Publications by authors named "Zeynep Cakir"

50 Publications

Effectiveness of Modified HEART Score in Predicting Major Adverse Cardiac Events.

Eurasian J Med 2021 Feb;53(1):57-61

Department of Emergency Medicine, Ataturk University School of Medicine, Erzurum, Turkey.

Objective: The most important problem for emergency physicians in patients presenting with chest pain is deciding whether to discharge the patient or not. Therefore, many scoring systems have been developed to help with this decision making process. We aim to achieve a modified HEART value by combining the VAS value with the HEART score.

Materials And Methods: Data were collected on age, sex, duration of the symptoms, pain severity using a 10-point visual analog scale (VAS), and the presence of a major adverse cardiac event (MACE). The HEART score was calculated and modified (mHEART) by adding 1 point to the total HEART score for a VAS score of ≥7.

Results: During the study period, 4781 patients were admitted, and 293 participants were analyzed. Of the patients, 34(11.6%) experienced MACE within a month after the encounter. The mean VAS scores were 5.65±1.44. However, 77(26.3%) patients had VAS scores ≥7. Taking 3 as the threshold, 42(14.3%) patients had HEART scores of 4 and above, where 47(16.0%) had mHEART scores ≥4. The mHEART scoring demonstrated better test indicators than the HEART score. According to the HEART score, 6(2.3%) of the 251 patients predicted as negative would develop MACE, but this number decreased to 1(0.4%) in 246 using the mHEART score.

Conclusion: Although the HEART score performs reasonably well in discriminating patients who are MACE negative, it is possible to further improve the score by adding the VAS item. After validation by other studies, we would suggest modifying the HEART score by including the VAS item.
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http://dx.doi.org/10.5152/eurasianjmed.2021.20341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7929588PMC
February 2021

Lysosomal retargeting of Myoferlin mitigates membrane stress to enable pancreatic cancer growth.

Nat Cell Biol 2021 Mar 8;23(3):232-242. Epub 2021 Mar 8.

Department of Anatomy, University of California, San Francisco, San Francisco, CA, USA.

Lysosomes must maintain the integrity of their limiting membrane to ensure efficient fusion with incoming organelles and degradation of substrates within their lumen. Pancreatic cancer cells upregulate lysosomal biogenesis to enhance nutrient recycling and stress resistance, but it is unknown whether dedicated programmes for maintaining the integrity of the lysosome membrane facilitate pancreatic cancer growth. Using proteomic-based organelle profiling, we identify the Ferlin family plasma membrane repair factor Myoferlin as selectively and highly enriched on the membrane of pancreatic cancer lysosomes. Mechanistically, lysosomal localization of Myoferlin is necessary and sufficient for the maintenance of lysosome health and provides an early acting protective system against membrane damage that is independent of the endosomal sorting complex required for transport (ESCRT)-mediated repair network. Myoferlin is upregulated in human pancreatic cancer, predicts poor survival and its ablation severely impairs lysosome function and tumour growth in vivo. Thus, retargeting of plasma membrane repair factors enhances the pro-oncogenic activities of the lysosome.
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http://dx.doi.org/10.1038/s41556-021-00644-7DOI Listing
March 2021

Lidocaine versus dexketoprofen in treatment of tension-type headache: A double-blind randomized controlled trial.

Am J Emerg Med 2021 03 7;41:125-129. Epub 2021 Jan 7.

Department of Emergency Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey.

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http://dx.doi.org/10.1016/j.ajem.2020.12.057DOI Listing
March 2021

Comparative host-coronavirus protein interaction networks reveal pan-viral disease mechanisms.

Authors:
David E Gordon Joseph Hiatt Mehdi Bouhaddou Veronica V Rezelj Svenja Ulferts Hannes Braberg Alexander S Jureka Kirsten Obernier Jeffrey Z Guo Jyoti Batra Robyn M Kaake Andrew R Weckstein Tristan W Owens Meghna Gupta Sergei Pourmal Erron W Titus Merve Cakir Margaret Soucheray Michael McGregor Zeynep Cakir Gwendolyn Jang Matthew J O'Meara Tia A Tummino Ziyang Zhang Helene Foussard Ajda Rojc Yuan Zhou Dmitry Kuchenov Ruth Hüttenhain Jiewei Xu Manon Eckhardt Danielle L Swaney Jacqueline M Fabius Manisha Ummadi Beril Tutuncuoglu Ujjwal Rathore Maya Modak Paige Haas Kelsey M Haas Zun Zar Chi Naing Ernst H Pulido Ying Shi Inigo Barrio-Hernandez Danish Memon Eirini Petsalaki Alistair Dunham Miguel Correa Marrero David Burke Cassandra Koh Thomas Vallet Jesus A Silvas Caleigh M Azumaya Christian Billesbølle Axel F Brilot Melody G Campbell Amy Diallo Miles Sasha Dickinson Devan Diwanji Nadia Herrera Nick Hoppe Huong T Kratochvil Yanxin Liu Gregory E Merz Michelle Moritz Henry C Nguyen Carlos Nowotny Cristina Puchades Alexandrea N Rizo Ursula Schulze-Gahmen Amber M Smith Ming Sun Iris D Young Jianhua Zhao Daniel Asarnow Justin Biel Alisa Bowen Julian R Braxton Jen Chen Cynthia M Chio Un Seng Chio Ishan Deshpande Loan Doan Bryan Faust Sebastian Flores Mingliang Jin Kate Kim Victor L Lam Fei Li Junrui Li Yen-Li Li Yang Li Xi Liu Megan Lo Kyle E Lopez Arthur A Melo Frank R Moss Phuong Nguyen Joana Paulino Komal Ishwar Pawar Jessica K Peters Thomas H Pospiech Maliheh Safari Smriti Sangwan Kaitlin Schaefer Paul V Thomas Aye C Thwin Raphael Trenker Eric Tse Tsz Kin Martin Tsui Feng Wang Natalie Whitis Zanlin Yu Kaihua Zhang Yang Zhang Fengbo Zhou Daniel Saltzberg Anthony J Hodder Amber S Shun-Shion Daniel M Williams Kris M White Romel Rosales Thomas Kehrer Lisa Miorin Elena Moreno Arvind H Patel Suzannah Rihn Mir M Khalid Albert Vallejo-Gracia Parinaz Fozouni Camille R Simoneau Theodore L Roth David Wu Mohd Anisul Karim Maya Ghoussaini Ian Dunham Francesco Berardi Sebastian Weigang Maxime Chazal Jisoo Park James Logue Marisa McGrath Stuart Weston Robert Haupt C James Hastie Matthew Elliott Fiona Brown Kerry A Burness Elaine Reid Mark Dorward Clare Johnson Stuart G Wilkinson Anna Geyer Daniel M Giesel Carla Baillie Samantha Raggett Hannah Leech Rachel Toth Nicola Goodman Kathleen C Keough Abigail L Lind Reyna J Klesh Kafi R Hemphill Jared Carlson-Stevermer Jennifer Oki Kevin Holden Travis Maures Katherine S Pollard Andrej Sali David A Agard Yifan Cheng James S Fraser Adam Frost Natalia Jura Tanja Kortemme Aashish Manglik Daniel R Southworth Robert M Stroud Dario R Alessi Paul Davies Matthew B Frieman Trey Ideker Carmen Abate Nolwenn Jouvenet Georg Kochs Brian Shoichet Melanie Ott Massimo Palmarini Kevan M Shokat Adolfo García-Sastre Jeremy A Rassen Robert Grosse Oren S Rosenberg Kliment A Verba Christopher F Basler Marco Vignuzzi Andrew A Peden Pedro Beltrao Nevan J Krogan

