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Acute poisoning cases admitted to a university hospital emergency department in Diyarbakir, Turkey
(Sage Publications Ltd, 2005) Güloglu, C; Kara, IH
Aim: This study was conducted to determine the biological effects of acute poisoning, the nature of agents involved and the pattern of poisoning in Diyarbakir City, in the Southeast Anatolian region of Turkey, during 2000. Method: Hospital records of all admissions to the Emergency Department (ED) of Dicle University Hospital following acute poisoning were revised and all data from January to December 2000 were analysed. The present study included 44 (25.9%) male (M) and 126 (74.1%) female (F), a total of 170 patients. The M/F ratio was 1.0/3.5. Results: The mean age of patients was 23.3 +/- 6.3 years; 63 (37.1%) of them were under 20 years of age and 147 (86.5%) were under 30 years of age. Most intoxication cases occurred during the summer season (93 of 170 patients). On a monthly basis, admissions during April, May and July were most common (24, 26 and 30 patients, respectively). Sixty-two (36.5%) cases involved accidental poisoning while 108 (63.5%) involved deliberate poisoning. In suicide attempts, intoxications were more common in females (77 cases, 71.3%, P < 0.05), and in unmarried persons (74 cases, 68.5%, P < 0.05). There were only two deaths (1.2%) among the 170 admissions of acute poisonings. One of the deaths was due to pesticide poisoning and the other was due to medical drug abuse. Tachycardia (59, 34.7%), vomiting (55, 32.4%) and loss of consciousness (42, 24.7%) were frequently observed, whereas hypersecretion (15, 8.8%), bradycardia (5, 2.9%), convulsion (8, 4.7%) and hypertension (2, 1.2%) were less frequent. Among pesticide poisoning cases the incidence of convulsion (6, 10.2%), miosis (6, 10.2%), and hypersecretion (12, 20.3%) were significantly higher when compared to other cases (P = 0.018, P < 0.0001 and P < 0.0001, respectively). Conclusion: In the Southeast Anatolian region of Turkey, pesticide intoxication is common especially among young, unmarried females and most of these intoxications are intentional self-poisonings. The annual rate of poisoning-related ED visits and mortality were found to be within expected ranges; psychoactive agents being the most common cause.
Are polysulfone dialyzers stimulating cytokines in hemodialyzed patients with hepatitis C?
(Wiley, 2001) Yilmaz, ME; Kara, IH; Sari, Y
The purpose of this study was to determine serum cytokine levels in hemodialyzed patients and healthy controls, and also to investigate the relationship among circulating cytokine and liver enzyme levels reflecting inflammation of the liver in hepatitis C virus (HCV) infection. The present study included 35 patients without HCV and 30 patients with HCV undergoing hemodialysis (HD) at the HD Center of Dicle University in Turkey, and 20 healthy individuals who served as controls. The levels of serum interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-alpha), and soluble interleukin receptor-2 (sIL-2R) were measured. In patients undergoing HD, serum cytokine levels were measured before and after the treatment. Our observation that TNF-alpha levels are hyperexpressed in chronic renal failure patients with chronic HCV infection suggests a mechanism of inflammation in the liver. In contrast to past studies about cuprophane or hemophan dialyzers, the present study shows that polysulfone dialyzers did not specifically influence levels of TNF-alpha, IL-1 beta, IL-6, or IL-8. Serum sIL-2R levels were significantly increased after HD with polysulfone dialyzers in both groups of hemodialyzed patients.
