Side effects of sugammadex use in pediatric patients
Sinem Sarı, Banu Taşdemir, Sezen Özkısacık, Feray Gürsoy
J Clin Exp Invest 2013;4(3):265-268.
https://doi.org/10.5799/ahinjs.01.2013.03.0281
Research Article
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Objective: It is accepted that sugammadex show its effects more rapidly than the other neuromuscular block antagonists in many studies, however especially in pediatric cases, it is seen that about its reliability and side effects are limited in some studies. In our retrospective study, we aimed to present our experiences on sugammadex in terms of its side effects in the pediatric cases in our hospital for a 1-year period.
Methods: The patient files and intraoperative anesthesia records, postoperative 24th hour and after postoperative 24th hour of the cases that underwent the application of sugammadex under general anesthesia in pediatric surgery operating room in a 1-year period were analyzed.
Results: Totally 46 patients received sugammadex; infants (28 days-23 months) (n=24), children (2 years-11 years) (n=16) and adolescent (11-17 years) (n=6). None of the patients showed hypersensitivity and statistically significant side effects correlated to sugammadex.
Conclusion: We think that sugammadex may open new doors in pediatric patient group with its features. However, more documentation is needed about the safety in pediatric patient group, particularly in infants.
Keywords: Sugammadex, pediatric patient, side effect
The relationship between blood lactate levels and mortality in pediatric intensive care patients
İlyas Yolbaş, Velat Şen, Mehmet Boşnak, Servet Yel, Ali Güneş, Selvi Kelekçi
J Clin Exp Invest 2013;4(3):269-273.
https://doi.org/10.5799/ahinjs.01.2013.03.0282
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Objective: To determine relationship between blood lactate level and mortality rate in children admitted to the intensive care unit.
Methods: 298 critically ill patients aged between 28 days and 16 years admitted to Dicle University Hospital, the third step Pediatric Intensive Care Unit in between January 2007 and December 2007 were included. Age, sex, diagnosis, Glasgow coma score points, the first measured blood lactate levels (lactate 1) and the arithmetic average of all measured blood lactate levels during treatment (lactate 2) of cases were evaluated. Patients were divided into group A (lactate < 20 mg/dl) and B (lactate ≥ 20 mg/dl). According to the results, patients were classified as survivors and non-survivors. Both lactate 1 and lactate 2 were compared with mortality rates.
Results: In this study, a total of 298 patients were evaluated, 158 of them were nonsurvivors and 140 were survivors. A significant correlation was found between lactate levels and mortality rates. Lactate levels were higher in non-survivor cases (p<0.001). In group B, lactate 1 had 68% (106/156) sensitivity and 75% (106/142) specificity for determining the risk of mortality. Also in group B, lactate 2 had 85% (134/158) sensitivity and 79% (134/169) specificity for determining the risk of mortality.
Conclusion: There is a strong association between high blood lactate levels and mortality rates in the critically ill patients in pediatric intensive care unit. In these patients blood lactate levels can be used for follow-up and evaluation of the effectiveness of treatment and determining mortality.
Keywords: Pediatric intensive care unit, critically ill children, blood lactate levels, mortality
Demographic characteristics of patients in a state hospital emergency service: meta-analysis of 2011
Kenan Ahmet Türkdoğan, Mücahit Kapcı, Orhan Akpınar, Ali Duman, Gülçin Bacakoğlu, Figen Tunalı Türkdoğan, Mustafa Karabacak, Şevki hakan Eren, Abuzer Coşkun
J Clin Exp Invest 2013;4(3):274-278.
https://doi.org/10.5799/ahinjs.01.2013.03.0283
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Objective: The examination and treatment modalities should be measurable for improve the service quality of emergency service. This may be possible with the data collection system which is comprehensive and world-wide known. The aim of this study is to investigate the demographical features of patients who admitted to our service by computer based patient recording system and create a better service quality in the view of these data.
Methods: Registered 115,185 patients were included whom admitted to our service between January 2011 and December 2011. The demographic characteristics, symptoms, triage distributions, the average length of stay, consultation rates, hospital admission forms, hospitalization and discharge rates were classified according to the International Classification of Diseases-10 (ICD-10).
Results: The mean age of patients was 38.70±19.92 years and 44.8% of the patients were male. Triage categories of the patients in category red, yellow and green 5.5%, 53.1%, 41.4%, respectively. Patients older than 65 years old were 14,643 (12.7%). Most common presentation day was Monday and the time period was between 20 p.m. and 24 p.m. The mean length of emergency service stay was 47 minutes, consultation and admission rates were 8.5% and 3.2%, respectively. 1,876 patients of older than 65 years old were admitted to the services.
Conclusions: Emergency service admission registrations should be stored and analyzed by using the digital and sharable systems to serving a better qualified service in emergency services which provides continued service step to health care. This will allow the national standardization and determine the international location.
Keywords: Emergency service, meta-analysis, demographic data, triage
The effects of typical and atypical antipsychotics on the electrical activity of the brain in a rat model
Oytun Erbaş, Mustafa Yılmaz
J Clin Exp Invest 2013;4(3):279-284.
https://doi.org/10.5799/ahinjs.01.2013.03.0284
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Objective: Antipsychotic drugs are known to have strong effect on the bioelectric activity in the brain. However, some studies addressing the changes on electroencephalography (EEG) caused by typical and atypical antipsychotic drugs are conflicting. We aimed to compare the effects of typical and atypical antipsychotics on the electrical activity in the brain via EEG recordings in a rat model.
Methods: Thirty-two Sprague Dawley adult male rats were used in the study. The rats were divided into five groups, randomly (n=7, for each group). The first group was used as control group and administered 1 ml/kg saline intraperitoneally (IP). Haloperidol (1 mg/kg) (group 2), chlorpromazine (5 mg/kg) (group 3), olanzapine (1 mg/kg) (group 4), ziprasidone (1 mg/ kg) (group 5) were injected IP for five consecutive days. Then, EEG recordings of each group were taken for 30 minutes.
Results: The percentages of delta and theta waves in haloperidol, chlorpromazine, olanzapine and ziprasidone groups were found to have a highly significant difference compared with the saline administration group (p<0.001). The theta waves in the olanzapine and ziprasidone groups were increased compared with haloperidol and chlorpromazine groups (p<0.05).
Conclusion: The typical and atypical antipsychotic drugs may be risk factor for EEG abnormalities. This study shows that antipsychotic drugs should be used with caution.