Science 2020 12 15;370(6521). Epub 2020 Oct 15.

Quantitative Biosciences Institute (QBI) COVID-19 Research Group (QCRG), San Francisco, CA 94158, USA.

The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a grave threat to public health and the global economy. SARS-CoV-2 is closely related to the more lethal but less transmissible coronaviruses SARS-CoV-1 and Middle East respiratory syndrome coronavirus (MERS-CoV). Here, we have carried out comparative viral-human protein-protein interaction and viral protein localization analyses for all three viruses. Subsequent functional genetic screening identified host factors that functionally impinge on coronavirus proliferation, including Tom70, a mitochondrial chaperone protein that interacts with both SARS-CoV-1 and SARS-CoV-2 ORF9b, an interaction we structurally characterized using cryo-electron microscopy. Combining genetically validated host factors with both COVID-19 patient genetic data and medical billing records identified molecular mechanisms and potential drug treatments that merit further molecular and clinical study.
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http://dx.doi.org/10.1126/science.abe9403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808408PMC
December 2020

Comparison of ibuprofen and piroxicam gel in the treatment of trauma pain: A randomized double-blind trial of geriatric population.

Am J Emerg Med 2020 10 17;38(10):2110-2115. Epub 2020 Aug 17.

Department of Emergency Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey.

Objective: This study aimed to compare the analgesic efficacy of topical ibuprofen and topical piroxicam for acute musculoskeletal injuries.

Methods: In this prospective, randomized, controlled, double-blinded study, geriatric patients were assigned to groups to receive either topical ibuprofen (n = 70) or topical piroxicam (n = 69). The first dose of gel was applied in the emergency department and the remaining doses were self-administered at home by the patients thrice daily for 72 h. For each patient, the initial baseline visual analog scale (VAS) score (V 0) was compared with the VAS scores at the 60 min (V1), 120 min (V2), 24 h (V3) and 72 h (V4) time points. The decreases in VAS scores, clinical effectiveness of the treatments, and incidence of adverse events were evaluated.

Results: In the topical ibuprofen group, the VAS scores were significantly lower at each measurement time point compared to baseline (p < .001). The results were as follows: V0 -V: 1.08, 95% CI: 0.56-1.61; V0 -V2: 1.09, 95% CI: 0.49-1.69; V0 -V3: 1.44, 95% CI: 0.81-2.07; V0 -V4: 1.59, 95% CI: 0.91-2.26. The mean percentage decrease in the VAS scores in the topical ibuprofen group was significantly higher than that in the topical piroxicam group (p < .001). The clinical effect of treatment was found to be significantly higher for the ibuprofen gel group (p < .001). There was no substantial difference in treatment-related adverse events between the groups (p > .05).

Conclusion: Ibuprofen gel, which is a safe treatment option for geriatric patients, is more clinically effective than piroxicam gel. Response to Reviewers.
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http://dx.doi.org/10.1016/j.ajem.2020.08.041DOI Listing
October 2020

Comparison of topical capsaicin and topical piroxicam in the treatment of acute trauma-induced pain: A randomized double-blind trial.

Am J Emerg Med 2020 09 2;38(9):1767-1771. Epub 2020 Jun 2.

Department of Emergency Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey.

Background: This study aimed to compare the analgesic efficacy of topical capsaicin and topical piroxicam in acute musculoskeletal injuries.

Methods: This is a prospective, randomized, controlled, double-blinded study. The data for the 67 patients in the piroxicam group and the 69 in the capsaicin group were examined. The initial visual analog scale (VAS) scores were compared with the 60th and 120th minute as well as the 24th and 72nd hour values. Differences between the VAS scores, clinical effectiveness of the treatment and side effects were evaluated.

