Publications by authors named "Ibrahim Ikizceli"

33 Publications

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

Interpretation of the effect of CYP2C9, VKORC1 and CYP4F2 variants on warfarin dosing adjustment in Turkey.

Mol Biol Rep 2019 Apr 2;46(2):1825-1833. Epub 2019 Feb 2.

Department of Molecular Medicine, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.

It was aimed to underline the importance and explain the meaning of genetic testing in warfarin dosing and investigate and evaluate the contributions of the CYP2C9, VKORC1, and CYP4F2 variants in a Turkish population. Two hundred patients were genotyped for CYP2C9 (rs1799853, rs1057910 and rs56165452), VKORC1 (rs9934438, rs8050894, rs9923231, rs7294 and rs2359612) and CYP4F2 (rs2108622), yet, only 127 patients were found suitable for further evaluation in terms of their personal response to warfarin due to long term usage and available INR and dose usage information. The DNA sequences were determined by the ABI PRISM 3100 Genetic Analyzer to 3130xl System (Applied Biosystems, Foster City, California). Warfarin dose application suggestions by warfaringdosing.org, FDA and MayoClinic were followed. Dose requirements in the Turkish population were found higher than the suggested doses by warfarindosing.org. The multivariate logistic regression analysis reveals the utilization of VCORC1 genetic evaluation is valuable in warfarin dosing (low and moderate vs. high) in this study (p < 0.001). The present study provides findings for clinicians to adapt the genetic data to the daily practice. We observed that the VKORC1 variant showed a more potent impact in warfarin dosing in this study.
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http://dx.doi.org/10.1007/s11033-019-04634-9DOI Listing
April 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

Role of H-FABP values in determining the etiologic factors of the cardiac injuries.

Pan Afr Med J 2017 24;26:36. Epub 2017 Jan 24.

Sisli Hamidiye Etfal Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey.

Introduction: Cardiac injury resulting from blunt thoracic trauma is a frequent clinical occurrence which is difficult to diagnose. Our purpose in this study was to research whether H-FABP, which is a new marker for the diagnosis of cardiac injury, can be used in this patient group.

Methods: 50 patients with blunt thoracic injury who were admitted to our emergency service within a period of 8 months and 50 cases as controls were included in our study.

Results: Of the 50 patients with blunt thoracic injury in our study, 88% were male while 12% were female. The average age of the patients was 43 ± 15.15. While 27 (54%) of the 50 patients with blunt thoracic injury had cardiac injury, 23 (46%) did not have cardiac injury. The results of the statistical analyses showed a significant association between thorax trauma and cTnI, CPK, CPKMB and H-FABP (p<0.05). While there was a significant association between cardiac injury resulting from thoracic trauma and cTnI, ECG and TTE (p<0.05), there was no significant association between CPK, CPKMB and H-FABP (p>0.05).

Conclusion: In thoracic traumas, cardiac injury diagnosis can be made as a result of the assessment with Troponin-I, ECG and ECHO. For cardiac injury diagnosis, wide scale prospective studies are needed for H-FABP use.
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http://dx.doi.org/10.11604/pamj.2017.26.36.8746DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398237PMC
June 2017

Heart-type fatty acid binding protein and cardiac troponin I may have a diagnostic value in electrocution: A rat model.

J Forensic Leg Med 2016 Apr 22;39:76-9. Epub 2016 Jan 22.

Department of Emergency Medicine, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey.

Although cardiac injury is known to be the leading cause of death in electrocution, the differential diagnosis can be challenging in forensic practice since the exact mechanism is poorly understood and there is lack of reliable markers. Thus, death due to electrocution may be classified as a negative autopsy. The serum levels of and myocardial immunostaining loss for cardiac troponins and heart-type fatty acid binding protein (H-FABP) are highly sensitive and specific biomarkers of ischemic myocardial damage and may have a diagnostic value in determining the myocardial injury or the cause of death due to electrocution. Due to this reason, a rat model is prepared to investigate these issues. Thirty-two Wistar albino female rats were included and randomly divided into four groups of eight subjects. Group A was the control group, and Group B, C, and D were exposed to electrical current of 110 volt (V), 220 V, and 600 V, respectively. Blood samples and the hearts were collected from the rats for biochemical and immunostaining analyses. It is found that increased serum H-FABP levels were significantly associated with the higher voltage immediately after electrocution. However, serum cardiac troponin I (cTnI) levels did not show significant changes associated with the higher voltage in the early period of electrocution. As for histopathological examinations, the only significant difference in myocardial immunostaining loss was for H-FABP in Group B. Serum H-FABP levels may have a diagnostic value in the early postmortem period immediately after electrocution. Besides, it seems that serum H-FABP levels may be a better indicator than those of cTnI to reflect the myocardial damage in the early period of the electrocution.
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http://dx.doi.org/10.1016/j.jflm.2016.01.015DOI Listing
April 2016

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

Low Colonization is Associated with Reduced Bone Mineral Density in Urinary Stone Forming Patients.