Keywords: Haloperidol, chlorpromazine, olanzapine, ziprasidone, EEG, rat
Emergency service admissions of patients with burn injury
Sadiye Yolcu, Nesrin Gökben Beceren, Hüseyin Timuçin, Ulaş Uludağ
J Clin Exp Invest 2013;4(3):285-288.
https://doi.org/10.5799/ahinjs.01.2013.03.0285
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Objective: In this study, we aimed to investigate the properties of burn injured patients who admitted to our hospital emergency service.
Methods: Patients were detected from the hospital records of emergency service during six months period and were divided into five groups according to their ages (<10, 11-20, 21-40, 41-60 and >60 years). Age, gender total body surface area (TBSA), mechanism of injury and the outcome of emergency evaluation were recorded.
Results: Totally 111619 patients admitted to our emergency service between 01.07.2011 and 31.12.2011. During six months, 2349 males and 1960 females totally 4309 patients were burn injured patients. 1773 patients were between 0-10 years, 1083 patients were 11-20 years, 735 patients were between 21 and 40, 361 patients were between 41 and 60 and 357 patients were over 60 years. Most of the patients were treated in the emergency service (90.1%). 0-10% TBSA patients constituted 94.2%. This ratio for burn area >40% was 0.6%. Hot liquid burn (vapored water, milk etc.) was 60.2%. There was a significant relation between mechanism of burn injury and age groups (p<0.05). No corrosive and sunburn injuries determined in females. Age groups were related with hospitalization (p<0.05). The highest intensive care unit admission was found in the 0-10 age group (1.3%).
Conclusion: Emergency service is the first admission department of burn injury patients. Knowing the properties of burn injury patients, would help hard-working emergency doctors in triage of these patients. Also, reporting the data of emergency service burn injury patients would be helpful for further studies.
Keywords: Burn injury, emergency service, total body surface area
The evaluation of cases with pneumothorax in the neonatal intensive care unit
Müsemma Karabel, Duran Karabel, Mehmet Hanifi Okur, İlhan Tan, Selvi Kelekçi, Velat Şen, Ünal Uluca
J Clin Exp Invest 2013;4(3):289-292.
https://doi.org/10.5799/ahinjs.01.2013.03.0286
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Objectives: Early diagnosis and treatment is essential in reducing mortality in newborns with pneumothorax. In this study, newborns with a diagnosis of pneumothorax in neonatal intensive care unit of our hospital were evaluated and aimed to increase the awareness of physicians.
Methods: 12 cases with pneumothorax were evaluated retrospectively. The gender, birth weight, gestational age, mode of delivery, the presence of underlying disease, pneumothorax localization, implementation of the surfactant and mechanical ventilation and existence or absence of mortality were recorded.
Results: During the study, pneumothorax was detected 12 patients. Male/female ratio was 1.4. Eight of the patients had born with cesarean delivery, the mean birth weight of cases was 2623±912 g and, 66.7% of cases were term babies. Pneumothorax was observed in the first week of life in all patients and it occurred spontaneously in 4 patients. The frequency of bilateral pneumothorax was 41.7%. For the treatment, closed tube drainage was performed in 9 patients. The overall mortality rate was 66.7%. Half of the patients who died had congenital anomalies such as diaphragmatic eventration (n=1), hydrocephalus (n=1), encephalocel (n=1), non-immune hydrops fetalis (n=1).
Conclusion: Additional congenital anomalies, such as PDAs and persistent pulmonary hypertension were found to be effective on mortality in neonates with pneumothorax. Although, it is a life-threatening condition, the emergency treatment is life saving. Therefore, in patients with risk factors, keeping pneumothorax in mind is also the first step of the treatment.
Keywords: Newborn, respiratuar distress, pneumothorax, treatment, outcome
Relationship between subclinical hypothyroidism and serum homocysteine concentration in premenopausal women
Ayfer Çolak, Ramazan Avcı, Serkan Yener, Yusuf Kurtulmuş, Mustafa Osman Zengin, Ümit Bozkurt, Füsun Üstüner
J Clin Exp Invest 2013;4(3):293-297.
https://doi.org/10.5799/ahinjs.01.2013.03.0287
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Objective: In our study we aimed to examine serum homocysteine levels of patients without thyroid dysfunctions who have high serum anti thyroid peroxidase (anti-TPO) levels and patients with subclinical hypothyroidism who have high serum thyroid stimulating hormone (TSH) and anti-TPO levels.
Methods: One hundred and seven premenopause female outpatients who referred to endocrine clinic of our hospital were included in our study. We generated 3 groups. First group (Control) consists of 53 (50%) patients between the ages of 30-40 years. Second group (Euthyroid) consists of 31 (29%) patients between the ages of 26-49. Third group (Subclinical Hypothyroidism) consists of 23 (21%) patients between the ages of 33-53 years. Serum total cholesterol, triglycerides, high density lipoprotein (HDL) levels were measured by Olympus 2700 autoanalyzer. Serum TSH, free T4, anti-TPO and homocysteine levels were measured by Siemens Immulite 2000 autoanalyzer.
Results: In our study, total cholesterol, triglycerides, low density lipoprotein (LDL) and very low density lipoprotein (VLDL) levels were not statistically significantly different among the groups. Although serum homocysteine levels of the third group were higher than the other groups it was not statistically significantly different among the groups.
Conclusion: Serum homocysteine and lipid levels of patients with euthyroidism and subclinical hypothyroidism who have positive anti-TPO levels may be inadequate in assessing the risk of cardiovascular diseases.
Keywords: Hypothyroidsm, homocysteine, premenopause
The importance of mean platelet volume in early mortality of pulmonary embolism
Hadice Selimoğlu Şen, Özlem Abakay, Mahşuk Taylan, Abdullah Çetin Tanrıkulu, Cengizhan Sezgi, Abdurrahman Abakay, Halide Kaya
J Clin Exp Invest 2013;4(3):298-301.
https://doi.org/10.5799/ahinjs.01.2013.03.0288
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Objective: In this study whether mean platelet volume (MPV) is associated with early period hospital mortality or not in patients with pulmonary embolism (PE) was investigated.
Methods: Data of patients that hospitalized in chest diseases clinic with the diagnosis of PE between the years 2009-2012 were screened retrospectively from digital archive system. The demographic data, symptoms, treatment outcomes and MPV values in complete blood count of patients were recorded.
