Nihal Akar Bayram

Yıldırım Beyazıt Üniversitesi, Engüri, Ankara, Turkey

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Publications (83)196.68 Total impact

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    ABSTRACT: Introduction: Transcatheter aortic valve implantation for severe symptomatic aortic stenosis in patients with a previous mitral valve prosthesis is technically challenging, and pre-procedural comprehensive assessment of these patients before transcatheter aortic valve implantation is vital for an uncomplicated and successful procedure. Aim: We want to share our experience with transcatheter aortic valve implantation in patients with a preexisting functional mitral valve prosthesis and describe a series of important technical and pre-procedural details. Material and methods: At our center, 135 patients with symptomatic severe aortic stenosis were treated with transcatheter aortic valve implantation. Six of them with a preexisting mitral valve prosthesis received an Edwards SAPIEN XT valve through the transfemoral route. Results: Transcatheter aortic valve implantation was performed successfully in all 6 patients without any deformation of the cobalt-chromium/steel stents of the aortic valve bioprosthesis. Also no distortion or malfunction in the mitral valve prosthesis was observed after the procedure. There were no complications during the hospitalization period. Post-procedural echocardiography revealed no or mild aortic paravalvular regurgitation and normal valve function in all the patients. In addition, serial echocardiographic examination demonstrated that both the stability and function of the aortic and mitral prosthetic valves were normal without any deterioration in the gradients and the degree of the regurgitation at long-term follow-ups. Conclusions: Our experience confirms that transcatheter aortic valve implantation is technically feasible in patients with previous mitral valve replacement but comprehensive evaluation of patients by multimodal imaging techniques such as transesophageal echocardiography and multislice computed tomography is mandatory for a successful and safe procedure.
    No preview · Article · Dec 2015 · Postepy w Kardiologii Interwencyjnej / Advances in Interventional Cardiology
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    Preview · Article · Dec 2015
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    ABSTRACT: Objective: The high incidence of non-organ specific autoantibodies in patients with mitral valve prolapse (MVP) may suggest an association between MVP and autoimmune diseases. A higher incidence of MVP in patients with chronic lymphocytic thyroiditis and Graves’ disease has been demonstrated in various studies. In particular, an increased incidence of MVP in patients with autoimmune thyroid disease characterized with hyperthyroidism may suggest an association between MVP and thyroid functions. To the best of our knowledge, there is a lack of literature regarding the evaluation of autoimmune thyroid diseases in patients with MVP. This study primarily aimed to evaluate the autoimmune thyroid disease using thyroid ultrasonography and autoimmune thyroid antibodies in patients with MVP. Materials and Methods: Thyroid function tests, thyroid autoimmune antibodies, and thyroid ultrasonographic examination were evaluated in 30 patients with MVP (19 females and 11 males; mean age: 29.6±9.3 years) and 30 healthy volunteers (19 females and 11 males; mean age: 27.6±7.5 years). Results: Two groups were similar in terms of demographical and clinical characteristics. Evaluation of the thyroid functions, autoimmune thyroid antibodies, and thyroid ultrasonography revealed no statistically significant difference between the study groups. Conclusion: The results of the study suggest no association between MVP and autoimmune thyroid diseases. This requires further clarification with large-scaled studies.
    Preview · Article · Oct 2015
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    ABSTRACT: Objective: Cardiac surgery may be performed in patients with hematologic disorders, but carries an increased risk of morbidity. This series describes an experience of transcatheter aortic valve implantation (TAVI) in patients with hematologic malignancies, and highlights the technical considerations to be kept in mind. Methods: Between June 2011 and April 2014, 133 consecutive high-risk patients with symptomatic severe aortic stenosis were treated with TAVI at our centre. Based on consensus among the local heart team, five patients with hematologic malignancies (myelodysplastic syndrome [2],chronic lymphocytic leukemia [2], Hodgkin lymphoma [1]) were considered high risk for surgery (Logistic EUROSCORE 17.2±14.0% and STS score 5.8±4.3%). Serial echocardiographic and clinical follow-ups were done pre- and post-procedure, at discharge, and at 1, 3, 6 and 12 months. Results: Our procedural success rate was 80%. Two heart valves were implanted in one patient due to aortic embolization of the previous valve. Perforation of the right ventricle and cardiac tamponade occurred in the same patient. Mean blood transfusion requirement was 1.0±1.4 U (range: 0 to 3 U). Mean aortic valve gradient was reduced from baseline to 9.2±3.27 mmHg, and the effective orifice area was significantly increased to 1.96±0.29 cm2. Paravalvular aortic regurgitation (AR) was absent-mild in all the patients. Conclusion: This present series demonstrates that TAVI with a balloon-expandable valve can be performed safely and effectively and is technically feasible in high-risk patients with hematologic malignancies.