The determination of insulin sensitivity in hemodialysis and continuous ambulatory peritoneal dialysis in nondiabetic patients with end-stage renal disease
(Saudi Med J, 2005) Tuzcu, A; Bahceci, M; Yilmaz, ME; Turgut, C; Kara, IH
Objectives: To determine the beta-cell function and insulin sensitivity with homeostasis model assessment (HOMA) and area under curve (AUC) in nondiabetic uremic hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients cross sectionally. Methods: The study was performed between January to August 2001 in the Department of Nephrology, Dicle University School of Medicine, Diyarbakir, Turkey. Fifty-one HD patients, 45 CAPD patients, and 50 healthy control subjects were included in the study. Height, weight, waist and hip circumference, fat mass and percentage of body fat, and body mass index (BMI) were measured. The total high density lipoprotein (HDL) and low density lipoprotein (LDL)-cholesterol, triglyceride, urea, creatinine, insulin, potassium, parathyroid hormone (PTH) and 1,25 dihydroxycholecalciferol levels were measured. Oral glucose tolerance test (OGTT) was performed in the mid-week dialysis-free interval in HD patients, whereas after at least a night without dialysis exchanges in CAPD group. Area under curve both of insulin and glucose were calculated. The HOMA [insulin sensitivity (%S)] and AUC were used as indices of tissue insulin sensitivity. Results: The LDL-cholesterol levels of patients with CAPD was higher than the HD group (p<0.001) and control group (p<0.0001). The baseline glucose levels of the 2 groups were not significantly different. Baseline insulin levels of CAPD group were higher than the HD group (p<0.001) and the control group (p<0.0001). Area under curve for glucose (AUCgluc) and insulin (AUCins) value of CAPD patients were higher than the HD patients than the control group (p<0.0001). The HOMA [beta-cell function (%B)] values of CAPD group were higher than both HD (p<0.02) and control Group (p<0.04). The HOMA [insulin sensitivity (%S)] levels of CAPD group was significantly lower than the HD patients (p<0.002) and the control group (p<0.001). Conclusions: The CAPD treatment may lead to insulin insensitivity in non-diabetic end-stage renal disease patients and the high glucose content of CAPD Solutions may be responsible for insulin resistance in CAPD patients.
Dichlorvos poisoning after intramuscular injection
(W B Saunders Co, 2004) Guloglu, C; Aldemir, M; Orak, M; Kara, IH
[Abstract Not Available]
The effect of add-back treatment with tibolone on patients with myoma uteri treated with triptorelin
(Oxford Univ Press, 1999) Göçmen, A; Kara, IH; Karaca, M
[Abstract Not Available]
Effectiveness of collagenase in the treatment of sacrococcygeal pilonidal sinus disease
(Springer-Verlag, 2003) Aldemir, M; Kara, IH; Erten, G; Taçyildiz, I
Purpose. Sacrococcygeal pilonidal sinus disease (SPSD) is a disease affecting young patients, which results in a long-term loss of productive power, and also tends to have high rates of morbidity since it has no ideal treatment. The main purpose of this study was to investigate the effectiveness of topical collagenase in the treatment of SPSD. Methods. In the present study, 40 patients admitted to our department were separated into two groups. Excision and marsupialization with dressing by bacterial collagenase was performed in the first group, while the treatment was excision and marsupialization without dressing by bacterial collagenase in the second group. Results. We determined that the healing in terms of the width and depth of the wound in the first week and in depth of wound in the second week was better in group I than in group 2 (P = 0.040, P = 0.020, P = 0.048, respectively). The duration of wound healing was 21.9 +/- 1.3 days in group 1, and 28.1 +/- 1.3 days in group 2 (P = 0.0001). The recurrence rate in the intergluteal area, which heals by granulation and has no hair follicles, tends to decrease when a partial closure is obtained. Conclusion. We therefore recommend an excision, marsupialization, and dressing with bacterial collagenase, in cases with noncomplicated SPSD.
An epidemic caused by measles virus type D6 in Turkey
(Turkish J Pediatrics, 2005) Ceylan, A; Ertem, M; Korukluoglu, G; Acemoglu, H; Kara, IH; Erten, PG; Arslan, C
In this study, the extent of measles outbreak was investigated in the Idil and Cizre counties of Sirnak Province. New cases determined in patients who applied to primary care clinics and those detected during home visits were evaluated. In 2001, a total of 2,143 cases reported in Sirnak Province were signified as a probable outbreak. Three hundred and thirty-three patients in Cizre and 219 patients in Idil applied to the primary care clinics. Of the cases, in Cizre 8.4% (n=28) and in Idil 6.4% (n=14) were infants aged nine months and younger who had not yet been vaccinated. Totally, 17 new cases (8 in Cizre and 9 in Idil) in the exanthema phase were determined during home visits and these were considered as outbreak cases. Virus isolation was achieved in 12 cases. All isolates were sent to the Centers for Disease Control (CDC) for genotyping and classified as D6 group. In conclusion, measles epidemics are still seen in our country. Therefore, measles outbreaks necessitate intensive intervention by physicians who are employed in primary health care services.
