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Ozdil K.,Umraniye Training and Research Hospital | Kahraman R.,Umraniye Training and Research Hospital | Sahin A.,Umraniye Training and Research Hospital | Calhan T.,Umraniye Training and Research Hospital | And 4 more authors.
Rheumatology International | Year: 2013

Patients with gastroesophageal reflux disease (GERD) receive long-term therapy with proton pump inhibitor (PPI) agents. Several studies have recently been published suggesting that treatment with PPI may cause bone fractures, although the number of prospective studies in this regard is limited. The aim of this study is to prospectively investigate the effect of PPIs on bone density. Between March 2009 and January 2011, 114 GERD patients (18-56 years) and 110 healthy controls were included in the present study. Bone mineral densitometry (BMD) by using dual-energy X-ray absorptiometry was assessed at lumbar spine and femur neck. BMD measurements were performed on all subjects at the beginning of the study. The patients were divided according to three drugs by their treatment with esomeprazole, lansoprazole, or pantoprazole. The study group was followed for at least 6 months on PPI therapy, and then BMD measurements were repeated. The mean duration of treatment with PPIs was 8.5 ± 2.3 months. In patients receiving PPIs, the mean reduction in total vertebra T score following treatment compared to pre-treatment values was 00.23 ± 0.42 units (95 % CI 0.15-0.30) (p < 0.01), while the mean reduction in the femur T score was 0.10 ± 0.40 units (95 % CI 0.03-0.18) (p = 0.03). Reduction following treatment in L4 and total vertebra T scores of lansoprazole group was significantly higher than of pantoprazole group (p = 0.04). Reduction in femur T score of esomeprazole group was higher than of lansoprazole group and pantroprazole group, but it is not statistically significant. Treatment with a PPI results in a significant reduction in bone density. Close monitoring is beneficial for patients who are to receive long-term treatment with PPI. © 2013 Springer-Verlag Berlin Heidelberg.


Cefle A.,Kocaeli University | Inanc M.,Istanbul Medical Faculty | Sayarlioglu M.,Istanbul Medical Faculty | Kamali S.,Istanbul Medical Faculty | And 4 more authors.
Rheumatology International | Year: 2011

Pulmonary hypertension (PH) in systemic lupus erythematosus (SLE) is associated with an unfavorable prognosis. We investigated the characteristics of SLE patients with PH. The patients with a pulmonary artery systolic pressure more than 30 mmHg at rest on echocardiogram were diagnosed with PH. Echocardiography was done only in patients with clinical or radiological evidence suggesting PH. Right heart catheterization was not performed. We identified 10 SLE patients with PH between 1980 and 2000. We compared their clinical and laboratory parameters with those of 97 consecutive SLE patients without PH. Nine of the ten patients with PH were females. The mean age at the time of SLE onset was 25.2 ± 6.9 years; the mean duration of follow-up was 93.4 ± 52.8 months, and the interval between the onset of SLE and PH diagnosis was 9.0 ± 4.6 (5-21) years. Antiphospholipid antibody positivity was significantly higher in the PH group (80 vs. 36%; p < 0.05), but there was no significant difference between two groups in regard to secondary antiphospholipid syndrome. The frequency of Raynaud's phenomenon was higher in PH group (60 vs. 27%; p < 0.05). Renal involvement (80 vs. 43%; p < 0.05), neuropsychiatric involvement (40 vs. 7.2%; p < 0.005) and serositis (70 vs. 14.4%; p < 0.001) were significantly more frequent in the PH group. The mean damage score in patients with and without PH were 4.0 ± 2.4 and 0.4 ± 1.0, respectively (p < 0.001). Four patients with PH died during the followup. This study reveals that the presence of PH defines a subgroup of patients with a severe disease and increased mortality. Antiphospholipid antibodies and Raynaud's phenomenon may contribute to the pathogenesis of PH. We recommend that all patients with SLE, especially those positive for antiphospholipid antibodies and/or with signs of Raynaud's phenomenon should be regularly evaluated for the development of PH. © Springer-Verlag 2009.