    No preview · Article · Sep 2015 · Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir
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    ABSTRACT: Electrophysiological changes are observed following mechanical stretches due to pressure overload in patients with severe aortic stenosis (AS). The electrical instability occurs after depolarization and dispersion of repolarization. The aim of this study was to evaluate changes in ventricular repolarization following transcatheter aortic valve implantation (TAVI). Thestudypopulationincluded 100 consecutive patients with severe AS thatunderwent TAVI. Electrocardiography (ECG) was performed at baseline, immediately after TAVI, and 1 week after TAVI. The mean age of the patients was 78.2 ± 7.2 years. Thirty-four (34%) of the patients were male and 66 (66%) were female. Compared to the baseline, mean QT dispersion (QTd) immediately after TAVI and 1 week after TAVI decreased significantly (82.8 ± 26.5,75.6 ± 25.2, and 65.8 ± 28.3, respectively, P < 0.001). Likewise, compared to the baseline, mean corrected QTd (QTcd) immediately after TAVI and 1 week after TAVI decreased significantly (84.7 ± 25.2, 76.7 ± 30.8, and 69.1 ± 31.4, respectively, P < 0.001). QTd is indicative of heterogeneity of ventricular refractoriness and is prolonged in patients with AS. Following TAVI, a decrease in QTd might reduce the risk of ventricular arrhythmia in patients with severe AS.
    No preview · Article · Aug 2015 · Turkish Journal of Medical Sciences
  • Cenk Sarı · Abdullah Nabi Aslan · Serdal Baştuğ · Nihal Akar Bayram
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    ABSTRACT: Permanent pacemaker implantation (PPI) is usually a very safe procedure with a low complication risk. It is a relatively straightforward process carried out under local anesthetic. This case report presents an 80-year-old male patient who required a permanent pacemaker due to complete atrioventricular (AV) block, and who developed cyanosis and was diagnosed with methemoglobinemia after the pacemaker insertion procedure, in which the local anesthetic prilocaine was administered. To our knowledge, this is the first case in the literature to describe methemoglobinemia developing after PPI.
    No preview · Article · Jul 2015 · Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir
  • C. Sari · A.N. Asian · S. Baştuʇ · N.A. Bayram
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    ABSTRACT: Permanent pacemaker implantation (PPI) is usually a very safe procedure with a low complication risk. It is a relatively straightforward process carried out under local anesthetic. This case report presents an 80-year-old male patient who required a permanent pacemaker due to complete atrioventricular (AV) block, and who developed cyanosis and was diagnosed with methemoglobinemia after the pacemaker insertion procedure, in which the local anesthetic prilocaine was administered. To our knowledge, this is the first case in the literature to describe methemoglobinemia developing after PPI.
    No preview · Article · Jul 2015
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    ABSTRACT: The aim of this single-center study was to assess the incidence and predictors of in-hospital access site complications related to transcatheter aortic valve implantation (TAVI) performed with new delivery systems in our hospital which has the largest case series in Turkey. We performed successful TAVI with the Edwards Sapien XT valve to 127 (46 male) patients via a transfemoral (121), trans-subclavian (5) and transapical (1) approach. Access site complications were defined according to the Valve Academic Research Consortium (VARC) end-point definitions. Vascular complications occurred in 10.1% of patients. There was negative correlation between vascular complications and diameter of the common femoral artery (r = - 0.301, p=0.004), external iliac artery (r = - 0.327, p=0.004) and common iliac artery (r = - 0.324, p=0.004), but positive correlation between diabetes (r =0.240, p=0.008), sheath to femoral artery ratio (SFAR), sheath to external iliac artery ratio (SEIAR), procedure time, discharge time and the Society of Thoracic Surgeons (STS) score (respectively; r=0.339, 0.001, 0.527, 0.361, 0.289, p=0.003, 0.001, 0.001, 0.001, 0.002). The incidence of vascular complications was significantly higher in patients with diabetes and a high STS score. VARC bleeding complications occurred in 11.7 % of patients. The learning curve pointing out the importance of experience was significantly important in decreasing both bleeding and vascular complications. In this study, we demonstrated that major vascular complications related to TAVI decrease with the use of smaller delivery systems and experience and increase with high-risk scores (STS) and the presence of diabetes. In addition, VARC major vascular complications, observed mostly in patients with diabete mellitus (DM) and high STS scores, were associated with vascular diameters. These results further underline the importance of experience and a multidisciplinary team in patient selection and management for TAVI. © The Author(s) 2015.
