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Erdem K, Duman I, Ergün R, Ergün D. The correlation between electrocardiographic parameters and mortality in non-cardiac ICU patients. Eur Rev Med Pharmacol Sci 2023; 27:6662-6670. [PMID: 37522677 DOI: 10.26355/eurrev_202307_33136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
OBJECTIVE This study aimed to determine the correlation between selected electrocardiogram (ECG) parameters (recorded at admission) and mortality in non-cardiac, non-COVID-19 intensive care unit (ICU) patients, and to determine the sensitivity and specificity of a novel admission ECG score (AD-ECG) for predicting mortality. Additionally, the sensitivity and specificity of the AD-ECG and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores for predicting ICU mortality were compared. PATIENTS AND METHODS Clinical and laboratory data, and ECG parameters were compared between ICU survivors and non-survivors. ECG parameters (the QTc and Tpe intervals, and the Tpe/QT and Tpe/QTc ratios) and pulse pressure at ICU admission (baseline) were used to calculate the AD-ECG score. Cut-off values for ECG parameters, pulse pressure, and AD-ECG and APACHE II scores were calculated. The sensitivity and specificity of the APACHE II and AD-ECG scores were determined. RESULTS The study included 167 patients. Mortality was higher in the patients with comorbidities, mechanical ventilation, and length of ICU stay (p < 0.05). The QTc and Tpe intervals, and the TPe/QT and TPe/QTc ratios differed significantly between the survivors and non-survivors (p < 0.05). The sensitivity and specificity of the AD-ECG score were similar to those of the APACHE II score. When pulse pressure, and the QTc and Tpe intervals were added to APACHE II, the sensitivity of the APACHE II score increased from 78.9% to 85.5%, and its specificity increased from 75% to 86.8%. CONCLUSIONS A novel admission ECG score (AD-ECG) based on ECG parameters (the QTc and Tpe intervals, and the Tpe/QT and Tpe/QTc ratios) and pulse pressure has similar sensitivity and specificity as the APACHE II score for predicting non-cardiac ICU mortality. Adding pulse pressure, and the QTc and Tpe intervals increases the sensitivity and specificity of the APACHE II score; however, as the present study included non-cardiac patients only, additional larger-scale studies are needed to obtain more precise results.
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Affiliation(s)
- K Erdem
- Department of Cardiology, Faculty of Medicine, Selçuk University, Konya, Turkey.
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Büyükcavlak M, Duman I, Eryavuz OD, Ünlü A, Duman A. Effects of artemisinin and hydroxychloroquine on cytokines in experimental sepsis. Trop Biomed 2022; 39:547-551. [PMID: 36602214 DOI: 10.47665/tb.39.4.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pro-and anti-inflammatory cytokines mediate the inflammatory response in sepsis. Therefore, regulation of cytokines with medications in risky situations may protect the patients from sepsis. Hydroxychloroquine and artemisinin are antimalarial drugs with immunomodulatory properties. In this study, we intended to investigate the effects of artemisinin and hydroxychloroquine on the cytokines released during sepsis in the rat model. Twenty-four rats were randomized into four groups. The control group received oral saline, the sepsis group received oral saline and intraperitoneal lipopolysaccharide toxin (LPS), the artemisinin-treated sepsis group received oral 33.33 mg/kg of artemisinin, and the hydroxychloroquinetreated sepsis group received oral 33.33 mg/kg of hydroxychloroquine before LPS injection. Three hours later, serum cytokines were measured. An increase was detected in TNF-a, IL-1, and IL-6 levels in the sepsis group compared to the control (p<0.01). Oral pretreatment with artemisinin resulted in significant downregulation only of IL-1 levels (p<0.01). Cytokines IL-1 and IL-6 were significantly downregulated in the serum of LPS-induced rats pretreated with oral hydroxychloroquine than rats with sepsis (p<0.01). Decreases observed in TNF-a and IL-10 levels were insignificant. These results demonstrated that both artemisinin and hydroxychloroquine attenuate the release of pro-inflammatory cytokines three hours after LPS-induced sepsis in rats. A significant decrease was observed in serum IL-1 and IL-6 levels with hydroxychloroquine and IL-1 levels with artemisinin. Based on our findings, we suggest that the therapeutic potential of artemisinin and hydroxychloroquine may be beneficial in preventing cytokine storm during sepsis, and further research is needed to determine the optimal timing of administration.
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Affiliation(s)
- M Büyükcavlak
- University of Health Sciences, Konya City Hospital, Department of Anesthesiology and Reanimation, 42020, Karatay, Konya, Turkey
| | - I Duman
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Medical Pharmacology, 42080, Meram, Konya, Turkey
| | - O D Eryavuz
- Selcuk University, Faculty of Medicine, Department of Medical Biochemistry, 42130, Selçuklu, Konya, Turkey
| | - A Ünlü
- Selcuk University, Faculty of Medicine, Department of Medical Biochemistry, 42130, Selçuklu, Konya, Turkey
| | - A Duman
- Selcuk University, Faculty of Medicine, Department of Anesthesiology and Intensive Care, 42130, Selçuklu, Konya, Turkey
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Duman I, Celik JB, Iyisoy MS, Degirmencioglu S, Korkmaz A, Duman A. Evaluation of personalized methylprednisolone therapy in critically ill COVID-19 patients: an observational comparative study using real-life data. Eur Rev Med Pharmacol Sci 2022; 26:4497-4508. [PMID: 35776051 DOI: 10.26355/eurrev_202206_29089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Methylprednisolone is commonly used to attenuate the cytokine storm and prevent mortality in COVID-19 pneumonia. However, the optimal methylprednisolone dose and duration are unclear. Additional data are required on the effectiveness of methylprednisolone in reducing mortality in COVID-19. This real-life retrospective study aimed to analyze the data of a COVID-19 dedicated ICU and compare the mortality rates of standard care, low-dose, and pulse-dose methylprednisolone in patients requiring mechanical ventilatory support. PATIENTS AND METHODS Methylprednisolone's indication, dose, and duration were determined according to the severity of COVID-19 pneumonia based on the patient's demographic parameters, comorbidities, laboratory data, radiology, and arterial blood gas analysis results. 867 patients were grouped as: no methylprednisolone (standard care), low-dose (0.5-1 mg/kg/day) methylprednisolone or pulse-dose (250-1,000 mg/day) methylprednisolone. RESULTS The overall mortality rate was 63.78%. Adjusting the dose of methylprednisolone according to the severity of the disease resulted in statistically similar mortality rates despite the increase in disease severity. Mortality was 62.71% in standard treatment, 65.76% in low-dose, and 62.10% in pulse-dose methylprednisolone groups (p = 0.633). Invasive mechanical ventilation at admission was associated with increased mortality (HR: 1.826 [95% CI: 1.542-2.161]; p < 0.001). Hematologic disorders and malignancies, arterial blood pH and HCO3, neutrophil count, and NLR at admission were also associated with mortality. CONCLUSIONS Personalizing the dose and duration of methylprednisolone according to the patient's disease severity assessed with demographic, clinical, and laboratory results may benefit mortality in severe COVID-19 patients receiving ventilatory support in the ICU. Hematologic disorders and malignancies, arterial blood pH and HCO3, neutrophil count, and NLR at admission were associated with mortality in our patient cohort.
