Arif Duran

Interleukin 10 reduces testicular damage in experimental testicular ischemia/reperfusion injury.

OBJECTIVE To evaluate the protective effect of interleukin 10 (IL-10) on biochemical and histopathologic changes in experimental testicular ischemia or reperfusion injury (RI) in rats. METHODS Sprague-Dawley rats were randomly divided into 3 groups, each containing 7 rats; sham-control, I-R/untreated group, and I/R treated with IL-10. The ischemia period was 6 hours, and orchiectomy was performed after 1 hour of detorsion. IL-10 was given intraperitoneally in a period of 10 minutes before reperfusion. In all groups, ipsilateral orchiectomies were performed to make histologic examination and biochemical analysis such as malondialdehyde, glutathione peroxidase, and myeloperoxidase (MPO). RESULTS IL-10 treatment significantly decreased the I-R-induced elevation in testes malondialdehyde levels. In the I-R/IL-10-treated group, testes glutathione peroxidase levels were increased compared with the I-R/untreated group rats. MPO activities were significantly increased in the testes tissues of the I-R/untreated group. However, in the I-R/IL-10-treated group, MPO levels significantly decreased. Histopathologically, in the I-R/untreated group rats, edema, congestion, hemorrhage among seminiferous tubules, and necrosis of the germinal cells were predominant features in sections. The testicular injury score was lower in the IL-10-treated group rats compared with the I-R/untreated group. CONCLUSION IL-10 might play a protective role in reducing reperfusion injury.

Protective effect of montelukast, a cysteinyl leukotriene receptor-1 antagonist, against intestinal ischemia-reperfusion injury in the rat.

Abstract Objective : Ischemia-reperfusion (I-R) injury of the intestine is a significant problem because the initial damage caused by ischemia is exacerbated by reperfusion. In this study, we examined the protective effect of montelukast against I-R-induced intestinal tissue damage. Materials and methods : Eight-week-old male Sprague-Dawley rats were randomly divided into three treatment groups: a sham-operated group, a group receiving I-R, and a group receiving I-R plus montelukast (I-R/M). Tissue samples were evaluated and scored histologically. The blood levels of malondialdehyde (MDA), myeloperoxidase (MPO), glutathione (GSH), and cardiotrophin-1 (CT-1) were measured. Results : In the I-R group, the histological score and the levels of serum MDA and MPO were increased compared with those in the control group. In the I-R/M group, the histological score and serum MDA and MPO levels were significantly decreased compared with those in the I-R group. Additionally, compared with the IR group, the I-R/M group had increased serum GSH and CT-1 levels and a decreased intestinal injury score. Ileal sections from the I-R/M group showed minimal alterations, characterized by moderate lifting of the epithelial layer from the lamina propria, and few apoptotic enterocytes were observed compare with the number in the I-R group. Conclusion : The findings of the present study demonstrated that montelukast can protect I-R-induced intestinal damage in rats.

A New Diagnostic Marker For Acute Pulmonary Embolism In Emergency Department: Mean Platelet Volume

OBJECTIVE To investigate the diagnostic importance of mean platelet volume (MPV) on acute pulmonary embolism (APE) in the emergency Department (ED). METHODS Subjects were selected from patients admitted to ED with clinically suspected APE. Demographic, anthropometric and serologic data were collected for each patient. RESULTS A total of 315 consecutive patients were analyzed, including 150 patients (53.44 ± 15.14 y; 92 men/58 women) in APE group and 165 patients (49.80 ±13.76y; 94 men/71 women) in the control group. MPV in the APE group was significantly higher than in the control group (9.42±1.22 fl vs. 8.04±0.89 fl, p<0.0001). The best cut-off values for MPV when predicting APE in patients with clinically suspected APE presenting at the ED were 8.55 fl (sensitivity 82.2%; specificity 52.3%). CONCLUSIONS MPV is a helpful parameter for the diagnosis of APE in ED, for the first time in the literature.

