Ramazan Coskun

The Role of Plasma Exchange in HELLP Syndrome

Plasma exchange therapy has been successfully used in selected patients with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome who have organ failure or refractory to treatment. There is no prospective study regarding plasma exchange and its effect in HELLP syndrome. The aim of this study was to investigate the effects of early postpartum use of plasma exchange in patients with HELLP syndrome on outcomes. The mortality rate and the recovery times were compared in patients with HELLP syndrome treated with plasma exchange and historic control group of patients treated conservatively. During a 3-year period (between April 2000 and December 2003), 29 consecutive patients with HELLP syndrome were treated with single or multiple plasma exchange by using fresh-frozen plasma at post-partum period. The control group consist of 26 patients with HELLP syndrome treated between 1993 and 1999. Maternal mortality rate was 23.1% in the control group; there was no death in plasma exchange group; and the mortality rate was significantly higher in the control group (p=0.006). The length of stay at the intensive care unit was shorter in the plasma exchange group (p<0.0001). Rapid improvement of the platelet, aspartate aminotransferase, alanine aminotransferase, and lactic dehydrogenase levels were observed in the plasma exchange group. This study showed that postpartum early plasma exchange therapy improves treatment outcomes in patients with severe HELLP syndrome.

Metabolic syndrome prevalence according to ATP III and IDF criteria and related factors in Turkish adults.

Introduction The aim of this study is to investigate the prevalence of metabolic syndrome (MS) and its components according to Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) criteria and the risk factors affecting MS. Metabolic syndrome prevalence was evaluated according to certain quintet age groups, altitude, location and demographic features. Material and methods This study was a cross-sectional survey conducted in 24 provinces from the 7 regions of Turkey. A total of 4309 adults from 7 regions participated in the study (1947 males, 45.2%). Results The mean age of participants was 47 ±14 years. Metabolic syndrome prevalence was found as 36.6% according to ATP III and 44.0% according to IDF. The MS rate was found to be higher in females compared to males in both groups (p < 0.01). According to both criteria, MS prevalence was found to be higher in subjects who lived in coastal regions when evaluated according to altitude and in subjects who lived in district centers when evaluated according to location. The MS risk is 1.62-fold higher in females compared to males. Metabolic syndrome risk increases as age increases and is highest in the 61-65 age group. Metabolic syndrome risk increases 2.75-fold in the overweight compared to normal weighing subjects and 7.80-fold in the obese. Conclusions Metabolic syndrome prevalence was found to be high in Turkey according to both criteria. Metabolic syndrome prevalence increases as age and body mass index (BMI) increase. Age, female gender and obesity are independent risk factors for MS development.

Experiences with endosulfan mass poisoning in rural areas.

This paper describes very rare chemical poisoning and characteristics of patients with acute endosulfan mass poisoning in a rural area of Turkey and our experiences of these patients. We included 41 patients who were treated in our hospital with the diagnosis of endosulfan poisoning. After the first vital intervention they were examined in terms of age, sex, symptoms and physical examination findings, laboratory results, treatment and outcome. Forty-one patients were admitted to the emergency department (ED) after triage. Nineteen (46.3%) of the patients were female, 22 (53.7%) were male. The mean age was 27.9±16.0 years (1–67 years). The mean time to the ED was 4.1±0.9 h (3–6.5 h). The most common symptoms were anxiety (97.6%), nausea (56.1%) and vomiting (48.8%). Tests of the blood samples obtained at the ED revealed leucocytosis (11 070.6±4302.5/μl), increased blood glucose, LDH, CK and CK-MB levels. Toxicological analysis of blood and urine samples revealed endosulfan as the causative agent. Especially in the rural areas, cases with acute repetitive seizures should suggest endosulfan intoxication when the aetiology is uncertain even in the absence of any signs of intoxication. Health care professionals should understand the hazards associated with the pesticide use as well as diagnosis and treatment of these types of poisonings.

Changing pattern of antibiotic susceptibility in intensive care units: ten years experience of a university hospital.