Seyhan E.C.,Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery | Ozgul M.A.,Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery | Tutar N.,Kayseri Medical Faculty | Omur I.,Istanbul Medical Faculty | And 2 more authors.
COPD: Journal of Chronic Obstructive Pulmonary Disease | Year: 2013

Background: Cardiovascular disease (CVD) contributes significantly to mortality in chronic obstructive pulmonary disease (COPD). Red blood cell distribution width (RDW), an automated measure of red blood cell size heterogeneity that is largely overlooked, is a newly recognized mortality marker in patients with established CVD. It is unknown whether RDW is associated with mortality in COPD patients. Aims: To study the prognostic value of RDW in patients with COPD and to compare the value of this measurement with cardiac, respiratory, and hemotological status. Method: We performed retrospective analyses of 270 patients stable with COPD who were admitted to our hospital between January 2007 and December 2009. Demographic, clinical, echocardiographic, and laboratory characteristics were registered and recorded COPD deaths were registered as outcomes. Results: In the overall patients, the RDW level had a mean value of 15.1 ± 2.4. RDW was positively correlated with C-reactive protein (CRP) (p = 0.008, r = 0.21), right ventricular dysfunction (RVD) (p < 0.001, r = 0.25), and pulmonary arterial hypertension (PAH) (p = 0.03, r = 0.14). Variables (p < 0.1) included in the univariate survival analysis were forced expiratory volume in 1 second (FEV1% predicted), RDW levels, age, PaCO2, albumine and CRP levels, presence of CVD, presence of anemia, presence of RVD, and presence of PAH. Subsequent multivariate analysis suggested that RDW levels (1.12; 95% CI, 1.01 to 1.24; p = 0.01), and presence of RVD (2.6; 95% CI, 1.19 to 5.8; p = 0.01) were independently related to mortality. Conclusion: Elevated RDW levels were associated with increased mortality risk in stable COPD patients. © 2013 Informa Healthcare USA, Inc.


Selcuk C.T.,Dicle University | Kuvat S.V.,Istanbul Medical Faculty | Bozkurt M.,Dicle University | Yasar Z.,Dicle University | And 4 more authors.
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2012

Previous studies have shown that nicotine increases the risk of necrosis in skin flaps. We investigated the effect of hyperbaric oxygen (HBO 2) treatment on the survival of random skin flaps in nicotine-treated rats. Thirty-two Sprague-Dawley rats were divided into four groups with eight rats in each group. Group 1 (n = 8) was the control, group 2 (n = 8) received HBO 2 treatment without being exposed to nicotine, group 3 (n = 8) received nicotine and group 4 (n = 8) received HBO 2 treatment with exposure to nicotine. The rats in the nicotine-treated groups were prepared by treating them with nicotine for 28 days. At the end of the 28th day, standard McFarlane-type random skin flaps were lifted from the backs of all the rats. In groups 2 and 4, HBO 2 treatment started at the 30th min following the surgery and continued once a day for 7 days. The flap survival rates and histopathological evaluation results related to neovascularisation and granulation tissue formation were significantly better in the HBO 2-treated groups (groups 2 and 4) than in the groups that did not receive HBO 2 treatment (groups 1 and 3) (p < 0.05). The flap survival rates, neovascularisation and granulation tissue formation were highest in group 2 and lowest in group 3 (p ≤ 0.001). No significant difference was observed between group 4, which received HBO 2 treatment with nicotine exposure, and the control group (group 1) (p > 0.05). In conclusion, our study demonstrates that HBO 2 treatment has a positive effect on flap survival in nicotine-treated rats. © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.


