Publications by authors named "Afsin Ipekci"

8 Publications

  • Page 1 of 1

Efficacy of Serum Angiotensin II Levels in Prognosis of Patients With Coronavirus Disease 2019.

Crit Care Med 2021 Feb 26. Epub 2021 Feb 26.

Cerrahpasa Faculty of Medicine, Department of Emergency Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey. Cerrahpasa Faculty of Medicine, Department of Medical Biochemistry, Istanbul University-Cerrahpasa, Istanbul, Turkey. Cerrahpasa Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Istanbul, Turkey. Cerrahpasa Faculty of Medicine, Department of Intensive Care, Istanbul University-Cerrahpasa, Istanbul, Turkey.

Objectives: We aimed to determine serum angiotensin II levels in patients with coronavirus disease 2019 infection and to investigate the effect of these levels on the prognosis of the disease.

Design: The study was planned prospectively and observationally.

Setting: The study was conducted in a tertiary university hospital.

Patients: Coronavirus disease 2019 patients older than 18 years old, polymerase chain reaction test positive, with signs of pneumonia on tomography, and hospitalized were included in the study. ICU need, development of acute respiratory distress syndrome, and in-hospital mortality were considered as primary endpoints.

Interventions: Blood samples were taken from patients three times for angiotensin II levels.

Measurements And Main Results: Angiotensin II levels were studied by enzyme-linked immunosorbent assay method. The SPSS 24.0 program (Statistics Program for Social Scientists, SPSS, Chicago, IL) was used to analyze the data. A total of 112 patients were included in the study, of which 63.4% of the patients were men. The serum angiotensin II levels were statistically significantly lower in the patients with coronavirus disease 2019 compared with the healthy control group (p < 0.001). There was no statistical significance between the serum angiotensin II levels measured at three different times (p > 0.05). The serum angiotensin II levels of the patients with acute respiratory distress syndrome were found to be statistically significantly lower than those without acute respiratory distress syndrome in three samples collected at different clinical periods (p < 0.05). The angiotensin II levels of the patients who required admission to the ICU at all three times of blood sample collection were found to be statistically significantly lower than those who did not (p < 0.05). Although the serum angiotensin II levels of the patients who died were low, there was no statistically significant difference in mortality at all three times (p > 0.05).

Conclusions: The serum angiotensin II levels decrease significantly in patients with coronavirus disease 2019, and this decrease is correlated with lung damage.
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http://dx.doi.org/10.1097/CCM.0000000000004967DOI Listing
February 2021

Chest Computed Tomography Findings of Eight Patients With Covid-19 Diagnosis: Case Series.

Acta Biomed 2021 01 19;91(4):e2020136. Epub 2021 Jan 19.

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COVID-19 is an infectious disease caused by the virus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and declared a pandemic on March 11, 2020, by the world health organization. In Turkey, the first cases began to appear on March 11, 2020. After the cases in China, the appearance of ground glass with or without consolidation in the posterior and periphery of the bilateral lung is determined as the main finding of COVID-19. In this article, we wanted to share the tomography findings of eight patients who were diagnosed with COVID-19 in our emergency department and who had lung involvement.
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http://dx.doi.org/10.23750/abm.v91i4.9722DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927549PMC
January 2021

Tacrolimus-Induced Vision Loss in a Renal Transplant Patient: Posterior Reversible Encephalopathy Syndrome.

Exp Clin Transplant 2019 May 17. Epub 2019 May 17.

From the Cerrahpasa Medical Faculty, Istanbul University Cerrahpasa, Istanbul, Turkey.

Posterior reversible encephalopathy syndrome is a rare and serious neurologic adverse effect of calcineurin inhibitors. The pathophysiology of this clinical entity is still unclear. Impaired cerebral autoregulation and endothelial dysfunction are thought to be the main pathologic processes. Imaging shows the syndrome to be characterized by vasogenic edema or cytotoxic edema in parietal and occipital areas of the brain. With regard to clinic presentation, headache, diminished visual acuity, cortical blindness, altered consciousness, seizures, and hallucinations can be seen. It is known that the clinical presentation is improved when calcineurin inhibitors are stopped early. Here, we present and evaluate a case of a cortical blindness that developed in a 36-year-old patient who had been using tacrolimus after renal transplant and who returned to health after 1 week of hospitalization.
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http://dx.doi.org/10.6002/ect.2018.0193DOI Listing
May 2019

Bleeding Complications in Warfarin-Treated Patients Admitted to the Emergency Department.

