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Öğe Association between ischemia-modified albumin, homocysteine, vitamin B-12 and folic acid in patients with severe sepsis(WALTER DE GRUYTER GMBH, 2012) Erdem, Said Sami; Yerlikaya, Fatma Humeyra; Cicekler, Humeyra; Gul, MehmetBackground: The aim of the present study was to investigate scrum ischemia-modified albumin (IMA), homocysteine, malondialdehyde (MDA), vitamin B-12 and folic acid levels in patients with severe sepsis, compared to healthy control subjects. Also, we examined associations of these parameters with high-sensitivity C-reactive protein (hsCRP) in patients with severe sepsis and healthy control subjects. Methods: This study was performed on 71 (40 male, 31 female) patients with severe sepsis aged 18-65 years and 70 (34 male, 36 female) healthy control subjects aged 18-65 years. Samples of patients were obtained at study entry within 24 h of onset of severe sepsis. Results: Serum IMA, homocysteine and MDA levels of the patients with severe sepsis were significantly higher than those of the healthy control subjects (p<0.0 I for IMA and homocysteine, and p<0.001 for MDA). There was no significant difference between serum vitamin B12 and folic acid levels of the groups. Serum hsCRP levels were positively correlated with IMA (p<0.01) and MDA (p<0.01) in the patients with severe sepsis. Conclusions: Our findings show that IMA may be useful as a prognostic biomarker because it can indicate the severity of illness in patients with sepsis.Öğe Diagnostic and prognostic value of procalcitonin and phosphorus in acute mesenteric ischemia(TURKISH ASSOC TRAUMA EMERGENCY SURGERY, 2011) Karabulut, Keziban; Gul, Mehmet; Dundar, Zerrin Defne; Cander, Basar; Kurban, Sevil; Toy, HaticeBACKGROUND In this study, using an animal model of acute mesenteric ischemia (AMI), we investigated the possible use of procalcitonin and phosphorus in the early diagnosis of AMI. METHODS In this study, 21 New Zealand rabbits were used. Subjects were allocated into three groups as Control, Sham and Ischemia. No intervention was performed in the subjects in the Control group. In the subjects in the Sham and Ischemia groups, laparotomy was performed with midline incision. In the Ischemia group, the superior mesenteric artery was found and tied after laparotomy. Blood was drawn from the animals in all groups at 0, 1, 3 and 6 hours, and procalcitonin and phosphorus levels were studied in these samples. RESULTS In the Ischemia group, the increase in the levels of serum phosphorus and procalcitonin was found to be statistically significant compared to the Control and Sham groups (p < 0.05). The levels of phosphorus and procalcitonin were detected to increase from the 1st hour after ischemia onset, and the increase continued for the following 6 hours (p < 0.05). CONCLUSION Phosphorus and procalcitonin may be important parameters for use in the early diagnosis and prognosis of AMI.Öğe The effect of N-acetyl cysteine on serum glutathione, TNF-alpha and tissue malondialdehyde levels in the treatment of sepsis(TURKISH ASSOC TRAUMA EMERGENCY SURGERY, 2011) Gul, Mehmet; Ayan, Murat; Seydanoglu, Abdusselam; Cander, Basar; Girisgin, Sadik; Erayman, Ibrahim; Erdem, SamiBACKGROUND The aim of this study was to investigate the effects of N-acetyl cysteine (NAC) on the levels of reactive oxygen species in sepsis. METHODS In this study, 30 Sprague-Dawley female rats weighing 180-200 g were used. Rats were randomized into three groups, each containing 10 rats, as follows: Group I: Sham, Group II: Sepsis and Group III: Sepsis+NAC. Group I underwent only laparotomy. In Groups II and III, sepsis was induced by cecal ligation and perforation (CLP) technique. NAC (20 mg/kg/day) was administered orally to Group III at 0, 8 and 16 hours. At the 24th hour, tissue and blood samples were taken for erythrocyte glutathione (GSH) and serum tumor necrosis factor (TNF)-alpha levels, histopathological determination, and lung, liver and kidney tissue malondialdehyde (MDA) analyses. RESULTS Group III was significantly different from the other groups with respect to erythrocyte glutathione, serum TNF-alpha and kidney MDA levels (p<0.05). There was no significant difference between the groups regarding liver MDA levels and histopathological parameters for lung, liver and kidney (p>0.05). CONCLUSION NAC treatment had beneficial effects on erythrocyte GSH, serum TNF-alpha, lung function, and kidney MDA levels in sepsis-induced rats. However, this beneficial effect was not confirmed as histopathological improvement. Further research is needed to prove the effect of NAC in sepsis treatment.