Evaluation of clinical profile, laboratory characteristics, and outcome of tuberculosis cases in a hemodialysis center in southeast Turkey
(Wiley, 2005) Yilmaz, ME; Kara, IH; Kadiroglu, AK; Ozekinci, T; Özçelik, Y; Isikoglu, B
Patients with chronic renal failure (CRF) requiring dialysis are at an increased risk of developing tuberculosis (TB) when compared with chronic renal failure (CRF) requiring dialysis are at an increased risk of developing tuberculosis (TB) when compared with the total population. In dialysis patients, the tuberculin skin test (TST) is not helpful diagnostically; this may be due to an overwhelming infection impairing the immune response. The purpose of this study was to evaluate the clinical profile, laboratory characteristics, and outcome of TB in patients with CRF undergoing hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). Since February 1999, we have diagnosed only 8 active TB patients (5.4%) among a total 149 dialysis patients in our dialysis programs (HD or CAPD). Five patients developed pulmonary TB (including 2 with tuberculous pleurisy), I had cavitary TB, and 2 had miliary TB. Three of those patients developed extrapulmonary TB (I had synovial and bone TB in the knee, and 2 had tuberculous lymphadenitis). All 8 patients who developed TB after starting dialysis had low creatinine clearances and, in general, hypoalbuminemia. We conclude that the appearance of miliary infiltrates or cavitary or pleural effusion on chest x-ray associated with fever in a dialysis patient strongly suggests TB. Therefore, the absence of acid-fast bacilli in investigated materials and negativity of the TST does not exclude TB in patients with CRF.
The evaluation of immune responses that occur after HBV infection and HBV vaccination in hemodialysis patients
(Elsevier Sci Ltd, 2004) Kara, IH; Yilmaz, ME; Suner, A; Kadiroglu, AK; Isikoglu, B
The hepatitis B virus (HBV) vaccination never lose its importance; however, we did not get immune response with vaccination in some cases at the hemodialysis (HD) units. In this research, our aim was to evaluate antibody responses that constitute with natural ways and vaccination against HBV infection in chronic HD patients. In this retrospective cohort study (between 1999 February and 2001 December), 34 patients, 19 males and 15 females that were at the HD program, were enrolled. Patients were divided into two groups: group A, vaccination group (n = 15); and group B, anti-HBc IgG (+) cases (n = 19). We injected 40 mug of recombinant HBV vaccine into the deltoid muscle at 0, 11 2, and 6 months. The anti-HBs levels, over 10 mIU/mL, were accepted for enough immunization. In group A, after vaccination 12 of 15 (80%) patients had seroconversion but later, in five of 12 (33.3%) patients, HBs-antibody became negative and in seven of 12 (46.7%) patients the positivity of HBs-antibody continued. However, in group B, 16 of 19 (66.7%) immune patients who faced HBV infection. it was established that antibody response continued (P > 0.05). The patients in group A who had anti-HCV negativity and serum albumin levels greater than or equal to3.5 g/dL (7/0; P < 0.05) had too much antibody response against the vaccine. The difference of our research was that patients under 49 years old, patients who did not respond to HBV vaccine, were proportionally higher as compared to those from other researches. In conclusion, it was realized that the immune response of the HBV vaccine was low in the HD patients and it was affected by several factors such as gender, anti-HCV positivity and nutritional status. But, in spite of getting all universal precautions, still to face with new cases emphasizes the importance of the vaccination. (C) 2004 Elsevier Ltd. All rights reserved.