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Affiliation(s)
- I Duman
- Department of Medical Pharmacology, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey.
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Okka B, Durduran Y, Duman I, Ery?lmaz A. Trends in traditional and complementary medicine practices in Turkey: Results of two consecutive surveys 2012-2018. J PAK MED ASSOC 2022; 72:691-695. [DOI: 10.47391/jpma.3218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Objective: To determine the knowledge, opinions, experiences and trends regarding herbal treatment, traditional medicine and other complementary and alternative medicine.
Methods: Two cross-sectional studies were conducted at Meram Faculty of Medicine Hospital, Konya, Turkey, in 2012 and 2018, comprising subjects of either gender aged >18 years. Data was collected using a survey form prepared in the light of relevant literature. Data was summarised and compared between the two studies.
Results: Of the 810 subjects in the two studies, there were 405(50%) in 2012 with a mean age of 32.5±14.0 years, while the remaining 405(50%) were part of the 2018 study with a mean age of 34.4±13.8. There were significant differences between the two group of subjects about the use and indications of traditional and complementary medicine as those who believed traditional and complementary medicine was proper to use increased and those who believed it should not be used decreased significantly (p<0.001). There was a twofold increase in the use of social media as the source of relevant information (p<0.001).
Conclusion: Significant changes in trends related to the use of traditional and complementary medicine between 2012 and 2018 were observed.
Key Words: Complementary medicine, Traditional medicine, Herbal therapy.
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Duman I, Ünal G, Yilmaz AI, Güney AY, Durduran Y, Pekcan S. Inhaled Dry Powder Mannitol Treatment in Pediatric Patients with Cystic Fibrosis: Evaluation of Clinical Data in a Real-World Setting. Pediatr Allergy Immunol Pulmonol 2022; 35:19-26. [PMID: 35285672 DOI: 10.1089/ped.2021.0127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: Cystic fibrosis (CF) is a genetic disorder, in which defective clearance of airway secretions leads to progressive lung function loss. Inhaled mannitol is used to increase sputum and mucociliary clearance. There are little data from real-world studies on the effectiveness of mannitol in children. Our objective was to evaluate the spirometry and clinical results of mannitol in pediatric patients. Methods: We retrospectively reviewed the records of 30 children and adolescents with CF receiving inhaled mannitol who were already on recombinant human deoxyribonuclease (rhDNase) treatment. The change in forced expiratory volume in 1 second (FEV1) from baseline at 2-4 months was the primary outcome. Secondary measures were other spirometry results, body mass index (BMI), hospital admissions, sputum characteristics, and positive bacterial colonization. Results: Compared to baseline, we found significant improvement in percent predicted FEV1 at 2-4 months of treatment; 84.50 (58.00-99.00) vs. 96.00 (66.00-106.00) (P = 0.0007). The absolute change in FEV1 was +11.5% at 2-4 months, +6.5% at 5-7 months, and +4% at 8-12 months. Also, significant improvements in other spirometry results were observed. Adolescents had significantly lower FEV1 results, but the improvement in their lung function was sustained for a more extended period than children. Mannitol provided easier sputum removal, increased sputum volume, significant decline in hospitalizations, and significantly fewer patients with positive sputum cultures. A significant increase in BMI at 8-12 months was observed. Cough was the most frequent adverse effect. Conclusion: In a real-world setting, our results demonstrated that adding mannitol to rhDNase therapy is tolerable in pediatric patients with CF and may provide improved spirometry and clinical outcomes. In addition, our results showed that mannitol provided recovery in overall lung function at 2-4 months, which was sustained up to 12 months together with improved BMI, easier sputum removal, and a decline in bacterial colonization and hospital admissions. However, cough was the most frequent side effect.
