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Basturk T.,Bagcilar Education and Research Hospital | Unsal A.,Sisli Etfal Education and Research Hospital
Kidney and Blood Pressure Research | Year: 2011

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.


Belli H.,Bagcilar Education And Research Hospital | Belli S.,Bagcilar Education And Research Hospital | Oktay M.F.,Bagcilar Education And Research Hospital | Ural C.,Bagcilar Education And Research Hospital
General Hospital Psychiatry | Year: 2012

Background: The aim of this review to investigate presence of psychopathological states and efficacy of psychopharmacological drugs in the treatment of tinnitus. Materials and Methods: An extensive Internet search has been performed for this aim through PubMed by using related key words in English. Results: Higher anxiety and depression levels and somatoform disorder clusters are defined in patients with tinnitus. Additionally, impulsivity, hostility, demanding, physical discomfort, anxiety for health, emotionality and suicidal tendency are also defined in these people. Personality characteristics in these patients are depression, hysteria and hypochondriac features. Besides these symptom clusters, more severe psychopathologies like personality disorders may be encountered in these patients. Sertraline, paroxetine and nortriptyline can be considered as the first-line antidepressants in the psychopharmacological treatment of tinnitus. There are studies which have reported the efficacy of sulpiride. Carbamazepine, valproate and gabapentin can be effective as mood stabilizers. Short-acting benzodiazepines like alprazolam and midazolam are effective in signs of anxiety. Clonazepam and diazepam can be evaluated as other options. However, some glutamate receptor antagonists also can be used in the treatment of tinnitus.Disturbed sleep is frequently associated with tinnitus. Sleep disturbance can disrupt the quality of life in the patients with tinnitus. These patients might benefit from cognitive-behavioral therapy, which offers the promise of relief from tinnitus-related distress and insomnia. Conclusion: When pathophysiologic reasons are excluded, it should be at least considered that tinnitus is exaggerated by psychopathological symptoms. Life quality of patients can be increased by treating these symptoms. © 2012 Elsevier Inc.


Biteker M.,Istanbul University | Dayan A.,Haydarpasa Numune Education and Research Hospital | Tekkesin A.I.,Training Hospital | Can M.M.,BagcIlar Education and Research Hospital | And 3 more authors.
American Journal of Surgery | Year: 2014

Background The aim of this study was to determine the incidence rate, identify the risk factors, and describe the clinical outcome of perioperative acute kidney injury (AKI) in patients undergoing noncardiac, nonvascular surgery (NCS). Methods A total of 1,200 adult consecutive patients undergoing NCS were prospectively evaluated. Patients with pre-existing renal dysfunction were excluded. The primary outcome of this study was perioperative AKI defined by the RIFLE (risk, injury, failure, loss of function, and end-stage kidney disease) criteria. Results Eighty-one patients (6.7%) met the AKI criteria. Multivariate analysis identified age, diabetes, revised cardiac risk index, and American Society of Anesthesiologists physical status as independent predictors of AKI. Patients with AKI had more cardiovascular (33.3% vs 11.3%, P <.001) complications and a higher in-hospital mortality rate (6.1% vs 0.9%, P =.003) compared with patients without AKI. Conclusions Several preoperative predictors are found to be associated with AKI after NCS. Perioperative AKI is an independent risk factor for outcome after NCS. © 2014 Elsevier Inc. All rights reserved.


Belli H.,Bagcilar Education and Research Hospital | Ural C.,Bagcilar Education and Research Hospital | Vardar M.K.,Bagcilar Education and Research Hospital | Yesilyurt S.,BakIrkoy Mazhar Osman Education and Research Hospital for Mental Health and Neurological Diseases | Oncu F.,BakIrkoy Mazhar Osman Education and Research Hospital for Mental Health and Neurological Diseases
Comprehensive Psychiatry | Year: 2012

The present study attempted to assess the dissociative symptoms and overall dissociative disorder comorbidity in patients with obsessive-compulsive disorder (OCD). In addition, we examined the relationship between the severity of obsessive-compulsive symptoms and dissociative symptoms. All patients admitted for the first time to the psychiatric outpatient unit were included in the study. Seventy-eight patients had been diagnosed as having OCD during the 2-year study period. Patients had to meet the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for OCD. Most (76.9%; n = 60) of the patients were female, and 23.1% (n = 18) of the patients were male. Dissociation Questionnaire was used to measure dissociative symptoms. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Dissociative Disorders interviews and Yale-Brown Obsessive Compulsive Checklist and Severity Scale were used. Eleven (14%) of the patients with OCD had comorbid dissociative disorder. The most prevalent disorder in our study was dissociative depersonalization disorder. Dissociative amnesia and dissociative identity disorder were common as well. The mean Yale-Brown score was 23.37 ± 7.27 points. Dissociation Questionnaire scores were between 0.40 and 3.87 points, and the mean was 2.23 ± 0.76 points. There was a statistically significant positive correlation between Yale-Brown points and Dissociation Questionnaire points. We conclude that dissociative symptoms among patients with OCD should alert clinicians for the presence of a chronic and complex dissociative disorder. Clinicians may overlook an underlying dissociative process in patients who have severe symptoms of OCD. However, a lack of adequate response to cognitive-behavioral and drug therapy may be a consequence of dissociative process. © 2012 Elsevier Inc.