    Full-text · Article · Mar 2015 · Perfusion
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    ABSTRACT: Emerging evidence suggests that the neutrophil-to-lymphocyte ratio (NLR) may be a useful marker of inflammation and aortic stiffness. Markers of inflammation and aortic stiffness are both indicators of cardiovascular events. We, therefore, investigated whether the NLR is associated with aortic stiffness in patients with type 1 diabetes mellitus. We examined the relationship of the NLR to aortic stiffness in 76 people with type 1 diabetes and 36 healthy controls. The NLRs in the group with type 1 diabetes were higher than in the controls (2.33±0.95 vs. 1.80±0.68, respectively; p=0.003). Aortic strain and aortic distensibility, the parameters of aortic stiffness, measured noninvasively by the help of echocardiography, were significantly decreased in the patient group compared to controls (8.0%±1.5% vs. 13.1%±3.3 %; p<0.001 and 3.6±1.1 cm(2).dyn(-1).10(-3) vs. 6.0±2.1 cm(2).dyn(-1).10(-3); p<0.001, respectively). There were negative correlations between NLR and distensibility (r: -0.40; p<0.001) and strain (r: -0.57; p<0.001) in patients with type 1 diabetes. We have demonstrated that there is a significant negative correlation between the NLR and markers of aortic stiffness in patients with type 1 diabetes, indicating a potential association between inflammation and arterial stiffness. Accordingly, a higher NLR may be a useful additional measure in determining the cardiovascular risks of patients with type 1 diabetes in our clinical practice. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Mar 2015
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    ABSTRACT: Transcatheter aortic valve implantation (TAVI) is a minimally invasive, emerging therapy in surgically high risk, or inoperable patients. Parameters used for risk classification have some deficiencies in the selection of patients. The objective of this study is to evaluate the impact of TAVI on carbohydrate antigen 125 (CA125) and N-Terminal pro Brain-type Natriuretic Peptide (NT-proBNP) as biomarkers that have been used frequently in recent years, and also the relationship of these biomarkers to prognosis. Transcatheter aortic valve implantation was practiced on 31 patients in this study. Then, CA125 and NT-proBNP levels studied in patients prior to and after the TAVI were evaluated. The patients were also grouped in accordance with their left ventricular ejection fraction (LVEF) and CA125 levels (LVEF ≥ 40% and < 40%; CA125 ≤ 35 U/L and > 35 U/L). The TAVI operation was successfully performed in all patients. There was no in-hospital mortality and substantial improvement in functional capacity was detected at follow ups. In addition, a statistically significant decrease was detected in post-TAVI CA125 and NT-proBNP levels of all patients (CA125 83.8 ± 18.1 U/L vs. 64.3 ± 14.2 U/L, P = 0.008; NT-proBNP: 4633.6 ± 627.6 pg/mL vs. 2866.3 ± 536.8 pg/mL, P < 0.001). In groups divided according to the CA125 levels, there was also statistically significant post-TAVI decline in CA125 levels. Within CA125 > 35 U/L and LVEF < 40% groups, the permanent need for a pacemaker was required in one (3.2%) patient and mortality was observed in two (6.4%) patients after TAVI at follow up. The results show that TAVI can be performed effectively and reliably in patients with high baseline levels of CA125 and NT-proBNP. These biomarkers are reduced substantially with TAVI, while high biomarker levels are associated with undesired events, and certainly, these biomarkers can be used for risk classifications in patient selection for TAVI.