The study was performed to assess microorganisms and antibiotic susceptibility patterns during ten years in intensive care units of a University Hospital. Infection Control Committee has active, prospective surveillance in ICUs for thirteen years. Ten years data of ICUs was evaluated retrospectively from surveillance forms. Microorganisms and their antibiotic resistance were recorded according to the years. During ten years, gram negative microorganisms were the most frequent isolated microorganisms from clinical specimens. Acinetobacter baumannii (21.8%), Pseudomonas aerigunosa (16%), Escherichia coli (10.4%) and Klebsiella pneumoniae (8%) were the most common gram negative microorganisms. However, Staphylococcus aureus was the most prevalent gram positive microorganism, the incidence decreased from 18.6% to 4.8% during ten years. Also antibiotic susceptibility of microorganisms changed during ten years. Carbapenem resistance increased from 44% to 92% in A. baumannii and ciprofloxacin resistance increased in E. coli from 28% to 60% and in K. pneumoniae from 21% to 55% during ten years. However, methicilin resistance decreased in S. aureus from 96% to 54%. In conclusion, antibiotic resistance is growing problem in ICUs. Rationale antibiotic policies and infection control measures will prevent the development of resistance.

Antiphospholipid Syndrome Associated with Malignant Mesothelioma Presenting with Superior Vena Cava Thrombosis: A Case Report

A 59-year-old woman who had dyspnea and neck swelling for 10 days was admitted to the hospital. Malignant peritoneal mesothelioma was diagnosed previously. According to the clinical findings, and laboratory and pathologic examination, the patient was found to have disseminated venous thrombosis and antiphos pholipid syndrome, which is treatment-resistant autoimmune paraneoplastic syndrome.

Novel Copolymers of 4-Chloronaphthyl Methacrylate with Acrylonitrile: Determination of Monomer Reactivity Ratios and Antimicrobial Activity

Methacrylate based monomer, 4-chloronaphthyl methacrylate (4-CNMA) was synthesized by reacting 4-chloro naphthol with methacryloyl chloride in the presence of triethylamine (NR3) at 0–5°C. The free-radical initiated copolymerization of (4-CNMA), with acrylonitrile (AN) was carried out in 1,4-dioxane-dimethyl sulfoxide mixture (8:2) solution at 70 ± 1°C using 2,2′-azobisisobutyronitrile (AIBN) as an initiator with different monomer-to-monomer ratios in the feed. The monomer 4-CNMA, poly(4-CNMA) and copolymers were characterized by FT-IR and 1H-and 13C-NMR spectral studies. The copolymer composition obtained by elemental analysis led to the determination of reactivity ratios employing Fineman-Ross (F-R), Kelen-Tüdös (KT) and Extended Kelen-Tüdös (EKT) linearization methods. These parameters were also estimated using a non-linear computational fitting procedure, known as reactivity ratios error in variable model (RREVM). The solubility of the polymers was tested in various polar and non-polar solvents. Gel permeation chromatography was employed to determine the molecular weights (Mw and Mn) and polydispersity index of polymers. Thermogravimetric analysis of the polymers reveals that the thermal stability of the copolymers increases with increase in the mole fraction of 4-CNMA in the copolymers. The prepared homo and copolymers were tested for their antimicrobial activity against bacteria, fungi and yeast.

A retrospective review of intensive care management of organophosphate insecticide poisoning: Single center experience.

BACKGROUND Organophosphate (OP) compounds are used as insecticides. Given the widespread availability and use of these chemicals, OP poisoning is quite common following either accidental or intentional exposures. Immediate intensive care management can save lives in these patients. We aimed to investigate intensive care management provided to OP poisoning patients in a tertiary care hospital in Turkey. SUBJECTS AND METHODS This was a retrospective chart review of 62 patients, admitted to the Intensive Care Unit (ICU) with OP poisoning between 2000 and 2012. RESULTS Of the 62 patients studied, 40 (65%) were male, 45 (73%) were suicide attempts, 59 (95%) ingested the OP compounds, and three patients (5%) (two patients with suicide and 1 with accidental exposure) died in the ICU. There were statistically significant differences between survivors and nonsurvivors for Glasgow Coma Scale (GCS) on admission (P = 0.034), Acute Physiology and Chronic Health Evaluation II (APACHE II) score (P = 0.003), Sequential Organ Failure Assessment (SOFA) score (P = 0.024), time to initiation of treatment (P = 0.034) and serum lactate dehydrogenase (LDH) levels (P = 0.007). CONCLUSIONS Organophosphate poisoning is a life-threatening condition that requires immediate diagnosis and management. GCS, APACHE II score, SOFA score, and time to admission to the emergency department and LDH levels can provide prognostic information and predict outcomes.