The evaluation of postdialysis L-carnitine administration and its effect on weekly requiring doses of rHuEPO in hemodialysis patients
(Taylor & Francis Ltd, 2005) Kadiroglu, AK; Yilmaz, ME; Sit, D; Kara, IH; Isikoglu, B
Background. In this study, our aim was to evaluate the effect of postdialysis administration of parenteral L-carnitine supplementations on hematological parameters and also on weekly requiring dose of the recombinant human erythropoietine (rHuEPO) in hemodialysis (HD) patients. Material and Methods. The stable 34 patients (17 male, 17 female) were enrolled in the study who were on rHuEPO therapy and a regular maintenance HD program at 5 h, three times a week with bicarbonate dialysate and with biocompatible membranes in HD Center of Medical Faculty Hospital in University of Dicle. rHuEPO was administered subcutanously at 80- 120 U/kg/week. The patients were divided into two groups: Group 1, rHuEPO therapy (n = 17) and Group 2, rHuEPO therapy + L-carnitine (n = 17). L-carnitine (L-carnitine ampul, Santa Farma) 1 g was injected postdialysis intravenously via venous route of the dialytic set, three times a week. The patient's hemoglobin (Hgb), hernatocrit (Hct), serum iron (Fe+2), total iron-binding capacity (TIBC), transferrin saturation index (TSI), and serum ferritin (Fer) levels were followed during the 16-week period. The weekly requiring doses of rHuEPO and hematological parameters of patients were recorded at the beginning of the study, at 8 weeks, and at 16 weeks of the study period. Results. In group I (n = 17, 13 female, four male), the mean age was 38.8 +/- 12.1 years, mean period time on HD therapy was 18.1 +/- 14.9 months, and mean KIN value was 1.48 +/- 0.28. In group 2 (n = 17, 13 male, four female), the mean age was 48.1 +/- 15.4 years, mean period time on HD therapy was 34.4 +/- 23.0 months, and mean KIN value was 1.29 +/- 0.20. The hematological parameters of the groups were found as follows: in group 1, Hgb: 7.9-10.8 g/dl, Hct: 25.3-32.5%; in group 2, Hgb: 10.2-11.8 g/dl, Hct: 30.6-35.4%, respectively (p<0.05). The target Hgb/Hct values were achieved at the end of the study in both groups. Both groups were the same according to their serum Fe+2 markers (p>0.05). But unlike serum Fe+2 markers, there were significant differences on weekly requiring doses of rHuEPO therapy between groups. While in group 1, the mean weekly requiring dose of rHuEPO was 6529 U/week (120 U/kg/ week) at the beginning of the study, and maintenance weekly requiring dose of rHuEPO was 3588 U/week (66 U/kg/week) at the end of the study, in group 2, they were 4882 U/week (80 U/ kg/week), and 1705 U/week (28 U/kg/week), respectively. According to these values, the total reduction in weekly requiring dose of rHuEPO was 45% in group 1, and 65% in group 2; the net gain was 20% in group 2 (p<0.05). Conclusions. If other factors related to anemia are excluded, the postdialysis parenteral L-carnitine therapy can be considered in selected stable patients, which may improve anemia and may reduce the weekly requiring dose of the rHuEPO and also be cost-effective.
The evaluation of serum zinc and copper levels in hemodialysis patients in southeast Turkey
(Creative Age Publ, 2000) Yilmaz, ME; Kiraz, M; Kara, IH
Our purpose was to determine serum zinc (Zn) and copper (Cu) levels in patients with chronic renal failure (CRF) undergoing hemodialysis (HD) and to investigate the influence of HD duration on these trace elements. The study group included 26 HD patients and a control group of 26 healthy subjects. Blood samples were drawn for determination of serum Zn and Cu levels, which were measured by atomic absorption spectrophotometry. The mean age was 43 +/- 15 yr in the HD group, and 40 +/- 17 yr in the control group. Laboratory findings showed the following mean values: Zn 69.6 +/- 17.6 mug/dl in the HD group (vs. 114.6 +/- 34.3 mug/dl in the control group); Cu, 85.3 +/- 14.8 mug/dl in the HD group was significantly lower than that of the control group (p<0.0001). The serum Cu level of the HD group was also significantly lower than that of the control group (p<0.0001), but was in the normal range. Statistically, we didn't find any significant differences in the serum Zn and Cu levels between long-term and short-term dialyzed patients (p>0.05). Because the serum Zn level of the HD group was significantly low, we recommend that Zn should be given to patients with CRF undergoing HD.