    Full-text · Article · Mar 2015 · Journal of Geriatric Cardiology

  • No preview · Article · Dec 2014 · Minerva cardioangiologica
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    ABSTRACT: Background and aim: Pulmonary hypertension (PH) is common in patients with severe aortic stenosis (AS). The prognostic effect of PH in high-risk patients undergoing transcatheter aortic valve implantation (TAVI) remains unknown. The aim of this study was to examine the feasibility of TAVI in patients with PH and to determine the effect of TAVI on PH. Methods and results: TAVI was performed in 70 patients (mean age, 77.6 years; 51 females and 19 males) between July 2011 and December 2012, in our hospital. The patients were divided into three groups based on their systolic pulmonary artery pressure (sPAP) values. Group 1 comprised patients with sPAP values <40 mmHg; group 2 included patients with sPAP values ranging from 40 to 59 mmHg; and group 3 included patients with sPAP values >60 mmHg. Seventy percent of the patients were in groups 2 and 3. After TAVI, the sPAP values of the patients in groups 2 and 3 were significantly decreased (47.4 ± 4.6 and 36.6 ± 6.3, P < 0.001 and 64.5 ± 4.7 and 43.2 ± 9.2, P < 0.001, respectively). However, this reduction was sustained for 6 months in group 2 (P = 0.006), whereas the reduction lost its statistical significance (P = 0.07) after 1 month in group 3 (64.5 ± 4.7 and 40.8 ± 8.0, P = 0.001). Significant differences between the sPAP values in all three groups before the procedure were sustained after TAVI (P ≤ 0.001) and after the 1st month (P = 0.02); however, no statistically significant difference was observed after the 6th month (P = 0.06). Conclusion: In this study, we demonstrated that TAVI could be reliably and successfully performed in PH patients with severe AS and that TAVI results in a permanent and significant reduction in sPAP.
    No preview · Article · Oct 2014 · Echocardiography

  • No preview · Article · Aug 2014 · Echocardiography
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    ABSTRACT: Introduction: It was aimed to calculate QT intervals in patients with acromegaly and to reveal its correlation between QT intervals, and growth hormone and insulin like growth factor-1. Material and Methods: Forty-one patients with acromegaly were enrolled into the study. Another 41 individuals with similar features, such as comorbid diseases, age and sex constituted the control group. The electrocardiographies of patients with acromegaly were evaluated at the baseline and after the follow-up. Only one electrocardiography was performed for controls. QT maximum, QT minimum, QT dispersion, corrected QT maximum, corrected QT minimum and corrected QT dispersion were calculated. Results: Baseline QT maximum, QT dispersion, corrected QT maximum and corrected QT dispersion were significantly longer than the values of controls. Corrected QT maximum and corrected QT dispersion were significantly shorter after the follow-up, compared to the baseline in patients. QT maximum, QT dispersion, corrected QT maximum and corrected QT dispersion after the follow-up were not statistically different from the values of controls. Except the negative correlation between growth hormone and corrected QT dispersion in patients after the follow-up, no other correlation was detected between QT values and growth hormone or insulin like growth factor-1 levels. Corrected QT dispersion was found to be related with the disease duration in patients. Discussion: For acromegaly patients, it is important to detect clinical predictors of cardiac arrhytmias. QT dispersion is considered a beneficial predictor for ventricular arrhytmias. When compared to controls, prolonged QT intervals were determined in our acromegalic patients. Conclusion: We consider that QT intervals may also be utilized in the evaluation of increased cardiovascular risk in patients with acromegaly.
    No preview · Article · Jul 2014 · Acta medica portuguesa
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    ABSTRACT: Transcatheter aortic valve implantation is a promising alternative to high risk surgical aortic valve replacement. The procedure is mainly indicated in patients with severe symptomatic aortic stenosis who cannot undergo surgery or who are at very high surgical risk.