A case of Crimean-Congo haemorrhagic fever successfully treated with therapeutic plasma exchange and ribavirin.

Crimean-Congo haemorrhagic fever (CCHF) has become an important problem in certain parts of the world. Cytokine storm plays a critical role in the pathogenesis of CCHF. Early diagnosis, supportive therapy and invasive monitoring are the cornerstones of the management of CCHF. Ribavirin is active against CCHF virus in vitro, however, evidence of clinical efficacy is still conflicting. Here, we describe a patient successfully recovered from CCHF with a combination of plasma exchange and ribavirin therapy.

Preparation of Double Amidoxime-Containing Chelating Fiber for Removal of Chrome (VI) Ions

In this study, an adsorbent including double amidoxime groups was prepared by graft copolymerization of glycidly methacrylate (GMA) onto poly(ethyleneterepthalate) (PET) fibers using benzoyl peroxide (Bz2O2) as initiator in aqueous solution. Grafted PET fibers were modified with iminodiacetonitrile (IDAN) in ethanol at 80°C. Afterwards, the nitrile groups were amidoximated by using 6% (m/v) hydroxylamine hydrochloride in methanol solution. The grafted and modificated fibers were characterized by FTIR, SEM and TGA analysis. The removal of Cr(VI) ions from aqueous solution onto amidoximated fibers was studied. The important parameters such as pH, initial concentration, contact time and adsorption temperature on uptake of Cr(VI) ion were investigated. All adsorption experiments of Cr(VI) ions from aqueous solution onto amidoximated fibers were studied by using the batch adsorption method. The results show that the adsorption amount of Cr(VI) ions increased with initial ion concentration, shaking time, temperature but decreased with increasing pH of the medium. The Langmuir, Freundlich and Dubinin-Radushkevich (D-R) isotherm models were employed to discuss the adsorption behavior. The adsorption isotherms of Cr(VI) on amidoximated fiber were well described by Langmuir isotherm and the maximum adsorption capacity calculated from Langmuir isotherm model was 125 mg/g. Adsorption processes for Cr(VI) ions onto amidoximated was found to follow pseudo-second order type adsorption kinetics. Thermodynamic parameters, such as change in standard free energy (ΔG), enthalpy (ΔH) and entropy (ΔS), have also been evaluated and it has been found that adsorption spontaneous and endothermic in nature. It was observed that the amidoximated fibers are regenerable by KOH and it is more selective for Cr(VI) ions in the mixed solution of Cr- Pb- Co-Ni –Cd-Cu at pH 2.

Outcomes of percutaneous endoscopic gastrostomy in hospitalized patients at a tertiary care center in Turkey

Background/objectives:The aim of this study was to perform a retrospective analysis characterizing patients receiving tube feeding following percutaneous endoscopic gastrostomy (PEG) tube placement between 2004 and 2012 at Erciyes University Hospital in Turkey.Subjects/Methods:Patients above the age of 18 years who required long-term enteral tube feeding were studied. All PEGs were performed using the pull-through technique by one experienced endoscopist. Demographic, clinical outcomes and PEG-related complication data were collected.Results:Of the 128 subjects studied, 91 were men (71%) and 37 were women (29%). The mean age of this patient population was 54±19 years. The most common reason for PEG tube insertion was the inability to consume oral diet due to complications of cerebrovascular disease (27%), while cerebral hypoxia, occuring after nonneurological medical disorders, was the second most common indication (23%). A total of 70 patients (55%) had chronic comorbidities, with hypertension being the most common (20%). The most common procedure-related complication was insertion-site bleeding, which occurred in 4% of patients. Long-term complications during 1 year were insertion-site cellulitis, gastric contents leakage and peristomal ulceration, which occurred in 14%, 5% and 0.5% of patients, respectively. There were no PEG insertion-related mortalities; 1-year mortality was unrelated to the indication for PEG tube insertion.Conclusions:PEG tube insertion was a safe method to provide enteral access for nutrition support in this hospitalized patient population.