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Biomedical subjects

S Unal

Publications and source records attributed to S Unal.

At least 37 records · Page 2Linked to original sources
PubMed2002

Seroprevalence of Helicobacter pylori infection among children and their parents in eastern Turkey.

OBJECTIVES: To determine the seroprevalence of Helicobacter pylori infection among healthy children in eastern Turkey, to assess risk factors for seroconversion, and to assess the role of parental infection status in the transmission of H. pylori. METHODS: A commercial enzyme immunoassay test for IgG to H. pylori was used. Demographic information obtained included age, gender, socio-economic status and living conditions. RESULTS: One hundred and fifty-two (43.9%) of 346 children were seropositive. There was no significant difference in rates of seroprevalence between boys and girls (P > 0.05), but a significant rise was noted with increasing age (P < 0.001). We found a strong inverse correlation between family income and seropositivity (P < 0.001). Seroprevalence also varied significantly with the educational level of the mother (P < 0.001). There were no significant differences in seroprevalence associated with place of residence, water supply and the number of persons per room (P > 0.05). The prevalence of infection in the corresponding parents was 85.4% for mothers and 76.3% for fathers. Seroprevalence was higher in children whose mother was infected (P < 0.001). CONCLUSIONS: In eastern Turkey, as in other developing countries, H. pylori infection occurs early and increases with age. Infected parents, especially infected mothers, may have a important role in the transmission of H. pylori within families.

Adolescent↗
PubMed2001

Efficacy of calcium dobesilate in treating acute attacks of hemorrhoidal disease.

PURPOSE: A randomized, double-blind, controlled study was conducted to investigate the efficacy of oral calcium dobesilate therapy in treating acute attacks of internal hemorrhoids. METHODS: Twenty-nine well-documented adult patients with first- or second-degree internal hemorrhoids were treated with calcium dobesilate for two weeks, while16 patients received only a high-fiber diet to serve as control. Both symptoms and anoscopic inflammation were scored on a scale from 0 to 2 before (T0) and two weeks after treatment (T2). RESULTS: A success rate of 86.21 percent with cessation of bleeding plus lack of severe anitis anoscopically at two weeks were achieved with calcium dobesilate. The pretreatment symptom score of 2 fell significantly to 0.45 +/- 0.13, and the pretreatment anitis score of 1.69 +/- 0.09 fell to 0.55 +/- 0.12 at T2 (P = 0.0001 for both comparisons). The symptom and anoscopic inflammation scores obtained with calcium dobesilate treatment were also significantly better than those with diet only (P = 0.0017 and P = 0.0013, respectively). CONCLUSION: Together with recommendations about diet and bowel discipline, oral calcium dobesilate treatment provides an efficient, fast, and safe symptomatic relief from acute symptoms of hemorrhoidal disease. This symptomatic healing is associated with a significant improvement in the anoscopically observed inflammation.

Acute Disease↗
PubMed2001

Acute gastric dilatation complicating the use of mydriatics in a preterm newborn.

A 2-month-old girl who had been born at 27-weeks' gestation was admitted for her screening examination for retinopathy of prematurity and given two drops each of cyclopentolate 0.5% and phenylephrine 2.5%. Approximately 2 h after completion of the examination, the infant had episodes of apnoea and vomiting. She was noted to be distended, and an abdominal radiograph demonstrated acute gastric dilatation. Apnoea, vomiting and distension resolved after 18 h and a repeat abdominal radiograph demonstrated resolution of the gastric dilatation.

Acute Disease↗
PubMed2001

A retrospective review of 228 episodes of infective endocarditis where rheumatic valvular disease is still common.

Two hundred and twenty-eight episodes of infective endocarditis in adult patients (mean age 36 years) were reviewed retrospectively. There were 183 episodes (80%) of native valve, 15 (7%) early prosthetic valve and 30 (13%) late prosthetic valve endocarditis. The most common predisposing factor was rheumatic valvular disease (65%). None of the patients were intravenous drug users. According to the Duke criteria, the number of definite, probable and rejected episodes were 121 (53%), 94 (41%) and 13 (6%), respectively. Additional minor criteria increased the number of definite endocarditis to 82%. The Duke criteria are not primarily intended to influence treatment decisions but are helpful in standardising research activities. The choice of the level of sensitivity or specificity of the criteria may be adjusted according to the aim of the study and prevalence of disease in a particular area. More sensitive criteria may be valuable in those countries where the prevalence of rheumatic valvular disease is still high.

Adolescent↗
PubMed2001

The changing nature of aminoglycoside resistance mechanisms and prevalence of newly recognized resistance mechanisms in Turkey.