Curr Urol 2015 Dec 10;8(4):189-193. Epub 2015 Nov 10.

Zeytinburnu District Directorate of Health, Medipol University, Istanbul, Turkey.

Introduction: Lower bone mineral density (BMD) and reduced colonization are common findings in urolithiasis patients. But none of the studies conducted investigated the relationship between decreased bone mineral density and reduced Oxalobacter colonization. Here we evaluated the relation between BMD and colonization in urolithiasis patients.

Materials And Methods: 50 stone formers (48.9 ± 11.9 years) and 50 control (47.2 ± 13.4 years) adult male subjects were included in the study. Alterations in colonization were determined as absolute count from fecal samples by real time polymerase chain reaction using species specific primers. BMD was evaluated from t- and z- scores calculated by using dual energy absorptiometry in the total femoral neck and lumbar spine (L2-L4).

Results: Low BMD was observed in 18 (36%) urinary stone forming patients and in 7 (14%) control subjects in the lumbar area (p < 0.05). The mean count in stone formers and control subjects were 19,257 (5,791 ± 1,117.93) and 143,850 (2,815,725 ± 3,946,044.7) (p < 0.05) respectively. We observed a correlation between decreased lumbar BMD and colonization and testosterone levels in stone formers. Our results indicated that diminished colonization in the gut of urinary stone forming subjects was associated with reduced BMD.
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http://dx.doi.org/10.1159/000365715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6151321PMC
December 2015

Does usage of peritonism tests in an emergency department have any benefit?

Med Glas (Zenica) 2014 Feb;11(1):105-9

1Department of Emergency Medicine, Canakkale Onsekiz Mart University Medical School, Canakkale, 2Erciyes University Medical School, Departments of Emergency Medicine, Kayseri, Turkey, 3Department of Emergency Medicine,Istanbul University Cerrahpasa Medical School; Istanbul, Turkey.

Aim: To evaluate the usage of inspiration, expiration, cough, and heel drop jarring tests that are applied for determination of peritonism in cases with acute abdominal pain.

Methods: A prospective study based on observation of patients between 16-65 years of age and presented to the Emergency Department within a 3-month period starting from June 2007, was conducted. The patients were asked to rate their pain level between "0" and "10". Following the measurement of the vital signs, 4 tests were conducted by an emergency medicine resident. The medical records of all the patients were reviewed after 3 months. Data concerning clinical diagnosis, hospital admission and discharge processes, and surgical results, were all recorded.

Results: Seventy-seven patients had peritonism tests performed. Inspiration test was positive in 29 (of 51, 56.9%) patients admitted to the hospital. However, there was no correlation between the cases admitted to the hospital and the other 3 tests (p more than 0.05). Twenty-one (of 34, 61.8%) patients which have been subjected to surgical treatment, showed positive inspiration test results. Surgical treatment was performed on nine (of 11, 81.8%) patients who showed positive results for all 4 tests.

Conclusion: The applied tests are helpful in determining a serious abdominal disease, particularly alongside findings of rebound, tenderness, and laboratory results.
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February 2014

Value of the serum I-FABP level for diagnosing acute mesenteric ischemia.

Surg Today 2014 Nov 17;44(11):2072-6. Epub 2013 Dec 17.

Department of Emergency Medicine, Samsun Training and Research Hospital, Baris Bulvari Kadikoy Mahallesi no:199, İlkadim, Samsun, Turkey,

Purpose: This study examined the feasibility of using the serum intestinal fatty acid binding protein (I-FABP) level for the early diagnosis of acute mesenteric ischemia, and investigated whether it contributes to the clinical decision-making process.

Method: Thirty patients diagnosed with acute mesenteric ischemia, 27 patients with other types of acute abdomen who presented with acute abdomen symptoms but were not diagnosed with acute mesenteric ischemia, and 20 healthy people were included in the study. Mesenteric ischemia was confirmed by a pathological evaluation in patients who underwent intestinal resection due to detection of mesenteric ischemia during surgery.

Results: There was no significant difference in the leukocyte counts and D-dimer levels between subjects with mesenteric ischemia and acute abdomen due to other causes (p > 0.05). There was a significant difference in the serum I-FABP level between these groups (p < 0.001).

Conclusion: The I-FABP level is a more reliable parameter for diagnosing acute mesenteric ischemia compared to leukocytosis and D-dimer elevation.
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http://dx.doi.org/10.1007/s00595-013-0810-3DOI Listing
November 2014

A giant tumor thrombi filling right ventricle in a thrombocytopenic patient with renal cell carcinoma.

Anadolu Kardiyol Derg 2012 Apr 20;12(3):E11. Epub 2012 Apr 20.

