Hacettepe Üniversitesi Açık Erişim Sistemi (HÜAES)
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ACİL SERVİSTE PULMONER TROMBOEMBOLİ ŞÜPHESİ İLE TETKİK EDİLEN HASTALARIN BAŞVURU VİTAL BULGULARININ KESİN TANIYA KATKISI
(Tıp Fakültesi, 2026) Hasan Can Sağlam; Nalan Metin Aksu; Volkan Arslan; Acil Tıp
Sağlam H.C., The Contribution of Admission Vital Signs to the Definitive Diagnosis in Patients Presenting to the Emergency Department with Suspected Pulmonary Thromboembolism, Hacettepe University Faculty of Medicine, Department of Emergency Medicine, Specialty Thesis, Ankara, 2026.
Introduction and Aim: Pulmonary thromboembolism (PTE) is a high-mortality emergency that is difficult to diagnose because of its nonspecific clinical presentation. Data on the contribution of vital signs measured at admission to the definitive diagnosis are limited. This study aimed to determine the contribution of admission vital signs to the definitive diagnosis of PTE and their association with mortality in patients presenting to the emergency department with suspected PTE.
Materials and Methods: This prospective observational study was conducted in the Emergency Department of Hacettepe University Hospital. A total of 1,582 patients aged 18 years and older who underwent contrast-enhanced thoracic computed tomography angiography (CTPA) or ventilation/perfusion (V/Q) scintigraphy with a presumptive diagnosis of PTE between July 1, 2024, and October 1, 2025, were included in the study.
Results: Of the 1,582 patients included, 48.5% were female and 51.5% were male, with a median age of 66 years (IQR: 23). PTE was diagnosed in 300 patients (19%), with segmental-level PTE being the most frequent (9.5%). In PTE-positive patients, median systolic and diastolic blood pressures were significantly lower (121.5 vs. 128 mmHg, p<0.001, and 76 vs. 79 mmHg, p=0.001, respectively), heart rate (110 vs. 95 beats/min, p<0.001) and respiratory rate (24 vs. 20 breaths/min, p<0.001) were significantly higher, and oxygen saturation was lower (91% vs. 94%, p<0.001). No significant difference was observed between the groups with respect to body temperature (p=0.585). In the diagnostic performance analysis, respiratory rate achieved the highest sensitivity (0.790), whereas heart rate achieved the highest negative predictive value (0.895). Hypotension, tachycardia, tachypnea, and hypoxemia were significantly associated with mortality; body temperature did not predict mortality at any time point.
Conclusion: In patients presenting to the emergency department with suspected PTE, admission vital signs—with the exception of body temperature—contribute significantly both to establishing the definitive diagnosis and to predicting short- and intermediate-term mortality. Nevertheless, no single vital parameter possesses adequate diagnostic performance on its own; therefore, vital signs should be used in integration with clinical decision support systems, laboratory tests, and imaging methods.
