This study is a randomized controlled, pre-test-post-test experimental research aimed at examining the effects of mandala art therapy on symptom severity and quality of life in individuals diagnosed with Multiple Sclerosis (MS). The main goal is to determine whether mandala art therapy helps reduce the frequency and severity of MS symptoms while improving participants' overall quality of life.
It is expected that mandala art therapy will support MS patients in managing current and potential symptoms, coping more effectively with the disease, and improving adherence to treatment. As a result, a reduction in healthcare utilization, related costs, MS-related complications, and mortality is anticipated.
The study will be conducted between May and August 2025 at the Neurology Outpatient Clinic of Karadeniz Technical University Practice and Research Center, involving 70 patients-35 in the intervention group receiving mandala art therapy and 35 in the control group receiving standard care.

开始日期2025-05-10

申办/合作机构

Karadeniz Technical University

NCT06946251

/ Not yet recruitingN/AIIT

Evaluation of Patients With Reduced and Preserved Ejection Fraction After Transcutaneous Diaphragm Stimulation

The aim of this study is to compare the effects of transcutaneous electrical diaphragm stimulation (TEDS) on diaphragm thickness, duration of mechanical ventilation, length of ICU stay, and right/left heart functions between patient groups with low and high ejection fraction (EF) levels.
This randomized controlled trial will record demographic data, diaphragm ultrasound measurements, and echocardiographic findings of patients who receive or do not receive TEDS for five consecutive days.
Participants will be divided into four groups according to their EF levels and whether or not they receive diaphragm stimulation:
Group 1: Patients with low EF who receive TEDS Group 2: Patients with high EF who receive TEDS Group 3: Patients with low EF who do not receive TEDS Group 4: Patients with high EF who do not receive TEDS
Diaphragm thickness and echocardiographic assessments will be performed at baseline and at the end of the five-day TEDS intervention.
TEDS Application Protocol
In the ICU, TEDS is administered by a physiotherapist once daily for 20 minutes, five days a week, as part of the routine treatment protocol. The stimulation is delivered using the LGT-231 model device from the LONGEST brand.
A transcutaneous current with a frequency of 30-50 Hz and a pulse width of 300-400 microseconds is applied to the diaphragm. The stimulation intensity is increased until visible muscle contraction is achieved.
Electrode placement involves:
The first pair of electrodes placed bilaterally between the 8th and 10th anterior intercostal spaces, lateral to the xiphoid process.
The second pair placed along the mid-axillary line of the thorax, also between the 8th and 10th intercostal spaces.

开始日期2025-05-01

申办/合作机构

Karadeniz Technical University

NCT06950580

/ Not yet recruitingN/AIIT

Investigation of the Effect of Abdominal Massage on Patients in Intensive Care Unit: Randomised Controlled Trial

Bowel motility can be affected by many factors such as immobilization, lack of fiber in the nutritional formula, inadequate fluid intake, and lack of privacy for toileting in patients hospitalized in the intensive care unit. Abdominal massage, which is one of the effective methods to increase intestinal motility, is accepted as an intervention that can be safely applied in patients.
The aim of our study was to investigate the effect of abdominal massage applied to patients hospitalized in the intensive care unit on sepsis, survival, discharge time from intensive care unit, amount and duration of antibiotic use.
Hypotheses H0: Abdominal massage application has no effect on sepsis, survival, discharge time from intensive care unit, amount and duration of antibiotic use in patients hospitalized in intensive care unit.
H1: Abdominal massage application has an effect on sepsis, survival, discharge time from intensive care unit, amount and duration of antibiotic use in patients hospitalized in intensive care unit.
In this randomized controlled study, the data of patients who received abdominal massage for 5 days during routine physiotherapy applications and those who did not will be recorded. Randomization will be performed in a 1:1 ratio using a computer generated randomization schedule. The effect of abdominal massage on sepsis, survival, discharge time from intensive care, amount and duration of antibiotic use will be examined by using the data of 2 groups with and without abdominal massage in a randomized controlled trial.