Department of Cardiology, Faculty of Cerrahpaşa Medicine, İstanbul University, Turkey.

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http://dx.doi.org/10.5152/akd.2012.084DOI Listing
April 2012

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

Machine-related farm injuries in Turkey.

Ann Agric Environ Med 2010 ;17(1):59-63

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

Traumas connected with agricultural production can result in serious injuries and mortality. The objective of the study was to describe the characteristics of agricultural machines related work injury cases admitted to the Emergency Department, and to asses factors related to injury severity and hospital admission in the Central Anatolian Region of Turkey. All the cases presented related to injuries caused by work with agricultural machines between January 2006-November 2007 were included in the study. Information was collected concerning the demographic structures of the patients. Injury sites, injury types, and clinical features were recorded. Initial injury severity scores of all the cases were diagnosed at hospital admission. 91.9 percent of the cases were male. Mean age was 35.8 +- 17.0. The most common machine causing injuries was a tractor with 46 percent of cases, and all of these were fall traumas. 18.9 percent of the cases was considered as slight injury, 43.2 percent as moderate, and 37.9 percent as severe. Two male cases resulted in fatality. Our findings suggest that tractors are the most dangerous agricultural machines, and falls from tractors as the most common injury mechanism among machine-related injuries, especially for young people. In the rural areas of our country, Turkey, agricultural machines cause serious injuries that require hospitalization.
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February 2011

The role of heart-type fatty acid-binding protein in predicting properties of coronary atherosclerosis in patients with acute coronary syndrome.

Coron Artery Dis 2010 Nov;21(7):435-40

Department of Cardiology, Erciyes University, Kayseri, Turkey.

Introduction: Fatty acid-binding protein (FABP) is an independent predictor of cardiac events. However, the relation between increasing FABP and coronary atherosclerosis is unknown. We have investigated the relation between FABP and angiographic properties of coronary atherosclerosis in patients with acute coronary syndrome (ACS).

Methods: The study population consisted of 93 patients with ACS (mean age: 56±10 years). Patients presenting to the emergency department within 2 h after onset of anginal symptoms were enrolled in the study. FABP was measured at second, fourth and sixth hours of chest pain. Cut-off FABP was accepted as 1.9 ng/ml. Coronary atherosclerosis was assessed with diseased vessel number (≥50 and ≥70% luminal narrowing), Gensini and extent scores.

Results: Median FABP-2 was 2.9 ng/ml (interquartile range: 1.6-10.4). Peak FABP was measured at fourth hour [median: 35.0 ng/ml (interquartile range: 2-77)]. There was a nonsignificant relation between angiographic findings and FABP-2. At fourth hour, Gensini, extent score and diseased vessel number were significantly higher above the cut-off level of FABP-4 (Gensini score: 3.7±3.4 vs. 6.2±3.4, P=0.005; extent score: 11.1±10 vs. 22.3±19.2, P=0.007; diseased vessel: 0.7±0.6 vs. 1.6±1.0, P=0.003, respectively). The sensitivity of FABP-2 for at least 50% lesion was 70%. The highest sensitivity was obtained at fourth hour (85% for ≥50% and 88% for ≥70% lesions). The sensitivity and positive predictive values for revascularization were 70 and 77% for FABP-2, 89 and 80% for FABP-4 and 89 and 81% for FABP-6.

Conclusion: FABP levels are closely related with angiographic properties of patients with ACS. FABP may be an early and important marker for predicting the coronary anatomy and decision of treatment.
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http://dx.doi.org/10.1097/MCA.0b013e32833db539DOI Listing
November 2010

Occupational injuries admitted to the Emergency Department.

Ulus Travma Acil Cerrahi Derg 2010 May;16(3):241-7

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

Background: We aimed to identify the characteristics, causes and rates of injuries associated with occupational accidents.

Methods: Patients who presented to the Emergency Department due to injuries occurring as a result of occupational accidents were determined retrospectively. In occupational injuries, several parameters were evaluated, such as gender, occurrence mechanism, injury type, injury localization, severity score of the injury, and the type of profession.

Results: The number of occupational injury admissions in the Emergency Departments of our two centers during 2006 was 1038. Mean age of the cases was 31.6+/-9.6. The most common mechanism of injuries was determined to be caught-in-machinery, at 31.5%, followed by blunt object injury (21.5%), fall from height (18.9%), penetrating-sharp object injury (17%), ocular foreign body (3.9%), and others. Isolated extremity injuries (74.2%) were the most common injury site, followed by multiple bodily injuries (8.5%), facial injuries (5.5%) and head-neck injuries (4.6%). While 90% of cases were discharged after treatment in the Emergency Department, 7% were referred to various departments for hospitalization.