Factors affecting mortality and epidemiological data in patients hospitalised with burns in Diyarbakir, Turkey
(Sa Medical Assoc, 2005) Aldemir, M; Kara, IH; Girgin, S; Güloglu, C
Background. Burns continue to be responsible for significant morbidity and mortality in developing countries. In this study we aimed to determine the factors affecting mortality and epidemiological data by examining the records of burned patients. Method. The hospital records of 980 patients who were hospitalised in the Burns Unit at, Dicle University Hospital (DUH) between June 1994 and July 1999 were examined for factors affecting mortality. Factors evaluated included gender, age, burn type, degree and extent of bum, prognosis and length of hospitalisation (LH). We investigated the relationship (if any) between the demographic data, degree and extent of burns and mortality and morbidity rates. Results. The study group consisted of 325 males (33.2%) and 655 females (66.8%). Of the patients 738 (75.3%) were children (age under 15 years), 217 (22.1%) were younger adults (age 15 - 50 years), and 25 (2.6%) were older adults (age over 50 years). The mean age was 11.2 +/- 14.01 years (range 15 days - 95 years). Of the burns 618 (63.1%) were scalds, 199 (20.3%) burns from a flame and 163 (16.6%) electrical burns. The mean extent of bum was 24.3 +/- 14.5% (range 1 - 95%). Seven hundred and eighty-seven (80.3%) of the study group made a full recovery, 131 (13.4%) were discharged from hospital after partial recovery, and 62 (6.3%) died. The mean LH was 11.33 +/- 8.8 days (range I - 67 days). There was a positive correlation between burn extent and mortality (r = 0.35, p < 0.0001) and between age and type of burn (r = 0.60, p < 0.0001). While scalds had the highest frequency among children, flame and electrical burns were most common in the adult and older adult groups. There was also a positive correlation between degree and type of burn (r = 0.32, p = 0.0001), scalds tending to be more superficial while flame and electrical burns were generally more serious. Deaths of patients with extensive burns usually occurred in the first 5 days following injury due to acute renal failure and hypovolaemic shock, while deaths from moderate and minor burns usually occurred after 7 days and were due to wound infection and sepsis. Conclusion. We found positive correlations between age and type of burn, degree and type of burn, and the extent of burn and mortality. The overall mortality rate for our unit was 6.3%.
The factors influenced the concentration of plasma brain natriuretic peptide in patients on maintenance hemodialysis
(Oxford Univ Press, 2005) Kadiroglu, AK; Sit, D; Yilmaz, ME; Kara, IH; Batum, S; Isikoglu, B
[Abstract Not Available]
Influence of L-NAME and L-Arg on ischaemia-reperfusion induced gastric mucosa damage
(Acta Medical Belgica, 2002) Öztürk, H; Kara, IH; Otçu, S; Kilinc, N; Yagmur, Y
Objective : The aim of this study was to investigate effects of L-NAME and L-Arginine on gastric mucosal injury induced by ischaemia-reperfusion. Methods : In the experiment, 20 New Zealand rabbits were used (2700-3000 g). Celiac artery was clamped for 30 min for ischaemia and then 60 min of reperfusion followed this after all rabbits were anaesthetized. In the Sham-control group (G 1, n = 5), laparotomy was performed, and the celiac artery was prepared without clipping. Group 2 (Untreated, n = 5) rabbits were only subjected to ischaemia-reperfusion. Group 3 (n = 5) rabbits had L-Arginine Methyl Ester (L-Arg) 3 mg/kg/min as IV infusion during the first 15 min of the reperfusion. Group 4 (n = 5) rabbits had a nitric oxide inhibitor NG-nitro-L-arginine methyl ester (L-NAME) 100 mug/kg/min IV during the first 15 min of the reperfusion. After 60 min of reperfusion, the rabbits were killed, and their stomachs were removed for histopathologic evaluation and determination of malondialdehyde (MDA) level. Results : After ischaemia-reperfusion, Untreated group had macroscopic necrosis involving 50 +/- 6% of total gastric mucosa area and deep mucosal necrosis involving 10 +/- 5% of mucosal strips. In the group treated with L-NAME, macroscopic mucosal necrosis involved 52 +/- 6% of total gastric mucosa area and deep mucosal necrosis involved 11 +/- 3 % of mucosal strips (both p > 0.05 versus Untreated group). L-Arg treatment significantly reduced macroscopic mucosal necrosis area to 20 +/- 6% and deep mucosal necrosis to 3 +/- 1% (both p < 0.05 versus Untreated group and L-NAME group). MDA level in the L-Arg group was significantly lower when compared to control and L-NAME group MDA level (p < 0.05). Conclusion : These results suggest that NO increase induced by L-Arginine injection is involved in the protection of gastric mucosa after isehaemia-reperfusion.
