Aydın Çifci

Clinical importance of serum neopterin level in patients with pulmonary tuberculosis

OBJECTIVE Neopterin is a sensitive marker for cell-mediated immune response. Because of this, the neopterin levels of body fluids show cell-mediated immune response in different infectious diseases which involve T cells and macrophages. The aim of this study was to determine the clinical importance of neopterin levels in patients with tuberculosis and compare with those levels of healthy subjects. METHODS Seventy patients with tuberculosis (46 newly diagnosed cases, 15 relapse cases, and 9 multidrug-resistant tuberculosis cases) and 18 healthy adult individuals were included in the study. Neopterin concentrations were measured by the ELISA method according to the protocol of the manufacturer. Chi-square test was used in statistical analysis; p⩽0.05 was considered statistically significant. RESULTS Serum mean neopterin levels were 23.74±21.8nmol/L (median: 18.3) in newly diagnosed patients with pulmonary tuberculosis; 28.69±21.2nmol/L (median: 21.2) in relapse patients and 31.28±14nmol/L (median: 25.4) in multidrug-resistant tuberculosis cases, respectively. Serum mean neopterin levels were 4.03±5.12nmol/L (median: 5.1) in healthy subjects. The serum neopterin levels were found to be significantly higher in patients with tuberculosis than the control group. There was a statistically significant correlation between neopterin positivity (neopterin level ⩾10nmol/L was accepted to be positive) and clinical symptoms of hemoptysis and weight loss. Besides statistically significant correlations between neopterin positivity and hemoglobin level, sedimentation rate, mean leukocyte count and radiological involvement (localized or diffuse) were determined. CONCLUSION Serum neopterin levels can be used as a helper laboratory finding for the diagnosis of patients with tuberculosis. For this aim, further controlled studies are needed.

Kinolon ilişkili nadir bir komplikasyon: uzun QT sendromu

Enfekte diyabetik ayak ulserlerinin tedavisinde antibiyotikler sik kullanilan tedavi ajanlari arasinda yer almaktadir. Ancak antibiyotiklere bagli bazen hayati tehdit edebilecek boyutta ciddi yan etkiler gorulebilir. Bu yazida enfekte diyabetik ayak ulseri nedeniyle kinolon grubu antibiyotik tedavisi baslanan bir hastada bu tedaviyi takiben gelisen uzun QT sendromu ve devaminda kardiyopulmoner arrest gelisen ve defibrilasyon tedavisi ile reanimasyonu saglanan oldukca nadir bir vaka tartisilarak nadir gorulen komplikasyon uzerine dikkat cekmeyi amacladik.

Güncel kılavuzlar ışığında hiponatremi yönetimi

Hiponatremi serum sodyum duzeyinin 135 mmol/L altinda olmasi olarak tanimlanan ve hastanede yatan hastalarda en sik gorulen elektrolit bozuklugudur. Bu elektrolit bozuklugu artmis mortalite, morbidite ve uzamis hastane yatisi ile ilgilidir. Ozellikle yaslilarda, siddetli semptomu olan hastalarda hizli degerlendirme ve mudahale gerekebilmektedir. Farkli disiplinlerin farkli yaklasimlari olabilmekte ve bu durum standart yaklasim olmasini engellemektedir. Genellikle klinik degerlendirme gozardi edilmekte hastadan cok laboratuvar tetkikleri tedavi edilmeye calisilmaktadir. Bu amacla bircok dernegin katilimiyla yaklasimlari belli bir standartta toplamak amaciyla kilavuzlar olusturulmustur. Biz bu yazida kilavuzlari gozden gecirerek hiponatremiye uygun yaklasimlari pratik bir sekilde sunmayi amacladik.