Results: In the capsaicin group, the mean difference in the delta VAS scores was significantly higher at each measurement time. The mean of the percentage of reduction in the VAS scores of the topical capsaicin group was significantly higher than that in the topical piroxicam group. The highest difference in terms of both outcomes was determined at the 72nd hour VAS change. Mean differences were 1.53 (95% CI: 0.85-2.221) and 19.7 (95% CI: 12.4-27.2) respectively (p < 0.001). In the capsaicin group, the clinical effect of the treatment was found significantly higher (p < 0.01). The difference between the clinical effectiveness of the groups regarding the treatment outcomes was also statistically significant (p < 0.001). There was no significant difference between the patient groups regarding the presence of side effects.

Conclusion: Topical capsaicin can be used as an alternative to topical piroxicam initially and at follow-up in patients presenting to the emergency department with acute pain as there were no observable differences in side-effects between the two groups.
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http://dx.doi.org/10.1016/j.ajem.2020.05.104DOI Listing
September 2020

Intradermal injection for hiccup therapy in the Emergency Department.

Am J Emerg Med 2020 09 25;38(9):1935-1937. Epub 2020 Mar 25.

Department of Emergency Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey.

Hiccup is a condition caused by involuntary contraction of inspiratory muscles, especially the diaphragm. Although it is generally considered as a physiological. response, if hiccup persists for a long time, it can lead to many undesirable conditions such as depression, weight loss, insomnia, and fatigue. A 35-year-old male patient was admitted to our emergency department with hiccup lasting for 15 h. He had a history of several hiccup attacks. Classical non-pharmacological and pharmacological therapies were used to treat the condition without any response. As an alternative method, an intradermal injection was applied. A mixture of thiocolchicoside and lidocaine was administered intradermally to a depth of 1-3 mm at the epigastric region and adjacent to the sternocleidomastoid muscle. The patient's hiccup ended after the intradermal injection procedure. During 48 h of follow-up the hiccup attack did not develop again. No complications related to the process were detected. This is the first case in the literature demonstrating the use of intradermal injection to terminate hiccups. The intradermal injection approach can be administered in cases of hiccups that do not respond to medical treatment.
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http://dx.doi.org/10.1016/j.ajem.2020.03.044DOI Listing
September 2020

Comparison of effectiveness coolant spray and placebo in patients with acute ankle trauma prospective randomized controlled trial.

Am J Emerg Med 2020 07 7;38(7):1458-1462. Epub 2020 Jan 7.

Department of Emergency Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey.

Introduction: Coolant spray application in musculoskeletal injuries is an effective and harmless method to treat pain and reduce functional limitation. This study assessed the clinical value of coolant spray application on patient comfort before and during the radiographic imaging process along with its early analgesic and anti-edema effects.

Methods: A total of 155 patients, admitted to the emergency department between April 1, 2019, and June 31, 2019, were included in this study. The patients were randomly assigned to either a coolant spray or a saline spray (placebo) group. To the coolant spray group patients, Cryos ®Spray (Phyto Performance, Italy) was applied. To the placebo group patients, a normal saline solution in a bottle covered with white opaque paper and refrigerated at 4 °C was sprayed. Radiographic images of the patients were scored for appropriateness of the standard imaging characteristics.

Results: The mean scores were 8.13 ± 1.8 and 6.58 ± 2.2 for the coolant spray and normal saline spray groups, respectively; the differences were statistically significant between the two groups (mean difference: -1.56, 95% CI:-2.20 to -0.92; p = .000). Patients with fractures on their radiographs and treated with coolant spray received higher scores than similar patients treated with normal saline spray (mean difference:-1.92, 95% CI:-3.28 to -0.55; p = .009). The proportion of patients requesting analgesic treatment before discharge was statistically lower in the coolant spray group compared to the normal saline group (p = .025).

Conclusions: The radiographic images taken after coolant spray intervention in patients with acute ankle trauma were more successful in showing the target structures.
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http://dx.doi.org/10.1016/j.ajem.2019.12.054DOI Listing
July 2020

Comparison of intradermal mesotherapy with systemic therapy in the treatment of low back pain: A prospective randomized study.

Am J Emerg Med 2020 07 9;38(7):1431-1435. Epub 2019 Dec 9.

Department of Emergency Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey.

Introduction: Musculoskeletal pain such as low back pain (LBP) are routinely encountered in the ED and contribute to ED overcrowding. The aim of our study was to compare the efficiency of mesotherapy with systemic therapy in pain control in patients with lumbar disk herniation.

Methods: We conducted this prospective parallel randomized controlled trial with the patients admitted to the emergency department with low back pain related to herniated lumbar disk. Mesotherapy was performed to one group, while intravenous dexketoprofen was administered to the control group. Changes in pain intensity at 15th minute, 30th minute, 60th minute and 24th hours after treatment using Visual Analogue Scale (VAS), need to use analgesic drug within 24 h after treatment, and adverse effect of the treatment methods were compared between groups.

Results: The decreases in pain intensity were statistically significantly higher in mesotherapy group for all time intervals. The need to use analgesics was statistically significantly three fold higher in the systemic therapy group. There was no statistically significant difference in having any adverse effect between study groups during one-week follow-up period.

Conclusions: Changes in medical practices, from the systemic administration of NSAIDs to the minimally invasive techniques such as mesotherapy with potent efficacy and minimal side effects, may enhance the ability of EDs to meet the waiting time targets and improve patient's satisfaction.
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http://dx.doi.org/10.1016/j.ajem.2019.11.044DOI Listing
July 2020

Prognostic value of blood gas parameters and end-tidal carbon dioxide values in out-of-hospital cardiopulmonary arrest patients

Turk J Med Sci 2019 Oct 24;49(5):1298-1302. Epub 2019 Oct 24.

Emergency Department, Erzurum Regional Training and Research Hospital, University of Health Sciences, Erzurum, Turkey

Background/aim: This study aimed to evaluate the usefulness of blood gas and end-tidal carbon dioxide (EtCO2) measurements for predicting return of spontaneous circulation (ROSC) and for evaluating post-ROSC neurological survival.