Insulin response to oral glucose loading and coronary artery disease in nondiabetics
(Int Heart Journal Assoc, 2005) Karabulut, A; Iltumur, K; Toprak, N; Tuzcu, AK; Kara, IH; Kaplan, A; Aksu, Y
Hyperinsulinemia is related to coronary artery disease (CAD), as an indication of decreased insulin sensitivity. Although there are man), Studies showing the relation between fasting insulin levels and insulin resistance. there are fewer studies on postprandial insulin levels. The aim of the present Study was to investigate the relationship between postprandial insulin levels and CAD and its extent in our patients. For this purpose, oral glucose tolerance testing was performed in 222 patients with no known diabetes and who were scheduled to undergo diagnostic coronary angiography. The patients were first separated into two groups, one group (group I) having an insulin response within reference values to oral glucose loading, and the other group (group II) with a higher than normal insulin response. The presence and extent of CAD in the two groups were compared. While 65% of the patients in group I had CAD, this rate increased to 79% in group 2 patients (P = 0.02). The mean vessel scores were 0.92 +/- 0.78 in group I and 1.67 +/- 0.99 (P < 0.0001) in group 2 patients. The stenosis scores were 2.192 +/- 2.077 in group I and 5.588 +/- 3.519 (P < 0.001) in group 2, while the extent scores were 1.230 +/- 1.292 in group I and 2.729 +/- 1.847 in group 2 (P < 0.0001). The differences between the two groups were significant. Postprandial insulin values were positively correlated with CAD (P = 0.001, r = 0.214), vessel scores (P < 0.0001, r = 0.326), stenosis scores (P < 0.0001. r = 0.261), and extent scores (P < 0.0001, r = 0.419). Logistic regression analysis revealed hyperinsulinemia increased CAD independent from the other risk factors (OR = 5.742 CI 95%: 1.809-18.227, P = 0.003).
Looking at trauma and deaths: Diyarbakir city in Turkey
(Elsevier Sci Ltd, 1999) Yagmur, Y; Kiraz, M; Kara, IH
There were 329 trauma related deaths in Diyarbakir in 1997. Of these 226 were male (69%) and 103 were female (31%). The median age was 20 years old (range 1-82 years). Of the deaths, 30.5% were under 10, 51% were under 20 and 67% were under 30 years old. Two hundred and eleven deaths occurred in the hospital while 118 deaths occurred prehospital. Seventy-seven percent of hospital deaths (191) occurred in the first day. The most common cause of death was multiple injuries (151, 46%). Head injuries were the main reason for 128 deaths (46%). The most common mechanism of death was motor vehicle accident (131, 40%). The second was falls from a residential building (117, 33.7%). (C) 1999 Elsevier Science Ltd. All rights reserved.
