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A 5-year retrospective evaluation of snakebite cases in Hatay, Turkey
(Sage Publications Inc, 2015) Karakus, Ali; Zeren, Cem; Celik, M. Murat; Arica, Secil; Ozden, Raif; Duru, Mehmet; Tasin, Veyis
Snakebites are relatively rare medical emergency cases that might lead to serious consequences. This study aims to evaluate snakebite cases in terms of medical follow-up, antivenom therapy and antivenom reactions. Medical records of patients admitted to emergency department between January 1, 2006 and December 31, 2010 were retrospectively investigated. Snakebite-related cases of a total of 125 patients were included in the scope of the study. Of the total 125 cases, 54.4% were male and 45.6% were female. Most of cases (n: 65, 52%) were aged over 30years, while the mean age was 34.87 +/- 19.29years. Snakebite-related applications to the emergency department were mostly seen in June with 27 cases. Upon admitting, all patients were recorded to be conscious and showing good general conditions; however, they suffered from pain and edema at the site of bite. Of all, 25 patients only suffered from bite injury and ecchymosis due to snakebite. The site of bite was upper extremities in 66 patients (52.8%), whereas it was lower extremities in 58 (46.4%). Of all, antivenom was unnecessary in 25 (20%) patients, while four antivenoms were administered to each of the 23 (18.4%) patients. Furthermore, six (4.8%) patients needed nine antivenom administrations for each. Anaphylaxis (n: 2, 1.6%), compartment syndrome (n: 2, 1.6%) and serum sickness (n: 1, 0.8%) encountered in remaining cases. Of all, 86 (68.8%) patients were hospitalized in the emergency department, while 25 (20.0%) patients were followed up by observation in emergency service. Only one patient was treated and followed up in intensive care unit. Implementation of antivenom therapy is considered unnecessary for the treatment of all snakebite cases. Antivenom reactions and number of related cases might be reduced by continuous close monitoring, appropriate prophylaxis and controlled slow infusion administration of medications.
Akrep sokmalarında doksazosinin etkinliği : çocuk olgu sunumu
(2014) Karakuş, Ali; Tutanç, Murat; Arıca, Vefik; Karcıoğlu, Murat; Tuzcu, Kasım; Başarslan, Fatmagül; Duru, Mehmet
Akrep sokması vakaları, özellikle çocuklarda kalp, solunum ve nörolojik sistemi etkileyen komplikasyonlar nedeniyle ölümcül olabilen acil hastalar grubundadır. Kalp etkilenimi, alfa reseptörlerinin uyarımı sonucunda görülebilmektedir. Bir alfa reseptör blokoru olan doksazosin kalp etkilenimi olan olguların tedavisinde kullanılabilmektedir. Biz de ak- ciğer ödemi tablosunda olan ve doksazosin ile başarılı bir şekilde tedavi olan bir yaşındaki olguyu sunmayı hedefledik.
Akrep sokması sonucu trombositopeni ve lökopeni : olgu sunumu
(2014) Karakuş, Ali; Arslan, Gökhan; Çalışkan, Koca; Kaya, Ergün; Duru, Mehmet; Kekeç, Zeynep
Akrep sokması ciddi ve hayatı tehdit eden acil bir durumdur. Akrep sokmalarında klinik olarak; kardiyovasküler, nörolojik ve hematolojik anormallik ( trombositopeni, nötropeni ) görülebilir.Bu çalışmada; akrep sokması sonucu acil servisimize başvuran 60 yaşında bayan hastanın tanı ve tedavi metodları tartışıldı. Trombosit desteğine gerek kalmadan akrep antivenomu tedavisi ile trombosit seviyeleri düzeldi.
