% regional
anesthesia, and 41.1% local anesthesia with sedation. Overall, the most common
comorbidities were hypertension (70.3%) and coronary artery disease (37.3%), while
the most frequent complications were renal complications (6.3%) and bleeding (4.4%).
The 30-day mortality rate was 2.5%. In the EVAR group, significant differences were
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observed among anesthesia techniques in mean heart rate, administered fluid volume,
and length of hospital stay. Mean heart rate was significantly higher in patients who
received regional anesthesia than in those who received local anesthesia with sedation.
The amount of administered fluid was significantly higher in patients who received
general anesthesia than in those who received local anesthesia with sedation. In
addition, the length of hospital stay was significantly longer in EVAR patients
receiving regional anesthesia compared with those receiving local anesthesia with
sedation. In the TEVAR group, the rate of coronary artery disease was significantly
higher in patients who underwent local anesthesia with sedation than in those who
received general anesthesia. Furthermore, in TEVAR patients, mean heart rate,
operation time, and postoperative creatinine levels were significantly higher in the
general anesthesia group than in the local anesthesia with sedation group. In contrast,
no significant differences were found between anesthesia techniques in terms of age,
weight, sex, ASA class, most comorbidities, smoking status, type of surgery, access
site, pathology level, maximum aneurysm diameter, spinal drainage, mean arterial
pressure, blood transfusion, antihypertensive and vasopressor use, intensive care unit
stay, complication rates, endoleak, or 30-day mortality. Hemoglobin levels
significantly decreased in the postoperative period across all anesthesia techniques in
both the EVAR and TEVAR groups.
In conclusion, this study, which examined approximately 20 years of data,
reflects our center’s clinical experience with EVAR and TEVAR procedures. Although
the anesthetic approach in endovascular aortic repair appears to affect certain
perioperative parameters and selected laboratory outcomes, no clear superiority of any
anesthetic technique was demonstrated in terms of major complications, endoleak, or
early mortality. These findings emphasize that, when selecting an anesthetic technique
for endovascular aortic repair procedures, individualized decision-making based on
the type of intervention, anatomical characteristics, comorbidities, and center
experience is more important than following a standardized algorithm.
HEMODİYALİZ SÜRECİNDE MİKROPLASTİK VARLIĞININ VE MARUZİYET DÜZEYİNİN DEĞERLENDİRİLMESİ
(Tıp Fakültesi, 2026) İBRAHİM GÜMÜŞKEMER; İç Hastalıkları
ABSTRACT
Gümüşkemer İ.: Assessment of Microplastic Presence and Exposure Level
During Hemodialysis; Hacettepe University Faculty of Medicine (HÜTF),
Department of Internal Medicine Residency Thesis; Ankara, 2026.
Objective: This study aims to simultaneously characterize the presence of
microplastics across four sequential sampling points in a hemodialysis water
purification chain, as well as in pre- and post-dialysis blood samples from the same
patients, using five complementary analytical methods.
Materials and Methods: This cross-sectional observational pilot study,
conducted at Hacettepe University Faculty of Medicine Hospital in collaboration with
Bilkent University UNAM, enrolled 6 hemodialysis patients. Water samples were
collected at four points (municipal supply, post-purification, dialysis inlet, and dialysis
outlet water) across three independent sessions; blood samples were obtained pre- and
post-dialysis from each patient. Analytical evaluation comprised dynamic light
scattering (DLS), scanning electron microscopy (SEM), Nile Red fluorescence
microscopy, Raman spectroscopy, and Fourier-transform infrared spectroscopy (FTIR);
the Friedman and Wilcoxon signed-rank tests were used for statistical assessment.
Results: Dynamic light scattering analysis of the hemodialysis water
purification chain revealed a consistent directional particulate pattern: a marked
decrease following the purification stage and the highest values at the dialysis outlet.
This pattern was reproduced without exception across all three sessions [Friedman
χ²(3) = 8.200; p = 0.042; Kendall’s W = 0.911]; the mean hydrodynamic diameter
increased ~208% and ~61% across two separate sampling sessions. SEM documented
dominant fibrous morphology with accompanying fragmented and granular particles
in all six patients; Nile Red fluorescence microscopy identified hydrophobic
particulate structures in pre- and post-dialysis samples across all patients. Raman
spectroscopy and FT-IR demonstrated independent convergence at ~1,100 cm⁻¹ in all
water and blood samples; additional FT-IR bands (~2,848, ~2,915, ~2,960 cm⁻¹)
matched the characteristic polyethylene (PE) infrared signature. FT-IR revealed
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consistent PE- and polyethylene terephthalate (PET)-compatible differential spectral
patterns in pre- and post-dialysis isolates from all six patients. Blood DLS analysis
yielded a pre-dialysis median of 1,292.76 d.nm [interquartile range: 1,123.40–
1,487.13] and a post-dialysis median of 1,078.87 d.nm [IQR: 910.23–1,304.00].