Results: The mean age was 57.93 ± 18.52 years (16-91). The number of patients is 143 and 91 women (63.9%), 52 men (36.4%), respectively. MPV values were available for 137 of 143 patients. 129 of patients were discharged, and 8 had died in the early period of hospitalization. The mean MPV value was 7.85 ± 1.40 fL in patients who experienced and 9.08 ± 1.61 fL in died respectively. The difference was statistically significant (p = 0.01).
Conclusion: The results of this study suggests that increased MPV value may be used as a marker for early hospital mortality in patients with PE.
Keywords: Mean platelet volume, mortality, pulmonary embolism
In vitro effectiveness of Castellani solution including various ingredients against different microorganisms
Julide Sedef Göçmen, Şükran Çopur, Hanni Turan, Müge Demirbilek, Ebru Evren
J Clin Exp Invest 2013;4(3):302-305.
https://doi.org/10.5799/ahinjs.01.2013.03.0289
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Objective: As the external auditory canal is a moisture area, it facilitates the growth of bacteria and fungi. Infections and inflammation due to Staphylococcus aureus, Pseudomonas aeruginosa, Aspergillus spp. and Candida albicans can develop in this area. Classical Castellani solution including boric acid, fenol, fucsin, resorcinol, acetone, and alcohol is used for external ear tract infections due to fungi and bacteria, and also for the superficial dermatophytoses, and eczematous dermatitis of the external ear tract infections.
The purpose of this study is to investigate of the in vitro effectiveness of classical Castellani solution and its different formulations with different dilutions against the standard yeast and bacteria strains.
Methods: C. albicans ATCC 10231, C. krusei ATCC 6258, C. dubliniensis CD 36, C. guilliermondii ATCC 6260, C. parapsilosis ATCC22019, E. coli ATCC 25922, P. aeruginosa ATCC 27853, MRSA ATCC 43300, Staphylococcus aureus ATCC 25923, and S. epidermidis ATCC 12228 strains were included in the study. Broth microdilution method was used for each microorganism and Castellani formulation. The tests are repeated at least twice.
Results: The inhibitory concentration of classical Castellani solution against bacteria and fungi is 1/64-1/256, 1/32-1/64 for fuchsin free solution, 1/32-1/128 for boric acid-free solution and, 1/64-1/128 for resorcinol-free solution.
Conclusions: As a conclusion we think that the classical Castellani solution and its different formulations at various dilutions may be effective antimicrobial agents for different patient populations.
Keywords: Castellani solution, antimicrobial activity, in vitro
Pulsed-Field Gel Electrophoresis (PFGE) standardization protocol for Proteus mirabilis
Alper Karagöz, Mehmet Reşat Ceylan, Rıza Durmaz
J Clin Exp Invest 2013;4(3):306-312.
https://doi.org/10.5799/ahinjs.01.2013.03.0290
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Objective: For the detection of outbreaks caused by Proteus mirabilis, strains clonal relations are determined methods as “pulsed-field gel electrophoresis (PFGE)”. The aim of this study was optimization of a pulsed-field gel electrophoresis for molecular typing of P. mirabilis.
Methods: In this study, PFGE’ protocol is optimized for use in molecular typing of P. mirabilis. Phylogenetic analyzes of strains were evaluated with Bionumerics software system (version 6.01; Applied Maths, Sint-Martens-Latem, Belgium).
Results: This protocol compared with Gram-negative bacteria PFGE protocols, NotI enzyme is suitable for this bacterium. Electrophoresis conditions should be revealed as; - block 1: initial pulse duration 1 sec, ending pulse duration 30 sec, striking angle 120°, the current 6 V/cm2, temperature 14°C, time 8 hours; - block 2: initial pulse duration 30 sec, ending pulse duration 70 sec, striking angle 120°, the current 6 V/cm2, temperature 14°C, time 16 hours; - TBE, pH=8.4.
Conclusion: P. mirabilis strains were typed by PFGE and Bionumerics analysis program were determined clonal relationships. The procedure was simple, reproducible and suitable for these bacteria. Also it was evaluated, because of reducing time, the solution volumes and enzymes can be economically. Outbreaks of nosocomial infections due to bacteria studied assessment and the potential to provide useful information about the degree of prevalence. This optimized protocol is allowed different centers’ PFGE results to compare with other laboratories results.
Keywords: Proteus mirabilis, molecular typing, pulsed-field gel electrophoresis
Relationships between enuresis and sleep parameters in patients with obstructive sleep apnea syndrome
Özlem Abakay, Hadice Selimoğlu Şen, Mahşuk Taylan, Halide Kaya, Mehmet Halis Tanrıverdi, Abdullah Çetin Tanrıkulu, Abdurrahman Abakay, Gökhan Kırbaş
J Clin Exp Invest 2013;4(3):313-317.
https://doi.org/10.5799/ahinjs.01.2013.03.0291
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Objective: This study was aimed to investigate the obstructive sleep apnea syndrome (OSAS) in patients with enuresis the relationship between polysomnographic parameters.
Methods: A total of 67 OSAS patients included. Data taken knowledge were recorded standard form that all patients with night polysomnographic recordings parameters and the presence of enuresis.
Results: The mean age of patients was 45.0 ± 11.7 years. 54% of the patients were male and 46% female. The mean apnea-hypopnea index of the patients was 13.07 events/h. Frequency of enuresis was found 19%, nocturia frequency was found to be 55%. Arousal index, periodic leg movement index and oxygen desaturation index were found different (p<0.05) between enuresis group and non- enuresis group.
Conclusion: In our study was found to be associated the frequency of nocturia and enuresis severity of oxygen desaturation in OSAS patients.
Keywords: OSAS, enuresis, polysomnography
Antibiotic susceptibility of Acinetobacter baumannii strains in a university hospital
İlyas Yolbaş, Recep Tekin, Ali Güneş, Selvi Kelekçi, Velat Şen, İlhan Tan, Ünal Uluca
J Clin Exp Invest 2013;4(3):318-321.
https://doi.org/10.5799/ahinjs.01.2013.03.0292
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Objective: Nowadays nearly, Acinetobacter baumannii has become an incurable nosocomial infections’ pathogen due to its ability developing multiple resistance against antibiotics strains In our study, it was aimed to determine rates of resistance of A. baumannii strains isolated from various samples in the Dicle University Hospital.