Diyabetik ayak sebebiyle sepsis gelişen bir hastada şiddetli kolestatik sarılık

Bir diyabetli hastanin ayaginda ulser gelismesi hastalarda ciddi morbidite ve hatta mortaliteye neden olabilmektedir. Bu hastalarda yuk dagiliminda bozukluga yol acan mekanik problemler basta olmak uzere hem vaskuler patolojiler hem de kan sekeri regulasyonu bozuklugunun etkisiyle kucuk bir enfeksiyon odagi gunler icinde hizla sepsise ilerleyebilmektedir. Kullanilan agri kesici ve antibiyotiklerin karacigere olumsuz etkisi ve septik tablonun da katkisi ile karacigerin fizyolojik calisma sureci zorlasmaktadir. Bu vakanin oncelikli olarak enfekte diyabetik ayak ulserine yonelik degerlendirme ve tedavi plani icin hastaneye yatisi yapilmistir. Bununla birlikte primer karaciger problemi acisindan degerlendirilmeyi gerekli kilacak kadar siddetli sariligi olmasi ek arastirmalari gerekli kilmistir. Diyabetik ayak enfeksiyonu nedeniyle amputasyon yapilan hastanin operasyon oncesi klinik olarak saptanabilen sariligi ve bozulmus olan karaciger fonksiyon testleri amputasyon sonrasi enfeksiyon odaginin yok edilmesiyle dramatik sekilde duzelmistir.

Intralesional epidermal growth factor treatment on diabetic foot ulcers

Aydın Çifci1, Birhan Oktaş1, Şenay Arıkan Durmaz3, Aşkın Güngüneş3, İrfan Karahan4, Taner Sarak5 1Kırıkkale University, Faculty of Medicine, Department of Internal Medicine, Kırıkkale, Turkey 2Kırıkkale University, Faculty of Medicine, Department of Orthopedics and Traumatology, Kırıkkale, Turkey 3Kırıkkale University, Faculty of Medicine, Department of Endocrinology, Kırıkkale, Turkey 4Yenimahalle Traning and Research Hospital, Department of Internal Medicine, Ankara, Turkey 5Kırıkkale University, Faculty of Medicine, Department of Cardiology, Kırıkkale, Turkey

Hemodiyaliz hastalarında Staphylococcus aureus nazal taşıyıcılığı oranları ve risk faktörleri

Amac: Bu calismada, kronik bobrek yetmezligi nedeniyle ayaktan hemodiyaliz tedavisi alan hastalarda Staphylococcus aureus (S. aureus) ve MRSA nazal tasiyicilik oranlarinin ve tasiyicilikla iliskili risk faktorlerinin belirlenmesi amaclandi. Gerec ve Yontemler: Kirikkale ilindeki diyaliz merkezlerinde duzenli hemodiyaliz tedavisi goren 61 kadin (yas ortalamasi: 54,20 ± 15,9), 57 erkek (yas ortalamasi: 60,33 ± 15,8) olmak uzere toplam 118 hasta dahil edildi. Hastalar burun kulturu sonuclarina gore grup-1 MRSA nazal tasiyicisi olanlar, grup-2 metisiline duyarli S.aureus (MSSA) nazal tasiyicisi olanlar ve grup-3 S.aureus burun tasiyicisi olmayanlar olmak uzere 3 gruba ayrildi. Hastalarda eslik eden hastaliklar (hypertension, diabetes mellitus, akciger hastaliklari, gastrointestinal sistem hastaligi), diyaliz suresi, son bir yilda hastanede yatis, son 6 ayda antibiyotik kullanimi, ailede hastane personeli varligi, son bir yilda kateter enfeksiyonu gecirme, sigara aliskanligi, serum albumin duzeyi ile MRSA burun tasiyiciligi arasindaki iliski arastirildi. Hastalardan alinan burun suruntu ornekleri sirasiyla; mannitol salt agar ve kromojenik MRSA agar besiyerlerine (BBL Chromagar MRSA II) ekildi, izolatlar konvansiyonel bakteriyolojik yontemlerle tanimlandi. Izole edilen suslarda metisilin direnci sefoksitin disk difuzyon yontemiyle dogrulandi. Verilerin analizi SPSS for Windows 15 paket programinda yapildi. MRSA tasiyiciligi icin tek degiskenli analiz sonucunda anlamli cikan degiskenler cok degiskenli logistik regresyon analizi yontemiyle degerlendirilerek bagimsiz risk faktorleri belirlendi. P ≤ 0,05 degeri icin sonuclar istatistiksel olarak anlamli kabul edildi. Bulgular: Hastalarin 13’unde (%11) MRSA burun tasiyiciligi, 5’inde (%4,2) ise metisiline duyarli Staphylococcus aureus (MSSA) nazal tasiyiciligi saptandi. Kadin cinsiyette ve son 1 yilda kateter enfeksiyonu gecirme oykusu olanlarda MRSA burun tasiyiciligi orani statistiksel olarak anlamli oranda yuksekti (kadin cinsiyet icin P = 0,027, kateter enfeksiyonu gecirme oykusu icin P = 0,037). Cok degiskenli lojistik regresyon analizinde cinsiyet ve son bir yilda kateter enfeksiyonu gecirme oykusu MRSA burun tasiyiciligi icin bagimsiz risk faktorleri olarak belirlendi. Sonuclar: Sonuc olarak hemodiyaliz hastalarinda MRSA burun tasiyiciligi icin kateter enfeksiyonu gecirme oykusu bagimsiz risk faktoru olarak belirlendiginden, bu hastalarda MRSA tasiyiciliginin tasiyiciligin eradikasyonunun bu etkene bagli olarak gelisebilecek kateter enfeksiyonlarinin onlenmesine katki saglayacagi gorusundeyiz.