Intensity-based size distribution curves demonstrated that the small-particle
population observed pre-dialysis was largely replaced by larger-sized components
post-dialysis, a pattern consistent with membrane-derived particulate contribution
and/or aggregation mechanisms. The Wilcoxon test did not reach statistical
significance (W = 5.0; p = 0.313); however, a moderate effect size was observed (r =
0.471; Cohen’s d_z = 0.526), and post-hoc power analysis indicated that
approximately 33 patients would be required for 80% statistical power.
Conclusion: This first integrated pilot study to simultaneously examine the
hemodialysis water purification chain and blood samples from the same patients using
five analytical methods documented a particulate size increase at the dialysis outlet
despite reverse osmosis purification, and a consistent PE/PET-compatible particulate
burden in hemodialysis patient blood both before and after dialysis. These findings
provide a systematic framework for updating hemodialysis biosafety standards to
encompass plastic-derived contaminants, evaluating safer alternative polymer
materials, and designing adequately powered, outcome-focused studies specific to this
patient population.
Gonadotropin Salgılatıcı Hormon (GnRH) Agonist Tetiklemesi Uygulanan In-Vitro Fertilizasyon (IVF) Sikluslarında Oosit Verimi ve Oosit Matürasyonunu Belirleyen Faktörler
(Tıp Fakültesi, 0024-06-26) Beste Özge Özgen; Kadın Hastalıkları ve Doğum
Özgen, B.Ö., Factors Affecting Oocyte Yield and Oocyte Maturation in In Vitro Fertilization (IVF) Cycles Triggered with a Gonadotropin-Releasing Hormone (GnRH) Agonist, Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology, Residency Thesis, Ankara, 2026. The aim of this study was to evaluate the clinical, hormonal, and stimulation-related factors affecting the oocyte retrieval rate (ORR), oocyte maturation rate (OMR), and mature oocyte-to-aspirated follicle ratio (MPA) in ovarian stimulation cycles triggered with GnRH agonist for final oocyte maturation. This retrospective study was conducted at the Reproductive Medicine and Infertility Unit of Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology, and included the first IVF/ICSI cycle of 282 patients who underwent GnRH agonist triggering. Factors associated with ORR, OMR, and MPA were analyzed using beta-binomial regression models. In addition, potential differences in these associations according to the pituitary suppression protocol, namely GnRH antagonist and progestin-primed ovarian stimulation (PPOS), were evaluated. In multivariable analysis, increasing female age was associated with lower ORR (aOR=0.97; 95% CI: 0.94–0.99; p=0.013). Higher total gonadotropin dose was also associated with decreased ORR (aOR=0.74 per 1000 IU increase; 95% CI: 0.60–0.92; p=0.006). Low trigger-day progesterone levels (≤1.01 ng/mL) were associated with lower ORR compared with the middle progesterone tertile (1.01–1.58 ng/mL) (aOR=0.74; 95% CI: 0.55–1.00; p=0.052). No significant differences were observed between PPOS and antagonist protocols with respect to ORR, OMR, or MPA. In addition, basal LH level, BMI, basal estradiol, trigger-day estradiol, AMH, presence of PCOS, stimulation duration, and suppression protocol were not identified as independent predictors of ORR. No independent significant predictor of OMR was identified, whereas low trigger-day progesterone level was the only significant predictor of MPA. Interaction analyses demonstrated that the effect of total gonadotropin dose on ORR varied according to the suppression protocol (p=0.0092). In antagonist cycles, both low basal LH levels (OR=0.57; 95% CI: 0.38–0.88; p=0.0428) and high basal LH levels (OR=0.55; 95% CI: 0.32–0.92; p=0.0351) were associated with lower MPA. In conclusion, advanced female age and higher total gonadotropin dose were associated with lower ORR in IVF/ICSI cycles triggered with GnRH agonist. Although basal LH level was not identified as an independent predictor in the overall study population, it was associated with MPA in antagonist cycles. Furthermore, the negative effect of increasing gonadotropin dose on ORR was more pronounced in PPOS cycles. These findings suggest that oocyte yield may be influenced by patient characteristics, stimulation-related parameters, and the suppression protocol used.