J Clin Med Res 2019 Feb 5;11(2):106-113. Epub 2019 Jan 5.

Department of Emergency Medicine, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey.

Background: Increased use of warfarin for the treatment and prophylaxis of many diseases has increased the frequency of adverse events. Emergency departments (EDs) are the first places where early interventions for bleeding and other complaints related to warfarin use are performed. This study assessed the characteristics of patients receiving warfarin and the risk factors for bleeding complication among those admitted to the ED.

Methods: Patients admitted to the ED for any reason other than trauma during a 1-year period were retrospectively reviewed. The study population consisted of 96 patients who had received warfarin and had an international normalized ratio (INR) ≥ 3. Patient demographics and medical history were recorded.

Results: The mean age of the patients (female, 52.1%) was 64.9 ± 14.5 years. Fatigue was the most common presenting complaint (61%). At least one major and/or minor bleeding event had occurred in 32 (33.3%) of the patients. Patients with (n = 32) and without (n = 64) bleeding complications did not significantly differ with respect to age, sex, reason for warfarin initiation, duration of warfarin use, concomitant diseases, and concurrent medications. There were also no significant differences in the distribution of patient admissions in terms of season at presentation, INR level, and weekly warfarin dose.

Conclusions: While the parameters evaluated in this study did not significantly differ among warfarin-treated patients, they may nonetheless pose a risk of bleeding. Further large-scale and long-term studies that take into account biological variation are required to precisely identify the risk factors for bleeding.
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http://dx.doi.org/10.14740/jocmr3669DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340679PMC
February 2019

Beware Postpartum Shortness of Breath.

Pak J Med Sci 2015 Sep-Oct;31(5):1280-2

Ibrahim Ikizceli, MD, Professor, Department of Emergency Medicine, Sisli Hamidiye Etfal Education & Training Hospital, Istanbul, Turkey.

Peripartum cardiomyopathy (PPCM) is one of the potentially life-threatening complications of pregnancy. We report a case of a 36-year-old female patient who presented with shortness of breath, swelling of feet after giving birth to triplets, and her tests revealed that left ventricle is dilated with its diameter on the borderline and she had EF 35% with advanced systolic dysfunction. Anterior wall and septum were severely hypokinetic. In the presence of these findings, the patient was evaluated as PPCM. PPCM must be considered in the differential diagnosis of a patient presenting with shortness of breath and swelling of feet, which are also common in pregnancy.
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http://dx.doi.org/10.12669/pjms.315.8060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4641300PMC
December 2015

Importance of neutrophil gelatinase-associated lipocalin in differential diagnosis of acute and chronic renal failure.

Iran Red Crescent Med J 2014 Aug 5;16(8):e14133. Epub 2014 Aug 5.

Department of Emergency Medicine, Faculty of Medicine, Erciyes University, Kayseri, Turkey.

Background: Neutrophil Gelatinase-associated Lipocalin (NGAL) protein is easily detected in the blood and urine soon after acute renal injury. NGAL gains features of an early, sensitive and noninvasive biomarker for acute renal injury. Recent evidences suggest that its expression is also increased in CRF reflecting the severity of disease.

Objectives: In the present study, we aimed to investigate whether blood NGAL level plays a role in the differential diagnosis of acute and chronic renal failure.

Patients And Methods: This was a prospective case-control study. Fifty patients presented to emergency department with acute renal failure (ARF), 30 with chronic renal failure (CRF) and 20 healthy individuals as control group were included in this study. Blood pH, HCO3(-), BUN, creatinine and potassium values were evaluated in all patients. Blood NGAL values were evaluated in all groups. BUN, serum creatinine and NGAL values were statistically compared between patients and controls.