Methods: A. baumannii culture results of 270 patients that were followed in the Dicle University Medical Faculty Hospital between June 2010 and June 2011 were evaluated. Resistance rates of A. baumannii strains were cultured by conventional methods and BD Phoenix (BD Diagnostic Systems, Sparks, MD) automated system.
Results: Our study included 82 (30.4%) female and 188 (69.6%) male. Resistance rates of A. baumannii strains were as follows: amikacin (76%), ampicillin / sulbactam (94%), aztreonam (96%), cefepime (95%), cefotaxime (98%), ceftazidime (95%), ciprofloxacin (93%), colistin (6%), gentamicin (94%), imipenem (87%), levofloxacin (87%), meropenem (87%), piperacillin / tazobactam (92%), tetracycline (84%), trimethoprim / sulfamethoxazole (82%).
Conclusions: A. baumannii strains isolated from our cultures have very high rate of resistance against antimicrobial agents except colistin. It should not be forgotten that antibiotic susceptibility may change from year to year in the regions, hospitals and even clinics, and resistance rates should be continuously monitored. When selecting empiric treatment, resistance rates of A. baumannii of that location should be considered until having culture results. In the infections caused by A. baumannii cultures and antibiograms should be repeated during treatment because that A. baumannii strains may change resistance ratio.
Keywords: A. baumannii, antibiotic, resistance
The predictive value of risk of malignancy index calculation in adnexal masses
Sinem Ertaş, Fisun Vural, Gültekin Köse, Ayşe Deniz Ertürk Coşkun, Ertuğrul Can Tüfekçi, Nurettin Aka
J Clin Exp Invest 2013;4(3):322-325.
https://doi.org/10.5799/ahinjs.01.2013.03.0293
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Objective: Ovarian cancers, the relatively high frequency, poor prognosis and late diagnosis are considerable clinical issues and additional diagnostic methods are needed. The aim of this study was to evaluate the predictive value of RMI as a diagnostic marker in ovarian cancers.
Methods: Totally 80 patients with adnexal masses who were operated in Haydarpaşa Numune Training and Research Hospital Gynecology and Obstetrics Department between January 2012-June 2012, included in the study. This was a retrospective observational study. All patient’ documents were reevaluated and calculated for RMI. The calculated results were compared with histopathologic findings.
Results: The 30% (n=24) of women were in postmenopousal period. The major complains of patients during attendance were pelvic pain (65%) and 27.5% of the patients had no complaints and adnexal masses were detected during routine gynecological examination The 86.3% (n=69) of women had benign ovarian neoplasms, 11.3% (n=9) had malignant tumors and 2.5% (n=2) had borderline ovarian tumors. Most of the women with high RMI levels were in postmenopousal status (71.5%). The sensitivity and specificity of RMI were 81.8% and 92.6% respectively. The sensitivity and specificity of CA-125 levels were 90.9% and 36.4% respectively.
Conclusion: Using RMI in diagnosis of malign ovarian tumors is easily appliable method with high sensitivity and specificity without financial burden.
Keywords: Ovarian cancer, adnexal masses, risk of malignancy index
Alterations in intraocular pressure and ocular axial length after intravitreal Anti-VEGF injection
Hasan Ali Tufan, Selçuk Kara, Sedat Arıkan, Baran Gencer, Metin Ünlü
J Clin Exp Invest 2013;4(3):326-330.
https://doi.org/10.5799/ahinjs.01.2013.03.0294
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Objective: To evaluate the effect of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection on intraocular pressure (IOP) and ocular axial length (AL).
Methods: A prospective series of consecutive patients undergoing injection of intravitreal bevacizumab or ranibizumab in our clinic was investigated. IOP was measured with Tono-Pen and ocular AL with ultrasound biometry before (IOP0, AL0) and about 1 min (IOP1, AL1) and 24 hours (IOP2, AL2) after intravitreal injection. Logistic regression analysis was used to investigate factors (lens status, presence of glaucoma and previous intravitreal injection) associated with increased IOP and AL.
Results: We recruited 96 patients with a mean age of 66.7±12 years, 53 (55%) men and 43 (45%) women. One minute after the injection (IOP1), mean IOP increased from 15.2±3.5 mmHg (IOP0) to 22.2±8.6 mmHg (p<0.001). 24 hours after the injection, IOP decreased a mean level of 14.7±3.6 mmHg (IOP0 vs. IOP2, p˃0.05). Mean AL0, AL1 and AL2 values were 23.1± 0.82 mm, 23.25± 0.81 mm and 23± 0.8 mm, respectively. AL elongation was statistically significant just after injection (AL0 vs. AL1, p˂0.001). 24 hours after AL values were dropped below the baseline values (AL0 vs. AL2 p=0.04). Regression analysis showed a trend towards pseudophakic patients having higher IOP and AL at one minute. It was also observed that having previous intravitreal injections cause higher IOP elevation.
Conclusion: Intravitreal anti-VEGF injections may lead a transient IOP elevation and AL elongation. Clinicians should consider checking IOP after intravitreal injections as a precaution. Further investigations are required to understand biometric changes after intravitreal injections.
Keywords: Intravitreal injection, intraocular pressure, ocular axial length
Asthma exacerbation related with inhalation of hot peppers extract (capsaicin)
Erkan Ceylan
J Clin Exp Invest 2013;4(3):331-334.
https://doi.org/10.5799/ahinjs.01.2013.03.0295
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Objectives: In this study we aimed to prospectively investigate, asthma provoking factors and among these factors the place of Hot pepper (Isot) during August-September months which are time period for processing isot.
Methods: In this study, 73 female patients with exacerbation of asthma who applied to Chest Diseases Outpatient Clinic and emergency department in the period of August-September (2010) were evaluated prospectively.
Results: Seventy-three asthmatic female patients, means age 34.7±6.1 (22-43) years were included. Patients with exacerbation of asthma provoking factors are; inhalation of isot pepper 28.8%, infections 23.3%, irregular use of drugs 16.4%, exposure to biomass and cigarette smoke 13.7%, allergens 9.6%, emotional factors 5%, and gastroesophageal reflux 2.7%, physical exercise 1.4%.
Conclusion: We observed that the most important asthma provoking factor was the inhalation of isot extract in asthmatic female patients in August-September (2010) period in Sanliurfa.