Materials And Methods: This was a prospective case control study utilizing Atatürk University’s database of adult nontraumatic patients (over 18 years old) with out-of-hospital cardiac arrest (OHCA) over the course of a year. The neurological status of the patients was evaluated after 1 h at ROSC and at hospital discharge, as defined by the cerebral performance category score. The blood gas parameters pH, PO2, PCO2, lactate, and BE were compared with EtCO2 from capnography and arteriol/alveolar carbon dioxide difference (AaDCO2) by using both blood gas and capnography upon admission to the emergency department and at ROSC.

Results: A total of 155 patients were included in the study to form the control group with ROSC. The PO2, PCO2, and AaDCO2 values showed a prognostic marker for the supply of ROSC (P < 0.05). The EtCO2,lactate, and BE values measured by the blood gas were found to be insignificant in the prediction of ROSC (P > 0.05). Conversely, AaDCO2 was found to be significant in ROSC estimation (P < 0.05), but not in neurological evaluation (P > 0.05).

Conclusion: Blood gas parameters and EtCO2 are sufficient in predicting ROSC. The value of AaDCO2 calculated using EtCO2 and PO2may be used in predicting the prognosis of OHCA patients, but this value does not provide any conclusions concerning neurological survival.
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http://dx.doi.org/10.3906/sag-1812-156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018337PMC
October 2019

Comparison of two scores of short term serious outcome in COPD patients.

Am J Emerg Med 2020 06 27;38(6):1086-1091. Epub 2019 Jul 27.

Department of Emergency Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) related visits to the emergency department have increased substantially during the past decade. An important challenge facing emergency physicians when treating COPD patients is deciding on disposition. The aim of this study was to evaluate Integrated Pulmonary Index scoring to guide the disposition decisions of emergency physicians by comparing its compatibility with Ottawa COPD Risk Score.

Methods: This is a prospective methodological study, in which we compared the accuracies of the Integrated Pulmonary Index and Ottawa COPD Risk Score in predicting of the short-term serious outcomes in patients admitted to the emergency department with COPD exacerbation. Patients who admitted to our emergency department between 01.01.2019-31.03.2019 were evaluated.

The Results: Among the 208 patients, there were 154 (74.0%) short-term serious outcomes. The AUCs were 0.915 and 0.943 for Integrated Pulmonary Index and Ottawa COPD Risk Score, respectively. The difference between AUCs for two scores was not statistically significant. The best cut-off point for Integrated Pulmonary Index and Ottawa COPD Risk Score were ≤3 and >4, respectively. For these best cut-off points, the sensitivity and specificity of Integrated Pulmonary Index were 92.9 and 87.1, respectively. The sensitivity and specificity of Ottawa COPD Risk Score were 99.3 and 85.2, respectively. Besides, the accuracy of Integrated Pulmonary Index was 91.3, and the accuracy of Ottawa COPD Risk Score was 95.7.

Conclusions: Integrated Pulmonary Index was a potential candidate for evaluating respiratory status and prediction of short-term severe events in patients with acute COPD exacerbation in emergency departments.
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http://dx.doi.org/10.1016/j.ajem.2019.158376DOI Listing
June 2020

Parkin promotes proteasomal degradation of misregulated BAX.

J Cell Sci 2017 Sep 31;130(17):2903-2913. Epub 2017 Jul 31.

Institute of Biochemistry and Molecular Biology, ZBMZ, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany

The pro-apoptotic BCL-2 protein BAX commits human cells to apoptosis by permeabilizing the outer mitochondrial membrane. BAX activation has been suggested to require the separation of helix α5 from α6 - the 'latch' from the 'core' domain - among other conformational changes. Here, we show that conformational changes in this region impair BAX translocation to the mitochondria and retrotranslocation back into the cytosol, and therefore BAX inhibition, but not activation. Redirecting misregulated BAX to the mitochondria revealed an alternative mechanism of BAX inhibition. The E3 ligase parkin, which is known to trigger mitochondria-specific autophagy, ubiquitylates BAX K128 and targets the pro-apoptotic BCL-2 protein for proteasomal degradation. Retrotranslocation-deficient BAX is completely degraded in a parkin-dependent manner. Although only a minor pool of endogenous BAX escapes retrotranslocation into the cytosol, parkin-dependent targeting of misregulated BAX on the mitochondria provides substantial protection against BAX apoptotic activity.
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http://dx.doi.org/10.1242/jcs.200162DOI Listing
September 2017

Evacuation of Hospitals during Disaster, Establishment of a Field Hospital, and Communication.

Eurasian J Med 2017 Jun 28;49(2):137-141. Epub 2017 Apr 28.

Department of Emergency, Atatürk University School of Medicine, Erzurum, Turkey.

The buildings, working personnel, and patients and their relatives may directly or indirectly be affected by the disasters. Here we will discuss evacuation, establishing a field hospital, communication, the role of the media in disasters, and defending against sabotage. The affected individuals should be evacuated and transferred to secure zones safely and rapidly. How the decision for evacuation should be made and how the evacuation triage should be performed are important issues. Field hospitals should be established within the bounds of possibility for continuation of the treatments of evacuated people. The standards for the field hospitals and its sections that may be created according to the needs will be explained. Undoubtedly, since one of the most important subjects in disasters is communication, the types of communication in disasters and their significance will be mentioned. How the relationships with the media should be an aspect of communication and how they can be beneficially used will also be mentioned. As in all organizations and institutions, sabotage attempts may also be present concerning health facilities. For this reason, during the preparation of the hospital disaster plan, defending against sabotage will be discussed, and what should be done at that stage will be mentioned.
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http://dx.doi.org/10.5152/eurasianjmed.2017.16102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5469841PMC
June 2017

Characteristics of Patients Who Admitted to the Emergency Department Because of Burns Due to Dens Liquids Such as Hot Milk/Oil.