Amitriptyline and tianeptine poisoning treated by naloxone
(Sage Publications Ltd, 2010) Ari, Mustafa; Oktar, Suleyman; Duru, Mehmet
Introduction: Severe amitriptyline toxicity may cause cardiac dysrhythmias, severe hypotension, convulsions and CNS depression, including coma. Management with gastric lavage, activated charcoal, alkalinization and supportive care with mechanical ventilation, antiarrhythmics and anticonvulsants, if required, is the general approach. Case report: A 33-year-old woman who has taken overdose antidepressants (amitriptyline and tianeptine) was admitted to the emergency service. She was intubated because she had pure respiratory arrest. Besides hypotension (80/60 mmHg), she was unresponsive to verbal and painful stimuli and her Glasgow coma score was 6. Hemogram and serum biochemical parameters and electrocardiography were within normal limits. The patient was examined for substance dependence and no trace of the injector was found in the body. Patient underwent a coma cocktail (naloxone 2 mg/kg, 5% dextrose 25 g/body and tiamin 100 g/body). Activated charcoal and intravenous alkalinization by NaHCO3 were initiated. Spontaneous respiration started again 20 min after being given the coma cocktail. She became responsive to verbal stimuli first hour after the coma cocktail, and her Glasgow coma score improved to 13. She had spent 2 days in the service and was discharged by the second day of admission, without any complications. Discussion: Herein, we report successful treatment in a case of severe amitriptyline and tianeptine poisoning by naloxone in addition to the above supportive care. Naloxone treatment may have a beneficial role in lethal doses of amitriptyline ingestion because amitriptyline may affect opioid receptors.
Asymmetric septal hypertrophy with perimembranous septal defect and obstructive right ventricular outflow tract in a patient with hypertrophic cardiomyopathy
(2007) Seyfeli, Ergun; Akgül, Ferit; Seydaliyeva, Tunzale; Duru, Mehmet; Yalçın, Fatih
The previous echocardiographic studies have estimated the prevalence of hypertrophic cardiomyopathy (HCM) in the general population to be 0.2% (1). Asymmetric hypertrophy of the left ventricle, predominantly of the septum and anterior wall of the left ventricle, is present in 70 % of patients with HCM. However, right ventricular outflow obstruction with the left ventricular outflow tract intact is a very rare pathology (2). In addition, certain congenital cardiac malformations have been reported in patients with asymmetric septal hypertrophy (ASH) (3). To our knowledge, there are no studies and case reports, which show association between obstructive right ventricular hypertrophy and ASH with perimembranous ventricular septal defect (VSD). We present an ASH case with perimembranous septal defect and obstructive right ventricular hypertrophy.
Autonomic dysfunction and cardiac repolarization abnormalities in patients with migraine attacks
(Int Scientific Information, Inc, 2007) Melek, Ismet M.; Seyfeli, Ergun; Duru, Mehmet; Duman, Taskin; Akgul, Ferit; Yalcin, Fatih
The clinical symptoms of migraine are widely accepted to be related to the involvement of the autonomic nervous system, and especially to dysfunction in the regulation of the circulatory system and autonomic balance. Disturbance of the autonomic nervous system is a primary characteristic of migraine Therefore, patients with migraine have a variety of symptoms, such as vasodilatation (flushing), pilo-erection, nausea, vomiting, diarrhea, cutaneous vasoconstriction (pallor), and diaphoresis. The electrocardiographic changes seen during a migraine attack compared with the pain-free period could be secondary to reversible disturbances of the state of autonomic innervation of the heart and coronary arteries. Dysfunction of ANS may affect atrial and ventricular repolarization. For instance, increased sympathetic activity causes sinus tachycardia, but increased parasympathetic activity causes sinus bradycardia, atrioventricular block, and ST-segment and T-wave abnormalities. Comprehensive electrocardiographic analyses have been providing more details in terms of the detection of abnormalities in atrial and ventricular repolarization which potentially may result in arrhythmias in patients with migraine. However, there is no information in literature reporting the frequency of cardiac arrhythmias in migraine patients who had cardiac repolarization abnormalities. In this review, detailed electrocardiographic findings and their relation with the autonomic nervous system, including recent observations, have been evaluated. However, further studies are needed to investigate the association between autonomic dysregulation and cardiac repolarization abnormalities in patients with migraine.