Keywords: Asthma, hot pepper, Isot, capsaicin, Sanliurfa
Open heart surgery in dialysis-dependent patients with end stage renal failure
Orkut Güçlü, Süleyman Yazıcı, Sinan Demirtaş, Ahmet Çalışkan, Celal Yavuz, Binali Mavitaş, Suat Canbaz, Turan Ege
J Clin Exp Invest 2013;4(3):335-338.
https://doi.org/10.5799/ahinjs.01.2013.03.0296
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Objective: Patients with chronic renal insufficiency remain a risky subgroup in open heart surgery because of various reasons. The incidence of cardiovascular disease in hemodialysis dependent renal failure is found to be higher when compared with the normal population. Chronic dialysis is still a very important independent risk factor for mortality and morbidity despite of many studies. In this study, we retrospectively evaluated the outcome of patients with chronic renal failure who had undergone to open cardiac surgery.
Methods: The medical charts of 36 patients on maintenance dialysis who underwent cardiovascular surgery were retrospectively analyzed. Peroperative findings of these patients were analyzed from patients’ hospital records.
Results: Twenty-seven men (75%) and nine women (25%) totally 36 patients were included to study. The mean age was 58.3±8.5 (range, 44-76) years. 12 patients underwent coronary artery bypass surgery, 10 had concomitant coronary artery bypass surgery and valve replacements, five had valve replacements, three had concomitant coronary artery bypass surgery and left ventriculectomy, four had valve replacement with other valve repair, two had aortic surgery due to ascending aortic aneurysms. The mean cross clamp time was 78.1±31.3 min and the mean perfusion time was 158.8±92.2 min. The mean intensive care unit stay was 60±41 hours, and the mean hospital stay was 12±5 days. Hospital mortality rate was %38.8.
Conclusions: Cardiac and renal functions are closely associated with each other. Cardiac surgery operations can be applied to patients with end-stage renal failure under acceptable risks. Appropriate preoperative preparation with good postoperative patient follow-up is necessary to have acceptable levels of morbidity and mortality rates.
Keywords: Cardiac surgery, chronic renal failure, mortality
Demographic characteristics and ocular involvement in Behçet patients in Southeast Anatolia
Fatih Mehmet Türkcü, Harun Yüksel, Derya Uçmak, Zeynep Meltem Akkurt, Alparslan Şahin, Yasin Çınar, Abdullah Kürşat Cingü, İhsan Çaça
J Clin Exp Invest 2013;4(3):339-342.
https://doi.org/10.5799/ahinjs.01.2013.03.0297
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Objective: The aim of this study was to evaluate the demographic characteristics of Behcet's disease (BD) patients with and without ocular involvement.
Methods: In this retrospective study BD patients followed up between 2009 and 2013 years in ophthalmology and dermatology clinics were reviewed. Patients were divided into 2 groups according to the ocular involvement as ocular or non-ocular BD. For each patient, age of onset, gender, family history, and systemic involvement were examined. The frequency of these data was analyzed.
Results: Of the 295 patients 177 were ocular BD and 118 were non-ocular BD. Ocular involvement were seen more frequently in male patients than in females. There was no change between the groups in terms of age at onset of the disease, a history of thrombophlebitis or gastrointestinal, pulmonary and joint involvement. Pathergy test positivity and the presence of genital ulcers had more frequent in non-ocular BD.
Conclusion: In this study clinical and demographic characteristics of ocular and non-ocular BD patients in the Southeast Anatolian Region of Turkey were presented. A similar study was not performed previously in our region therefore we believe that those data will be useful for diagnosis and follow-up of BD patients.
Keywords: Behçet disease, eye involvement, demographic characteristics
Comparison of ELISA and direct microscopic examination for detecting Giardia intestinalis in children
Keramettin Yanık, Mehmet Cihan Ekmen, Ali Serkan Hepsert, Murat Hökelek, Murat Günaydın
J Clin Exp Invest 2013;4(3):343-346.
https://doi.org/10.5799/ahinjs.01.2013.03.0298
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Objective: Giardia intestinalis is the causes of giardiasis, which infects human fecally-orally. This leads to growth retardation in children, leading to malabsorption, which is widespread in Turkey, especially in the regions having low socio-economic status. In this study we aimed to compare results of Enzyme Linked Immunosorbent Assay (ELISA) and direct microscopic stool examination for detecting giardiasis.
Methods: The feces samples of 761 children aged between 0 and 16 years who applied to Ondokuz Mayıs University Hospital with diarrhea were evaluated by using ELISA test and direct microscopic examination.
Results: The study comprised 356 (46.7%) boys and 405 (53, 3%) girls. Both direct microscopy and ELISA gave positive results for giardiasis in 17 (2.2%) children. In 13 (17%) of the children ELISA was found positive but direct microscopy did not show Giardia intestinalis at stool samples. Both ELISA and direct microscopy of the remaining 731 (96.1%) of the patients gave negative results for giardiasis.
Conclusion: Direct microscopic examination methods are often preferred because they are more cost-effective, and some other parasites can be found by examination of feces. Yet, in cases in which children have giardiasis symptoms but parasites cannot be determined by microscopic examination to search for G. intestinalis antigen by means of ELISA can be used as an alternative method.
Keywords: G. intestinalis, ELISA, direct microscopic examination, comparison, diagnosis
Evaluation of risk factors in wheezy infants
Müsemma Karabel, Selvi Kelekçi, Tuba Tuncel, Velat Şen, Duran Karabel, Ünal Uluca, İlhan Tan, Mehmet Fuat Gürkan
J Clin Exp Invest 2013;4(3):347-351.
https://doi.org/10.5799/ahinjs.01.2013.03.0299
Research Article
[Abstract]
[PDF]
ABSTRACT
Objectives: In this study, it was aimed to investigate the environmental risk factors and demographic characteristics of wheezy infants.
Methods: A total of 118 children aged 6-24 months, investigated in two subgroups as first wheezing and recurrent wheezing infants. Age and sex matched, healthy 60 children were recruited as the control group. Questionnaire was filled by the parents including knowledge about socio-demographic features, history of familial and personal atopy, age at wheezing onset, parental education, smoking and stove heating at home, familial crowding index and child’s immunization status.