Belli H.,Bagcilar Education and Research Hospital
The West Indian medical journal | Year: 2013

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.


Okuyan E.,Bagcilar Education and Research Hospital | Uslu A.,Serife Baci State Hospital | Ozan Levent M.,Serife Baci State Hospital
Clinical Toxicology | Year: 2010

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.


Belli H.,Bagcilar Education and Research Hospital | Ural C.,Bagcilar Education and Research Hospital
West Indian Medical Journal | Year: 2012

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.


Orhan I.,Istanbul University | Aydin S.,Bagcilar Education and Research Hospital | Ormeci T.,Istanbul University | Yilmaz F.,Istanbul University
American Journal of Rhinology and Allergy | Year: 2014

Background: The aim of this study was to evaluate the relationship between nasal septum deviation grade and inferior turbinate hypertrophy with the computed tomography (CT). Methods: The paranasal sinus CTs of 82 patients with septum deviation were evaluated. Nonhypertrophied inferior turbinates on the deviated side of the nasal septum were accepted as the control group and hypertrophic inferior turbinates of the other side were taken as the compensatory group in the same patient. The turbinate bone, medial mucosa, lateral mucosa, septal deviation angle, and deviation volume were measured using three-dimensional CT. Results: The study group included 82 patients (M/F, 42/40) and ages ranged from 17 to 79 years (mean, 38.5 ± 14 years). There was a statistically significant positive correlation between the deviation angle and the deviation volume (p < 0.01). The measurements of the inferior turbinate bone and medial and lateral mucosal thickness were statistically different between the compensatory group and the control group (p < 0.01). There were no statistically significant differences in comparisons between the lateral and medial mucosal thickness with the deviation angle and the deviation volume in the two groups (p > 0.05). A positive correlation between the measurements of the deviation angle, deviation volume, and bone thickness was found statistically significant in the compensatory group (p < 0.05). Conclusion: The compensatory hypertrophy of inferior turbinates in patients with nasal septum deviation is not only caused by mucosal hypertrophy, but also by hypertrophy of the inferior turbinate bone itself. The assistance of preoperative CT before septoplasty can be useful when deciding on the surgical technique to fix turbinate. Copyright © 2014, OceanSide Publications, Inc.


Yildiz I.,Istanbul University | Ozguroglu M.,Istanbul University | Toptas T.,Marmara University | Turna H.,Istanbul University | And 2 more authors.
Journal of Palliative Medicine | Year: 2013

Background: The aim of this study was to determine the tendency to use complementary/alternative medicine (CAM) by patients with cancer in Turkey, and to compare sociodemographic and medical characteristics, perceptions, and quality of life of users and nonusers of CAM. Methods: A total of 1060 cancer patients were asked to complete a questionnaire about the use of CAM along with the European Organization for Research and Treatment of Cancer Life Quality Questionnaire C30 (EORTC QLQ-C30). Medical information was obtained from hospital chart records. Results: The response rate was 40.1% (425/1060). Use of at least one kind of CAM was identified in 57.4% of the patients. Herbal medications (95%), spiritual/religious affiliations (23.3%), multivitamins/antioxidants (18.4%), and transcendental meditation/yoga (8.6%) were the leading CAM methods. In multivariate analysis, CAM use was found to be associated with age (>60 years) only. Average expenditure on CAMs was 30 U.S. dollars (USD) per patient per month. The most common causes of CAM use were belief in their efficacy (41.3%) and intimate interaction with CAM users (37.2%). Only 41% of the users had informed their doctors that they used CAM. QLQ scores were similar between CAM users and nonusers. Of all participants, 15.5% had psychiatric support. Proportions of regular antidepressant and analgesic use were 16.4%, and 46.3%, respectively. CAM users had worse appetite scores. There was no difference in terms of other scales between the groups. Conclusions: This study showed that CAM use is widespread among Turkish cancer patients and CAM use does not improve QLQ scores. Physicians should be aware of high CAM utilization rate in patients with cancer and should better understand the factors directing the patients to such treatments. © Copyright 2013, Mary Ann Liebert, Inc.


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 | Year: 2011

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.

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