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Affiliation(s)
- Ipek Duman
- Department of Medical Pharmacology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Gokcen Ünal
- Department of Pediatric Pulmonology, and Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Asli Imran Yilmaz
- Department of Pediatric Pulmonology, and Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Ahmet Yasin Güney
- Department of Pediatric Pulmonology, and Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Yasemin Durduran
- Department of Public Health, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Sevgi Pekcan
- Department of Pediatric Pulmonology, and Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
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Duman I, Tanyeli Ö, Dereli Y, Oltulu P, Toy H, Sahin AS. The effects of botulinum toxin A and papaverine on human saphenous vein and internal mammary artery grafts: an in vitro study. Arch Med Sci 2022; 18:1607-1616. [PMID: 36457963 PMCID: PMC9710267 DOI: 10.5114/aoms/110157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 06/21/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Autologous saphenous vein (SV) and internal mammary artery (IMA) are used as bypass conduits during coronary artery bypass graft surgery. Vasospasm of the arterial and venous grafts may constitute a significant clinical problem. Pretreatment with a vasodilator drug of the graft ex vivo or intraluminal injection before implantation may be used for spasm prophylaxis. This in vitro study was designed to assess the vasoactive effects and time-dependent changes of botulinum toxin A (BTX-A) and papaverine pretreatment on vasospasm of human SV and IMA grafts. Also, histomorphology of the vessels was assessed. MATERIAL AND METHODS SV and IMA segments were suspended in organ baths, and isometric contraction responses to 2 different concentrations of 5-hydroxytryptamine (5-HT) and endothelin-1 (ET-1) were recorded after incubation with 2 different concentrations of BTX-A and papaverine at 2 time points (0 h and 2 h). RESULTS The results revealed the following: 1) incubation with BTX-A and papaverine relaxes both SV and IMA rings contracted with 5-HT and ET-1; 2) the duration of the relaxant effect of BTX-A lasts longer than papaverine; and 3) no apparent histomorphological changes were observed in the grafts under light microscopy. CONCLUSIONS This study demonstrates that in human SV and IMA grafts, pretreatment with both BTX-A and papaverine are safe and have a potent inhibitory effect depending on the vessel and vasoconstrictor agent. The long-lasting vasodilatory effect of BTX-A on vascular smooth muscle may provide promising results in the prevention of venous and arterial graft spasm.
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Affiliation(s)
- Ipek Duman
- Department of Medical Pharmacology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ömer Tanyeli
- Department of Cardiovascular Surgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Yuksel Dereli
- Department of Cardiovascular Surgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Pembe Oltulu
- Department of Pathology, Necmettin Erbakan University, Konya, Turkey
| | - Hatice Toy
- Department of Pathology, Necmettin Erbakan University, Konya, Turkey
| | - Ayse Saide Sahin
- Department of Medical Pharmacology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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Duman I, Soner BC, Inan SY, Sahin AS. Caffeic Acid Phenethyl Ester (CAPE), Active Phenolic Compound of
Propolis Attenuates Endothelin, Prostaglandin F2α and U46619 Elicited
Contractions of Isolated Human Umbilical Artery. CTM 2021. [DOI: 10.2174/2215083806999201214160640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Propolis is a product of honeybees that contains a variety of different compounds, including caffeic acid phenethyl ester (CAPE). Propolis and its bioactive compounds are widely used in folk medicine and as a dietary
supplement. Previously it has been shown that CAPE has antioxidant, anti-inflammatory, antimicrobial, antiviral, immunomodulatory, and anticancer activity.
Objective:
This in vitro study was designed to investigate the vasoactive effects of CAPE on quiescent and precontracted
human umbilical arteries.
Methods:
Umbilical artery strips were suspended in aerated organ baths containing a buffer solution. The strips were randomly allocated to study groups (n=8). Via a transducer and computer, changes in isometric tension were recorded. The
effects of cumulative CAPE (10-8-10-4M) on basal tone of the artery, and in different groups of strips, the vasodilatory effect of cumulative CAPE on the constriction elicited by endothelin (ET-1), prostaglandin F2α (PGF2α) and U46619, and
the effect of incubation with NO synthase inhibitor L-NAME, were recorded.
Conclusion:
CAPE elicits concentration-dependent relaxation on precontracted human umbilical artery strips depending
on the constrictor agent. NO plays significant role in CAPE’s vasorelaxant effect.
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Affiliation(s)
- Ipek Duman
- Department of Medical Pharmacology, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, 42080,Turkey
| | - Burak Cem Soner
- Department of Medical Pharmacology, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, 42080,Turkey
| | - Salim Yalcin Inan
- Department of Medical Pharmacology, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, 42080,Turkey
| | - Ayse Saide Sahin
- Department of Medical Pharmacology, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, 42080,Turkey
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Cura Z, Oc B, Arun O, Oc M, Duman I, Duman A. Effects of Sevoflurane and Propofol Anesthesia on Cerebral Oxygenation in Patients Undergoing Carotid Endarterectomy. Turk Neurosurg 2021; 32:76-82. [PMID: 34664695 DOI: 10.5137/1019-5149.jtn.33776-21.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM Information regarding the impact of the anesthesia technique on the neurological outcome of patients receiving carotid endarterectomy (CEA) is scarce. CEA requires the clamping of the ipsilateral carotid artery. Cerebral oximetry is based on near-infrared spectroscopy (NIRS) and can detect hypoperfusion during carotid artery clamping. This retrospective study compares the effects of sevoflurane and propofol anesthesia on perioperative cerebral oxygenation in patients undergoing CEA under general anesthesia by using NIRS monitoring. MATERIAL AND METHODS The perioperative data of 33 patients undergoing CEA were retrospectively evaluated. The study groups were organized according to the anesthesia drugs used for maintenance: sevoflurane (n = 17) and propofol (n = 16). The regional cerebral oxygen saturation (rScO2) of the ipsilateral and contralateral hemispheres was monitored continuously using a NIRS instrument and analyzed at specific time points starting from induction to the 12th hour postoperation. The data were analyzed using the appropriate tests, and a p value of 0.05 was considered significant. RESULTS Compared with those of groups with non-clamped hemispheres, the rScO2 values of the sevoflurane and propofol groups decreased significantly during clamping (p 0.05) and increased to above-preoperative values after declamping (p 0.05). When the sevoflurane and propofol groups were compared, a significant decrease in rScO2 was noted during extubation in the sevoflurane group (p 0.05). In the propofol group, female patients had significantly lower rScO2 values compared with male patients during clamping of the carotid artery (p 0.05). None of the observed decreases were greater than 20%, which is considered an indication for shunting. CONCLUSION Our NIRS monitoring results indicate that sevoflurane or propofol anesthesia does not generally cause significant differences in cerebral oxygenation during and after cross-clamping in patients undergoing CEA. The finding of sex-related differences in cerebral oxygenation in patients receiving propofol and decreased oxygenation during extubation in patients receiving sevoflurane warrants further studies.