Results: First wheezing group included 52, recurrent wheezing group included 66 patients. There was no statistically significant difference between study group and the controls in terms of sociodemographic features (p>0.05). Low educational level of mothers and maternal smoking in the study group was found to be significantly higher than controls (p<0.05). Family history of atopic diseases was significantly higher in the study group compared with the control group. Atopic dermatitis was significantly higher in recurrent wheezing subgroup and was significantly higher in the study group compared with the control group. The ratio of non-vaccinated children was significantly higher in the study group (31%) than the controls (6.7%), and was %6.7 in controls.
Conclusion: Maternal smoking and educational level, stove heating at home and lack of immunization are preventable environmental risk factors in wheezing infants. Examining risk factors and giving counseling can prevent recurrent hospitalizations and permanent bronchial damage.
Keywords: Respiratory distress, wheezy, infant, risk factors
Atypically located hydatid cyst cases
Fatih Meteroğlu, Ahmet Çalışkan, Atalay Şahin, Canan Eren, Menduh Oruç
J Clin Exp Invest 2013;4(3):352-355.
https://doi.org/10.5799/ahinjs.01.2013.03.0300
Brief Report
[Abstract]
[PDF]
ABSTRACT
Six hydatid cysts cases without a primary source anywhere were presented. Hydatid cyst is a parasitic disease well known for years are commonly located in liver and lungs. Those intradiaphragmatic and intramyocardiac were diagnosed preoperatively but those lying subcutaneously on sternum and the right first rib were recognized after operation. They were also confirmed with pathologic study. Patients were also detected for hydatid cysts elsewhere. As an endemic disease in our country, atypical locations should be kept in mind. This disease is to be remembered in considering soft tissue tumors.
Keywords: Atypically cyst, intradiaphragmatic cyst, intramyocardial cyst
The antibiotic sensitivity of bacteria isolated from urine cultures
Kemal Tolga Saraçoğlu, Vural Fidan, Özgür Pekel, Ayten Saraçoğlu, Sadettin Kalkandelen, Emre Arpalı
J Clin Exp Invest 2013;4(3):356-359.
https://doi.org/10.5799/ahinjs.01.2013.03.0301
Brief Report
[Abstract]
[PDF]
ABSTRACT
Objective: Urinary tract infections (UTI) come upon a common infection disease in hospital. Empiric antibiotic therapy for patients with suspected UTI is commonly used because obtaining antibiogram result is usually time consuming. Aim of the study was to investigate urine culture and antibiogram results of patients who were admitted to our hospital.
Methods: Urine cultures were investigated between November 2008 and June 2010 in database of laboratory information system. Samples of isolated microorganism and antibiogram results were evaluated.
Results: Microorganisms were isolated in 691 of 1342 urine cultures. Polymicrobial infection was determined in 46 patients. Most common identified microorganism was E. coli (71.3%). If all samples considered, bacteria resistance was detected against to ampicilline, trimethoprim/sulfamethoxazole (TMP/SMX) ampicilline/sulbactam (AMS) and ciprofloxacin (CIP) (52.1%, 39.5%, 22.7% and 19.6%). Lower bacterial resistance was determined against amicasin, gentamicine, tobramicine and nitrofurantoin (7.9%, 3.3%, 17.5% and 12.6%). As E. coli isolated samples were investigated, bacterial resistance was detected against ampicilline, CIP, levofloxacin and TMP/SMX (58.1%, 40.8%, 36.1% ve 39.5%). Nitrofurantoin, amicasin, gentamicine and tobramicine were found as sensitive antibiotics (90.3%, 88.9%, 79.4% and 69.9%).
Conclusion: High bacterial resistance was determined against to most preferred empiric antibiotics which are TMP/SMX, AMS and also CIP.
Keywords: antibiogram; drug resistance; urine culture
Bilateral complex regional pain syndrome following spinal cord injury and bilateral calcaneus fracture
Ahmet Boyacı, Ahmet Tutoğlu, Nurefşan Boyacı, Esra Çelen
J Clin Exp Invest 2013;4(3):360-363.
https://doi.org/10.5799/ahinjs.01.2013.03.0302
Case Report
[Abstract]
[PDF]
ABSTRACT
Complex regional pain syndrome (CRPS) is a disease affecting one or more extremities, characterized by spontaneous pain, allodynia, hyperpathia and hyperalgesia. CRPS is separated into Type 1 and Type 2. CRPS which develops after a nociceptive event is labeled as Type 1 and when it develops following peripheral nerve damage, Type 2. Although the pathogenesis is not fully understood, peripheral and central sensitivity are held responsible. Bilateral lower extremity involvement is extremely rare. However, it should be borne in mind that it can develop in traumatic injuries which occur in more than one area and diagnosis and commencement of a rehabilitation program should be made in the early period. The case is presented here of bilateral Type 1 CRPS developing after incomplete spinal cord injury and bilateral calcaneus fracture.
Keywords: complex regional pain syndrome, calcaneus fracture, spinal cord injury
Unilateral absence of sphenoid wing in a Neurofibromatosis type 1 patient: imaging findings
Emine Dağıstan, Arzu Canan, Abdullah Yüksel Barut, Yeşim Karagöz
J Clin Exp Invest 2013;4(3):364-366.
https://doi.org/10.5799/ahinjs.01.2013.03.0303
Case Report
[Abstract]
[PDF]
ABSTRACT
Neurofibromatosis type 1(NF-1) or von Recklinghausen disease is the most common of the neurocutaneous syndromes. It is characterized by pigmented cutaneous lesions and tumors of central nervous system. By the way, it could affect all the systems of the body. Sphenoid wing abnormalities are very rare and often associated with NF-1 so, they are considered pathognomonic. We report an unusual case NF-1 with unilateral absence of sphenoid wing and findings of multi-detector computed tomography and magnetic resonance imaging.
Keywords: Neurofibromatosis type 1, multi-detector computed tomography, magnetic resonance imaging, sphenoid dysplasia
Iatrogenic subdural hematoma mimicking acute epidural hematoma on computed tomography
Hakan Ak, Sadiye Yolcu, Tugay Atalay, Naciye Kış
J Clin Exp Invest 2013;4(3):367-369.
https://doi.org/10.5799/ahinjs.01.2013.03.0304
Case Report
[Abstract]
[PDF]
ABSTRACT
Computed tomography images of the subdural and epidural hematoma are well defined, crescent and lentiform shapes, respectively. However, it has been reported that both of them might mimic each other in rare instances. Literature reveals seven reports subdural hematoma mimicking epidural. We are reporting a new case of subdural hematoma mimicking epidural hematoma radiologically, which occurred after evacuation of chronic subdural hematoma with burr-hole in a 75 years old man.