Conclusion: In the majority of cases, patients with injuries associated with occupational accidents presented to Emergency Departments. Observations in Emergency Departments may help reveal details of occupational injuries and prevent workplace-related accidents.
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May 2010

Poisoning severity score, Glasgow coma scale, corrected QT interval in acute organophosphate poisoning.

Hum Exp Toxicol 2010 May 4;29(5):419-25. Epub 2010 Mar 4.

Canakkale Onsekiz Mart University Faculty of Medicine, Department of Emergency Medicine, Canakkale, Turkey.

The aim of this study was to investigate effectiveness of the poisoning severity score (PSS), Glasgow coma scale (GCS), and corrected QT (QTc) interval in predicting outcomes in acute organophosphates (OP) poisoning. Over a period of 2 years, 62 patients with OP poisoning were admitted to emergency department (ED) of Erciyes University Medical School Hospital. The age, sex, cause of contact, compound involved, time elapsed between exposure and admission to the ED, duration of hospital stay, and cardiac manifestations at the time of presentation were recorded. GCS and poisoning severity score (PSS) was calculated for each patient. Electrocardiogram (ECG) analysis included the rate, rhythm, ST-T abnormalities, conduction defects, and measurement of PR and QT intervals. Sixty-two patients with OP poisoning presented to our ED from January 2007 to December 2008 from which 54 patients were included in the study. The mean age was 34.1 +/- 14.8 years. Of the cases, 53.7% were female. Twenty-six patients had a prolonged QTc interval. Mean PSS of men and women was 1.8 +/- 1.0. No statistically significant correlation was found between the PSS and QTc intervals of the cases. A significant correlation was determined between the GCS and PSS of grade 3 and grade 4 cases. GCS is a parameter that helps clinician to identify advanced grade OP poisoning patients in the initial assessment in the ED. However, ECG findings, such as prolonged QTc interval, are not effective in determination of short-term prognosis and show no relationship with PSS.
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http://dx.doi.org/10.1177/0960327110364640DOI Listing
May 2010

The effect of rapid blood pressure control on P-wave dispersion in hypertensive urgency.

Adv Ther 2008 Dec;25(12):1303-14

Department of Cardiology, Firat University Hospital, Elazig, Turkey.

Introduction: A sharp increase in blood pressure, increase in atrial pressure and atrial strain, left ventricular diastolic dysfunction, and left ventricular hypertrophy (LVH) lead to heterogeneity and instability in atrial conduction. The resulting physiopathological situation may elevate maximum Pwave duration (P(max)) and P-wave dispersion (PWD) in electrocardiography. The objective of our study was to explore the effect of the sudden change in atrial hemodynamics on P(max) and PWD, which may indicate the risk of atrial fibrillation (AF) development in hypertensive urgency.

Methods: The study included patients diagnosed as hypertensive urgency (systolic blood pressure > or =180 mmHg, diastolic blood pressure > or =110 mmHg). Nitroprusside was started at a dose of 0.2 microg/kg/min, and the ensuing dose was arranged according to blood pressure. Echocardiography and electrocardiography were used to noninvasively measure changes in diastolic function and PWD and P(max), respectively.

Results: The study enrolled 102 patients (mean age 57.9+/-11.6 years; 32 [31.4%] males, and 70 [68.6%] females). P(max) decreased from 99.9+/-11.1 msec (95% confidence intervals [CI] 97.7, 102) to 88.5+/-9.3 msec (95% CI 86.6, 90.3) (P<0.001), while PWD decreased from 60.1+/-7.4 msec (95% CI 58.7, 61.6) to 43.9+/-6.7 msec (95% CI 42.5, 45.2) (P<0.001). In addition, most patients had LVH and diastolic dysfunction. After nitroprusside treatment improvements in indicators of diastolic functions such as E/A ratio, deceleration time, and isovolumetric relaxation time were observed.

Conclusion: The change observed in P(max) and PWD in hypertensive urgency may be associated with the rapid change in blood pressure and atrial strain, sympathetic nervous system activation, relative myocardial ischemia, and left ventricular diastolic dysfunction. Rapid regulation of blood pressure with nitroprusside brought about a marked decrease in P(max) and PWD in our patients. This improvement was interpreted as atrial conduction acquiring a stable and homogeneous character, which may reduce the risk of AF development in hypertensive urgency.
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http://dx.doi.org/10.1007/s12325-008-0120-0DOI Listing
December 2008

The effect of piracetam on brain damage and serum nitric oxide levels in dogs submitted to hemorrhagic shock.

Ulus Travma Acil Cerrahi Derg 2008 Oct;14(4):277-83

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

Background: To demonstrate the effect of piracetam on changes in brain tissue and serum nitric oxide levels in dogs submitted to hemorrhagic shock.