A Case of Ecstacy Induced Rhabdomyolysis and Acute Renal Failure
(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2016) Sahan, Mustafa; Turgut, Faruk; Eren, Abdulrahim; Duru, Mehmet
3,4-methylenedioxymethamphetamine (MDMA), popularly known as ecstasy, is a synthetic, psychoactive drug. MDMA has been reported to have several severe adverse effects including rhabdomyolysis, acute renal failure, liver failure and even sudden death. Herein, we present the case of a young man who presented with severe rhabdomyolysis and renal failure after taking 2 ecstasy pills. The patient initially received supportive care but he eventually needed hemodialysis.
Clinical presentation and laboratory findings of organic phosphorus poisoning
(Springer, 2007) Ozer, Cahit; Kuvandik, Guven; Gokel, Yuksel; Duru, Mehmet; Helvaci, Mehmet Rami
This study was conducted to evaluate the demographic, causative, and biologic characteristics of patients with organophosphate (OP) poisoning who were admitted to tertiary teaching and research hospitals at 2 different universities. All patients admitted to the emergency departments of Cukurova University Hospital in Adana, Turkey, between 2001 and 2003 and the Hospital of Mustafa Kemal University in Hatay, Turkey, between 2004 and 2006 were included. The study group consisted of subjects with a mean age of 28.5 +/- 14.1 y (range, 14-80 y), and the maximum number of cases in the second decade of life; the female-to-male ratio was 2.2:1. In all, 27 of 43 females and 16 of 20 males were married. Most subjects (n=55) had graduated from primary school; 3 were illiterate and 5 were highly educated. A total of 36 (57.1%) subjects belonged to lower socioeconomic groups. Fifty-three patients intended to commit suicide, and 10 cases were accidental. Mean arrival time of subjects to the hospital after poisoning was 9.9 +/- 16.1 h (range, 1-96 h); mean Glasgow Coma Scale score was 10.2 +/- 2.9 (range, 3-15). A total of 19 subjects were intubated, and 4 died. A total of 59 patients recovered completely. The mortality rate (6.3%) depended on various factors such as OP compound consumed, amount ingested, time interval before hospitalization, and patients' general health. Chances for recovery were greater when the patient was hospitalized at the earliest indication. In conclusion, ON especially affected young single females, and most cases were due to attempted suicide. Because OP poisoning is an important cause of morbidity and mortality, therapy should be started immediately to avoid undesirable consequences.
DEMOGRAPHIC, CLINIC AND LABORATORY CHARACTERISTICS OF CASES PRESENTED TO EMERGENCY DEPARTMENT WITH SCORPION STING: 345 CASES OVER A 4-YEARS PERIOD
(Carbone Editore, 2013) Duru, Mehmet; Karakus, Ali; Yengil, Erhan; Sahan, Mustafa; Zeren, Cem; Kekec, Zeynep; Yagiz, Abdullah Erman
Introduction: In the scorpion stings, based on the involved system, clinical and laboratory changes may be seen in a wide spectrum from mild pain and flushing to death. The present study was aimed to assess patient demographics, clinical characteristics and outcomes. Methods:All patients presented to emergency department with scorpion sting between 2008 and 2011 were retrospectively evaluated by using electronic database. Results: Overall, 345 cases were included into the study, consisting of 160 male (46.4%) and 185 female (53.6%) with a mean age of 34.39 +/- 19.47 years. It was found that scorpion sting patients were most commonly stung at extremities (n=322; 93.3%). The most commonly observed complaint was pain (n=334; 96.8%).Localized flushing and edema were observed in 307 cases (89.0%). In the laboratory evaluation, it was found that mean values of complete blood counts, biochemistry assays and prothrombin time (PT). international normalized ratio (INR) and partial thromboplastin time (PTT) were within normal range. Of the cases, 99.4%(n=343) were discharged, while two children (0.6%) died due to cardiac and respiratory complications. Conclusions: Since complete blood count and coagulation assays may be normal, these assays aren't routinely needed in all cases with scorpion sting. Anti-serum therapy should be considered at early course of the disease in children and elderly patients due to complications and mortality; it should be intravenously administered V indicated, but it should not be used in all patients.