Evaluation of patients with Tularemia in Bolu province in northwestern Anatolia, Turkey

INTRODUCTION Tularemia is a zoonotic disease caused by Francisella tularensis. Here we present an epidemic occurring in Bolu province, located in northwestern Anatolia in Turkey, and some features of the cases. METHODOLOGY The data was provided by the Bolu Provincial Health Directorate. All of the antibody response tests were studied in the National Health Institute (formerly named Refik Saydam Hygiene Department), the reference laboratory of the Ministry of Health of the Turkish Republic. A total of 393 individuals were tested by microagglutination test (MAT) for tularemia between 2006 and 2011. A total of 218 patients whose demographical data were available were included in the study; 83 were accepted as the patient group and 135 were the controls. Of the patients, 31 (37.3%) were male and 52 (62.7%) were female. RESULTS Fever (p < 0.001), URTI symptoms (p = 0.047), conjunctivitis (p = 0.004), and rash (p = 0.026) were significantly higher in the patient group. A positive association was found between MAT and fever (r = 0.324; p < 0.001), and a negative association was found between MAT and both lymphoadenopathy (r = -0.25; p = 0.013) and chills (r = -0.218; p = 0.035). Higher MAT titers were detected in oropharyngeal tularemia (r = 0.306; p = 0.003). CONCLUSIONS In conclusion, tularemia must be considered in differential diagnosis in patients presenting with fever and LAP in non-endemic regions. Furthermore, water sources and contact with rodents must be investigated.

Frequency of MEFV mutation and genotype–phenotype correlation in cases with dysmenorrhea

We aimed to investigate the relation between mutations and polymorphisms playing roles in the onset of clinical findings of Familial Mediterranean Fever (FMF) and clinical phenotypic reflections manifesting with painful episodes, such as dysmenorrhea.

The importance of the mean platelet volume in the diagnosis of supraventricular tachycardia

BACKGROUND The diagnosis of palpitation can be difficult in the emergency department (ED) and the waiting time for a first appointment with an arrhythmia clinic can be very long. The inflammation is sufficient to facilitate the initiation of supraventricular tachyarrhythmia (SVT). The increased mean platelet volume (MPV) is closely correlated with inflammation and to reflect inflammatory burden in different condition. OBJECTIVE In this study, we aimed to investigate the relation between MPV and SVT in patient with documented atrial tachyarrhythmia in ED. METHODS Two study groups were compared; a SVT group with arrive at the ED with documented SVT (n=122) and 100 healthy adult without any palpitation symptom, arrhythmic disease, and with normal physical examination results that were brought for checkups to the cardiology polyclinic were classified as control group. Blood samples were obtained from all patients for determining the hematologic counts and MPV during first hour in ED period. RESULTS In terms of the focus of the study, hemoglobin, neutrophil count, mean cell volume (MCV), red cell distribution width (RDW), platelet, white blood cell (WBC), and lymphocyte counts were similar in both group (p>0.05). MPV in the SVT group was signifi cantly higher than in the control group (9.12±1.22 fl vs 8.64±0.89 fl , p<0.001). Multivariate logistic regression analysis showed that just MPV was independent predictor of SVT in patients with palpitation in ED (odds ratio [OR] 8.497, 95% confidence interval (6.181 to 12.325), p=0.012). CONCLUSIONS Our study described that MPV is helpful parameter for the diagnosis of SVT in emergency department, for the first time in the literature.

The diagnostic significance of NT-proBNP and troponin I in emergency department patients presenting with palpitations