Methods: The subjects were randomized into four subgroups each consisting of 10 dogs. Hemorrhagic shock was induced in Group I for 1 hour and no treatment was given to this group. Blood and saline solutions were administered to Group II following 1 hour hemorrhagic shock. Blood and piracetam were given to Group III following 1 hour shock. No shock was induced and no treatment was applied to Group IV. Blood samples were obtained at the onset of the experiment and at 60, 120 and 180 minutes for nitric oxide analysis. For histopathological examination, brain tissue samples were obtained at the end of the experiment.

Results: The observed improvement in blood pressure and pulse rates in Group III was more than in Group II. Nitric oxide levels were increased in Group I; however, no correlation between piracetam and nitric oxide levels was determined. It was seen that recovery in brain damage in Group III was greater than in the control group.

Conclusion: Piracetam, added to the treatment, may ecrease ischemic damage in hemorrhagic shock.
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October 2008

Experiences with endosulfan mass poisoning in rural areas.

Eur J Emerg Med 2009 Feb;16(1):53-6

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

This paper describes very rare chemical poisoning and characteristics of patients with acute endosulfan mass poisoning in a rural area of Turkey and our experiences of these patients. We included 41 patients who were treated in our hospital with the diagnosis of endosulfan poisoning. After the first vital intervention they were examined in terms of age, sex, symptoms and physical examination findings, laboratory results, treatment and outcome. Forty-one patients were admitted to the emergency department (ED) after triage. Nineteen (46.3%) of the patients were female, 22 (53.7%) were male. The mean age was 27.9+/-16.0 years (1-67 years). The mean time to the ED was 4.1+/-0.9 h (3-6.5 h). The most common symptoms were anxiety (97.6%), nausea (56.1%) and vomiting (48.8%). Tests of the blood samples obtained at the ED revealed leucocytosis (11 070.6+/-4302.5/microl), increased blood glucose, LDH, CK and CK-MB levels. Toxicological analysis of blood and urine samples revealed endosulfan as the causative agent. Especially in the rural areas, cases with acute repetitive seizures should suggest endosulfan intoxication when the aetiology is uncertain even in the absence of any signs of intoxication. Health care professionals should understand the hazards associated with the pesticide use as well as diagnosis and treatment of these types of poisonings.
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http://dx.doi.org/10.1097/MEJ.0b013e3283088e2bDOI Listing
February 2009

[Injuries due to parachute jumping].

Ulus Travma Acil Cerrahi Derg 2008 Jul;14(3):201-4

Department Of General Surgery, Erciyes University Medical School, Kayseri, Turkey.

Background: Parachuting is performed for sportive and occupational purposes and demands a high level of controlled physical performance. In conjunction with the growing interest in parachuting, injury rates in the emergency departments are also increasing. We thus aimed to evaluate the mechanism and characteristics of injuries due to parachuting.

Methods: Parameters of the patients injured and presenting to the emergency department, including mean age, body area exposed to injury, definite diagnosis, applied treatment modalities, and admission to/discharge from the hospital, were all recorded in a previously prepared form and analyzed. Degree of injury was detected by calculating the Injury Severity Score (ISS) using the Abbreviated Injury Scale (AIS).

Results: Mean ISS of the patients was 8.15+/-4.29. The most commonly affected body sites were the extremities. Of the extremity injuries, 13 (81%) involved lower extremities and 3 (19%) involved upper extremities. The most commonly affected site in the lower extremities was the ankle (47%). Head injuries followed extremity injuries as the second most affected site.

Conclusion: Injuries from parachute jumping mostly occur during landing due to loss of balance. Loss of balance was seen to result from change in wind direction and personal factors. When jumpers acquire adequate knowledge about phases of parachute jumping and landing, probability of injury will decrease.
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July 2008

Experimental inhalation of chlorine gas produced with a different method; effects of N-acetyl cysteine on acute pulmonary damage.

Toxicol Mech Methods 2008 Jan;18(9):739-43

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

ABSTRACT The two most common gas inhalation injuries encountered in emergency departments are carbon monoxide and chlorine inhalations. In this study, chlorine was produced through a method different to the previous experimental models. Rats were subjected to inhale chlorine, after which the effects of N-acetylcysteine on pulmonary damage were evaluated. A total of 50 rats were equally divided into five groups. Group 1 received nothing. Groups 2 and 3 were taken as 6 h, groups 4 and 5 as 24 h control and N-acetylcysteine groups, respectively. Firstly, 200 ppm chlorine gas was given for 20 min. Then, 40 mg/kg N-acetylcysteine was given intraperitoneally. The same procedure with the same dose was repeated 3 h later. The same procedures were applied to the control group but this time saline was used. Tissue samples of lungs were taken. Glutathione levels of the rats in the N-acetylcysteine group sacrificed at 24 h were significantly higher than those of the control group. Histopathological evaluation of the pulmonary tissues of the rats sacrificed at 6 and 24 h revealed mild-to-moderate degrees of tissue damage. The degree of tissue damage at 6 h and 24 h N-acetylcysteine group rats was lower than that in the control group. As a result, tissue damage resulting from experimental chlorine inhalation can be alleviated by N-acetylcysteine. This is mainly the result of the antioxidant effects of the N-acetylcysteine.
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http://dx.doi.org/10.1080/15376510802354912DOI Listing
January 2008

Acute organophosphate poisoning in university hospital emergency room patients.