Cri du Chat Sendromu Tanısıyla İzlenen Olguların Klinik ve Moleküler Özellikleri ile Genotip-Fenotip Korelasyonu Açısından Değerlendirilmesi
(Tıp Fakültesi, 2026) Tutku Annakkaya Koçyiğit; Çocuk Sağlığı ve Hastalıkları
Cri du chat syndrome (CdCS) is a rare chromosomal disorder caused by deletions of varying sizes on the short arm of chromosome 5. The most characteristic features of the syndrome include a high-pitched cat-like cry, developmental delay, intellectual disability, and distinctive facial dysmorphism. The severity of clinical manifestations may vary depending on the size and location of the deletion. Chromosomal microarray analysis enables a more detailed evaluation of genotype–phenotype correlations. In this study, the clinical, laboratory, imaging, and genetic characteristics of 23 patients diagnosed with CdCS were comprehensively evaluated. Demographic and clinical data were collected retrospectively and prospectively, and genotype–phenotype correlations were investigated in 15 patients who underwent chromosomal microarray analysis. Female patients accounted for 60.9% of the cohort. The most common clinical findings were language and motor developmental delay and intellectual disability (100%), followed by a high-pitched cry (95%), microcephaly (87%), epicanthal folds (82.6%), hypertelorism (81.8%), micrognathia (81.8%), and feeding difficulties (81%). Chromosomal microarray analysis revealed an interstitial deletion in one patient and terminal deletions in the remaining patients. Furthermore, the 4.7 Mb terminal deletion identified in our cohort represents one of the smallest deletions reported in the literature to be associated with the CdCS phenotype. Increasing deletion size was associated with a younger age at diagnosis, supporting the concept that larger deletions result in a more severe clinical phenotype. In addition, micrognathia and clinodactyly were found to be potentially associated with deletions proximal to the 5p15.3 region. In conclusion, this study represents one of the largest CdCS cohorts reported from Türkiye, providing a comprehensive characterization of the clinical and molecular features of the syndrome, identifying one of the smallest terminal deletions reported in the literature, and contributing important data regarding genotype–phenotype correlations. Larger multicenter studies are needed to validate these findings and to further define the critical genomic regions involved in CdCS.
Acil Servise Başvuran Febril Nötropeni Hastalarında MASCC Skorlaması ile Yapılan Hasta Yönetiminin FRAİL Kırılganlık İndeksi Skorları ile Karşılaştırılması ve Değerlendirilmesi: Gözlemsel Çalışma
(Tıp Fakültesi, 2026) Ozan Sarıkaya; Acil Tıp
Sarıkaya O. Comparison and Evaluation of Patient Management Based on MASCC Scoring with FRAIL Frailty Index Scores in Febrile Neutropenia Patients Presenting to the Emergency Department: An Observational Study Hacettepe University Faculty of Medicine, Department of Emergency Medicine Thesis of Specialty in Medicine, Ankara, 2026.
Febrile neutropenia is a major cause of morbidity and mortality in oncology patients and requires rapid, accurate risk stratification in the emergency department. This study aimed to evaluate the performance of the MASCC score and the FRAIL Frailty Index—individually and in combination—in predicting mortality and safe discharge among oncology patients presenting to the emergency department with febrile neutropenia, and to determine whether a combined model derived from the two instruments provides incremental predictive value. In this prospective observational study, 276 oncology patients presenting with febrile neutropenia were enrolled. MASCC and FRAIL scores were calculated at admission, and clinical course, hospitalization, safe discharge, and mortality outcomes were recorded. Because the two instruments are scored in opposite directions, the MASCC score was inverted relative to its maximum value and combined using the formula Combined Score = FRAIL + (26 − MASCC). Diagnostic performance was assessed by ROC curve analysis. The median age was 64.0 years, 51.8% were female, and the overall mortality rate was 15.6%. Both the MASCC and FRAIL scores were independently and significantly associated with mortality and clinical outcome. The combined model achieved an AUC of 0.757 for mortality prediction (negative predictive value 0.913; specificity 0.807) and 0.717 for safe discharge prediction (specificity 0.730), outperforming either score alone. Neither score significantly predicted length of hospital stay (MASCC p = 0.099; FRAIL p = 0.144). In conclusion, adding the FRAIL Frailty Index to the MASCC score provides incremental value in predicting mortality and safe discharge in patients with febrile neutropenia; integrating frailty assessment into risk stratification yields discriminative ability that cannot be obtained with MASCC alone.