Predisposing factors for delirium in the surgical intensive care unit
(Biomed Central Ltd, 2001) Aldemir, M; Özen, S; Kara, IH; Sir, A; Baç, B
Background Delirium is a sign of deterioration in the homeostasis and physical status of the patient. The objective of our study was to investigate the predisposing factors for delirium in a surgical intensive care unit (ICU) setting. Method Between January 1996 and 1997, we screened prospectively 818 patients who were consecutive applicants to the general surgery service of Dicle-University Hospital and had been kept in the ICU for delirium. All patients were hospitalized either for elective or emergency services and were treated either with medication and/or surgery. Suspected cases of delirium were identified during daily interviews. The patients who had changes in the status of consciousness (n=150) were consulted with an experienced consultation-liaison psychiatrist. The diagnosis of delirium was based on Diagnostic and Statistical Manual of Mental Disorders (revised third edition) criteria and established through psychiatric interviews. Patients were divided into two groups: the 'delirious group' (DG) (n=90) and the 'nondelirious group' (NDG) (n=728). During delirium, all abnormal findings related to physical conditions, laboratory features, and additional diseases were evaluated as probable risk factors of delirium. Results Of 818 patients, 386 (47.2%) were male and 432 (52.8%) were female. Delirium developed in 90 of 818 patients (11%). The cases of delirium in the DG were more frequent among male patients (63.3%) than female patients (36.7%) (chi (2) = 10.5, P=0.001). The mean age was 48.9 +/- 18.1 and 38.5 +/- 13.8 years in the DG and NDG, respectively (t=6.4, P=0.000). Frequency of delirium is higher in the patients admitted to the Emergency Department (chi (2) = 43.6, P=0.000). The rate of postoperative delirium was 10.9%, but there was no statistical difference related to operations between the DG and NDG (chi (2) = 013, P=0.71). The length of stay in the ICU was 10.7 +/- 13.9 and 5.6 +/-2.9 days in the DG and NDG, respectively (t=0.11, P=0.000). The length of stay in hospital was 15.6 +/- 16.5 and 8.1 +/-2.7 days in the DG and NDG, respectively (t=11.08, P=0.000). Logistic regression was used to explore the associations between probable risk factors and delirium. Delirium was not correlated with conditions such as hypertension, hypo/hyperpotassemia, hypernatremia, hypoalbuminemia, hypo/hyperglycemia, cardiac disease, emergency admission, age, length of stay in the ICU, length of stay in hospital, and gender. It was determined that conditions such as respiratory diseases (odds ratio [OR] = 30.6, 95% confidence interval [CI] = 9.5-98.4), infections (OR = 18.0, 95% CI = 3.5-90.8), fever (OR = 14.3, 95% CI = 4.1-49.3), anemia (OR = 5.4, 95% CI = 1.6-17.8), hypotension (OR 19.8, 95% CI = 5.3-74.3), hypocalcemia (OR = 30.9, 95% CI = 5.8-163.2), hyponatremia (OR 8.2, 95% CI = 2.5-26.4), azotemia (OR = 4.6, 95% CI = 1.4-15.6), elevated liver enzymes (OR 6.3, 95% CI = 1.2-32.2), hyperamylasemia (OR = 43.4, 95% CI = 4.2-442.7), hyperbilirubinemia (OR = 8.7, 95% CI = 2.0-37.7) and metabolic acidosis (OR = 4.5, 95% CI = 1.1-17.7) were predicting factors for delirium. Conclusion We determined that conditions such as respiratory diseases, infections, fever, anemia, hypotension, hypocalcemia, hyponatremia, azotemia, elevated liver enzymes, hyperamylasemia, hyperbilirubinemia and metabolic acidosis were predicting factors for delirium.
The prevalence of insulin resistance and its relationship between anemia, secondary hyperparathyroidism, inflammation, and cardiac parameters in chronic hemodialysis patients
(Taylor & Francis Ltd, 2005) Sit, D; Kadiroglu, AK; Yilmaz, ME; Kara, IH; Isikoglu, B
Background. Insulin resistance (IR) frequently accompanies end-stage renal disease (ESRD). There is a positive correlation between IR and cardiovascular pathologies that plays a role in mortality and morbidity on patients with ESRD. We aim to research the prevalence and evaluability of homeostasis model assessment-insulin resistance (HOMA-IR) in hemodialysis (HD) patients and also to evaluate the relationship of this value with various clinical parameters. Material and Methods. 57 ESRD patients, regularly undergoing HD were enrolled in the study. Obese patients (BMI >25 kg/m(2)) and ESRD patients with diabetic etiology were excluded. Twenty-nine patients were men (50.9%), and 28 patients were women (48.1%); the mean age was 45.9 +/- 13.6 years. Results were recorded after evaluated by HOMA-IR. In addition to calculating the HOMA index, anthropometrical parameters, plasma levels of total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), hematocrit (hct), parathyroid hormone (PTH), calcium (Ca), phosphorus (P), C-reactive protein (CRP), fasting glucose, and insulin plasma levels were measured by standard methods in all subjects. The systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure were recorded, and left ventricle posterior wall thickness was measured by echocardiography. All patients completed the study. The minimum HOMA-IR value was 0.11, maximum value was 5.18, and the cut-off point was 1.23. According to this value, the patients were classified into two groups: HOMA-IR positive that were equal or higher than 1.23 (group 1), and HOMA-IR negative that were under this value (group 2). Results. We established that 18 of 57 (31.6%) patients were HOMA-IR positive and 39 of 57 (68.4%) patients were negative. In group 2, hct levels were higher than in group 1 and the weekly requiring dose of rHuEpo was significantly low in group 2 compared with group 1 (p<0.05). Interestingly, the CaxP products (>= 55 mg/dL) were significantly higher in group 2 than in group I (p<0.05). There was not any significant correlation between HOMA-IR and anthropometrics measurements, hemodialysis adequacy, plasma PTH level, cardiac parameters, and inflammation markers. We established the prevalence of IR as 31.6% in our HD patients' cohort. Conclusions. There was a positive correlation between low HOMA-IR value with target hct levels and administration of the rHuEpo. Because insulin resistance is an independent risk factor of cardiovascular mortality in ESRD patients, it was accepted that being able to correct the insulin resistance could be a novel therapeutic approach in this cohort.