Öğe The effectiveness of various doses of octreotide for sulfonylurea-induced hypoglycemia after overdose(HEALTH COMMUNICATIONS INC, 2006) Gul, Mehmet; Candler, Basar; Girisgin, Sadik; Ayan, Murat; Kocak, Sedat; Unlu, AliThis study was conducted to investigate the effectiveness of various doses of octreotide in reducing hypoglycemic attacks and the need for dextrose in patients with refractory and recurrent hypoglycemia related to sulfonylurea toxicity. This study was carried out at the Center of Experimental Research of Selcuk University Merann School of Medicine in Konya, Turkey. A total of 40 New Zealand rabbits of both sexes, weighing between 2500 and 3000 g, were used in this experiment. Rabbits were randomly divided into 4 groups, each of which consisted of 10 animals. All animals were given oral glidazide 100 mg. For the treatment of hypoglycemic attacks in group 1, only 15 mL of 50% dextrose (7.5 g) was given intravenously; in groups II, III, and IV, octreotide was given in doses of 25 mu g, 50 mu g, and 100 mu g, respectively. Octreotide was given to groups II, III, and IV at the 8th hour (when hypoglycemic attacks were induced), along with an intravenous infusion of an additional 15 mL of 50% dextrose (7.5 g) for each hypoglycemic attack that occurred. After the toxic dose was given, the rabbits were given the amount of dextrose used before and after octreotide administration, and the numbers of hypoglycemic attacks were recorded. The values of blood glucose for all animals were read every hour on the hour from the beginning of the study, and the study ended at the 24th hour, when hypoglycemic attacks stopped. A significant difference was observed between groups I, II, and IV in numbers of hypoglycemic attacks that occurred and dextrose doses given between 9 and 24 h (P=.001). The findings of this study suggest that a single dose of octreotide 100 mu g may be used to reduce the number of refractory and recurrent hypoglycemic attacks that occur because of sulfonylurea overdose; large prospective studies are needed to validate these findings.Öğe Prediction of prognosis in patients with epidural hematoma by a new stereological method(TOHOKU UNIV MEDICAL PRESS, 2007) Kalkan, Erdal; Cander, Basar; Gul, Mehmet; Girisgin, Sadik; Karabagli, Hakan; Sahin, BunyaminEpidural hematoma (EH) is a serious clinical event observed in 2% of head trauma patients. Studies regarding the effects of epidural hematoma volume (EHV) on prognosis are not sufficient. In this study, we applied the volume fraction approach of the stereological method to estimate the hematoma to brain volume fraction (HBVF), and investigated the relation between the HBVF and prognosis. Fifty-nine EH patients (46 male and 13 female subjects, with average age of 21 years) admitted to the emergency clinic were included. The HBVF was estimated on the printed films of cranial computed tomography scans. For this purpose, common point counting grids were superimposed over the scan frames. According to the clinical results, patients were divided into three groups as complete recovery (43), disability (8) and exitus (8). The HBVF was compared with the clinical results. HBVF was determined as 4.6% in the patients with recovery, 8.1% in disability, and 7.6% in exitus patients. The HBVF values were lowest in recovery patients, and the difference between the recovery and the other two groups was statistically significant (p = 0.007). However, there was no statistically significant difference in HBVF between disability and exitus patients (p > 0.05). In conclusion, the HBVF can be an important tool to determine prognosis, and it can be measured using the volume fraction approach of stereological methods as developed in the present study.Öğe Prognostic value of serum zinc levels in critically ill patients(W B SAUNDERS CO-ELSEVIER INC, 2011) Cander, Basar; Dundar, Zerrin Defne; Gul, Mehmet; Girisgin, SadikPurpose: We investigated the hypothesis that a decline in serum zinc concentrations among critically ill patients is related to mortality, length of stay in the intensive care unit, and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment (SOFA) scores. Materials and Methods: All the patients (>= 18 years old) presenting to the intensive care unit from September 2009 through November 2009 were enrolled the study. Patients' demographic characteristics and Acute Physiology and Chronic Health Evaluation and SOFA scores were recorded. Blood samples were collected within 24 hours after admission and analyzed for serum zinc, copper, C-reactive protein, and albumin levels. Patients were followed up for mortality and length of stay in the intensive care unit for 28 days. Results: A total of 36 patients, with a median age of 70.5 years (range, 18-87 years), were enrolled during the study period. Serum zinc levels were found to be inversely correlated with SOFA scores (r = -0.41, P < .01). Patients with SOFA scores of 8 or higher had significantly lower serum zinc levels compared with patients with SOFA scores lower than 8 (6.74 +/- 1.63 and 9.17 +/- 2.76 mu mol/L, respectively; P < .01). Conclusion: The result of this study supports the fact that organ failure and critical illness lead to a decline in serum zinc concentrations and that administration of zinc may be beneficial for critically ill patients. (C) 2011 Elsevier Inc. All rights reserved.