Demographic, clinic and laboratory characteristics of cases presented to emergency department with scorpion sting: 345 cases over a 4-years period
(Acta Medica Mediterranea, 2013) Duru, Mehmet; Karakus, Ali; Yengil, Erhan; Sahan, Mustafa; Zeren, Cem; Kekec, Zeynep; Yagiz, Abdullah Erman
Introduction: In the scorpion stings, based on the involved system, clinical and laboratory changes may be seen in a wide spectrum from mild pain and flushing to death. The present study was aimed to assess patient demographics, clinical characteristics and outcomes. Methods:All patients presented to emergency department with scorpion sting between 2008 and 2011 were retrospectively evaluated by using electronic database. Results: Overall, 345 cases were included into the study, consisting of 160 male (46.4%) and 185 female (53.6%) with a mean age of 34.39±19.47 years. It was found that scorpion sting patients were most commonly stung at extremities (n=322; 93.3%).The most commonly observed complaint was pain (n=334; 96.8%).Localized flushing and edema were observed in 307 cases (89.0%). In the laboratory evaluation, it was found that mean values of complete blood counts, biochemistry assays and prothrombin time (PT), international normalized ratio (INR) and partial thromboplastin time (PTT) were within normal range. Of the cases, 99.4%(n=343) were discharged, while two children (0.6%) died due to cardiac and respiratory complications. Conclusions: Since complete blood count and coagulation assays may be normal, these assays aren't routinely needed in all cases with scorpion sting. Anti-serum therapy should be considered at early course of the disease in children and elderly patients due to complications and mortality; it should be intravenously administered if indicated, but it should not be used in all patients.
Dystonia due to Bee Sting: A Case Report
(Aves, 2014) Karakus, Ali; Caliskan, Koca; Duru, Mehmet; Kuvandik, Guven; Arslan, Gokhan; Erdogan, Yakup Kadri; Sahan, Mustafa
Introduction: Dystonia is anabnormal contraction due to primary and secondary causes of the muscles in the body. Case Report: In the literature, although many cases of congenital or edynsel with dystonia have been reported, a case as a result of a bee sting has not. Conclusion: We aimed to present a case with recurrent dystonia as a result of a bee sting.
Effect of weight loss on P wave dispersion in obese subjects
(Wiley, 2006) Duru, Mehmet; Seyfeli, Ergun; Kuvandik, Guven; Kaya, Hasan; Yalcin, Fatih
Objective: The aim of this study was to investigate effect of loss weight on P wave dispersion in obese subjects. Research Methods and Procedures: After a 12-week weight loss program (diet and medical therapy), a total of 30 (24 women and six men) obese subjects who had lost at least 10% of their original weight were included in the present study. All subjects underwent a routine standard 12-lead surface electrocardiogram. Electrocardiograms were transferred to a personal computer by a scanner and then magnified 400 times by Adobe PhotoShop software (Adobe Systems, Mountain View, CA). P wave dispersion, which is also defined as the difference between the maximum P wave duration and the minimum P wave duration, was also calculated. Results: After a 12-week weight loss program, BMI (p < 0.001), maximum P wave duration (p < 0.001), and P wave dispersion (p < 0.001) significantly decreased. The mean percentage of weight loss was 13% (10% to 20.3%). The decrease in the level of P wave dispersion (21 +/- 10 and 7 +/- 12 ins, p < 0.002) was more prominent in Group II (>= 12% loss of their original weight) than Group I (<12% loss of their original weight) after the weight loss program. A statistically significant correlation between decrease in the level of P wave dispersion and percentage of weight loss was found (r = 0.624, p < 0.001). Discussion: Substantial weight loss in obese subjects is associated with a decrease of P wave duration and dispersion. Therefore, these observations suggest that substantial weight loss is associated with improvement in atrial repolarization abnormalities in obese subjects.