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Kandemir B, Duman I, Durduran Y, Metin Akcan O, Selver MB, Pekcan S. Unnoticed Adverse Effect of Isoniazid during Childhood Tuberculosis Preventive Treatment: Hyperuricemia. J PEDIAT INF DIS-GER 2021. [DOI: 10.1055/s-0041-1724022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Abstract
Objective Isoniazid for 6 to 9 months is the most widely used form of tuberculosis (TB) preventive treatment. We aimed to assess the adverse effects of isoniazid by using the serum levels of aspartate transaminase (AST), alanine transaminase (ALT), and uric acid (SUA) in children and adolescents receiving long-term isoniazid for latent TB infection.
Methods The study included children ≤18 years of age who underwent TB preventive treatment with isoniazid (IPT) between 2015 and 2019 at a university hospital. Serum transaminase, SUA, urea, and creatinine levels of patients were measured before the initiation of IPT, 15th day, and once a month during treatment. Patients with ALT, AST, or SUA results above cut-off levels during treatment were evaluated. The final values in follow-up were included in the data analysis.
Results A total of 141 children who underwent IPT were included. In total, 70 children had family members with confirmed TB disease, and 71 children had a positive tuberculin skin test. SUA increased above cut-off values in 16 children (11.3%), and half of them had uric acid levels over 7 mg/dL. The median duration of the development of hyperuricemia was 4.0 months. ALT or AST increased above cut-off values in 23 children (16.3%). ALT was above cut-off values in seven patients, AST was high in 20 patients. The median duration to the development of AST and/or ALT levels above cut-off was 4.0 months. Two patients had hepatotoxic transaminase levels. Three patients had both elevated transaminases and SUA levels.
Conclusion Isoniazid may also cause hyperuricemia besides elevation in transaminases in children.
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Affiliation(s)
- Bahar Kandemir
- Department of Infectious Diseases and Clinical Microbiology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ipek Duman
- Department of Pharmacology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Yasemin Durduran
- Department of Public Health, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ozge Metin Akcan
- Department of Paediatric Infectious Diseases, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Muhammed Burak Selver
- Department of Paediatrics, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Sevgi Pekcan
- Department of Paediatric Pulmonology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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Dagli C, Duman I. Successful Use of Early Therapeutic Hypothermia in an MDMA and Amphetamine Intoxication-Induced Out-of-Hospital Cardiac Arrest: A Case Report. J Emerg Med 2020; 59:e89-e92. [PMID: 32712033 DOI: 10.1016/j.jemermed.2020.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/22/2020] [Accepted: 06/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Deaths caused by recreational drug abuse have increased considerably in recent years. Therapeutic hypothermia offers the potential to improve neurological outcomes in post-resuscitation patients. CASE REPORT A 19-year-old man was brought to our emergency department after suffering out-of-hospital ventricular fibrillation (VF) cardiac arrest. He was resuscitated at our emergency department again due to VF. Urine analysis showed high levels of amphetamine and 3,4 methylenedioxymethamphetamine (MDMA) (ecstasy). The patient was intubated, sedated, and ventilated. Within 1 h after the return of spontaneous circulation and hemodynamic stabilization, therapeutic hypothermia was initiated for neurologic protection. An external-cooling device was used for cooling. He was maintained at 33oC for 72 h. The patient was weaned from the ventilator and extubated on day 5. He was discharged from the hospital on the day 10 with good cerebral performance. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Initiation of early therapeutic hypothermia within 1 h after return of spontaneous circulation might contribute to better neurologic outcome in patients who suffer VF cardiac arrest. We suggest that early therapeutic hypothermia may be considered in patients who suffer out-of-hospital cardiac arrest due to MDMA and amphetamine intoxications.
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Affiliation(s)
- Celalettin Dagli
- Department of Emergency Medicine and Intensive Care, Medicana Hospital, Konya, Turkey
| | - Ipek Duman
- Department of Medical Pharmacology, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
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Kara I, Sargin M, Bayraktar YS, Sahinoglu M, Ildarov G, Duman I, Celik JB, Karabagli H. The Relationship Between Vasoactive-Inotropic Score and Mortality in Adult Patients with Traumatic Brain Injury. Turk Neurosurg 2019; 29:254-261. [PMID: 30649831 DOI: 10.5137/1019-5149.jtn.25177-18.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM To assess the feasibility of the vasoactive-inotropic score (VIS) in determining the amount of vasoactive support and its relationship with the mortality rate and characteristics of the patients with traumatic brain injury (TBI). MATERIAL AND METHODS This study was conducted with a retrospective design involving the years 2013-2018 in a university hospital which provides tertiary intensive care service. A total of 102 patients who were admitted in the ICU with the diagnosis of severe TBI, and also were followed by neurosurgery service and who received vasoactive and inotropic support were analyzed concerning VIS value. RESULTS The median age of the patients was 34 years, and 69.6% of the patients were male. Mortality rate was 43.1%. In the group with mean VIS≥10, the admission duration in the ICU and hospital were shorter (p < 0.0001) whereas mortality rates were higher (81.1% vs 21.5% and p < 0.0001). Besides, the number of patients with a VIS score of ≥10, ≥15 and ≥20 were higher in the group of patients who died (p < 0.0001). The results of the multivariate analysis such as VIS≥10 were significant. CONCLUSION We can conclude that VIS, which is used to determine the amount of vasoactive and inotropic medicines during cardiac surgery and in sepsis patients, may be useful in predicting mortality in TBI patients.