Keywords: Subdural hematoma, epidural hematoma, computed tomography, brain
Eccrine porocarcinoma: A case report and literature review
Deniz Arslan, Muhammet Ali Kaplan, Ali Murat Tatlı, Mükremin Uysal
J Clin Exp Invest 2013;4(3):370-373.
https://doi.org/10.5799/ahinjs.01.2013.03.0305
Case Report
[Abstract]
[PDF]
ABSTRACT
Eccrine porocarcinoma is a rarely seen malignant tumor of the sweat glands. It is commonly seen in elderly people and it tends to involve lower extremities. Surgical excision is the main therapeutic modality. It may show local recurrences and systemic metastasis. The effects of chemotherapy and radiotherapy are contradictory. Here, we present a case of 90-years-old female patient with eccrine porocarcinoma localized in the axillary area and additionally we review the existing literature.
Keywords: Eccrine porocarcinoma, malignant tumor
A case of colistin-induced fixed drug eruption
Ismail Necati Hakyemez, Abdulkadir Kucukbayrak, Aslihan Burcu Yikilgan, Elif Sultan Bolac, Nebil Yildiz, Cetin Boran, Hayrettin Akdeniz
J Clin Exp Invest 2013;4(3):374-376.
https://doi.org/10.5799/ahinjs.01.2013.03.0306
Case Report
[Abstract]
[PDF]
ABSTRACT
Several medicines, especially antimicrobials, play a role in the etiology of fixed drug eruption (FDE). The clinical manifestation is quite typical for a drug-induced reaction. FDE which developed in an 83-year-old male patient who has been administered colistin due to Acinetobacter pneumonia is presented here since it is very rarely seen. Therefore colistin should also be considered in the differential diagnosis of FDE.
Keywords: Fixed drug eruption, etiology, colistin
Recurrent metastasis of progressive parachordoma of spermatic duct to different sites in a year: A rare case
Mehmet Erol Yildirim, Hüseyin Şahin, Hüseyin Badem, Ersin Cimentepe, Cenap Dener
J Clin Exp Invest 2013;4(3):377-379.
https://doi.org/10.5799/ahinjs.01.2013.03.0307
Case Report
[Abstract]
[PDF]
ABSTRACT
Parachordoma is a rare entity with an unknown origin, which reported nearly in 60 cases. We are reporting an aggressive tumor that has two recurrences in 5 months in different sites. A 49 year old male admitted with right inguinal pain that underwent a computed tomography, revealed a 52x50 mm tumor at the right inguinal subepidermal region. After the resection, pathology of the mass was parachordoma. Four months after the operation, patient admitted with a solitary mass in the right testis. Ultrasonography revealed four different masses in the right inguinal and right testicular region. Second pathology results were also parachordoma. One month later the second operation, patient again admitted to hospital with right hip pain, had a solitary mass on the collum femoris in the magnetic resonance imaging consulted for radiotherapy. Parachordoma is a rare, benign entity that must be closely followed up. The physician must be aware of the malignancy especially in the first year with existence of recurrence and metastasis. Radiotherapy is recommended after maximal resection of tumor especially in metastatic cases.
Keywords: Parachordoma, pelvic tumor, radiotherapy
Reoperative coronary artery bypass grafting
Hüseyin Katlandur, Şeref Ulucan, Ahmet Keser, Zeynettin Kaya, Abdullah Tuncez
J Clin Exp Invest 2013;4(3):380-382.
https://doi.org/10.5799/ahinjs.01.2013.03.0308
Case Report
[Abstract]
[PDF]
ABSTRACT
Reoperative coronary artery bypass grafting (redo CABG) operation is associated with a high rate of mortality up to 11.4%. It has been estimated that 10-20% of patients with history of coronary artery bypass grafting (CABG) operation need redo CABG operation within 10 years. Due to high operation risk percutaneous coronary interventions have emerged as the preferred treatment for the patients with a history of CABG operation and presenting with acute coronary syndrome. Here, we reported percutaneous coronary intervention in a patient needed redo CABG operation.
Keywords: Acute coronary syndrome, redo CABG operation, percutaneous coronary intervention
Morganella morganii in sinonasal region: A rare case report
Haşmet Yazıcı, Sedat Doğan, İlknur Haberal Can, Yusuf Baygit, Ali Cem Tekin
J Clin Exp Invest 2013;4(3):383-386.
https://doi.org/10.5799/ahinjs.01.2013.03.0309
Case Report
[Abstract]
[PDF]
ABSTRACT
Morganella morganii is a gram negative pathogen and may cause potentially lethal disease especially in patients with underlying or immunosuppressive disease. It is commonly found in long-term urinary catheter used and immune system deficiency patients as nosocomial disease. Involving other systems such as skin, skeletal system and central nervous system can be seen too. Sporadic occurrence is rare and can be seen in any system by various causes like AIDS, snake bites and poisoning. In this case we present sporadic Morganella morganii infection on sinonasal region with the presence of sinusitis, sino-cutaneous fistula, preseptal cellulitis and hard palate defect on 58 year old male diabetic patient. Microbiological assessment from open wound and sinuses were reported as Morganella morganii. To our knowledge, this is the first case of sino-nasal Morganella morganii infection with sino-cutaneous fistula, preseptal cellulitis and maxillofacial bone destruction.
Keywords: Morganella Morganii, sino-nasal fistula, preseptal cellulitis, bone destruction
Giant inflammatory fibroid polyp causing invagination: case report
İsmail Demiryılmaz, İsmayil Yılmaz, Kemal Peker, Serpil Postgil Yılmaz, Nurdan Sekban, Yavuz Albayrak
J Clin Exp Invest 2013;4(3):387-389.
https://doi.org/10.5799/ahinjs.01.2013.03.0310
Case Report
[Abstract]
[PDF]
ABSTRACT
İnvagination is a clinical entity, which describes infolding of proximal part of the intestine with in distal part. Only 5% of the invaginations occur in adulthood. İnflammatory polyp, is a rare disorder, which may present in anywhere of gastrointestinal tract but mostly originated from gastral antrum. We report a 42-year-old patient who developed an ileocholic invagination due to a giant polypoid mass on terminal ileum. To whom we performed terminal ileum resection with right hemicholectomy and pathologic examination showed that the mass is inflammatory polyp.