Eurasian J Med 2016 Feb 7;48(1):20-3. Epub 2015 Jul 7.

Department of Emergency Medicine, Atatürk University School of Medicine, Erzurum, Turkey.

Objective: Burn is the tissue damage on body caused due to various reasons. Although all burns caused by hot liquids are investigated as scalding burns, dense liquid burns (DLB) caused by such as milk and oil are different from other burns. The aim of this study was to report the properties of DLB.

Materials And Methods: Patients admitted to the Emergency Service of Atatürk University Hospital, with DLB from June 2003 to December 2008, were examined retrospectively.

Results: During the study, 28 DLB patients were admitted to the emergency service. The most common admission were found in autumn 28.6% (n=8), and in May and June, 17.9% (n=5). The frequency of burns on the right upper extremity was seen in 50% (n=14) of the patients. The burn degree of all patients was determined as 2(nd) degree. Seventy-five percent (n=21) of the patients were discharged, 14.3% (n=4) were hospitalized. None of the patients died.

Conclusion: Dense liquid burns is a burn type that is commonly seen in women, absolutely causing 2(nd) degree burns, frequently reported in upper extremity and head/neck regions, and in contrast to other studies, in our region it is completely seen in patients living in city centre.
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http://dx.doi.org/10.5152/eurasianjmed.2015.34DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4792491PMC
February 2016

The role of vagal nerve root injury on respiration disturbances in subarachnoid hemorrhage.

Turk Neurosurg 2015 ;25(2):273-8

Ataturk University, School of Medicine, Department of Neurosurgery, Erzurum, Turkey.

Aim: We examined whether there is a relationship between vagal nerve root injury and the severity of respiration disorders associated with subarachnoid hemorrhage (SAH).

Material And Methods: This study was conducted on 20 rabbits. Experimental SAH was induced by injecting homologous blood into the cisterna magna. During the experiment, electrocardiography and respiratory rhythms were measured daily. After the experiment, any axonal injury or changes to the arterial nervorums of the vagal nerves were examined. All respiratory irregularities and vagal nerve degenerations were statistically analyzed.

Results: Normal respiration rate, as measured in the control group, was 30 ± 6 bpm. In the SAH-induced group, respiration rates were initially 20 ± 4 bpm, increasing to 40 ± 9/min approximately ten hours later, with severe tachypneic and apneic variation. In histopathological examinations, axon density of vagal nerves was 28,500 ± 5,500 in both control and sham animals, whereas axon density was 22,250 ± 3,500 in survivors and 16,450 ± 2,750 in dead SAH animals. The severity of axonal degeneration of vagal nerves was greater in the six dead animals than in the survivors.

Conclusion: If vagal nerves are lesioned, the muscles of respiration are paralyzed and respiratory reflexes are disrupted. That the ischemic and mechanical factors created by SAH cause vagal nerve root injury and respiration disorders may be inevitable and fatal.
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http://dx.doi.org/10.5137/1019-5149.JTN.9964-13.1DOI Listing
December 2015

A rare cause of acute abdomen for which broad-spectrum antibiotics should be initiated in emergency service: typhlitis.

Am J Emerg Med 2015 May 30;33(5):738.e1-3. Epub 2014 Oct 30.

Department of Emergency Medicine, Medical Faculty, Ataturk Unıversity, Erzurum, Turkey.

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http://dx.doi.org/10.1016/j.ajem.2014.10.040DOI Listing
May 2015

Differential retrotranslocation of mitochondrial Bax and Bak.

EMBO J 2015 Jan 5;34(1):67-80. Epub 2014 Nov 5.

Institute for Biochemistry and Molecular Biology University of Freiburg, Freiburg, Germany Spemann Graduate School of Biology and Medicine SGBM, Freiburg, Germany BIOSS, Centre for Biological Signaling Studies, University of Freiburg, Freiburg, Germany

The Bcl-2 proteins Bax and Bak can permeabilize the outer mitochondrial membrane and commit cells to apoptosis. Pro-survival Bcl-2 proteins control Bax by constant retrotranslocation into the cytosol of healthy cells. The stabilization of cytosolic Bax raises the question whether the functionally redundant but largely mitochondrial Bak shares this level of regulation. Here we report that Bak is retrotranslocated from the mitochondria by pro-survival Bcl-2 proteins. Bak is present in the cytosol of human cells and tissues, but low shuttling rates cause predominant mitochondrial Bak localization. Interchanging the membrane anchors of Bax and Bak reverses their subcellular localization compared to the wild-type proteins. Strikingly, the reduction of Bax shuttling to the level of Bak retrotranslocation results in full Bax toxicity even in absence of apoptosis induction. Thus, fast Bax retrotranslocation is required to protect cells from commitment to programmed death.
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http://dx.doi.org/10.15252/embj.201488806DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291481PMC
January 2015

Brain natriuretic peptide among stroke patients.

Ann Indian Acad Neurol 2014 Apr;17(2):243

Department of Emergency Medicine, Atatürk University School of Medicine, Erzurum, Turkey.

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http://dx.doi.org/10.4103/0972-2327.132667DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4090865PMC
April 2014

Patient-staff safety applications: the evaluation of blue code reports.

Eurasian J Med 2013 Oct;45(3):163-6

Ataturk University Medical Faculty, Department of Emergency Medicine Erzurum Turkey.

Objective: Blue code systems (BCS) are communication systems that ensure the most rapid and effective resuscitation when a patient is in respiratory or cardiac arrest. A hospital employee faced with the situation of a cardiopulmonary arrest (CPA) starts the system by dialing 6666 from any phone in the hospital. We created a five-person team that includes a doctor, nurse, anesthesia technician, stretcher officer and security guard. The purpose of this study is to share our experiences in initiating the use of the BCS in our hospital.