OBJECTIVE: To determine the most frequently occurring individual and combined resistance mechanisms in Gram-negative bacteria resistant to any of the clinically available aminoglycosides in Turkey, and to compare these mechanisms with those found in smaller, earlier studies. METHODS: Aminoglycoside resistance mechanisms in Gram-negative isolates resistant to either gentamicin, tobramycin, netilmicin or amikacin collected in different regions of Turkey were evaluated both phenotypically and genotypically using 12 aminoglycosides and up to 22 aminoglycoside resistance gene probes. RESULTS: Among 696 aminoglycoside-resistant Gram-negative bacteria, resistance rates were very high for gentamicin (94.5%), tobramycin (82.4%), netilmicin (53.6%), and amikacin (49.7%). Although isepamicin was the most active aminoglycoside against Gram-negative bacteria, increased resistance (29.7%) was found and resistance rates were higher than those in most of the other countries surveyed in earlier studies. The most common aminoglycoside resistance mechanisms (AAC(3)-II (GTN), AAC(6')-I (TNA), and ANT(2")-I (GT)) in the earlier studies were also found in the present isolates of Klebsiella spp., Enterobacter spp. and Escherichia coli, with increased complexity. In addition to these old mechanisms, two new aminoglycoside resistance mechanisms, namely AAC(6')-III (TNAI) and AAC(6')-IV (GTNA), were also found at significant frequencies (11.9% and 26.9%, respectively) in these isolates of Enterobacteriaceae (n = 435). Among the isolates of Pseudomonas spp. (n = 150), in addition to the increased complexity of enzymatic resistance mechanisms (AAC(3)-I (16.6%), AAC(6')-II (29.3%), AAC(6')-III (19.3%), ANT(2")-I (40%)), permeability resistance seemed to be responsible for the high rates of resistance to aminoglycosides. CONCLUSION: The results of this study indicated increased resistance to clinically available aminoglycosides, including isepamicin, even though it was the most active, as a result of both the presence of new aminoglycoside resistance mechanisms and the increased complexity of all mechanisms, including permeability resistance, particularly in Pseudomonas in Turkey.

Aminoglycosides↗
PubMed2001

Echocardiographic evaluation of cardiac functions and left ventricular mass in children with malnutrition.

OBJECTIVE: This study was undertaken to assess the left ventricular mass (LV Mass) and systolic and diastolic functions of the left ventricle in children with protein energy malnutrition (PEM). METHODOLOGY: Thirty children, aged between 2 months and 2 years with PEM (four kwashiorkor, seven marasmic- kwashiorkor, 19 marasmus), and 17 healthy, age-matched children, using Doppler echocardiography were studied. RESULTS: The mean LV Mass in the patients was lower than that in the controls (14.5 +/- 5.2 vs 19.8 +/- 4.7 g, P < 0.05). However, the LV Mass/body surface area was not different in the patients with PEM and in the control group (52 +/- 9.2 vs 53.9 +/- 8.2g/m(2), P > 0.05), indicating that LV Mass was reduced in proportion to decrease in body size in malnutrition. Left ventricular septal and posterior wall thickness in PEM were also lower than that in the controls, and the most significant reduction in the LV Mass, septal and posterior wall thickness were found in the kwashiorkor group. Cardiac output was reduced in proportion to decrease in body size in the patient group (1.6 +/- 0.5 vs 2.1 +/- 0.8 L/min, P < 0.05), therefore cardiac index was not significantly different between the patients and the control subjects (5.9 +/- 1.4 vs 5.7 +/- 1.6 L/min/m(2), P > 0.05). Systolic function indices including ejection fraction, fractional shortening, and diastolic function indices were not significantly different in the groups. CONCLUSIONS: We demonstrated that LV Mass and cardiac output were reduced in proportion to decrease in body size in patients with PEM, and LV systolic and diastolic functions were preserved in atrophic hearts.

Blood Pressure↗
PubMed2001

Effect of warm ischemia on neovascularization of island flaps.

Poor neovascularization in free-flap transfers is considered to be a consequence of insufficient hypoxic stimulus in a transferred flap with good axial-pattern circulation and a short warm ischemia time. The purpose of the study was to investigate the effect of warm ischemia time on neovascularization of axial-pattern flaps. Oblique adipomusculocutaneous groin island flaps based on the superficial epigastric vessels were raised on the right side of 21 Wistar rats, evaluated in three groups. In Group 1 (n=7), flaps were resutured without creating ischemia; in Groups 2 (n=7) and 3 (n=7), flaps were resutured after 90-min and 180-min warm ischemic periods, respectively. At 5 days postoperatively, an intravenous fluorescein test was performed following pedicle ligation, and survival was assessed by planimetric technique 7 days after pedicle ligation. Histopathologic scoring was performed according to capillary formation, inflammation, and necrosis. The intravenous fluorescein test revealed significantly higher uptake in the group with the longest ischemic period, while the mean surviving area was greater in the groups with ischemic insult, comparing to the non-ischemic group. Similarly, histopathologic scoring showed significantly higher values in the ischemic groups. The authors demonstrated that neovascularization was enhanced after 90- and 180-min warm ischemia times. The authors concluded that short ischemia time in free flaps may be an attributable factor in late flap failures, due to pedicle obstruction.