OBJECTIVE: This prospective study investigated the diagnostic significance of the N-terminal pro-brain natriuretic (NT-proBNP) and troponin I peptides in emergency department patients presenting with palpitations. METHODS: Two groups of patients with palpitations but without documented supraventricular tachycardia were compared: a group with supraventricular tachycardia (n = 49) and a control group (n = 47). Both groups were diagnosed using electrophysiological studies during the study period. Blood samples were obtained from all of the patients to determine the NT-proBNP and troponin I levels within the first hour following arrival in the emergency department. RESULT: The mean NT-proBNP levels were 207.74±197.11 in supraventricular tachyarrhythmia group and 39.99±32.83 pg/mL in control group (p<0.001). To predict supraventricular tachycardia, the optimum NT-proBNP threshold was 61.15 pg/mL, as defined by the receiver operating characteristic (ROC) curve, with a non-significant area under the ROC curve of 0.920 (95% CI, 0.86-0.97, p<0.001). The NT-proBNP cut-off for diagnosing supraventricular tachycardia had 81.6% sensitivity and 91.5% specificity. Supraventricular tachycardia was significantly more frequent in the patients with NT-proBNP levels ≥61.15 pg/mL (n = 44, 90.9%, p>0.001). The mean troponin I levels were 0.17±0.56 and 0.01±0.06 pg/mL for the patients with and without supraventricular tachycardia, respectively (p<0.05). Of the 96 patients, 21 (21.87%) had troponin I levels ≥0.01: 2 (4.25%) in the control group and 19 (38.77%) in the supraventricular tachycardia group (p<0.001). CONCLUSION: Troponin I and, in particular, NT-proBNP peptide were helpful for differentiating supraventricular tachycardia from non- supraventricular tachycardia palpitations. Further randomized, large, multicenter trials are needed to define the benefit and diagnostic role of NT-proBNP and troponin I in the management algorithm of patients presenting with palpitations in emergency departments.

A case of abdominal pain; rectus sheath hematoma

Rektus kılıf hematomu, rektus kasının veya epigastrik damarların yırtılması neticesinde gelişen akut karın ağrısı nedenlerinden birisidir. Ender olarak acil başvuru olması, akut karın ağrısı tanısında kolay hatırda tutulmamasına neden olurken, kanama bozukluğu olan hastalarda akılda tutulmalıdır. Karın ağrısı yakınması acile başvuruların önemli bir kısmıdır (1). Ağrının nedeni önemsiz bir neden olabileceği gibi, yaşamı tehdit eden çok ciddi birtakım patolojiler ağrı nedeni olabilir. Rektus kılıf kanamaları yaşlı ve kadınlarda daha sık görülür (2). Bu makalede karın ağrısının nadir nedenlerinden olan rektus kılıf hematomu olgusunu literatür eşliğinde sunmayı amaçladık. OLGu

Uveitis attack and drug reaction due to cefuroxime axetil.

Abstract Antibiotics are natural or synthetic substances that are used to control bacterial infections because antibiotics are by definition only effective against bacteria. A 30-year-old female came to our emergency clinic complaining rubor in both eyes, especially in the left eye, with swelling, rubor and pain in ears, and eruption in lips extremities. In her anamnesis, it has been determined that she did not have any medical disease that requires regular utilization of drugs. After the patient received cefuroxime axetil for acute tonsillitis, she observed eruptions in lip extremities on the 3rd day, but she did not care about it. On the 5th day, rubor in both eyes and, especially in the left eye, have been developed, and complaints such as unable to look toward light and pain have started together with swelling, rubor, and pain in both ears. She came to our clinic because she was very much worried about the situation. In this study, we aimed to discuss a drug reaction characterized by face and ear skin observations, due to uveitis after the use of antibiotics including cefuroxime axetil for acute tonsillitis.

Anaphylactic Shock Diagnosed with Bedside Abdominal Ultrasonography and Computerized Tomography

Aim: The utility of ultrasound in assisting with the presentation of undifferentiated shock is becoming widely accepted as an invaluable tool with triaging both etiology and treatment. We believe this case highlights the utility of ultrasound in assisting with the clinical care of patients with anaphylactic shock. Case: Here, we present a 29-year-old man with no medical history, who was brought to our emergency department (ED) as intubated due to unconsciousness, hypotension, severe dyspnea and pruritus. On arrival to our ED, his pulse was filiform, and his extremities were cold and cyanotic. FAST examination to rule out trauma revealed anechoic cysts in liver. His abdominal CT revealed ruptured pouch of a hydatid cyst. He was admitted to ICU after 2-day follow up in the surgery clinics. He was discharged with full recovery. Conclusion: In conclusion, when critically ill patients with undifferentiated shock present in areas where animal husbandry is common, anaphylaxis due to hydatid cyst rupture should be kept in mind. Given the age, local agricultural practices, and presentation of distributive shock with concomitant liver cysts on ultrasonography we were able to triage the patient to abdominal computerized tomography scan and ultimately to definitive treatment.