High mean platelet volume in prolactinoma treated with cabergoline

Results According to our findings, serum prolactin levels in prolactinoma before and after the cabergoline treatment were significantly different (128.0±99.7 vs 35.5±39.5 ng/ml, p=0.0001, respectively). Mean cumulative cabergoline dose were calculated as 218.1±252.5 mg. We found that the mean pre-treatment MPV values in prolactinoma group were lower than post-treatment MPV values (8.9±0.8 and 9.6±0.8 fL, p=0.0001, respectively) and lower than control group (8.9±0.8 and 9.8±0,9 fL, p=0.0001, respectively). There was no correlation both between posttreatment MPV and CCD. Moreover, there were not any relationships between MPV and both prolactin levels before and after the treatment.

Cardiac tissue Doppler echocardiographic evaluation of patients with prolactinoma treated with cabergoline

Conclusions Low-dose cabergoline in patients with prolactinoma is not associated with cardiac valvular dysfunction and also left ventricular systolic and diastolic dysfunction by conventional and tissue doppler echocardiography. However, high cumulative cabergoline dose may relate to increase in DT and Am parameters that may be related to diastolic dysfunction in the future. Introduction There are few side effects of cabergoline which is used for medical treatment of prolactinoma. For this reason, cabergoline is considered as first-line therapy of prolactinoma. However, chronic administration of high dose cabergoline in patients with prolactinoma may be associated with valvular heart disease. The aim of this study is to evaluate left ventricular systolic and diastolic functions by conventional and tissue doppler echocardiography in patients with prolactinoma who have been chronically treated with cabergoline. Methods A total of 30 patients with prolactinoma who have been treated with cabergoline [mean age 33.4±8.5 years and body mass index (BMI): 28.1±7.8 kg/m2] were included in this study. Thirty ageand BMI-matched (mean age 30.0±9.8 years; BMI: 26.8±6.4 kg/m2) hyperprolactinemia patients without cabergoline treatment were also included, and 30 ageand BMI-matched healthy subjects (mean age 31.0±7.0 years; BMI: 25.2±2.9 kg/m2) were assigned to control group. Cumulative cabergoline dose in patients with prolactinoma was calculated as 218 mg. Mean duration of cabergoline therapy was 121.9±98.5 weeks (range 52-468 weeks). All patients were evaluated by transthoracic and tissue doppler echocardiography. Left ventricle systolic and diastolic functions and left ventricle, left atrium diameters were measured. All biochemical and hormonal analysis were performed by automatic analyzer. Results According to our data, serum prolactin levels were 35.5±39.5 ng/ml in prolactinoma group during cabergoline treatment, 58.3±40.5 ng/ml in hyperprolactinemia group without cabergoline treatment and 16.2±8.3 ng/ml in control group. Left ventricle systolic and diastolic functions parameters were normal among all of the study groups. . Prolactinoma group (A) n:30 Hyperprolactinemia group (B) n:30 Control (C) n:30 P A-B P A-C P B-C