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    Comparison of nursing home-acquired pneumonia and community-acquired pneumonia and evaluation of factors predicting mortality
    (Erciyes Univ Sch Medicine, 2022) Yencilek, Halil İlker; Şener, Alp; Özhasenekler, Ayhan; Ergin, Mehmet; Günaydın, Gül Pamukcu; Gökhan, Servan; Ere, Özcan
    Objective: The number of admissions to the emergency department (ED) of elderly patients who reside in nursing homes with a diagnosis of pneumonia continues to grow. This study was designed to assess factors that predicted mortality in the patient group defined as those with nursing home-acquired pneumonia (NHAP). Materials and Methods: This was a prospective, observational study conducted in a hospital ED. The data of nursing home patients admitted to the ED with a pneumonia presentation (NHAP) were compared with those of patients with community-acquired pneumonia (CAP). Factors that predicted mortality in the NHAP group were analyzed. SPSS for Windows, Version 16.0 software (SPSS Inc., Chicago, IL, USA) was used to perform the statistical analysis. Results: A total of 98 patients >18 years of age, 36 of whom were NHAP patients, were included in the research. The risk level and rates of intensive care admission and mortality were significantly higher in the NHAP group (p<0.05), and the thiol level, an antioxidant parameter, was lower in the NHAP group than that of the CAP group (p<0.001). Evaluation of the NHAP group alone revealed a higher mortality rate in patients with congestive heart failure, those hospitalized in intensive care, and those with high risk scores (p<0.05). The shock index (SI) value was found to be an independent predictor of mortality in the NHAP group. The study results indicated that each 0.1 unit increase in the Si increased mortality 3.637 times (95% confidence interval: 1.024-12.921) (p=0.046). Conclusion: The findings suggest that the SI could serve as a valuable marker for predicting mortality in NHAP patients.
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    Patterns of expression of h2s-producing enzyme in human renal cell carcinoma specimens: Potential avenue for future therapeutics
    (Int Inst Anticancer Research, 2020) Söğütdelen, Emrullah; Pacoli, Katharine; Juriasingani, Smriti; Akbari, Masoud; Gabril, Manal; Şener, Alp
    Background: Renal cell carcinoma (RCC) is the most common cancer of the kidney. The most common histotype is clear-cell (cc) RCC. Hydrogen sulfide (H2S) is an angiogenic and anti-apoptotic gasotransmitter that is elevated under pseudohypoxic conditions. H2S is endogenously produced by three enzymes: Cystathionine gamma-lyase (CSE), cystathionine beta-synthase (CBS), and 3-mercaptopyruvate sulfurtransferase (MPST). Seeing as increased expression of these enzymes has been observed in other human cancer types, this study aimed to quantify H2S-producing enzyme expression in human RCC samples and evaluate whether it correlated with clinical outcomes. Patients and Methods: Eighty-eight human kidney tissue specimens, with healthy and cancerous tissue components, were immunohistochemically stained for CSE, CBS, and MPST. The mean pixel intensity of positively stained areas was quantified. A retrospective analysis was conducted to obtain patient demographics, rates of metastasis/recurrence, and prognostic characteristics. Statistical correlations between enzyme expressions and subsequent patient outcomes were evaluated. Results: There was significantly greater expression of CSE, CBS, and MPST in cc-RCC compared to paired healthy tissue (p<0.0001). The difference in expression of CSE in cancerous versus normal tissue was significantly greater than that for CBS and MPST (p<0.000I and p<0.01, respectively). Enzyme expression patterns in cancerous versus normal tissue did not correlate with nuclear grade, stage, histological type or cancer recurrence/metastasis. Conclusion: To our knowledge, this is the first report of the differential increase in expression of CSE, CBS, and MPST in human RCC. Although these patterns do not appear to correlate with cancer recurrence, metastasis, size or nuclear grade, their differential increase suggests a potential therapeutic target.