    Full-text · Article · Jun 2014 · Postepy w Kardiologii Interwencyjnej / Advances in Interventional Cardiology
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    ABSTRACT: Background: Aortic stenosis increases with age. According to guidelines, left ventricular systolic dysfunction is an indication for aortic valve replacement, even in asymptomatic patients. There is no clear data on the application of transcatheter aortic valve implantation (TAVI), which is a method showing continuous improvement in recent years, in patients with reduced ejection fraction (REF) having a poor prognosis for surgical aortic valve replacement. We therefore aimed to investigate the effect of TAVI on left ventricular ejection fraction (LVEF) and also its efficacy and safety in patients with REF. Methods and results: The study included 104 patients who underwent transfemoral TAVI in our clinic. The patients were divided into two groups: LVEF ≤ 45% (REF group, n = 28) and LVEF > 45% (preserved ejection fraction [PEF] group, n = 76). Follow-up measure-ments were performed at baseline, discharge, 1st, 6th and 12th months. No statistical difference was found between the groups with respect to complications and mortality rates. A statistically significant difference was detected in LVEF after TAVI, either in all patients (53.9 ± 14.6, 57.0 ± 11.4, 59.4 ± 8.4, 60.4 ± 6.8, 63.2 ± 3.9, respectively, at baseline, discharge, 1st, 6th and 12th months, p < 0.001) or in the groups separately. A statistically significant increase in LVEF (p < 0.001) was determined at discharge, 1st, 6th and 12th months, whereas LVEF increased in all follow-ups of the PEF group, however this elevation reached a statistical significance only at the 1st month (p = 0.04). Conclusions: Our study has shown the positive effect of TAVI on LVEF and its effective and safe applicability in patients with REF.
    No preview · Article · May 2014 · Cardiology journal
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    ABSTRACT: Background: There is an established relationship between depression/anxiety disorders and cardiovascular morbidity and mortality which has been previously documented. However, there has been no study evaluating coronary slow flow in association with depression and anxiety. Methods and Results: A total of consecutive 90 patients were included in the study. All patients completed scoring scales for depression [Hamilton Rating Scale for Depression (HAMD)] and anxiety (STAI-1, State anxiety subscale of State-Trait Anxiety Inventory; STAI-2, Trait anxiety subscale of State-Trait Anxiety Inventory). Thereafter, they underwent selective coronary angiography and 2 groups were formed: coronary slow flow (n = 42), and normal coronary flow (n = 48). The two groups had comparable baseline characteristics. However, significant differences were found between coronary slowflowand normal coronary flowgroups regarding depression (13.1 ± 8.2 and 6.9 ± 6.7, p < 0.001 for HAMD, respectively) and anxiety (46.2 ± 15.0 vs. 32.6 ± 9.9, p < 0.001 for STAI-1 and 51.0 ± 16.7 vs. 43.0 ± 10.7, p = 0.009 for STAI-2, respectively) scores. There were also significant positive correlations between depression/anxiety scores and TIMI frame counts of all major epicardial coronary arteries. In addition, after adjustment for smoking, hypertension, scoring scales, and the presence of depressive mood, all scoring scales and depressive mood were found to be independent risk factors for coronary slow flow in multivariable logistic regression analysis. Conclusions: Significant association was found among coronary slow flow, depression/anxiety scores and depressive mood. © 2014, Republic of China Society of Cardiology. All rights reserved.
    No preview · Article · May 2014 · Acta Cardiologica Sinica
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    ABSTRACT: Hyperglycemia on admission is associated with increased mortality and morbidity in acute coronary syndrome (ACS) irrespective of presence of diabetes mellitus. To the best of our knowledge, no evidence on the relationship between stress hyperglycemia (SH) and the extent of coronary artery disease is found in the literature. Our objective in this study is to assess the relationship of SH with the prognosis of acute coronary syndrome, extent of coronary artery disease (CAD), development of arrhythmia, and major adverse cardiac events.89 patients who were hospitalized in the coronary intensive care unit with diagnosis of ACS between January 2010 and June 2010 were enrolled in the study. The patients were separated into 2 groups as having stress hypergly-cemia or not, according to their blood glucose levels on admission. TIMI and GRACE risk scores were obtained and GENSINI scoring was performed to assess CAD extent for all the patients. Major adverse cardiac events (MACE) (death, MI, re-revascularization, stroke) were recorded for all patients while in the hospital and at 1st and 6th months.In our study, MACE, GENSINI scores at 6 months and development of in-hospital arrhythmia rates were statistically significantly higher and left ventricular ejection fractions were statistically significantly lower in the group with SH. The association of TIMI, GRACE, GENSINI, New York Heart Association (NYHA) and Killip classifications with blood glucose, fasting blood glucose and HbA1c on admission was confirmed.Prognostic course happens to be worse and CAD is more extensive in patients with SH. In addition, blood glucose values may have to be estimated lower compared to the samples in the literature, in order to diagnose SH.