Animals↗
PubMed2001

Comparison of cefepime and ceftazidime in combination with amikacin in the empirical treatment of high-risk patients with febrile neutropenia: a prospective, randomized, multicenter study.

A total of 208 adult patients with cancer and febrile neutropenia from 5 medical institutions were randomized to receive either cefepime (2 g b.i.d.) or ceftazidime (2 g t.i.d.) in combination with amikacin (15 mg/kg/o.d.). Ninety-seven patients in the ceftazidime (CEZ) group and 98 in the cefepime group (CEF) were evaluable for efficacy. In 68 patients (35%), infection could be documented. The average duration of antibiotic therapy was 11 and 12 d and response rates to the empirical regimen were 36 and 30% for the CEZ and CEF groups, respectively (p > 0.05). The average time of defervescence in responders was 3 d for both groups. Modification of the initial regimen with antivirals and/or azole antifungals raised the number of responders to 44% and 35%, respectively (p > 0.05). Vancomycin was additionally given to 29 patients in the CEZ group and to 27 patients in the CEF group. Twenty-six patients in each group received empirical amphotericin B. Mild, reversible study drug-related side-effects were observed in 12 patients (12%) in the CEZ group and 13 patients (13%) in the CEF group (p > 0.05). Cefepime in combination with amikacin seems to be as effective, safe and tolerable as ceftazidime + amikacin in patients with high-risk neutropenia and fever.

Adolescent↗
PubMed2001

The effect of gradually increased blood flow on ischemia-reperfusion injury.

Even with excellent operative techniques, prolonged ischemic periods may cause unwanted results because of a complex mechanism called reperfusion injury. Various pharmacological and immunological agents have been used to prevent this type of injury. Another known way to diminish reperfusion injury is the gradual reperfusion of the ischemic tissues. In this study, the effect of a gradual increase in blood flow on ischemia-reperfusion injury of the skeletal muscle was investigated. The right hind limbs of 15 rats were partially amputated, leaving the femoral vessels intact. Preischemic femoral arterial blood flow was measured by using a transonic small-animal blood flowmeter (T106) in all animals. The rats were divided into three groups: Group I consisted of control rats; no ischemia was induced. Group II was the conventional clamp release group. Clamps were applied to the femoral vessels to induce 150 minutes of ischemia. The clamps were then released immediately and postischemic blood flow was measured. Group III was the gradual clamp release group. After 150 minutes of ischemia, clamps were released gradually at a rate so that the blood flow velocity would reach one fourth the mean preischemic value at 30 seconds, one half at 60 seconds, three fourths at 90 seconds, and would reach its preischemic value at 120 seconds. Total clamp release was allowed when blood flow was less than 1.5 fold of the preischemic values. Postoperatively the soleus muscles were evaluated histopathologically, and malonyldialdehyde and myeloperoxidase levels were measured. The mean preischemic blood flow was 13.6 +/- 2.24 ml per kilogram per minute in all groups. In the conventional release group, postischemic flow reached four to five fold its preischemic values (61.06 ml per kilogram per minute). Histopathology revealed more tissue damage in the conventional release group. Malondialdehyde and myeloperoxidase levels were also significantly lower in the gradual release group. Depending on histological and biochemical findings, a gradual increase in blood flow was demonstrated to reduce the intensity of ischemia-reperfusion injury in the soleus muscle of this animal model.

Animals↗
PubMed2000

Susceptibility testing of voriconazole, fluconazole, itraconazole and amphotericin B against yeast isolates in a Turkish University Hospital and effect of time of reading.

Voriconazole is a promising azole effective against a variety of fungi, including yeasts. In this study, we tested in vitro activities of voriconazole, fluconazole, itraconazole and amphotericin B against some ATCC and reference strains and 250 clinical yeast isolates. We also evaluated the effect of time of reading on MIC results. Voriconazole was the most active agent against Candida and Trichosporon isolates, including the putatively fluconazole-resistant C. krusei (MIC(90) 0.25 microg/ml) and C. glabrata (MIC(90) 0.5 microg/ml). Amphotericin B MICs were scattered in a considerably narrow range in both RPMI 1640 and Antibiotic Medium 3. MICs at 24 hours and 48 hours were similar in general for all antifungals tested. The highest percentage of strains that showed 24-hour and 48-hour MICs within +/-1-log(2) dilution was observed for amphotericin B tested in RPMI (99%), and the lowest for amphotericin B tested in Antibiotic Medium 3 (80%). In conclusion, voriconazole is very effective against a wide spectrum of Candida species and 24-hour readings could substitute 48-hour MIC evaluation.