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Affiliation(s)
- Iskender Kara
- Selcuk University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Division of Critical Care Medicine, Konya, Turkey
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Tanyeli O, Duman I, Dereli Y, Gormus N, Toy H, Sahin AS. Relaxation matters: comparison of in-vitro vasodilatory role of botulinum toxin-A and papaverine in human radial artery grafts. J Cardiothorac Surg 2019; 14:15. [PMID: 30665449 PMCID: PMC6341691 DOI: 10.1186/s13019-019-0837-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 01/14/2019] [Indexed: 11/26/2022] Open
Abstract
Background Radial artery (RA) is widely used in coronary artery bypass (CABG) surgery and the prevention of spasm is crucial for graft patency. Botulinum toxin A (BTX-A) and B are commonly used for aesthetic reasons and neuromuscular disorders. They are proven to raise blood flow and increase survival of ischemic skin flaps. In this study we evaluated and compared the vasodilator effects of BTX-A and papaverine on human RA grafts. Methods After resting 60 min in isolated organ baths, human RA grafts were examined. Contraction responses for different doses of serotonin (5-HT) and endothelin-1 (ET-1) were evaluated as a percent of maximum contraction response elicited by 80 mM potassium chloride (KCl). The inhibitory effects of BTX-A and papaverine on contraction responses taken at the 0th hour were compared with the 1st and 2nd hour responses. Inhibitory effects of BTX-A and papaverine against the contractile agent were evaluated by comparing the results of the first and last (0th and 2nd hour) application. Results In low concentrations, when we compared the effects of BTX-A (10− 8 M) and papaverine (10− 6 M) on 5-HT, papaverine was found to be more effective at both the 0th and 2nd hour (p < 0.05). Both BTX-A and papaverine inhibited the maximum contractile effect of ET-1 to the same extent at the 0th hour; but, the inhibitory effect of BTX-A was significantly stronger at the 2nd hour (p < 0.05). In high concentrations, when we compared the effects of BTX-A (10− 6 M) and papaverine (10− 4 M) on 5-HT, papaverine showed stronger inhibition (p < 0.05), whereas both agents had similar action of inhibition on ET-1 mediated maximum contraction responses. Conclusion BTX-A inhibits both ET-1 and 5-HT induced contractions and its effectiveness does not decrease over time as observed with papaverine. This study is the first in the literature using human RA for prevention of vasospasm by BTX-A.
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Affiliation(s)
- Omer Tanyeli
- Department of Cardiovascular Surgery, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey.
| | - Ipek Duman
- Department of Pharmacology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Yuksel Dereli
- Department of Cardiovascular Surgery, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Niyazi Gormus
- Department of Cardiovascular Surgery, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Hatice Toy
- Department of Pathology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Ayse Saide Sahin
- Department of Pharmacology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
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Arun O, Taylan SB, Duman I, Oc B, Yilmaz SA, Tekin A, Celik C, Bariskaner H, Celik JB. In vitro vasoactive effects of dexmedetomidine on isolated human umbilical arteries. ACTA ACUST UNITED AC 2019; 120:40-45. [DOI: 10.4149/bll_2019_006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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14
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Sarier M, Demir M, Goktas S, Duman I, Buyukkinaci M, Yuksel Y, Tekin S, Yavuz AH, Sengul A. Results of Real-time Multiplex Polymerase Chain Reaction Assay in Renal Transplant Recipients With Sterile Pyuria. Transplant Proc 2018; 49:1307-1311. [PMID: 28735999 DOI: 10.1016/j.transproceed.2017.02.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/07/2017] [Indexed: 12/17/2022]
Abstract
Urinary tract infections are a major cause of morbidity and hospitalization after renal transplantation. Patients treated with immunosuppressive drugs suffer not only from common uropathogens but also from opportunistic infections caused by unusual uropathogens. Sterile pyuria is associated with numerous infectious agents including viruses, fungi, and atypical or fastidious organisms. The objective of this study was to investigate the pathogens using real-time multiplex polymerase chain reaction (rtMPCR) assay in sterile pyuria of renal transplant recipients. In this prospective controlled study, pathogen detection was performed with rtMPCR assay on October 2016 in 60 patients with sterile pyuria who had undergone kidney transplantation. A total of 40 renal transplant patients were determined as the control group. Male-to-female ratio was same. The mean age of the subjects with sterile pyuria was 45.7 ± 12.1 (25-74). The mean duration after transplantation was 28.8 ± 3.97 (3-102) months. Pathogens were detected with rtMPCR in 61.7% of sterile pyuria group. This rate was significantly higher compared with the control group (P < .001). Two or more different pathogens were found in 13 (21.7%) patients in sterile pyuria group. The pathogens found included cytomegalovirus in 10 patients (19%), Gardnerella vaginalis and obligate anaerobes in 20 patients (38%), Ureaplasma spp in 17 patients (33%), Candida spp in 2 patients (4%), Mycoplasma hominis in one patient (2%), herpes simplex virus-2 in one patient (2%), and Trichomonas vaginalis in one patient (2%). Sterile pyuria may indicate the presence of genitourinary pathogens that cannot be detected with conventional urine culture method in renal transplantation patients. rtMPCR is an accurate and convenient method for detection of multiple potential pathogens of sterile pyuria in renal transplant patients.
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Affiliation(s)
- M Sarier
- Department of Urology, Kemerburgaz University Medical Faculty, İstanbul, Turkey.