Intern Med 2007 2;46(13):965-9. Epub 2007 Jul 2.

Department of Emergency Medicine, Kocatepe University Medical Faculty, Afyonkarahisar, Turkiye.

Objects: In the present study, we evaluated patients who were admitted to our emergency department with a diagnosis of organophosphate poisoning and discussed clinical, social and demographic features.

Methods: A retrospective study was conducted with organophosphate poisoning patients admitted to our emergency department between January 1995 and December 2004. Data regarding the age, sex, occupation, type of agent, route of poisoning, clinical effects of cholinergic overactivity, laboratory findings, and mortality rate were obtained from the patient files.

Results: During the study period, 220 patients who had organophosphate poisoning with a known agent were admitted to the ED. The estimated mean admission time to the ED after the exposure was 3.9 +/- 3.1 (1-14) hours. There were 131 (59.5%) female and 89 (40.5%) male patients. The most affected age group was 15-24 years (40.5%), in both sexes. Oral ingestion (86.5%) was found to be the most common route of poisoning. The most frequent reason for poisoning was attempted suicide (75.9%). The most common organophosphate compounds exposed were dichlorvos, diazinon and parathion-methyl. The most frequent clinical signs were miosis, respiratory system findings, tachycardia, loss of consciousness, and hypertension. Twenty patients (9.1%) died due to sudden respiratory and cardiac arrest (45%), respiratory failure (25%), CNS depression (5%) and septic shock (25%).

Conclusion: We think that the appropriate use of these compounds, instruction of the public about their harmful effects and restriction of their uncontrolled sales by legal regulations can reduce the incidence of organophosphate poisoning.
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http://dx.doi.org/10.2169/internalmedicine.46.6304DOI Listing
August 2007

Effect of interleukin-10 on tissue damage caused by organophosphate poisoning.

Basic Clin Pharmacol Toxicol 2007 May;100(5):323-7

Department of Emergency Medicine, Kocatepe University Medical Faculty, Afyon, Turkey.

Organophosphate poisoning is a common cause of severe morbidity and mortality among patients admitted to emergency departments. Tissue damages as a consequence of organophosphate poisoning are frequently reported, but preventing this potentially severe complication has not been the subject of much research. We tested whether interleukin-10, a cytoprotective agent, could prevent or diminish pathological signs of tissue damages caused by organophosphate poisoning. Thirty rats were divided into three equal groups (n = 10). Group 1 (sham) did not receive any agent during the experiment. Group 2 (control) received 0.8 g/kg of fenthion intraperitoneally, followed by 6 ml/kg of intraperitoneal normal saline 30 min and 3 hr later. Group 3 (treatment) received 0.8 g/kg of fenthion intraperitoneally, followed by 2 microg/kg of interleukin-10 intraperitoneally 30 min and 3 hr later. All rats were killed under anaesthesia after 6 hr and tissue samples were obtained from liver, kidneys and lungs. Even organophosphate poisonings do not cause significant clinical problems; several degrees of damages could be observed in liver, kidneys and lungs. These damages could be reduced by interleukin-10 treatment.
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http://dx.doi.org/10.1111/j.1742-7843.2007.00049.xDOI Listing
May 2007

Cardiovascular effects of carbon monoxide poisoning.

Am J Cardiol 2007 Feb 29;99(3):322-4. Epub 2006 Nov 29.

Department of Cardiology, Erciyes University, School of Medicine, Kayseri, Turkey.

Carbon monoxide (CO) poisoning is an important health problem. Cardiac abnormalities may occur in patients with CO poisoning; however, the severity and duration of cardiac abnormalities are not well known. In this study, cardiac structures and function in CO poisoning were evaluated prospectively. Twenty patients were enrolled in the study. Echocardiographic examination was performed in all patients on admission, at 24 hours, and within the first week. B-type natriuretic peptide and carboxyhemoglobin levels were measured. Patients with increased cardiac markers underwent coronary angiography. Cardiac markers were high in 6 patients. Patients with high cardiac markers had significantly higher carboxyhemoglobin levels and longer exposure to CO. Left ventricular ejection fraction (LVEF) was <45% in 8 patients (group I) on admission and >55% in 7 patients in group I 24 hours after echocardiography. A significant negative correlation was found between B-type natriuretic peptide and LVEF on admission (r = -0.586, p <0.01). The decrease in LVEF was also negatively correlated with carboxyhemoglobin level and CO exposure duration. All angiograms showed normal coronary arteries. In conclusion, despite normal coronary arteries, myocardial dysfunction may occur in patients with CO poisoning. LV systolic function might be normal or mildly to severely impaired. However, most of the myocardial dysfunction dissipates at 24 hours in patients with CO poisoning.
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http://dx.doi.org/10.1016/j.amjcard.2006.08.030DOI Listing
February 2007

Ocular trauma in Turkey: a 2-year prospective study.

