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    Clinical characteristics of Graves’ disease following COVID-19 infection or vaccination: a multicenter case-control study
    (TUBITAK, 2025) Gökçay Canpolat, Asena; Agbaht, K.; Elhan, Atilla Halil; Cesur, Mustafa; Alphan Üç, Ziynet; Akçay, Seckin; Iliksu Gözü, Hülya
    Background/aim: To describe Graves’ Disease (GD) associated with COVID-19 infection (COVID) or its vaccines (VAC) and to compare the clinical presentations, laboratory parameters, and short-term clinical course of the disease among different etiology groups (COVID, VAC, and GD control). Materials and methods: Included in this multicenter matched case–control, retrospective cohort study were 239 patients with newly diagnosed (n = 196) or recurrent GD (n = 43) associated with COVID (n = 79) or VAC (n = 160). Each case was matched (1:1) with a control who had been diagnosed with GD prior to COVID. Results: The median age of the entire group was 42 years (female:male = 137:102). Both the COVID (4.6-fold) and VAC (4.1-fold) groups demonstrated higher TSH receptor antibody (TRAb) titers (p < 0.001) compared with the control group (3.5-fold), as well as a higher proportion of recurrent cases. At baseline, the COVID group had higher free triiodothyronine (fT3) levels than the other groups. Graves orbitopathy (GO) was observed in 60 patients (12.6%), with a higher frequency in classical GD (18.4%). At baseline, the variables associated with thyrotoxicosis severity (defined as fT3 levels) were younger age, higher thyroid gland volume (TGV), and etiology, with the COVID and, to a lesser extent, VAC groups presenting with higher fT3 levels. The variables associated with GO were higher TGV, TRAb titers, and smoking, while no association with etiology was identified. Conclusion: The clinical course was similar in all groups other than in some laboratory findings. Although the frequency of GO associated with COVID and VAC was lower, the proportion of cases with a Clinical Activity Score of ?3 was higher compared to GD. This pattern suggests a potentially stronger immunologic trigger in these cases. © TÜBİTAK.
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    Developing an Item Bank for Progress Tests and Application of Computerized Adaptive Testing by Simulation in Medical Education
    (Ijate-Int Journal Assessment Tools Education, 2019) Kosan, Aysen Melek Aytug; Koc, Nizamettin; Elhan, Atilla Halil; Oztuna, Derya
    Progress Test (PT) is a form of assessment that simultaneously measures ability levels of all students in a certain educational program and their progress over time by providing them with same questions and repeating the process at regular intervals with parallel tests. Our objective was to generate an item bank for the PT and to examine the possible fit of CAT for PT application. This study is a descriptive study. 1206 medical students participated. During the analysis of the psychometric properties of PT item bank, the Rasch model for dichotomous items was used. Several CAT simulations were performed by applying various stopping rules of different standard errors. CAT simulation estimates were compared with the estimates generated from the original calibration of the Rasch model where all items were included. After Rasch analysis, a unidimensional PT item bank consisting of 103 items was obtained. The item bank reliability was calculated as 0.77 with Person Separation Index (PSI) and Kuder-Richardson Formula 20 (KR-20). A high correlation between. estimations obtained from paper-and-pencil (theta RM) and CAT applications (theta(CAT)) was detected for simulation conditions ([N(0,1)] and [N(0,3)]) at the end of our analysis. In CAT, estimation can be made with an average of 14 questions (reduced 86,4%) and 17 questions (reduced 83,4%) [for N(0,1) and [N(0,3) respectively] with reliability of 0,75. This study reveals that it is possible to develop an appropriate item bank for the PT, and the difficulty of administering large number of items in PT can be scaled down by incorporating CAT application.