| | - M Demir
- Department of Biochemistry, Kemerburgaz University Medical Faculty, İstanbul Turkey
| | - S Goktas
- Department of Clinical Microbiology and Infectious Disease, Gelişim Medical Laboratories, İstanbul, Turkey
| | - I Duman
- Department of Urology, Kemerburgaz University Medical Faculty, İstanbul, Turkey
| | - M Buyukkinaci
- Department of Obstetrics and Gynecology, Medical Park Hospital, Antalya, Turkey
| | - Y Yuksel
- Department of Transplantation Unit, Medical Park Hospital, Antalya, Turkey
| | - S Tekin
- Department of Surgery, Kemerburgaz University, İstanbul, Turkey
| | - A H Yavuz
- Department of Transplantation Unit, Medical Park Hospital, Antalya, Turkey
| | - A Sengul
- Department of Clinical Microbiology and Infectious Disease, Medical Park Hospital, Antalya, Turkey
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Cepni E, Oc B, Ugurluoglu C, Duman I, Arun O. The Effects of Intra-Articular Injection of Ibuprofen on Knee Joint Cartilage and Synovium in Rats. Clin Ther 2017. [DOI: 10.1016/j.clinthera.2017.05.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Yuksel Y, Tekin S, Yuksel D, Duman I, Sarier M, Yucetin L, Turan E, Celep H, Ugurlu T, Inal MM, Asuman YH, Demirbas A. Pregnancy and Delivery in the Sequel of Kidney Transplantation: Single-Center Study of 8 Years' Experience. Transplant Proc 2017; 49:546-550. [PMID: 28340831 DOI: 10.1016/j.transproceed.2017.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Depending on hyphothalamic, hyphophyseal, and gonadal axis dysfunction, anovulatory irregular cycles occur and the probability of pregnancy decreases in the patients with chronic kidney disease (CKD). Maternal mortality and morbidity rates are increased in CKD patients; the risk of premature delivery is 70% and the risk of preeclampsia is 40% more than normal among those with a creatine level of >2.5 mg/dL. METHODS If a pregnancy is expected in the sequel of kidney transplantation (KT), a multidisciplinary team approach should be adopted and both the gynecologist and the nephrologist should follow the patient simultaneously. Among 3883 patients who underwent KT at Antalya Medical Park Hospital Transplantion Department between November 2009 and October 2016, the records of 550 female patients between the ages of 18 and 40 years were examined retrospectively; 31 patients who complied with these criteria were included in the study group. In 6 of these patients who had an unplanned pregnancy, medical abortion was performed after the families were informed about the possible fetal anomalies caused by the use of everolimus in the first trimester, and they were excluded from the study (pregnant group). The control group consisted of 43 patients who had a KT and became pregnant, and of those who had recently undergone KT and shared similarities regarding age, CKD etiology, duration of dialysis, and number of transplants. RESULTS In both groups, the ages of the patients, their follow-up span and dialysis duration, tissue compatibility, age of the donor, and time elapsed until the pregnancy was analyzed, whereas in the control group, creatinine levels in the first, second, third, and fourth years after the KT were reviewed. Additionally, in the pregnant group, creatinine levels of the first, second, and third trimesters; delivery week; birth weight of the baby; APGAR scores of the first minute; postnatal creatinine levels of first, second, and third years; and prenatal, maternal, and postnatal acute rejections were reviewed. We measured the creatine clearance by use of the Cockcroft-Gault formula in the pregnancy group before pregnancy and during delivery [Cockcroft-Gault formula: (140 - age) × body weight (kg)/72 × plasma creatine level (mg/dL) × 0.85]. CONCLUSIONS Pregnancy after KT is risky both for the mother and the baby; however, if planned and followed in coordination within an experienced center, both the pregnancy period and the birth process can occur without distress.
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Affiliation(s)
- Y Yuksel
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey.
| | - S Tekin
- Department of General Surgery, Faculty of Medicine, Kemerburgaz University, Istanbul, Turkey
| | - D Yuksel
- Department of Anesthesia, and Reanimasyon Unit, Training and Research Hospital, Antalya, Turkey
| | - I Duman
- Department of Urology, Faculty of Medicine, Kemerburgaz University, Istanbul, Turkey
| | - M Sarier
- Department of Urology, Faculty of Medicine, Kemerburgaz University, Istanbul, Turkey
| | - L Yucetin
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - E Turan
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - H Celep
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - T Ugurlu
- Department of Obstetrics and Gynecology, Medical Park Hospital, Antalya, Turkey
| | - M M Inal
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kemerburgaz University, Istanbul, Turkey
| | - Y H Asuman
- Department of Nephrology and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - A Demirbas
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey
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Yuksel Y, Tekin S, Yuksel D, Duman I, Sarier M, Yucetin L, Kiraz K, Demirbas M, Kaya Furkan A, Aslan Sezer M, Demirbas A, Asuman YH. Optimal Timing for Removal of the Double-J Stent After Kidney Transplantation. Transplant Proc 2017; 49:523-527. [PMID: 28340826 DOI: 10.1016/j.transproceed.2017.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Urologic complications (UC) have gradually decreased in recent years after advanced surgical experience. The incidence of urologic complications varies between 0.22% and 30% in different medical studies. There is no routine usage of double-J stenting (DJS) during renal transplantation (RT) in the literature. It is a necessity, and optimal timing for stent removal is an important question for many transplantation centers. METHODS This study includes 818 renal transplant patients whose ureteroneocystostomy anastomoses were completed by use of the Lich-Gregorie procedure during a 2-year period at a transplantation center. We performed 926 renal transplantations at Antalya Medical Park Hospital Renal Transplantation Center between January 2014 and January 2016. The patients were divided into four groups according to the timing of DJS removal. RESULTS For group 1, removal time for DJS was between 5 and 7 days; group 2, Removal time for DJS was between 8 and 14 days; group 3, removal time for DJS was between 15 and 21 days; and group 4, removal time for DJS was later than 22 days. The patients were divided into two groups according to removal time of stent as 5 to 14 days and >15 days. DJS was performed again in the patients whose urine output was reduced during the first 5 days after removal of the DJS, whose creatine level increased, and whose graft ureter and collecting tubules were extended as an ultrasonographic finding. CONCLUSIONS There is no declared optimal time for the removal of DJS. The removal time was reported between postoperative first week and 3 months in some of the reports of RT centers, according to their protocols. We emphasize that the optimal time for the removal of DJS is 14 to 21 days after RT, based on the findings of our large case report study.