Amphotericin B↗
PubMed2000

99Tc-HmPAO SPECT in 13 patients with classic lissencephaly.

In this study, technetium-99 ((99)Tc)-hexamethylpropyleneamine-oxine single-photon emission computed tomography (SPECT) was performed on 13 children with classic lissencephaly (nine with epileptic seizures, four without seizures). Focal or multifocal hypoperfusions were observed in 12 patients. The hypoperfused areas observed on SPECT scanning did not correlate with the localization of agyric-pachygyric regions in all patients. The distribution of perfusion abnormalities by SPECT and the localization of agyria-pachygyria as detected by magnetic resonance imaging did not correlate strongly. All nine patients with seizures and three of the four patients without seizures had focal or multifocal cerebral blood flow abnormalities on the SPECT scans. The presence of brain perfusion abnormalities detected by SPECT and the occurrence of epileptic seizures did not have a significant relationship. These results suggest that the role of SPECT studies in classic lissencephaly is not clearly defined. More sophisticated methods are needed to clarify the correlation between structural and functional abnormalities of patients diagnosed with lissencephaly.

Brain↗
PubMed2000

Risk factors influencing clinical outcome in Staphylococcus aureus bacteraemia in a Turkish University Hospital.

A total of 101 episodes of Staphylococcus aureus bacteraemia were evaluated for the factors influencing prognosis. The overall episode mortality rate and the mortality rate due to bacteraemia were 43.6 and 21.8%, respectively. Episodes with methicillin-resistant S. aureus (MRSA) bacteraemia had a significantly higher overall mortality rate (58.7 vs. 30.9%, P<0.01) and mortality rate due to bacteraemia (32.6 vs. 12.7%, P=0.02) when compared with episodes caused by methicillin-sensitive S. aureus (MSSA). The multivariate analysis revealed that the underlying disease, presence of infective endocarditis, septic shock and central intravascular catheter and methicillin resistance of S. aureus were the five independent risk factors associated with a higher mortality rate.

Adult↗
PubMed2000

Surveillance of antimicrobial resistance among gram-negative isolates from intensive care units in eight hospitals in Turkey.

With the participation of eight major reference hospitals in Turkey, 749 aerobic Gram-negative isolates obtained from 473 intensive care patients in 1997 were tested for their susceptibility to 13 commonly employed antibacterial agents. The frequency with which species were isolated and resistance rates were compared with data from the previous 2 years. Imipenem was the most active agent against the majority of isolates (75%), followed by ciprofloxacin, cefepime and amikacin. The per cent susceptibility to all antibiotics declined from 1995 to 1996. With the exception of imipenem, for which there was no change in resistance, the per cent susceptibility somewhat increased in 1997. However, it was still lower than in 1995.

Anti-Bacterial Agents↗
PubMed2000

Surgical treatment of urethral fistulas following hypospadias repair.

Development of urethral fistulas is one of the most common late complications of hypospadias surgery. A total of 161 male patients who had 186 urethrocutaneous fistulas were first classified according to the fistula classification of Horton and colleagues and then treated with three types of procedures: simple closure, local rotation flaps, or tube graft reconstruction. With initial surgical intervention, 156 of 186 fistulas were treated successfully. The remaining 30 fistulas (16.1%) recurred during the follow-up period. In the recurrent cases, immediate closure was not preferred, and an average of 6 months was waited before considering any additional surgical attempt. Distal cases had a higher failure rate, and the simple closure technique failed to show a success rate as high as local flap or tube graft repair. The high recurrence of distal cases was attributed mainly to the lack of adequate soft tissue adjacent to the fistula, which is vital for safe closure. In addition, the traction effect of erection on the skin and urethra, which is more prominent distally than proximally, is also believed to play an additive role. To increase success, the selection of appropriate treatment modality and customization of techniques for each patient cannot be overemphasized. However, the authors conclude that careful presurgical assessment of the patient, a 6-month delay before any secondary surgical attempt, inversion of the urethral mucosa, avoidance of any overlapping suture lines, urinary diversion proximal to the repair site for 5 to 11 days, and usage of thin, absorbable suture materials are the main criteria that should be met for a satisfactory hypospadias fistula repair.

Adolescent↗