Risperidone treatment in preschool children with disruptive behavior disorders: a chart review study Objective: To gather data about the efficacy and safety of risperidone in normally developing preschool children with disruptive behavior disorders (DBDs). Methods: This is a retrospective chart review study of preschool aged children who were referred to a university hospital or a private child psychiatry clinic and treated with risperidone for the presence of DBDs. Charts of the subjects were reviewed for psychiatric characteristics of the subjects as well as the efficacy and safety of risperidone. Symptom severity and improvement were assessed with Clinical Global Impression- Severity (CGI-S) and Improvement (CGI-I) scales. Results: The subjects were 21 boys (84%) and 4 girls (16%) with an age range of 26-64 months (45.79±11). The duration of risperidone treatment ranged from 2-60 weeks (18.87±15.19). Risperidone dosage ranged from 0.25-1 mg/ day (0.52±0.22 mg). Baseline and end point CGI-S scores ranged from 6-7 (6.56±0.5) and 2-7 (3.96±1.3), respectively. A nonparametric Wilcoxon t-test revealed significant differences between baseline and end point CGI-S scores (p>0.001). The majority of the subjects (n=18; 72%) showed much to very much improvement in target disruptive behavior symptoms. Overall five subjects (20%) did not report any side effects. The most frequently reported side effects were sedation, increased appetite, weight gain, enuresis, headache, dermatological reactions, and fatigue. Four subjects discontinued the medication due to side effects. Side effects were generally transient and mild to moderate in severity and no life threatening side effects were reported.Conclusions: Psychosocial interventions should be the first-line of treatment in preschool children with DBDs. Psychopharmacological treatment may be considered in severely impaired subjects with careful monitoring. Risperidone may generally be a safe and effective option in treating DBDs in preschool children; however, relatively high rates of side effects should suggest caution in the use of this drug. Further systematically designed studies are needed on this topic.


Jones R.N.,JMI Laboratories | Flonta M.,Infectious Disease Hospital | Gurler N.,Istanbul Medical Faculty | Cepparulo M.,Pfizer | And 2 more authors.
Diagnostic Microbiology and Infectious Disease | Year: 2014

In the European component of the Regional Resistance Surveillance study for 2011, a total of 21 countries were monitored for antimicrobial resistance patterns including Belgium, Bulgaria (BU), Croatia, Czech Republic, France (F), Germany (GE), Greece (GR), Ireland (IR), Israel (IS), Italy (IT), Poland (PO), Portugal (PT), Romania (RO), Russia (RU), Slovakia (SK), Slovenia, Spain, Sweden (SW), Turkey (T), Ukraine, and United Kingdom. Results from testing 12,572 strains (100 [BU] to 1535 [F] per nation) were interpreted by contemporary published breakpoints. Samples from 47 hospitals were reference tested against agents such as amikacin (AMK), cefoperazone/sulbactam (C/S), colistin (COL), levofloxacin, linezolid (LZD), tigecycline (TIG), vancomycin (VAN), and 21 others. Among Staphylococcus aureus, LZD (MIC90, 2 μg/mL), TIG (MIC90, 0.12 μg/mL), and VAN (MIC90, 1 μg/mL) exhibited complete coverage and methicillin resistance rates among nations (average, 31%) ranged from 0.9% (SW) to 60.0-60.2% (PT, SK). Seven LZD-resistant coagulase-negative staphylococci (only 1.1% resistance overall) were noted in 5 nations, and a Staphylococcus simulans strain (MIC, 8 μg/mL from RO) had L3 mutations (N130D, G152A, F147S, A157R); also 6 LZD-resistant enterococci were detected in 3 countries (GE, IR, T). VAN-resistant enterococci (10% overall; 84% VanA) were found in 14 countries, highest in GE and IR (23.0%). The ESBL phenotype rate for Escherichia coli was 20.1% (range, 0.9% [SW] to 70.0-89.7% [BU, RU]), best inhibited by COL (100.0% S), TIG (100.0%), AMK (83.3-94.1%), C/S (81.0%), and carbapenems (>99.0%; resistant strains in IS and T). Klebsiella spp. had greater ESBL rates (45.7% overall, range 2.5-100.0%), as well as carbapenem resistance (8.3% overall, greatest in BU, GR, IS, IT, PO, RO, RU, T). Non-fermentative Gram-negative bacilli (Pseudomonas aeruginosa, Acinetobacter [ACB]) were generally less susceptible, except against COL (99.2-99.6% S) and TIG (95.0% inhibited at ≤2 μg/mL; ACB only). The following carbapenemases were detected: VIM-1 (2 countries); IMP-1 (1 from T); KPC-2 or -3 (2 countries); VIM-4 (1 from PO), NDM-1 (2 in RO; 2 centers); and OXA-48 or -162 (5 from T; 2 centers). European surveillance sampling demonstrates a wide array of resistant isolates, less prevalent among Gram-positive cocci that remain inhibited by several available agents. However, beta-lactamase-mediated mechanisms have spread widely among Gram-negative bacilli, especially across the Eastern and Southern European nations, severely limiting infection chemotherapy and necessitating escalated antimicrobial stewardship. © 2014 Elsevier Inc.