Effect of weight loss on QTc dispersion in obese subjects
(2006) Seyfeli, Ergün; Duru, Mehmet; Kuvandik, Güven; Kaya, Hasan; Yalçın, Fatih
Amaç: Artmış QTc dispersiyonu ventriküler aritmiler için bir göstergedir. Bu çalışmanın amacı diyet ve medikal tedavi ile kilo kaybı programı sonrası QTc dispersiyonunun azalmasını araştırmaktır. Yöntemler: Bu çalışmaya 12 haftalık kilo kaybı programı sonrası mevcut kilolarının en az %10'nu veren 30 (24 kadın ve 6 erkek, ort. yaş: 44±8 yıl) obez birey dahil edildi. Obezite vücut kitle indeksi'nin (VKİ) ?30 kg/m2 olarak tarif edildi. Normal kilo ise VKİ'nin ? 25 kg/m2 olarak tarif edildi. Bulgular: On iki haftalık kilo kaybı programı sonrası, VKİ 42±5 kg/m2'den 36±4 kg/m2 (p<0.001) azaldı ve obez bireylerin ortalama ağırlığı 110±17 kg'dan 95±15 kg (p<0.001) azaldı. Kilo kaybının ortalama miktarı 14.5±5.0 kg (9-32 kg arasında) idi. Kilo kaybının ortalama yüzdesi ise 13% (10.0%-20.3%) idi. Maksimum QTc interval (446±19 ms'den 433±27 ms, p=0.024) ve QTc dispersiyonu (66±18 ms'den 52±25 ms, p=0.024) kilo kaybı programı sonrası önemli oranda azaldı. QTc dispersiyonun seviyesindeki azalma ile kilo kaybının miktarı arasında istatistiksel olarak anlamlı ilişki bulundu (r=0.487, p=0.007). Sonuç: Obez bireylerde önemli kilo kaybı QTc dispersiyon seviyesini önemli oranda azaltmıştır. QTc dispersiyon azalmasının derecesi kilo kaybının miktarı ile ilişkilidir.
Effects of Erdosteine on Acetaminophen-induced Hepatotoxicity in Rats
(Sage Publications Inc, 2008) Kuvandik, Guven; Duru, Mehmet; Nacar, Ahmet; Yonden, Zafer; Helvaci, Rami; Koc, Ahmet; Kozlu, Tolunay
We investigated the effects of erdosteine on acetaminophen (APAP)-induced hepatotoxicity in rats. Superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), AST (aspartate aminotransferase), and ALT (alanine transaminase) activities, and malonyldialdehyde (MDA) and nitric oxide levels as oxidant/antioxidant biochemical parameters were investigated with light microscopic evaluation in adult female Wistar Albino rats. APAP administration produced a decrease in hepatic SOD, CAT, and GSH-Px activities, and coadministration of erdosteine (150 and 300 mg/kg) resulted in increases in the activities. MDA and NO levels increased in the APAP group, and erdosteine treatments prevented these increases. Significant elevations in serum AST and ALT levels were observed in the APAP group, and when erdosteine and APAP were coadministered, their serum levels were close to those in the control group. Light microscopic evaluation of livers showed that there were remarkable centrilobular (zone III) hepatic necrosis and mild to moderate sinusoidal congestion in the APAP group, whereas in the erdosteine group, cellular necrosis was minimal and the hepatocytes maintained a better morphology when compared to the APAP group. Erdosteine prevented APAP-induced liver injury and toxic side effects probably through the antioxidant and radical scavenging effects of erdosteine.
The efficacy of tow-dose antivenom therapy on morbidity and mortality in snakebite cases
(W B Saunders Co-Elsevier Inc, 2008) Acikalin, Ayca; Gokel, Yuksel; Kuvandik, Gueven; Duru, Mehmet; Koseoglu, Zikret; Satar, Salim
Similar to the cases seen around the world, snakebite causes mortality and morbidity in Turkey. The venom of different types of snake in the region of Cukurova causes serious systemic and local tissue damage. Methods: We performed this prospective study on 45 patients who complained of snakebite. We grouped the patients according to their clinical presentations to facilitate treatment and follow-up period procedures. Results: Whereas the patients with grade I envenomation did not receive any antivenom, grades 2 and 3 patients received 2.70 +/- 0.77 and 4.88 +/- 1.65 vials of antivenom, respectively. One of our patients had to undergo finger amputation but there were no deaths. Allergic reactions developed after antivenom therapy in 8 patients (17.8%). Conclusions: When we considered the cost and complications of the antivenom treatment, it was seen that low-dose antivenom treatment effectively treated the patients with venomous snakebite injuries in our region. (c) 2008 Elsevier Inc. All rights reserved.