Keywords: Intussusception, inflammatory fibroid polyp
The case of malignancy mimicking legionella pneumonia
Ali Karakuş, Ersin Şükrü Erden, Cenk Babayiğit, Eyüp Büyükkaya, Mehmet Mustafa Akın, Muhammet Murat Çelik, Veyis Taşın
J Clin Exp Invest 2013;4(3):390-392.
https://doi.org/10.5799/ahinjs.01.2013.03.0311
Case Report
[Abstract]
[PDF]
ABSTRACT
Legionella pneumophila is a bacterium, which can grow in water pipe networks and climate systems. Contamination occurs by aspiration of infected water or aerosol inhalation. It is usually presented with fever, bradycardia, and change in mental status, hyponatremia, elevation of liver enzymes and deterioration of renal function. The definite diagnosis is established by detection of the antigens and cultivating in the culture medium. Also, malign lung tumors can encounter with the same clinical findings, so lung cancer should be remembered in differential diagnosis. The patient hospitalized for the Legionella pneumophila due to the physical examination and laboratory findings during the first evaluation in the emergency department. However, further examinations pointed to the cancer. We aimed to emphasize the probability of malignant tumors in terms of hyponatremia, increase in the liver enzymes, and failure in the renal functions, which were usually experienced in emergency unit.
Keywords: Legionella pneumophila, pneumonia, lung malignancy
High altitude related bilateral subconjunctival hemorrhage
Onur Çatak, Veysel Aykut
J Clin Exp Invest 2013;4(3):393-394.
https://doi.org/10.5799/ahinjs.01.2013.03.0312
Case Report
[Abstract]
[PDF]
ABSTRACT
Subconjunctival hemorrhage (SCH) is an easily detectable examination finding for an ophthalmologist. It is a benign disorder with good visual prognosis. Herein, a 18-year-old male reported bilateral SCH. When the patient was reexamined, it has been observed in his history that patient climbed the mountain for the purpose of hunting the day before. This case emphasizes the importance of a thorough anamnesis in cases presenting with SCH.
Keywords: Subconjunctival hemorrhage, Acute mountain sickness
Acute epiploic appendagitis: Computed tomography findings
Mehmet Sait Doğan, Sümeyra Doğan, İsmet Baran
J Clin Exp Invest 2013;4(3):395-397.
https://doi.org/10.5799/ahinjs.01.2013.03.0313
Case Report
[Abstract]
[PDF]
ABSTRACT
Acute epiploic appendagitis, an inflammatory process of epiploic appendages, is a rare cause of acute abdominal pain. Accurate diagnosis of this self limiting, conservatively treatable disease is important for preventing unnecessary hospital admission and surgery. In this paper we present pre- and post-treatment computed tomography findings of a 41 years old male patient who admitted to emergency service with acute abdominal pain and diagnosed with acute epiploic appendagitis.
Keywords: Epiploic appendagitis, acute abdomen, computed tomography
Cardiovascular and metabolic effects of vitamin D
Veysel Kıdır
J Clin Exp Invest 2013;4(3):398-404.
https://doi.org/10.5799/ahinjs.01.2013.03.0314
Review
[Abstract]
[PDF]
ABSTRACT
In humans, approximately 95% of the total requirement for vitamin D is synthesized in the skin by the effects of sunlight. The active vitamin D synthesis from 25 (OH) D takes place via the 1-alpha hydroxylase enzyme both in renal and non-renal tissues. The effect of vitamin D on the receptor level is through active vitamin D. Vitamin D receptors are shown in more than 30 tissues. Non-classical effects of vitamin D are grouped under three main headings: Regulation of hormone secretion, regulation of immune function, regulation of cell proliferation and differentiation. Cardiovascular diseases, renal diseases, diabetes, obesity, metabolic syndrome are mostly researched diseases related with vitamin D. Vitamin D levels were shown inversely to be related with hypertension, obesity, diabetes and hypertriglyceridemia. In vitro studies have shown that vitamin D accelerates relaxation in cardiomyocytes and improves diastolic function of the heart. In clinical studies done in patients with chronic kidney disease, poor vitamin D status was shown to be an independent risk factor for coronary vascular calcification, other heart diseases such as heart failure, and cardiovascular mortality. In this review, the cardiovascular and metabolic effects of vitamin D have been reviewed in the light of current knowledge.
Keywords:
Current diagnosis and treatment in pulmonary thromboembolism
Hadice Selimoğlu Şen, Özlem Abakay
J Clin Exp Invest 2013;4(3):405-410.
https://doi.org/10.5799/ahinjs.01.2013.03.0315
Review
[Abstract]
[PDF]
ABSTRACT
Pulmonary thromboembolism (PTE), is usually a complication of deep vein thrombosis (DVT). Pulmonary thromboembolism develops as a result of obstruction of pulmonary artery and / or branches with pieces that ruptured from the deep vein thrombosis of the leg. Pulmonary thromboembolism and DVT is also referred as venous thromboembolism (VTE) because of two events often remain together. The true incidence is uncertain because of more than half of the patients can be lost before the diagnosis. Despite the many new developments in the last decade on the diagnosis and treatment, PTE is still one of the difficult to diagnose and fatal diseases of lungs. Classical and contemporary approaches to the diagnosis and treatment of PTE were evaluated together in this review.
Keywords: Pulmonary, thromboembolism, diagnosis, treatment
The role of vitamin D in the brain and related neurological diseases
Mustafa Yılmaz, Nigar Yılmaz
J Clin Exp Invest 2013;4(3):411-415.
https://doi.org/10.5799/ahinjs.01.2013.03.0316
Review
[Abstract]
[PDF]
ABSTRACT
Vitamin D is a steroid hormone that is produced photochemically in epidermis. It is known that vitamin D involved in the regulation of bone mineralization and calcium-phosphorus balance. However, in recent studies have suggested that vitamin D may have a significant impact in the development of the cell proliferation, differentiation, neurotransmission, neuroplasticity, neurotropic and neuroprotective effects in central nervous system (CNS). For the reason of the effects, it can be considered as a neurosteroid was reported. It was discussed that the level of vitamin D may be associated to neurodegenerative diseases such as Parkinson's disease, Alzheimer's disease, multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS). The role of vitamin D and the mechanisms of these diseases will be discussed in the review.
Keywords: Vitamin D, neurosteroid, brain, neurologic diseases