Seroprevalence and risk factors of HCV in dialysis patients in a university hemodialysis, center of southeast Anatolia, Turkey
(Wiley, 2001) Kara, IH; Yilmaz, ME; Sari, Y; Düzen, S; Usul, Y; Isikoglu, B
Nowadays, the increased seroprevalence of hepatitis C virus (HCV) in hemodialysis (HD) patients is an important problem. The aim of this study was to investigate the seroprevalence and risk factors that lead to the spread of HCV in HD and continuous ambulatory peritoneal dialysis (CAPD) patients. Sixty-seven HD and 35 CAPD patients were enrolled in the study, 44 (43.1%) of whom were female and 58 (56.9%) of whom were male. Any risk factor for HCV infection was questioned. In our HD center, all precautions have been taken for the prevention of the spread of HCV Rooms and dialysis machines used by HCV (+) patients-mean age, 41.6 +/- 15.3 yr (range, 19-75 yr)-are separated from the others. All HCV (+) cases except two had received blood transfusions, and all cases had at least one surgical intervention (central venous catheter and/or arteriovenous shunting operation). Eight (7.8%) of the cases had dental interventions, including conservative tooth treatment or tooth extractions. There was no relation between socioeconomic status or duration on dialysis with a higher prevalence of HCV in the dialysis patients (p>0.05). In general, anti-HCV seropositivity in our center was 41%, and these cases were generally asymptomatic except for elevated liver enzyme levels and slightly decreased albumin levels. All cases had at least one risk factor. The seroconversion rate/yr of our anti-HCV (-) patients was 0.148/patient-yr in HD patients and 0.002/patient-yr in CAPD patients. The seroconversion rate/yr and prevalence of HCV were higher in the HD patients than in the CAPD patients. It is necessary to take additional measures with regard to universal precautions for the prevention of the spread of HCV, including separation of dialysis machines, education of nurses, and the regular changing of gloves when moving from patient to patient.
Spontaneous rupture of malarial spleen
(Current Science Ltd, 2000) Yagmur, Y; Kara, IH; Aldemir, M; Büyükbayram, H; Tacyildiz, IH; Keles, C
Malaria has long been among the most common diseases in the southeast Anatolia region of Turkey. In 1992, 18 676 cases were diagnosed in Turkey, and Diyarbakir city had the highest incidence (4168 cases), followed by SanliUrfa city (3578 cases). Malaria was especially common during 1994 and 1995, with 84 345 and 82 094 cases being diagnosed in these years, respectively. Spontaneous rupture of malarial spleen is rare. We saw two cases during 1998, which are reported herein. Both patients were male, and were receiving chloroquine treatment for an acute attack of malaria. One of the patients had developed abdominal pain and palpitations, followed by fainting. The other patient had abdominal pain and fever. Explorative laparotomy revealed an enlarged spleen in both patients. Splenectomy was performed in both patients. We have identified 15 episodes of spontaneous rupture of the spleen in the English language literature published since 1961. Because of increased travel to endemic areas and resistance to antimalarial drugs, malaria is a major medical problem that is becoming increasingly important to surgeons worldwide. Malaria is a particularly important problem in the southeast Anatolia region of Turkey. Prophylactic precautions should be taken by tourists who travel to this region, especially during the summer.

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