Materials And Methods: In our hospital, the records of calls that were made by Callvision BCS were analyzed retrospectively from May 2010 to the end of January 2011.

Results: A total of 474 calls were made using the blue code system. Of those calls, 402 (84.5%) were determined to be inappropriate calls. The remaining 72 calls were responded to. Of the 72 patients who were treated, 21 were discharged after they were hospitalized in the service or intensive care unit, 45 cases resulted in exitus, and 5 cases were referred to the Ataturk University faculty of medicine.

Conclusion: The BCS has achieved its goal. The discharge rate of 29.5% that we achieved is a successful result.
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http://dx.doi.org/10.5152/eajm.2013.34DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4261432PMC
October 2013

Predictors of mortality in childhood burns: an 8-year review.

J Child Health Care 2014 Mar 31;18(1):84-95. Epub 2013 May 31.

Medical Faculty, Department of Emergency Medicine, Duzce University, Duzce, Turkey.

This study aims to analyze the epidemiological characteristics and predictors of mortality from burn injuries in childhood patients admitted to our hospital during an eight-year period. The medical records of acute childhood burn patients were reviewed retrospectively. All variables thought to be associated with mortality were entered in a multiple binary logistic regression model (method = stepwise). The magnitude of risk was measured by the odds ratio, and the 95% confidence interval was estimated. A total of 2269 acute childhood burn patients were admitted during the study period. A total of 86 (3.8%) children died due to burn injuries. Deaths were seen 1.849 times more in males than in females. According to the 1%-10% total body surface area (TBSA) burned group, mortality occurred 121.116 times more in the >41% TBSA burned group. Most burn injuries can be avoided by keeping children away from hazardous and dangerous environments. Also, requiring a multidisciplinary management in these patients, quality of care services given by physicians and nurses certainly will create a positive impact on patients' outcomes.
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http://dx.doi.org/10.1177/1367493512470575DOI Listing
March 2014

Autologous rabbit adipose tissue-derived mesenchymal stromal cells for the treatment of bone injuries with distraction osteogenesis.

Cytotherapy 2013 Jun 21;15(6):690-702. Epub 2013 Mar 21.

Department of Plastic Reconstructive and Aesthetic Surgery, Dokuz Eylul University, School of Medicine, Balcova, Izmir, Turkey.

Background Aims: Adipose tissue-derived mesenchymal stromal cells (MSCs) have a higher capacity for proliferation and differentiation compared with other cell lineages. Although distraction osteogenesis is the most important therapy for treating bone defects, this treatment is restricted in many situations. The aim of this study was to examine the therapeutic potential of adipose tissue-derived MSCs and osteoblasts differentiated from adipose tissue-derived MSCs in the treatment of bone defects.

Methods: Bone defects were produced in the tibias of New Zealand rabbits that had previously undergone adipose tissue extraction. Tibial osteotomy was performed, and a distractor was placed on the right leg of the rabbits. The rabbits were placed in control (group I), stem cell (group II) and osteoblast-differentiated stem cell (group III) treatment groups. The rabbits were sacrificed, and the defect area was evaluated by radiologic, biomechanical and histopathologic tests to examine the therapeutic effects of adipose tissue-derived MSCs.

Results: Radiologic analyses revealed that callus density and the ossification rate increased in group III compared with group I and group II. In biomechanical tests, the highest ossification rate was observed in group III. Histopathologic studies showed that the quality of newly formed bone and the number of cells active in bone formation were significantly higher in group III rabbits compared with group I and group II rabbits.

Conclusions: These data reveal that osteoblasts differentiated from adipose tissue-derived MSCs shorten the consolidation period of distraction osteogenesis. Stem cells could be used as an effective treatment for bone defects.
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http://dx.doi.org/10.1016/j.jcyt.2013.02.004DOI Listing
June 2013

Apoptotic effects of resveratrol, a grape polyphenol, on imatinib-sensitive and resistant K562 chronic myeloid leukemia cells.

Anticancer Res 2012 Jul;32(7):2673-8

Department of Molecular Biology and Genetics, Izmir Institute of Technology, Faculty of Science, Gulbahce Campus, 35430 Urla, Izmir, Turkey.

Aim: To examine the antiproliferative and apoptotic effects of resveratrol on imatinib-sensitive and imatinib-resistant K562 chronic myeloid leukemia cells.

Materials And Methods: Antiproliferative effects of resveratrol were determined by the 3-Bis[2-methoxy-4-nitro-5-sulphophenyl]-2H-tetrazolium-5-carboxanilide inner salt (XTT) cell proliferation assay. Apoptotic effects of resveratrol on sensitive K562 and resistant K562/IMA-3 cells were determined through changes in caspase-3 activity, loss of mitochondrial membrane potential (MMP), and apoptosis by annexin V-(FITC).

Results: The concentrations of resveratrol that inhibited cell growth by 50% (IC(50)) were calculated as 85 and 122 μM for K562 and K562/IMA-3 cells, respectively. There were 1.91-, 7.42- and 14.73-fold increases in loss of MMP in K562 cells treated with 10, 50, and 100 μM resveratrol, respectively. The same concentrations of resveratrol resulted in 2.21-, 3.30- and 7.65-fold increases in loss of MMP in K562/IMA-3 cells. Caspase-3 activity increased 1.04-, 2.77- and 4.8-fold in K562 and 1.02-, 1.41- and 3.46-fold in K562/IMA-3 cells in response to the same concentrations of resveratrol, respectively. Apoptosis was induced in 58.7%- and 43.3% of K562 and K562/IMA-3 cells, respectively, in response to 100 μM resveratrol.

Conclusion: Taken together these results may suggest potential use of resveratrol in CML, as well as in patients with primary and/or acquired resistance to imatinib.
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July 2012

The effect of degenerated neuron density of petrosal ganglion on the development of blood pressure variabilities after subarachnoid hemorrhage in a rabbit model: an experimental study.