Adv Ther 2006 Mar-Apr;23(2):274-83

Erciyes University Medical Faculty, Kayseri, Turkey.

This 2-year prospective study was conducted to identify those at risk for ophthalmologic emergencies, to define the risk factors and reasons for eye injuries, to analyze treatment options, and to compare findings with those of previous studies. A total of 203 patients (74% male, mean age 27.3+/-13.9 y, 51% right eye injuries, 44% left eye injuries, 5% bilateral injuries) with injury to 208 eyes who presented to the emergency department for treatment were included in this study. All patients were evaluated by an ophthalmologist, who completed a formal questionnaire. Information recorded included demographic data, details of the eye injury, whether eye protection was used, and the type, location, and mechanism of injury to the eye. Mechanism of injury was categorized as blunt, sharp, or a combination. The ophthalmologist reported the time that had passed between occurrence of injury and presentation for treatment. Each patient was examined by the ophthalmologist, and findings, diagnosis, and treatment were documented. Of treated patients, 93% were hospitalized, most of whom required surgical treatment. One hundred (48%) injuries were related to blunt trauma and 86 (41%) to sharp device trauma. Only 10 (4%) patients were wearing protective eyewear when injured. Ruptured globe was the most common diagnosis of hospitalized patients and the most frequent cause of this was corneal lesions; subconjunctival hemorrhage was the most common diagnosis among nonhospitalized patients. In this study, the leading cause of eye injury was workplace accidents, probably attributable to growing industrialization in the region. Ocular trauma continues to be an important health problem in Turkey. Investigators believe that with education about and use of proper eye protection, 90% of eye injuries could be prevented.
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http://dx.doi.org/10.1007/BF02850133DOI Listing
July 2006

[The effects of rapid and slow infusion of fluid on coagulation factors in hemorrhagic shock: an experimental dogs model].

Ulus Travma Acil Cerrahi Derg 2006 Apr;12(2):95-100

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

Background: The diagnosis of hemorrhagic shock in a patient with tachycardia and hypotension is generally straightforward. The difficulty lies in the selection of optimal approach for the patient. In this study on a canine model of deep hemorrhagic shock induced by bleeding, we used various amounts of fluid infusion to determine the most appropriate amount of fluid resuscitation.

Methods: The study included 30 mongrel dogs. Mongrel dogs were randomized to three equal groups of 10. The control group received no treatment. The rapid infusion group received 60 mL/kg of lactated Ringer's solution in half an hour whereas the third group received 30 mL/kg during the same time period.

Results: The lactate decreased in the two treatment groups. The platelet and fibrinogen levels did not vary in the slow infusion group but decreased markedly in the rapid infusion group.

Conclusion: In conclusion, fluid resuscitation should not be unnecessarily aggressive. The coagulation parameters are diluted in proportion with the amount of fluid given. Blood lactate level can be used as a guiding marker in evaluation of treatment effectiveness of hemorrhagic shock patients.
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April 2006

Acute amitraz poisoning in adults: clinical features, laboratory findings, and management.

Clin Toxicol (Phila) 2006 ;44(1):19-23

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

Background: Amitraz is a formamidine pesticide widely used in agriculture and veterinary medicine as an insecticide and acaricide. Reports on amitraz poisoning in humans are not as prevalent as those in animals. Of human intoxications in the medical literature, the majority of intoxications are in children. The number of adult intoxications with amitraz is limited.

Methods: In this study, we discuss the clinical features, laboratory findings, and management of 23 adults with amitraz poisoning cared for in our center. Data were extracted from the charts retrospectively, and included age, gender, mode of poisoning, initial symptoms, time to appearance of initial symptoms, clinical and laboratory findings, management, and prognosis.

Results: Fourteen of 23 patients were female (61%). Ages ranged from 16 and 78 years (mean 38.6 +/- 19.8 years). Twenty-one patients ingested amitraz orally while one was exposed through skin contact and one probably through skin contact and/or inhalation. Seven patients ingested amitraz with intent to commit suicide and 11 patients accidentally. Vomiting, altered consciousness, and drowsiness were the predominant initial symptoms. Initially, hypotension was present in seven patients (30%), bradycardia in two (8.7%), myosis in six (26%), and mydriasis (without atropine administration) in three (13%). Time to appearance of the initial symptoms ranged from 5 to 120 minutes. Laboratory findings included an initial blood glucose level higher than 120 mg/dL in 62% of patients (mean 191 +/- 70 mg/dL) and elevations in AST levels in four patients (81 +/- 28 U/L) and ALT levels in three (60 +/- 14 U/L). Ten patients had central nervous system depression, which resolved spontaneously. Five patients required mechanical ventilation for respiratory depression (mean duration of mechanical ventilatory support: 50 +/- 16 hours). Six patients were thought to have been poisoned with an organophosphate and three with a carbamate pesticide due to confusing clinical picture; four of these nine patients received pralidoxim.