Keywords: MASCC, FRAIL, febrile neutropenia, frailty, risk stratification
16. Yüzyıl Osmanlı Kültüründe Samek Ayyar Hikâyesi ve Musavver Nüshaları
(Sosyal Bilimler Enstitüsü, 2025) Karaaslan Ayhan, Serpil; Sanat Tarihi
This study examines the production and design processes of illustrated narratives that gained prominence during the intensified translation activities of the reigns of Murad III (1574-1595) and Mehmed III (1595 1603). In this context, the manuscript Kıssa-i Ferruhruz (British Library, Or. 3298), has been taken as the central focus of the research in order to understand the approaches that emerged in the writing and illustration of narratives transferred from Arabic and Persian literature into Ottoman culture. Representing the final sections of the Samak Ayyar story, which is thought to have been first committed to writing as early as the 12th century and recounting adventures and fantastic events surrounding a love affair, this work has been analyzed in detail with regard to its origins in the Ottoman world, its translation processes, modes of illustration and codicological features. The study also offers a comparative analysis with Kıssa-i Şehr-i Şatran (Istanbul University Library, T. 9303), which appears to serve as a continuation of the former manuscript in terms of both content and design. During the research process, unillustrated copies produced in the Ottoman domain were examined in order to understand the place of the work within the Ottoman literary environment. To this end, Dâsitân-ı Samak Ayyar (Cod. Turc. 202) at the Bayerische Staatsbibliothek in Munich and Kitâb-ı Hurşid Şah at the Süleymaniye Library were identified and their contents have been analyzed. In this way, the narrative was reconstructed on the basis of both illustrated and unillustrated manuscripts. Furthermore, a comparative analysis was conducted between the Turkish copies and the Persian manuscript Kitâb-ı Samak Ayyar, produced during the Inju dynasty in the 1330s and preserved at the Oxford Bodleian Library, with particular attention to principles of content and visual design. The missing sections within the three volumes of the Persian version were identified and reconstructed through comparison with the Turkish translations.
This dissertation offers a detailed analysis of the illustrated Ottoman versions of the Samak Ayyar story in terms of design principles, visual strategies and content, while also situating them within a holistic framework together with the unillustrated manuscripts. In addition, by presenting a thorough comparison with similar groups of works produced in the same period in terms of both design and content, it demonstrates how such narratives were reconfigured and illustrated within the Ottoman cultural and artistic
milieu, while also revealing the role that stories containing love, fantasy and supernatural elements played in the visual culture of the era. Thus, by examining the Samak Ayyar translations, which have not previously
been studied comprehensively, this study contributes new perspectives to the analysis of narrative and illustrative practices in Ottoman storybooks produced between the late 16th and early 17th centuries and offers fresh insights for literary history, art history and translation studies.
Hollywood’da Bir Ticari Strateji Olarak Sinemasal Evren İnşası: John Wıck Film Serisi Özgül Örneği
(Sosyal Bilimler Enstitüsü, 2025) Gölbaşı, Emin Onuralp; Radyo Televizyon ve Sinema
This study examines how the John Wick (Chad Stahelski, 2014–2023) action series, following the first film’s unexpected commercial success, was transformed into a transmedia narrative. It is argued that, in the sequels, the story of the main character was forefronted by more marketable elements, which reflects a recently popular strategy, not only in commercial cinema but across all commercial media. The Marvel Cinematic Universe and the Star Wars series (George Lucas, 1977–2005) are examples of transmedia
narratives. Recently, these series have expanded their production outside the realm of cinema and made their products more connected with the film than before. The conceptual framework includes discussions aimed at understanding narrative universes, which are argued to be the core element of transmedia storytelling. Henry Jenkins’ "Transmedia Storytelling" term is interpreted from a critical perspective, suggesting transmedia narratives expand and spread by foregrounding their universes. The contemporary marketing strategies of commercial cinema aligns with these narratives. Products for different mediums are
connected through their universes and mutually encourage consumption. The term “worldification” is proposed to explain the transformation of the John Wick series. The four films of the John Wick series are examined using textual analysis. Using the first film as a basis, changes in characters, time/space
construction, and the universe in the sequels are identified. It is observed that the success of the initial lowbudget production, which is argued to have made a mark in action cinema, led to various transformations. As “Wickverse” became more concrete, the sequels distanced themselves from the noir aesthetic and character-driven narrative, offering stories where the universe took precedence. The narrative universe was expanded with events independent of the main character, and with the addition of new characters, it was adapted into a transmedia narrative with multiple platforms and storylines.