EKG’de spesifik değişiklik gözlenmeyen ağır amitriptilin zehirlenmesi
(2010) Peker, Erdal; Duru, Mehmet; Kuvandık, Güven; Çağan, Eren; Doğan, Murat
Çocuklarda amitriptilin ile zehirlenme acil servise en çok başvurulan zehirlenmelerden biridir. Amitriptilin zehirlenmesi, çeşitli sistemleri etkileyen yan etkileri nedeniyle önemli sorunlara yol açmakta ve hayatı tehdit edebilmektedir. Genellikle ölüm sebebi kardiyak etkilenmeye bağlı olmaktadır. Bu yazıda, yüksek dozda amitriptilin almasına rağmen EKG’de QRS değişikliği göstermeyen ve kardiyak etkilenmenin olmadığı bir olgu sunulmaktadır.
Erratum: Giant left atrium mimicking a right thoracic mass: Case report (Journal of the American Geriatrics Society (2006) 54, (183-184))
(2006) Seyfeli, Ergun; Akoglu, Sebahat; Karazincir, Sinem; Akgul, Ferit; Seydaliyeva, Tunzale; Yalcin, Fatih; Duru, Mehmet
[No abstract available]
Esophagitis Corrosive Treatment of N-acetyl Cysteine Preventing Early Stricture use development activity
(Aves, 2011) Yetim, Tulin Durgun; Yetim, Ibrahim; Duru, Mehmet
Objective: Esophageal stricture early corrosive burns to investigate the effectiveness in preventing the use of N-acetyl-cysteine. Strictures of the esophagus due to caustic substances occur with the ingestion of solid or liquid corrosive materials. Materials and Methods: A prospective randomized study was performed to evaluate the effectiveness of conventional therapy alone and conventional therapy + N-acetyl cysteine. Fifty patients with grade 2b and grade 3 burnt were analyzed. Intensive n-acetyl cysteine therapy can reduce the incidence of stricture development in patients with advanced grade corrosive esophagitis. Results: N-acetyl cysteine group+ Konvansitonel used in 1 patient, stenosis developed in 7 patients in the group with conventional treatment. Conclusion: We believe that our findings will be better supported with the groups including larger number of patients or with the experimental studies.
Giant left atrium mimicking a right thoracic mass: Case report (vol 54, pg 183, 2006)
(Blackwell Publishing, 2006) Seyfeli, Ergun; Akoglu, Sebahat; Karazincir, Sinem; Akgul, Ferit; Seydaliyeva, Tunzale; Yalcin, Fatih; Duru, Mehmet
[Abstract Not Available]
Hepatitis C virus infection is probably associated with autoimmune disorders and malignancies but not with autoimmune thyroiditis
(Asian Network for Scientific Information, 2007) Kuvandik, Guven; Helvaci, Mehmet Rami; Ozer, Cahit; Altintas, Engin; Kaya, Hasan; Duru, Mehmet
In this study initially consecutive patients with Autoimmune Thyroiditis (AT) were taken in the Endocrinology Polyclinics. Beside that age and sex-matched patients with HCV infection and control cases were randomly studied in the Gastroenterology and Internal Medicine Polyclinics, respectively. One hundred and seventy-two patients with AT, 62 with HCV infection and 110 control cases were studied. AT was diagnosed in eight (12.9%) cases of the HCV infecteds' group and this ratio was 11.8% (13 cases) in the control group (p>0.05). Similarly, HCV infection was detected in one (0.5%) case of AT group and this ratio was 0.9% (one case) in the control group (p>0.05). Parallel to these results, prevalences of antithyroid peroxidase and/or antithyroglobulin antibodies were detected as 29.0% (18 cases) and 32.7% (36 cases) in the HCV infecteds' and control groups, respectively (p>0.05). As another face of the results, it was detected one case of monoclonal gammopathy of undetermined significance and one case of lichen planus in the HCV infecteds' group. As a conclusion, HCV infection may be associated with autoimmune disorders and malignancies but not with AT.

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