    Full-text · Article · Apr 2014 · Experimental and Clinical Endocrinology & Diabetes
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    ABSTRACT: Cardiovascular morbidity and mortality are increased in patients with primary hyperparathyroidism (PHPT). We aimed to evaluate left ventricle systolic and diastolic functions with tissue Doppler imaging (TDI) and strain and strain rate echocardiography in patients with PHPT. Thirty-one patients with PHPT and 29 healthy controls were evaluated with conventional and pulse Doppler echocardiography, TDI and strain and strain rate echocardiography. Myocardial performance index (MPI) was calculated. Strain and peak systolic strain rate in mid and basal segments of lateral, anterior, inferior, and septal walls of left ventricle were determined. TDI showed similar late diastolic myocardial peak velocity in two groups. Peak systolic mitral annular velocity, early diastolic myocardial peak velocity, and ratio of early to late diastolic myocardial peak velocity were lower in PHPT patients (p = 0.01, p < 0.001 and p < 0.001, respectively). MPI calculated by TDI was 0.53 ± 0.15 in PHPT group and 0.44 ± 0.09 in control group (p = 0.013). Strain values were lower in mid and basal segments of septum, lateral and anterior walls, and basal segment of inferior wall in PHPT patients. Mean systolic strain was -20.88 ± 2.30 and -24.25 ± 2.13 in PHPT patients and control group, respectively (p < 0.001). Mean strain rate was lower in PHPT patients compared to control group (-1.38 ± 0.19 vs -1.57 ± 0.25) (p = 0.002). Patients with PHPT, but no cardiac symptoms or documented cardiovascular disease, have subclinical systolic and diastolic myocardial dysfunction. Evaluation of these patients with TDI and S and Sr echocardiography in addition to conventional echocardiography might be valuable to detect subclinical cardiac involvement.
    No preview · Article · Mar 2014 · Endocrine
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    ABSTRACT: Previous studies have shown association between paraoxonase (PON) activity and the presence and severity of coronary atherosclerosis. The aim of the present study was to demonstrate any association between serum PON activity and the presence and severity of coronary artery calcification (CAC). A total of 156 consecutive patients having the suspicion of coronary atherosclerosis or needing risk stratification for cardiovascular events were included in the present study. Peripheral venous blood samples of all participants to measure serum PON activity were collected before undergoing multidetector computed tomography, which was used to determine the presence and quantity of CAC. Serum PON-1 levels were lower in CAC group compared with no CAC group (60 [35 - 96] U/L vs. 291 [230 - 371] U/L, respectively, p<0.001). There was a significant negative correlation between total CAC score and PON (r² = 0.335, p<0.001). In multivariate analysis, the significant and independent predictors of the presence of CAC were male sex, hsCRP and PON. Similarly, increased PON was significantly and independently associated with freedom from CAC. In ROC analysis, PON level <197 U/L had 87% sensitivity, 91% specificity, 93% positive predictive value, and 85% negative predictive value in predicting CAC. Diminished serum PON activity was significantly and independently associated with the presence and severity of CAC and vice versa.
    No preview · Article · Mar 2014 · Kardiologia polska

Publication Stats

241 Citations
196.68 Total Impact Points

Institutions

  • 2013-2015
    • Yıldırım Beyazıt Üniversitesi
      • Faculty of Medicine
      Engüri, Ankara, Turkey
  • 2013-2014
    • Ankara University
      Engüri, Ankara, Turkey
  • 2010-2014
    • Ankara Atatürk Training and Research Hospital
      Engüri, Ankara, Turkey
    • İzmir Atatürk Eğitim ve Araştırma Hastanesi
      Ismir, İzmir, Turkey
  • 2008-2014
    • Ataturk Chest Diseases and Chest Surgery Education and Research Hospital
      Engüri, Ankara, Turkey