Conclusions: In spite of a rapidly progressing and life-threatening clinical picture, amitraz intoxication in humans carries a low morbidity and mortality when appropriate supportive treatment is given. No antidote has been developed for use in more serious cases. To prevent accidental ingestions, prominent and clear warning labels should be placed on its containers.
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http://dx.doi.org/10.1080/15563650500357545DOI Listing
March 2006

[Juguler vein gunshot injury from blank cartridges].

Ulus Travma Acil Cerrahi Derg 2005 Jul;11(3):254-7

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

Blank cartridge guns, which are produced for self-defence needs and considered harmless, can be easily purchased by adults due to lack of legal regulations. We present this case because injuries caused by gunshot from blank cartridges may be fatal and are rarely encountered in emergency departments. A 3-year-old boy was brought to the emergency department since he had a wound on his neck caused accidentally by gunshot from blank cartridges. He had a moderate general condition and pale appearance. There was an irregular-edged, defective wound 2 cm above the sternal notch in midline localization with a dimension of 3 x 4 cm. Computed tomography of the thorax revealed contusion in the apex of the left lung. A 2-mm plastic piece embedded in the left internal jugular vein was removed during the operation. A mass education on danger and harm of these guns as well as legal regulations for restricted use seem to be necessary. Also, physicians should keep in mind that blank cartridge guns can cause fatal injuries.
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July 2005

Comparison of the effects of laser, ultrasound, and combined laser + ultrasound treatments in experimental tendon healing.

Lasers Surg Med 2004 ;35(1):84-9

Erciyes University Medical Faculty, Department of Physical Medicine & Rehabilitation, Kayseri, Turkey.

Background And Objective: Therapeutic ultrasound (US) and laser (L) treatments accelerate and facilitate wound healing, and also have beneficial effects on tendon healing. This randomized control study was designed to evaluate the effects of low-intensity US and low-level laser therapy (LLLT) on tendon healing in rats.

Study Design/materials And Methods: Eighty-four healthy male Swiss-Albino rats were divided into three groups consisting of 28 rats, the left Achilles tendons were used as treatment and the right Achilles tendons as controls. The right and left Achilles tendons of rats were traumatized longitudinally. The treatment was started on postinjury day one. We applied the treatment protocols including low-intensity US treatment in Group I (US Group), Sham US in Group II (SUS Group), LLLT in Group III (L Group), Sham L in Group IV (SL Group), US and LLLT in Group V (US + L Group), and Sham US and Sham L in Group VI (SUS + SL Group). The US treatment was applied with a power of 0.5 W/cm2, a frequency of 1 MHz, continuously, 5 minutes daily. A low-level Ga-As laser was applied with a 904 nm wavelength, 6 mW average power, 1 J/ cm2 dosage, 16 Hz frequency, for 1 minute duration, continuously. In the control groups, the similar procedures as in the corresponding treatment groups were applied with no current (Sham method). The treatment duration was planned for 9 days (sessions) in all groups, except the rats used for biochemical evaluation on the 4th day of treatment, which were treated for 4 days. We measured the levels of the tissue hydroxyproline for biochemical evaluation on the 4th, 10th, and 21st days following the beginning of treatment and the tendon breaking strength on the 21st day following the beginning of treatment for biomechanical evaluation. Seven rats in each group were killed on the 4th, 10th, and 21st days for biochemical evaluation and on the 21st day for biomechanical evaluation.

Results: The hydroxyproline levels were found to be significantly increased in the treatment groups on the 10th and 21st days compared to their control groups (P < 0.05). In comparison of the treatment groups on the 4th, 10th, and 21st days of the treatment, the levels of tissue hydroxyproline were found to be more increased in combined US+L Group compared with US Group and L Group, but the difference was not significant (P > 0.05). In comparison of the tendon breaking strengths, it was found as significantly increased in the treatment groups compared with their control groups (P < 0.05), although there was no significant difference between the treatment groups.

Conclusions: Although US, L, and combined US + L treatments increased tendon healing biochemically and biomechanically more than the control groups, no statistically significant difference was found between them. Also we did not find significantly more cumulative positive effects of combined treatment. As a result, both of these physical modalities can be used successfully in the treatment of tendon healing.
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http://dx.doi.org/10.1002/lsm.20046DOI Listing
June 2005