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Affiliation(s)
- Y Yuksel
- Medical Park Hospital, Department of General Surgery and Transplantation, Antalya, Turkey.
| | - S Tekin
- Kemerburgaz University, Faculty of Medicine, Department of General Surgery, Istanbul, Turkey
| | - D Yuksel
- Training and Research Hospital, Department of Anesthesia and Reanimasyon Unit, Antalya, Turkey
| | - I Duman
- Kemerburgaz University, Faculty of Medicine, Department of Urology, Istanbul, Turkey
| | - M Sarier
- Kemerburgaz University, Faculty of Medicine, Department of Urology, Istanbul, Turkey
| | - L Yucetin
- Medical Park Hospital, Department of General Surgery and Transplantation, Antalya, Turkey
| | - K Kiraz
- Ataturk Goverment Hostpital, Department of Chest Diseases, Antalya, Turkey
| | - M Demirbas
- Yuksek Ihtisas Training and Research Hospital, Department of Urology, Bursa, Turkey
| | - A Kaya Furkan
- Medical Park Hospital, Department of General Surgery and Transplantation, Antalya, Turkey
| | - M Aslan Sezer
- Medical Park Hospital, Department of General Surgery and Transplantation, Antalya, Turkey
| | - A Demirbas
- Medical Park Hospital, Department of General Surgery and Transplantation, Antalya, Turkey
| | - Y H Asuman
- Medical Park Hospital, Department of Nephrology and Transplantation, Antalya, Turkey
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Sarier M, Demir M, Duman I, Yuksel Y, Demirbas A. Evaluation of Ureteral Stent Colonization in Live-Donor Renal Transplant Recipients. Transplant Proc 2017; 49:415-419. [DOI: 10.1016/j.transproceed.2017.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Hanedan B, Saltali A, Duman I, Mermer A, Taylan S, Sari M, Apiliogulari S. Effect of Ondansetron On The Thermal Antinociceptive Effects of Procaine In The Rat Paw. Clin Ther 2016; 38:e31-e32. [DOI: 10.1016/j.clinthera.2016.07.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Duman I, Arun O, Arun F, Oc B. Off-Label use of Midazolam in randomized controlled trials. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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Akand M, Celik O, Avci E, Duman I, Erdogru T. Open, laparoscopic and robot-assisted laparoscopic radical prostatectomy: comparative analysis of operative and pathologic outcomes for three techniques with a single surgeon's experience. Eur Rev Med Pharmacol Sci 2015; 19:525-531. [PMID: 25753865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To compare outcomes of open (O-), laparoscopic (L-) and robot-assisted laparoscopic (RAL-) radical prostatectomy (RP) performed by the same surgeon. PATIENTS AND METHODS From May 1999 to April 2012, 484 RPs were performed by a single surgeon. Patients' data including age, body-mass index, serum prostate specific antigen (PSA) level, Gleason score of prostate biopsy and prostatectomy specimen, preoperative prostate and specimen volumes, clinical and pathologic stages, operation time, estimated blood loss (EBL), catheterization time, blood transfusion rate were recorded. Prospectively collected data was evaluated retrospectively by statistical analyses. RESULTS Of 484 radical prostatectomies, ORP (50), LRP (308) and RALRP (79) done by the same surgeon were included into study. Mean ages were 63.8, 62.7 and 60.3 years for ORP, LRP and RALRP respectively. Operation times for ORP, LRP and RALRP were 255, 208 and 242 minutes. EBL and hospitalization time were 602, 526, 234 mL, and 9.1, 3.2, 3.2 days for ORP, LRP and RALRP, respectively. While a significant advantage was found for EBL and complication rates in RALRP and for operation time in LRP, significant disadvantages were found in terms of catheterization time, hospitalization time, decrease in hemoglobin and blood transfusion in ORP. However, preoperative prostate volume and serum PSA level, oncologic outcomes and positive surgical margins were nearly similar in all operative techniques. CONCLUSIONS Minimally invasive techniques such as LRP and RALRP are promising techniques with comparable outcomes with ORP. Shorter catheterization time, less blood loss and fewer complication rates can be provided by RALRP.
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Affiliation(s)
- M Akand
- Department of Urology, Selcuk University, School of Medicine, Konya, Turkey.
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22
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Kara I, Duman I, Duman A. Delayed recovery from rocuronium block in an infant. Middle East J Anaesthesiol 2012; 21:731-733. [PMID: 23265038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Prolonged duration of action of rocuronium in an infant patient is rare. We report an unusual case of prolonged neuromuscular blockade with rocuronium in an infant undergoing cleft lip repair anesthetized with sevoflurane and management of the patient.
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Affiliation(s)
- Inci Kara
- Selcuk University, Selcuklu Medical Faculty, Department of Anesthesiology and Intensive Care, Konya, Turkey.
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Abstract
STUDY DESIGN Case report. OBJECTIVES To report a case of paraplegia with limb edema caused by pregabalin. SETTING Turkish Armed Forces Rehabilitation Center, Ankara, Turkey. CASE REPORT A 40-year-old male patient with T11 paraplegia had the complaint of swelling in both the lower limbs. He had been given pregabalin because of the neuropathic pain in both the lower limbs. At 10 months, the patient has experienced edema in lower limbs. There was severe edema in both legs, ankles and feet, more evident on the left. Venous Doppler ultrasound was normal on both sides. Blood tests for possible etiologies were normal. No other etiology could be found. The edema was considered to be caused by pregabalin and the medicine was ceased gradually. The edema resolved completely in 2 weeks. CONCLUSION Pregabalin, which is one of medications used for neuropathic pain, might cause limb edema, that is, a condition needs differential diagnosis. This is particularly important for patients with spinal cord injuries (SCIs). Such adverse effect of pregabalin should be kept in mind as an etiology of limb edema in SCI management.
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Affiliation(s)
- U Guzelkucuk
- Department of Physical Medicine and Rehabilitation, Gülhane Military Medical Academy, Turkish Armed Forces Rehabilitation Center, Ankara, Turkey.
