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Okuyan E.,Bagcilar Education and Research Hospital | Uslu A.,Serife Baci State Hospital | Ozan Levent M.,Serife Baci State Hospital
Clinical Toxicology

Background. Grayanotoxins (GTX), also known as andromedotoxins, are produced by plants of the Ericacae family. This toxin is responsible for "mad honey" intoxication, which can present with fatal cardiac bradyarrhythmias and circulatory collapse. GTXs lead to cardiac toxicity because they increase sodium channel permeability and activate the vagus nerve. Objective. We evaluated 42 patients (33 males) prospectively who had been hospitalized with diagnosis of "mad honey" intoxication in a state hospital setting. Methods and results. The median age of patients was 48.5 years and all patients were admitted with complaints of nausea, vomiting, dizziness, fainting, and sweating. Five of the patients had syncope before admission. On admission, the mean systolic blood pressure was 73.1 ± 12.7 mmHg, the mean diastolic blood pressure was 52.1 ± 11.3mmHg, mean heart rate was 38 ± 7 bpm. On initial electrocardiograms, 18 patients had sinus bradycardia, 15 patients had complete atrioventricular block, and 9 patients had nodal rhythm. All patients were monitored in a coronary care unit and treated sympomatically with atropine, intravenous fluids, and dopamine. None of the patients needed temporary pacing and all were discharged without complications. Conclusion. "Mad honey," which is produced widely in northern parts of Turkey can be toxic. This intoxication should be considered in patients admitted to emergency department with bradycardia and hypotension especially in regions where this honey is produced. © 2010 Informa UK, Ltd. Source

Belli H.,Bagcilar Education and Research Hospital
The West Indian medical journal

The present study attempted to assess childhood trauma events and dissociative symptoms in patients with obsessive compulsive disorder (OCD). The study included all patients who were admitted for the first time to the psychiatric outpatient unit over a 24-month period. Seventy-eight patients were diagnosed as having OCD during the two-year study period. Childhood traumatic events were assessed with a Childhood Trauma Questionnaire (CTQ). Obsessive compulsive disorder symptoms were assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). A Dissociation Questionnaire (DIS-Q) was also used to measure dissociative symptoms. The mean of Y-BOCS points were 23.37 +/- 7.27. Dissociation questionnaire scores were between 0.40 and 3.87 and the mean was 2.23 +/- 0.76. Childhood trauma points were 1.27-4.77 and the mean was 2.38 +/- 0.56. There was no statistically significant relationship between Y-BOCS points and childhood trauma points (p > 0.05). There was a statistically significant positive relationship between Y-BOCS points and DIS-Q points. There was no statistically significant relationship between DIS-Q points and childhood trauma points (p > 0.05). Childhood trauma questionnaire points might be significant clinically, although there was not a statistically significant correlation in our study. We also conclude that dissociative symptoms among patients with OCD should alert clinicians to treatment of the disorder. Source

Basturk T.,Bagcilar Education and Research Hospital | Unsal A.,Sisli Etfal Education and Research Hospital
Kidney and Blood Pressure Research

Background: The aim of this research was to establish whether there is a link between insulin resistance (IR) and glomerular filtration rate (GFR), and assess whether insulin-resistant subjects experience a more rapid deterioration in GFR. Methods: We enrolled 73 non-diabetic chronic kidney disease (CKD) stage 2-4 patients. All blood samples were taken after 10 h of overnight fasting. Fasting blood glucose (FBG), creatinine, uric acid, albumin, cholesterol, triglyceride, insulin, HbA1c, high-sensitivity C-reactive protein (hs-CRP) and intact parathyroid hormone (iPTH) levels as well as proteinuria were analyzed. Patients were followed up for a mean of 30 (24-35) months and renal and metabolic parameters were compared in conjunction with a homeostasis model assessment of IR (HOMA-IR) between the entry and the end of the study period. CKD progression was assessed by recording renal endpoints, which included end-stage renal disease, requiring renal replacement therapy, or overall mortality. Results: The study patients were divided into group 1 (n = 36), without IR, and group 2 (n = 37), with IR. Group 2 patients had a higher FBG (p = 0.003) and insulin level (p = 0.001) compared to group 1. The baseline and end of study systolic (p = 0.007) and diastolic (p = 0.001) blood pressures were decreased in group 1. In group 2, FBG (p = 0.008), HbA1c (p = 0.009), systolic (p = 0.024) and diastolic (p = 0.001) blood pressures and CRP (p = 0.047) were decreased. In group 2, 8 patients reached renal endpoints while in group 1, 9 patients reached study endpoints. HOMA-IR was not significantly higher among 17 patients who reached the renal endpoint than among the 56 who did not. At baseline, those patients who reached the renal endpoint showed lower GFR (p = 0.001), higher iPTH (p = 0.004) and hs-CRP (p = 0.002) levels. Conclusion: There was no significant difference in GFR at the end of the study between patients who had or did not have IR. Furthermore, HOMA-IR was not significantly different in patients with or without renal endpoints. Copyright © 2011 S. Karger AG. Source

Belli H.,Bagcilar Education and Research Hospital | Ural C.,Bagcilar Education and Research Hospital
West Indian Medical Journal

Background and objective: This review article aims to discuss and evaluate the risk factors for thedevelopment of violence and homicidal behaviour and the effectiveness and outcomes of the preferred atypical antipsychotics in patients diagnosed with schizophrenia. Method: For this purpose, the psychiatry literature was comprehensively reviewed. A screening of the articles in the international databases covering the period between 1970 and 2010 was performed. Results: Although the risk of homicidal behaviours is higher in patients with schizophrenia compared to the overall population, little is known about the relevant conditions triggering acts of violence among the patients with schizophrenia. The available results suggest that certain factors including some sociodemographic characteristics, young age, alcoholism, substance abuse, noncompliance with treatment, fulfillment of the criteria for antisocial personality disorder and paranoid subtype, history of suicidal ideation and attempts and history of frequent hospitalization increase the potential for violent episodes. Available data show clozapine to be the most rational therapeutic choice in preventing violent behaviour in patients with schizophrenia. There is evidence from randomized controlled trials in support of the specific anti-aggressive effect of clozapine. Conclusion: In clinical practice, patients with a risk of committing homicide should be detected and monitored closely. There are many trials showing the efficacy of clozapine on violent and aggressive behaviour. Source

Taskin U.,Bagcilar Education and Research Hospital | Yigit O.,Istanbul Education and Research Hospital | Sisman S.A.,Bagcilar Education and Research Hospital
Otolaryngology - Head and Neck Surgery

Objectives. To examine the closure of nasal septal perforations with bilateral nasal floor flaps combined with auricular cartilage grafts and a normally functioning nose in revision patients. Study Design. Case series with chart review. Setting. A tertiary referral hospital in Turkey. Subjects and Methods. Seventeen patients (11 men, 6 women) with nasal septal reperforation were treated surgically using combined bilateral nasal floor mucosal flaps with bilateral auricular cartilage interpositional grafts. Results. The mean follow-up was 15.2 (range, 9-28) months. The average anteroposterior diameter of perforation was 28 ± 3 (range, 20-38) mm, and the average vertical diameter was 23 ± 8 (range, 20-27) mm at the widest site. The nasal septal perforations were closed completely in 16 cases; in 1 case, the perforation was not repaired completely. Conclusions. A successful multilayer closure technique with good exposure was applied in patients with reperforation. © American Academy of Otolaryngology - Head and Neck Surgery Foundation 2011. Source

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