Tatli B.,Istanbul Medical Faculty | Ekici B.,Istanbul Medical Faculty | Ozmen M.,Istanbul Medical Faculty
Expert Review of Neurotherapeutics | Year: 2012

Subacute sclerosing panencephalitis is a progressive neurological disorder of children and young adults caused by a measles virus that became defective by persisting in the host. According to the results of clinical trials, antiviral and/or immunomodulatory therapy can slow the progression of the disease and improve life expectancy in patients. However, its long-term effects and eventual outcome remain debatable due to conflicting results and its lack of effect on the rapidly progressive form of the disease. Possible future therapies for subacute sclerosing panencephalitis are RNAi and antiapoptotic agents, which are currently in the hypothetical and experimental stages of research. © 2012 Expert Reviews Ltd.


Ozkaya E.,Istanbul Medical Faculty | Elinc-Aslan M.S.,Istanbul Medical Faculty
Dermatitis | Year: 2011

Fixed drug eruption (FDE) is a distinctive drug eruption characterized by recurrent well-defined lesions in the same location each time the responsible drug is taken. Two different clinical forms have been described: the common classic pigmenting form and the rare nonpigmenting form. Nonpigmenting FDE is mainly characterized by symmetrical large erythematous plaques and the dermal histopathologic reaction pattern. Pseudoephedrine is known as the major inducer of nonpigmenting FDE. Pigmenting FDE from pseudoephedrine has not been reported previously. Here, the first case of pseudoephedrine-induced pigmenting FDE is reported, showing the characteristic features of classic pigmenting FDE such as asymmetry, normal-sized lesions, and the epidermodermal histopathologic reaction pattern. Moreover, a positive occlusive patch-test reaction to pseudoephedrine could be demonstrated on postlesional FDE skin for the first time. © 2011 American Contact Dermatitis Society. All Rights Reserved.


Tutkavul K.,Haydarpasa Numune Education and Research Hospital | Baslo M.B.,Istanbul Medical Faculty
Clinical Neurophysiology | Year: 2010

Objective: To measure normal variability in neuromuscular transmission in the extensor digitorum communis (EDC) muscle voluntarily activated using a disposable monopolar needle electrode (MNPE). Methods: We examined the EDC muscle using MNPE in 50 healthy volunteers (12 male and 38 female, mean age: 41.5 ± 12.9 years, age range: 18-74 years). The high-pass filter setting was 3 kHz. Results: Jitter values are expressed as the mean consecutive difference (MCD) of 20 potential pairs. Mean MCD (n = 50) was 21.3 ± 3 μs (upper 95% confidence limit (CL): 27.3 μs). Mean MCD in all potential pairs (n = 1000) was 21.3 ± 6.6 μs (upper 95% CL: 34 μs). Mean MCD for the 18th highest value was 28 ± 4.7 μs (upper 95% CL: 37.5 μs). Conclusion: The suggested practical upper limit for mean MCD was set to 28 μs; for outliers it was 38 μs. Significance: The present study defines the normative value for jitter recorded with disposable MNPE, which is a low-cost alternative for the evaluation of neuromuscular transmission, although certain precautions must be taken. © 2010 International Federation of Clinical Neurophysiology.


Tatli B.,Istanbul Medical Faculty | Ekici B.,Istanbul Medical Faculty | Ozmen M.,Istanbul Medical Faculty
Medical Hypotheses | Year: 2010

Subacute sclerosing panencephalitis (SSPE) is a progressive devastating disease. Along with the slow measles virus infection, apoptotic cell death has shown to be one of the major mechanisms at the pathogenesis. Volume reduction in frontotemporal cortex has seen in patients at early stages of disease. At present, there is no effective treatment to completely cure SSPE. Oral isoprinosine and intrathecal or intraventricular alpha-interferon are anti viral therapies with limited success.Flupirtine is an anti apoptotic agent which has been used with limited success in Alzheimer disease, prion diseases and neuronal ceroid lipofuscinosis which is a inherited disease of apoptosis related genes. Therefore, we hypothesize that flupirtine with combination of antiviral therapy may halt the progressive course of the disease. © 2010 Elsevier Ltd.

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