Results: Median NGAL levels in patients was 304.50 (29), and 60 (0) in control, which was statistically significant between the two groups (Z = -6.477, P < 0.001). The median NGAL values were 261.50 ± 291 in ARF group and 428.50 ± 294 in CRF group. There was a significant difference in NGAL level between ARF and CRF groups (Z = -2.52, P = 0.012). Median BUN values were 153.46 ± 82.47 in ARF group and 169.40 ± 93.94 in CRF group. There was no significant difference in BUN value between ARF and CRF groups (P > 0.05). Median creatinine values were 2.84 ± 2.95 in ARF group and 4.78 ± 4.32 in CRF group. In serum creatinine values, a significant difference was found between ARF and CRF groups (P < 0.05).

Conclusions: Serum NGAL levels of ARF and CRF patients were significantly higher than healthy individuals. In addition, NGAL values of patients with CRF were significantly higher than those of ARF. Serum NGAL values can be used to detect renal injury and differentiate ARF and CRF.
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http://dx.doi.org/10.5812/ircmj.14133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4222006PMC
August 2014

Value of heart-type fatty acid-binding protein (H-FABP) for emergency department patients with suspected acute coronary syndrome.

Afr Health Sci 2014 Sep;14(3):757-62

Faculty of Cerrahpaşa Medicine, Đstanbul University, Emergency department.

Objective: The aim of this study is testing the value of H-FABP in the early diagnosis of ACS alone or with routinely used biomarkers such as myoglobin, CK-MB, and cTn I in patients who admitted to emergency department (ED) with complaint of chest pain and suspected acute coronary syndrome.

Material And Methods: This prospective and cross-sectional study was performed at the Emergency Department of University hospital between June 2009 and September 2010. Patients who were admitted with chest pain within first 48 hours and suspected ACS were enrolled to the study. Blood samples were taken for CK-MB, myoglobin, cTnI and H-FABP The patients were divided into two groups (ACS and non ACS). Statistical analyse were used for relation of biomarkers with diagnosis of ACS.

Results: A 66 patients were included to the study. H-FAPB values were positive in 15.2% patients. When H-FABP was added to routinely used biomarkers in the diagnosis of ACS, increasing was observed in all sensitivity, specificity, PPV and NPV values. However, this increase was not statistically significant.

Conclusion: H-FABP did not provide any significant change in early diagnosis and exclusion of ACS diagnosis when used either alone or combination with routinely used biomarkers.
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http://dx.doi.org/10.4314/ahs.v14i3.36DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4209662PMC
September 2014

Contrast-induced nephropathy risk due to emergency contrast-enhanced computed tomography.

Eur J Emerg Med 2012 Feb;19(1):20-3

Department of Emergency Medicine, Erciyes University Medical School, Kayseri, Turkey.

Objective: In this study, we aimed to compare serum creatinine, blood urea, and glomerular filtration rate (GFR) levels of patients at baseline and 48 h after the administration of radiocontrast agent in the emergency department.

Method: We prospectively enrolled 114 patients who underwent contrast-enhanced computed tomography scan and had a baseline creatinine level of 1.5 mg/dl or less. Serum creatinine and blood urea levels were measured at baseline and 48 h after the administration of radiocontrast agent. GFR and Mehran risk score were calculated at baseline and 48 h after the administration of radiocontrast agent.

Results: Baseline mean serum creatinine was 1.03±0.25 mg/dl. Forty-eight hours after the administration of radiocontrast agent, mean serum creatinine was 1.04±0.31 mg/dl, baseline mean blood urea was 8.14±4.04 mmol/l, mean blood urea was 8.42±4.42 mmol/l, baseline mean GFR was 76.74±27.08 ml/min, and mean GFR was 77.21±27.92 ml/min. There were no significant differences between baseline and 48 h after the administration of radiocontrast agent serum creatinine, blood urea levels, and GFR (P>0.05).

Conclusion: There was no statistically significant difference between basal and 48 h after the administration of radiocontrast agent serum creatinine and GFR levels of patients who were enrolled in this study. Results had shown that administration of intravenous radiocontrast agent (≤100 ml) for emergency imaging in the emergency department did not produce a risk for contrast-induced nephropathy in patients with serum creatinine levels of 1.5 mg/dl or less.
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http://dx.doi.org/10.1097/MEJ.0b013e32834749b3DOI Listing
February 2012