Öğe The prognostic value of the Glasgow coma scale, serum acetylcholinesterase and leukocyte levels in acute organophosphorus poisoning(K FAISAL SPEC HOSP RES CENTRE, 2011) Cander, Basar; Dur, Ali; Yildiz, Mesut; Koyuncu, Feridun; Girisgin, Abdullah Sadik; Gul, Mehmet; Okumus, MehmetBACKGROUND AND OBJECTIVES: Organophosphate poisoning (OP) is a serious clinical condition that may sometimes be fatal. The aim of this study was to determine whether the Glasgow coma scale (GCS), and serum acetylcholinesterase and leukocyte levels have prognostic value in acute OP poisoning. DESIGN AND SETTING: Retrospective review of records of patients admitted to the intensive care unit of Selcuk University, Meram Medical Faculty, Emergency Department, Konya, Turkey, between January 2006 and January 2009. METHODS: We studied acutely OP-poisoned patients admitted within 24 hours after OP exposure. RESULTS: The mean age of the 25 patients was 37 years (range, 20-80 years). Three (12%) of the 25 patients (male-female ratio, 12: 13) died. The mean GCS values of the patients who died were significantly lower compared to those of the group that survived (4 vs 11.7, respectively P <.05). While the mean serum acetylcholinesterase levels were lower in the patients who died, the difference in the mean serum acetylcholinesterase levels between the patients who died and the ones who survived was not statistically significant (3841 IU/L vs. 1768 IU/L, respectively). CONCLUSION: Although serum cholinesterase values can be used in the quick diagnosis, their efficiency at predicting outcome in patients with OP poisoning has not been established. It has also been determined that serum leukocyte values have no prognostic value in OP poisoning, but GCS values have been found to be effective in predicting the outcome.Öğe The role of optic nerve ultrasonography in the diagnosis of elevated intracranial pressure(B M J PUBLISHING GROUP, 2007) Girisgin, Abdullah Sadik; Kalkan, Erdal; Kocak, Sedat; Cander, Basar; Gul, Mehmet; Semiz, MustafaObjective: To evaluate the convenience and utility of optic nerve ultrasonography ( ONUS) in the evaluation of emergency patients with elevated intracranial pressure (EICP) due to traumatic or non-traumatic causes. Methods: This study was conducted between May 2005 and December 2005 in the emergency department of Meram Faculty of Medicine, Selcuk University. Patients with traumatic or non-traumatic EICP were included in the study. Among these, 28 patients with EICP determined on cranial computed tomography (CCT) and a control group of 26 patients with no disease had the vertical and horizontal diameters of the optic nerves (ONs) of both eyes measured by ultrasonography ( US). The measurements were done by wetting the closed eyelids and using a 7.5-MHz linear probe. Results: Horizontal and vertical diameters of both ONs of the 54 patients were measured and the averages calculated. The mean (SD) ON diameter for the group suspected of having EICP was found to be 6.4 (0.7) mm, and that for the control group to be 4.6 (0.3) mm. In the statistical analysis carried out between these two groups (t test), the difference was found to be significant at p< 0.001. Conclusions: In detection and follow-up of EICP cases, such as cerebrovascular accident and trauma, ONUS is a practical, risk-free, inexpensive, convenient and, if performed by experts, reliable method. As a result, although CCT may be more useful in diagnosis, ONUS may be more efficient in detecting EICP. In those cases where CCT and other conventional imaging methods are not available, ONUS can facilitate the diagnosis and help in treatment.Öğe Stevens-Johnson syndrome due to concomitant use of lamotrigine and valproic acid(ADIS INT LTD, 2007) Kocak, Sedat; Girisgin, Sadik A.; Gul, Mehmet; Cander, Basar; Kaya, Halil; Kaya, EsengulStevens-Johnson syndrome (SJS) is a rare but life-threatening acute mucocutaneous hypersensitivity reaction, usually related to drugs. Severe cutaneous adverse effects such as SJS and toxic epidermal necrolysis can arise during treatment with antiepileptic drugs (AEDs). A 23-year-old female patient with idiopathic epilepsy was referred to the emergency service with fever, oral and genital mucosal lesions, generalized rash, and weakness. She had been taking carbamazepine, valproic acid, and lamotrigine until 1 week prior to referral. Following consultations with a range of clinicians, the patient was diagnosed with SJS related to lamotrigine on the basis of her history and physical findings, and on consideration of current consensus definitions of this condition. The patient was followed up and treated in the emergency intensive care unit with intravenous fluids, antibacterial therapy, and methylprednisolone. After 18 days, the patient was considered to have made a sufficient recovery and was discharged. Patients who undergo therapy with AEDs, particularly new users of these agents, should be informed of and monitored for possible systemic and cutaneous adverse effects of AEDs. Polytherapy should be avoided for as long as possible as this increases the frequency of adverse effects, and treatment should be discontinued if any rash appears.