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Gökçe H, Ağaoğulları D, Yetmez M, Gündüz O, Aktaş C, Öveçoğlu M, Duman I, Agathopoulos S, Oktar F. Production and characterization of composites of hydroxyapatite reinforced with nano-yttrium-oxide. J Biomech 2011. [DOI: 10.1016/j.jbiomech.2011.02.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Çelik G, Özbek O, Yılmaz M, Duman I, Özbek S, Apiliogullari S. Vapocoolant spray vs lidocaine/prilocaine cream for reducing the pain of venipuncture in hemodialysis patients: a randomized, placebo-controlled, crossover study. Int J Med Sci 2011; 8:623-7. [PMID: 22022215 PMCID: PMC3198258 DOI: 10.7150/ijms.8.623] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 07/27/2011] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Patients undergoing hemodialysis are repeatedly exposed to stress and pain from approximately 300 punctures per year to their arteriovenous fistula. This study was designed to measure pain associated with venepuncture during AVF cannulation and to compare the effectiveness of ethyl chloride vapocoolant spray, topical eutectic mixture of local anesthetics (EMLA) cream and placebo in controlling pain caused by venepuncture of arteriovenous fistula patients undergoing chronic hemodialysis. METHODS This randomized, placebo-controlled, crossover study, included 41 patients undergoing conventional hemodialysis three times a week. First intervention was conducted as baseline pain assessment (control). In the three consecutive dialysis sessions, every patient randomly received 1) ethyl chloride vapocoolant spray, 2) EMLA, or 3) placebo cream before venepuncture. Pain perception was recorded by patients immediately after cannulation on a 0-100 mm visual analogue scale (VAS). p<0.05 was considered as significant. RESULTS VAS scores presented a marked inter-individual variation during venepuncture. EMLA application resulted in significantly lower total pain scores compared to control and all other interventions (p<0.05). No patient experienced severe pain with EMLA or vapocoolant. The patients reported less moderate and severe pain with EMLA, and vapocoolant spray compared to control and placebo interventions. Moderate and severe pain scores were similar between EMLA and vapocoolant spray (p>0.05). CONCLUSION Venipuncture for AVF cannulation causes mild to moderate pain in hemodialysis patients. Although local application of EMLA is more effective than in preventing venepuncture pain, ethyl chloride vapocoolant is as effective as EMLA for preventing mild to moderate puncture pain in patients undergoing hemodialysis.
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Affiliation(s)
- Gülperi Çelik
- Department Internal Medicine, Division of Nephrology, Faculty of Medicine, Selcuk University, Konya, Turkey.
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Abstract
BACKGROUND The effect of intrathecal fentanyl on the characteristics of spinal anesthesia has not been investigated in children undergoing inguinal hernia repair. The purpose of this study was to assess whether the incidence and severity of pain during peritoneal sac traction is decreased by addition of fentanyl to bupivacaine in children undergoing inguinal hernia repair with spinal anesthesia. METHODS Children (6-14 years) were randomized into two groups. Group F (n = 25): hyperbaric bupivacaine plus 0.2 microg.kg(-1) of fentanyl. Group P (n = 25): hyperbaric bupivacaine plus 0.9% NaCl (placebo). The dose of bupivacaine was 0.4 mg.kg(-1). The primary variable was the incidence and severity of pain during peritoneal sac traction. Spinal block characteristics, duration of spinal anesthesia assessed by recovery of hip flexion and duration of analgesia were the secondary variables measured, and the side effects were noted. RESULTS There were significant differences in incidence of pain and pain scores during sac traction with lower incidence and scores in the fentanyl group (P = 0.009). Two groups were similar regarding the level of sensory block during sac traction and duration of spinal anesthesia. Duration of spinal analgesia was prolonged significantly in the fentanyl group (P = 0.025). CONCLUSION Intrathecal fentanyl at a dose of 0.2 microg.kg(-1) added to bupivacaine significantly improves the quality of intraoperative analgesia and prolongs postoperative analgesia in children undergoing inguinal hernia repair with spinal anesthesia.
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Affiliation(s)
- Ates Duman
- Department of Anesthesia and Intensive Care, Medical Faculty, Faculty of Dentistry, Selcuk University, Konya, Turkey
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Duman A, Duman I, Ogun CO. Is nimodipine really effective in head trauma? Pharmacol Res 2009; 60:358; author reply 359-60. [PMID: 19410648 DOI: 10.1016/j.phrs.2009.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 04/22/2009] [Indexed: 10/20/2022]
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Duman I, Aydemir K, Taskaynatan MA, Dincer K. Unusual cases of acquired leukonychia totalis and partialis secondary to reflex sympathetic dystrophy. J Eur Acad Dermatol Venereol 2007; 21:1445-6. [DOI: 10.1111/j.1468-3083.2007.02262.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sahin AS, Duman A, Günaydin IG, Sahin TK, Görmüş N, Duman I. Effect of cooling on the responses of human saphenous vein to fentanyl, remifentanil and sufentanil. Fundam Clin Pharmacol 2006; 20:473-6. [PMID: 16968417 DOI: 10.1111/j.1472-8206.2006.00434.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We studied the vasodilatory effects of fentanyl, remifentanil and sufentanil on the human saphenous vein strips at 37, 32 and 28 degrees C. Fentanyl produced concentration-dependent relaxation of human saphenous vein strips precontracted with 5-hydroxytryptamine (5-HT) at every temperature studied. Compared with vein strips at 37 degrees C, relaxant responses to each one concentration of fentanyl were significantly reduced at 32 and 28 degrees C. Remifentanil relaxed vein strips in a concentration-dependent way and the relaxation for all concentrations were significantly greater at 32 and 28 degrees C compared with 37 degrees C. Sufentanil produced concentration-dependent relaxation in saphenous vein strips precontracted with 5-HT. These relaxant responses were similar at 32 degrees C compared with 37 degrees C. When bath temperature was lowered from 37 to 28 degrees C, the relaxant responses to sufentanil were significantly reduced. In summary, the present study suggests that cooling reduces the relaxation caused by fentanyl and sufentanil on human saphenous veins but augments the relaxation with remifentanil. The augmented vasodilatory effect of remifentanil with cooling may be useful on systemic vascular resistance and organ preservation under hypothermic conditions like cardiopulmonary bypass surgery.
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Affiliation(s)
- Ayşe Saide Sahin
- Department of Pharmacology, Meram Medicine Faculty, Selcuk University, Konya, Turkey.
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