开始日期2025-05-01

申办/合作机构

Karadeniz Technical University

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2025-12-01·Molecular Genetics and Genomics

Analysis of TSC1 and TSC2 genes and evaluation of phenotypic correlations with tuberous sclerosis

Article

作者: Eser, Metin ; Hekimoglu, Gulam ; Turkyilmaz, Ayberk ; Kutlubay, Busra ; Sager, Safiye Gunes

Tuberous sclerosis complex (TSC) is a rare genetic disorder characterized by the formation of benign tumors in various organs, particularly in the central nervous system. We aimed to delineate the molecular profile of Turkish individuals diagnosed with TSC by analyzing the TSC1 and TSC2 genes using next-generation sequencing (NGS). Sophia Genetics' Sophia Inherited Disease Panel was used to perform NGS on 22 individuals diagnosed with TSC and to identify pathogenic variants in the TSC1 and TSC2 genes. Among the 22 cases, mutations were found in 3 (13.6%) for TSC1 and in 16 (73%) for TSC2, while 3 (13.6%) exhibited no detectable mutations. Notably, one individual with a TSC2 mutation presented with angiofibroma, ungual fibroma, and pitted dental enamel, while another had cardiac rhabdomyoma. Autism spectrum disorders were observed in 6 (27%) with TSC2 mutations, including one with autistic behavior. Abnormal motor development was noted in 3 (13.6%), of which 2 had TSC2 mutations. Severe intellectual disability was found in 3 (13.6%) with TSC2 mutations, and developmental delay was seen in 2 (9%) with TSC2 mutations. Epileptic encephalopathy occurred in 3 (13.6%), with 2 having TSC2 mutations. Additionally, 6 (27%) exhibited drug resistance for focal seizures, with 5 of them having TSC2 mutations. These findings are consistent with other research indicating that TSC2 mutations are associated with a more severe phenotypic range compared to TSC1 mutations. Moreover, our analysis showed that some people with TSC1/TSC2 mutations did not match diagnostic criteria. This highlights the importance of genetic testing and molecular profiling in understanding the clinical variability and aiding in the management of TSC patients.

2025-12-01·Journal of Clinical Immunology

Diverse Clinical and Immunological Profiles in Patients with IPEX Syndrome: a Multicenter Analysis from Turkey

Article

作者: Ozturk, Necmiye ; Cavkaytar, Ozlem ; Bilgic Eltan, Sevgi ; Ozen, Ahmet ; Yakici, Nalan ; Yalcin Gungoren, Ezgi ; Amirov, Razin ; Can, Salim ; Gemici Karaarslan, Betul ; Orhan, Fazil ; Kiykim, Ayca ; Bekis Bozkurt, Hayrunnisa ; Catak, Mehmet Cihangir ; Kasap, Nurhan ; Bayram Catak, Feyza ; Baris, Safa ; Yorgun Altunbas, Melek ; Karakoc-Aydiner, Elif ; Bozkurt, Selcen ; Bal Cetinkaya, Fatma ; Sahin, Ali ; Arga, Mustafa