Turk Neurosurg 2011 ;21(4):559-66

Sisli Research and Education Hospital, Department of Neurosurgery, Istanbul Turkey.

Aim: The aim of this study was to determine the relationship between ischemic neurodegeneration, of the petrosal ganglion of the glossopharyngeal nerve, and BP fluctuations, after subarachnoid hemorrhage (SAH).

Material And Methods: Twenty-four rabbits had their blood pressure and heart rhythms studied daily over 20 days. Then, the histopathology of the petrosal ganglion was examined in all animals. Normal and apoptotic neuron density of the petrosal ganglion and blood pressure values were compared statistically.

Results: Mean total volume of the petrosal ganglia was calculated as 0.9 ± 0.34/mm3. BP level of control group was 96.1 ± 2.1 mmHg; 116.5 ± 4 mmHg of mild hypertension (HT) group and 128.1 ± 3.6mmHg in the severe HT group. When the groups were compared to each other they were significantly different. The level of normal-apoptotic neuron in control group was 11,240 ± 802/mm³ -40 ± 6.3/mm³; 9730 ± 148.7/mm³ - 1560 ± 256.2/mm³ in the mild HT group and 6870 ± 378.8/mm³-4240 ± 628.2/mm³ in the severe HT group. When the groups were compared to each other there was significantly difference.

Conclusion: Blood pressure variability observed in this study may be explained by ischemic neurodegeneration of petrosal ganglia caused by SAH. The results of this study suggest that petrosal ganglion ischemia has potential implications for the development of hypertension. These findings suggest that new treatment strategies should be considered for the treatment of SAH.
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http://dx.doi.org/10.5137/1019-5149.JTN .4553-11.1DOI Listing
April 2012

Electromyographic and electroneurographic changes in internal nasal muscles after endonasal and external rhinoplasty.

Aesthet Surg J 2011 Mar;31(3):297-301

Istanbul Education and Research Hospital, Turkey.

Background: Anatomical structures of the nose (including muscles) are elevated, sutured, or reshaped during rhinoplasty. Electromyography and electroneurography are the objective electrophysiologic tests performed for the direct measurement of nasal muscle function.

Objectives: The authors investigate the predictive values and functional status of nasal muscles during voluntary facial and nasal movements following open and closed rhinoplasty.

Methods: In 48 patients who underwent rhinoplasty, surface electrodes were placed to preoperatively and postoperatively measure nasal muscle function with electromyography and electroneurography. Results were analyzed according to whether the patient had undergone open or closed rhinoplasty.

Results: Electroneurography amplitudes were decreased postoperatively on both sides, in both groups. This increase was statistically significant (p < .001). Electromyography-recorded amplitude of nasal muscle contraction tension significantly decreased postoperatively in response to all voluntary movements in two cases in the closed rhinoplasty group (6.6%) and in two cases in the open rhinoplasty group (11.1%). In essence, the activity strength of the nasal muscles decreased postoperatively for some patients. The mean differences between the two groups were not statistically significant (p = .280).

Conclusions: The data showed no meaningful difference in injury to the nasal muscular layer between open and closed rhinoplasty.
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http://dx.doi.org/10.1177/1090820X11398478DOI Listing
March 2011

The role of ischemic neurodegeneration of the nodose ganglia on cardiac arrest after subarachnoid hemorrhage: an experimental study.

Exp Neurol 2011 Jul 29;230(1):90-5. Epub 2010 Sep 29.

Department of Neurosurgery, Ataturk University, Medical Faculty,Erzurum, Turkey.

Background: The heart is innervated by several systems that contribute to the control of the heart's rhythm. The cardiac fibers of the vagus nerve have an important role in the regulation of heart rhythm under many emotional and physical conditions. Severe electrocardiographic disturbances have been reported following subarachnoid hemorrhage (SAH), but ischemic neuronal degeneration of the nodose ganglion of the vagus nerve has not been previously investigated. We examined if there is a relationship between ischemic injury of the nodose ganglion of the vagus nerve and the severity of heart rhythm disorders after subarachnoid hemorrhage.

Methods: This study was conducted on 20 rabbits. Four rabbits were used as a baseline group. Experimental subarachnoid hemorrhage was applied to half of the remaining animals (n = 8) by injecting homologous blood into the cisterna magna, and the others (SHAM group, n = 8) were injected with isotonic saline solution in the same manner. For 20 days after the injection, heart rhythm changes were observed daily. After the experiment, normal and ischemic neuron densities in the nodose ganglia of the vagus nerves were examined stereologically. The number of heart rhythm irregularities and the number of degenerated neurons in the nodose ganglia were compared statistically.

Results: The normal heart rhythm rate was 280 ± 45/min. At the beginning of the SAH, the average heart rate was 220 ± 30/min; about 10 hours later, it decreased to 189 ± 30/min, indicating severe bradycardia. However, after 7 days, the average heart rate had increased to 350 ± 30/min. Six animals died due to irregularities in cardiac function and respiration. Histopathological examinations showed that the average density of normal neurons in the nodose ganglion was 10,500 ± 2500 in the baseline animals and the SHAM group, but the normal neuron density was 8250 ± 1500 in survivors and 6450 ± 1330 in dead animals. The ischemic neuronal degeneration in the nodose ganglia was more severe in the dead animals than in the survivors (p < 0.0001).

Conclusion: Afferent vagus nerves originating from the nodose ganglia have an important role in regulating heart rhythm via their afferent fibers and efferent connections. If neurons of the nodose ganglia are lesioned due to ischemic insult during subarachnoid hemorrhage, heart rhythm regulation by vagus afferent reflexes is disturbed. Vagus pathway paralysis may result in indirect sympathetic overactivity. The development of tachycardia causes depletion of the heart's reserves, and cardiac arrest may be inevitable following extensive subarachnoid hemorrhage.
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http://dx.doi.org/10.1016/j.expneurol.2010.09.018DOI Listing
July 2011

Assessment of cardiac injury in patients with blunt chest trauma.