PURPOSEImmunodysregulation, Polyendocrinopathy, Enteropathy, and X-linked syndrome (IPEX), caused by pathogenic FOXP3 variants, is a rare autoimmune disorder with diverse clinical features, including early-onset diabetes, eczema, and enteropathy. Atypical cases show milder symptoms and unique signs, requiring different treatments. Therefore, there are ambiguities in the accurate diagnosis and management of IPEX. We sought to present clinical, genetic, and immunological assessments of 12 IPEX patients with long-term follow-up to facilitate the diagnosis and management of the disease.METHODSClinical findings and treatment options of the patients were collected over time. Lymphocyte subpopulations, protein expressions, regulatory T (Treg) and circulating T follicular helper (cT_FH) cells, and T-cell proliferation were analyzed.RESULTSPredominant presentations included autoimmunity (91.6%), failure to thrive (66.7%), and eczema (58.3%). There were four classical and eight atypical IPEX individuals. Allergic manifestations were more common in atypical patients. Notably, chronic diarrhea demonstrated heightened severity compared to other manifestations. Four patients (33.3%) demonstrated eosinophilia, and nine (75%) showed high serum IgE levels. Most patients exhibited normal percentages of Treg cells with reduced CD25, FOXP3, and CTLA-4 expressions, corrected after hematopoietic stem cell transplantation (HSCT). Compared to healthy controls, the T_H2-like skewing accompanied by reduced T_H17-like responses was observed in cT_FH and Treg cells of patients. Overall, nine patients (75%) received immunosuppressants (ISs), and six (50%) underwent HSCT, which was the only treatment revealing sustained control. Sirolimus was used in six patients and showed better control than other ISs.CONCLUSIONSThe first cohort from Turkey with long-term follow-up results, comparing typical and atypical cases, provides insights into the outcomes of different therapeutic modalities and T- cell subtype changes in IPEX syndrome.

2025-08-01·The American Journal of Emergency Medicine

ChatGPT-supported patient triage with voice commands in the emergency department: A prospective multicenter study

Article

作者: Imamoğlu, Melih ; Beşer, Muhammet Fatih ; Pasli, Sinan ; Hiçyilmaz, Halil İbrahim ; Karakurt, Büşra ; Kirimli, Esma Nilay ; Şahin, Abdul Samet ; Unutmaz, İhsan ; Yadigaroğlu, Metin ; Ayhan, Asu Özden

BACKGROUNDTriage aims to prioritize patients according to their medical urgency by accurately evaluating their clinical conditions, managing waiting times efficiently, and improving the overall effectiveness of emergency care. This study aims to assess ChatGPT's performance in patient triage across four emergency departments with varying dynamics and to provide a detailed analysis of its strengths and weaknesses.METHODSIn this multicenter, prospective study, we compared the triage decisions made by ChatGPT-4o and the triage personnel with the gold standard decisions determined by an emergency medicine (EM) specialist. In the hospitals where we conducted the study, triage teams routinely direct patients to the appropriate ED areas based on the Emergency Severity Index (ESI) system and the hospital's local triage protocols. During the study period, the triage team collected patient data, including chief complaints, comorbidities, and vital signs, and used this information to make the initial triage decisions. An independent physician simultaneously entered the same data into ChatGPT using voice commands. At the same time, an EM specialist, present in the triage room throughout the study period, reviewed the same patient data and determined the gold standard triage decisions, strictly adhering to both the hospital's local protocols and the ESI system. Before initiating the study, we customized ChatGPT for each hospital by designing prompts that incorporated both the general principles of the ESI triage system and the specific triage rules of each hospital. The model's overall, hospital-based, and area-based performance was evaluated, with Cohen's Kappa, F1 score, and performance analyses conducted.RESULTSThis study included 6657 patients. The overall agreement between triage personnel and GPT-4o with the gold standard was nearly perfect (Cohen's kappa = 0.782 and 0.833, respectively). The overall F1 score was 0.863 for the triage team, while GPT-4 achieved an F1 score of 0.897, demonstrating superior performance. ROC curve analysis showed the lowest performance in the yellow zone of a tertiary hospital (AUC = 0.75) and in the red zone of another tertiary hospital (AUC = 0.78). However, overall, AUC values greater than 0.90 were observed, indicating high accuracy.CONCLUSIONChatGPT generally outperformed triage personnel in patient triage across emergency departments with varying conditions, demonstrating high agreement with the gold standard decision. However, in tertiary hospitals, its performance was relatively lower in triaging patients with more complex symptoms, particularly those requiring triage to the yellow and red zones.

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