Eur J Trauma Emerg Surg 2010 Oct 17;36(5):441-7. Epub 2010 Mar 17.

Department of Medical Education, Ataturk University, School of Medicine, Erzurum, Turkey.

Background: There has been difficulty in the appropriate determination of blunt cardiac injury (BCI) related to blunt thoracic trauma (BTT). The aim of this study is to assess BCI and the effectiveness of diagnostic tests in BTT in patients admitted to the emergency department (ED).

Methods: Eighty-eight patients with suspected myocardial injury in BTT were enrolled. The diagnostic criteria for BCI were: elevation of troponin I, arrhythmia requiring treatment, unexplained low voltage on electrocardiography (ECG), unexplained hypotension requiring vasopressor, cardiogenic shock requiring inotropes, and transthoracic echocardiographic (TTE) findings suggestive of BCI. Patients with arrhythmia in the medical history, congestive heart failure, ischemic heart disease, history of cardiac surgery, and those <16 years of age were excluded.

Results: The BCI rate was 25% in thoracic injuries. The sensitivity and specificity of troponin I, creatine kinase-MB fraction (CK-MB)/creatine kinase (CK) ratio, ECG, and CK-MB/CK ratio plus ECG were 68% and 100%, 50% and 53%, 54.5% and 72%, and 59% and 33%, respectively. Frequency of palpitation, initial CK-MB levels, initial heart rate, frequency of pulmonary contusion, abnormal ECG, and mortality rate were significantly higher in patients with BCI compared with patients without BCI. Pulmonary contusion, accompanying palpitation, Glasgow coma scale (GCS) ≤13, and abnormal ECG findings were important independent parameters increasing the likelihood of BCI on univariate analysis comparing patients with and without BCI.

Conclusion: Indicators such as cardiac enzymes and ECG have low sensitivity and specificity when used alone. The reliability of ECG in the diagnosis of BCI decreases in the later hours of trauma.
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http://dx.doi.org/10.1007/s00068-010-0005-1DOI Listing
October 2010

Acute abdomen associated with organophosphate poisoning.

J Emerg Med 2011 Nov 20;41(5):507-12. Epub 2010 Sep 20.

Department of Emergency Medicine, Atatürk University, School of Medicine, Erzurum, Turkey.

Background: Pesticides are extensively used in developed and developing countries.

Objectives: The present study was designed to evaluate the clinical course of patients with carbamate or organophosphate poisoning presenting to a University-based emergency department (ED).

Methods: All consecutive patients admitted to our ED due to intoxication with carbamate or organophosphate compounds over a 2-year period were enrolled prospectively.

Results: A total of 49 consecutive patients (26 females) were diagnosed with carbamate or organophosphate poisoning in the 24-month study period. The mean age of the patients was 32±13.1 years (range 16-70 years). Signs and symptoms most frequently noted in patients with organophosphate or carbamate poisoning were perspiration, vomiting, and bronchorrhea. Abdominal pain was reported by 65.3% of the patients. Abdominal ultrasonography was performed in 22 patients who complained of abdominal pain as a leading symptom. Among these, 63.6% were found to have abdominal free fluid. Pancreatitis and peritonitis developed in one case. Atropine treatment was administered for approximately 24-36h, with a mean total dose of 13.75±6.75mg. Pralidoxime was administered to 70.9% of patients with organophosphate poisoning, but was not used in patients intoxicated with carbamates. Endotracheal intubation and mechanical ventilatory support were required in 14.2% of the patients. Mean duration of mechanical ventilation was 3.7±2.2 days. The overall mortality rate was 10.2%.

Conclusion: Patients with a diagnosis of organophosphate poisoning should be screened for acute abdomen. The findings in our study suggest that these patients should undergo routine abdominal ultrasonography, especially in cases with abdominal pain along with other abdominal complaints.
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http://dx.doi.org/10.1016/j.jemermed.2010.05.072DOI Listing
November 2011

Suppression of STAT5A increases chemotherapeutic sensitivity in imatinib-resistant and imatinib-sensitive K562 cells.

Leuk Lymphoma 2010 Oct;51(10):1895-901

Department of Medical Biology, Medical School, Ege University, Izmir, Turkey.

STAT proteins are cytoplasmic transcription factors that are involved in the regulation of numerous cellular activities such as cell growth, differentiation, and survival. In this study, we aimed to identify the expression pattern of STAT genes in imatinib-sensitive and -resistant K562 cells, and further, to reveal the effects of STAT5A siRNA knockdown on cell growth and apoptosis induction. The XTT cell proliferation assay showed that both sensitive and resistant K562 cells were sensitized to imatinib upon transfection with STAT5A siRNA. Caspase-3 enzyme activity was increased significantly in both cells. These results may open up new opportunities to overcome chemotherapeutic resistance in leukemia.
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http://dx.doi.org/10.3109/10428194.2010.507830DOI Listing
October 2010

Allergic angina can be determined by the early use of cardiac magnetic resonance imaging.

Am J Emerg Med 2010 Nov;28(9):1061.e5-7

Department of Emergency Medicine, Ataturk University Medical Faculty, Erzurum, Turkey.

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http://dx.doi.org/10.1016/j.ajem.2010.01.029DOI Listing
November 2010

Lightning injury may cause abrupt cerebral salt wasting syndrome.

Am J Emerg Med 2010 Jun 12;28(5):640.e1-3. Epub 2010 Mar 12.

Department of Emergency Medicine, Ataturk University, Erzurum 25200, Turkey.

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http://dx.doi.org/10.1016/j.ajem.2009.07.010DOI Listing
June 2010