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Yayın Accidental oral poisoning caused by RDX (cyclonite): a report of 5 cases(SageJournals, 2003) Küçükardalı, Yaşar; Acar, H. Volkan; Özkan, Sezai; Nalbant, Selim; Yazgan, Yusuf; Atasoyu, Enes Murat; Keskin, Özcan; Naz, Alişan; Akyatan, Nevzat; Gökben, Melih; Danacı, MehmetThe explosive RDX (hexogen, cyclonite) is usually used for the production of C-4 explosive. The rare occurrence of accidental and intentional RDX intoxications has been reported during manufacturing process or in wartime. In this article, the authors report 5 cases of accidental oral RDX poisoning. On admission, observed signs and symptoms included repetitive generalized tonic-clonic convulsions, postictal coma, lethargy, confusion, hyperreflexia, postictal amnesia, nausea, vomiting, abdominal tenderness, sinusal tachycardia, dysrhythmia with frequent ventricular premature beats, generalized muscle spasms, and myoclonus. Leukocytosis, mild anemia, methemoglobinemia, elevated levels of blood glucose, serum aspartate transaminase, alanine transaminase, lactic dehydrogenase, creatine phosphokinase, amilase, hypokalemia, metabolic acidosis, proteinuria, glucosuria, and myoglobinuria were also noted. Plasma RDX concentrations were 268 to 969 ng/mL at 3 hours of ingestion. For management, supportive and symptomatic measures were taken. Whole-bowel irrigation might have been an effective therapeutic procedure due to probable slow gastrointestinal absorption of RDX. Three patients who developed severe metabolic acidosis underwent urgent hemodialysis. All patients were discharged 7 to 21 days after admission without any sequelae. Plasma RDX levels were strongly correlated with the clinical and laboratory manifestations. The available toxicological data on this rare accidental poisoning are reviewed in light of the literature.Yayın Albumin, hemoglobin, body mass index, cognitive and functional performance in elderly persons living in nursing homes(Elsevier, 2010) Önem, Yalçın; Terekeci, Murat Hakan; Küçükardalı, Yaşar; Şahan, Burak; Solmazgül, Emrullah; Şenol, Mehmet Güney; Nalbant, Selim; Sayan, Özkan; Top, Cihan; Öktenli, ÇağatayThe aim of this study is to produce the relation between cognitive and functional performance and some biochemical parameters in elderly population. So, we searched for the correlation between the activities of daily living (ADL), mini-mental state examination (MMSE) and body weight, age, hemoglobin, albumin, serum sodium level of 180 elderly people in five nursing homes. Face-to-face interviews and questionnaires were applied to evaluate ADL. To evaluate the cognitive function we used the MMSE. The average age of 180 people contacted was 71.5+/-5.1 (+/-S.D.), ranging 65-91 years; 112 of them were women (62.2%), 68 were men (37.8%). Of these elderly people, 25% had no medically diagnosed illnesses, whereas 17 of them (9.4%) were bedridden. There was a positive correlation between ADL and hemoglobin, albumin, body weight, cognitive function parameters and a negative one with age and serum sodium. There was a positive correlation between cognitive functions and hemoglobin, body weight, ADL and a negative one with serum sodium. Hemoglobin concentrations indicating anemia were observed in 30% of subjects, 3.9% of them had hyponatremia and 26.7% displayed a hypernatremia. There was a positive correlation between cognitive and physical function scores and hemoglobin, albumin levels in elderly patients. These results suggest that restoration of hemoglobin and albumin levels could improve cognitive and physical functional status in the elderly population.Yayın Aort Anevrizmalı Hastalarda Anti-Endotel Hücre Antikor Düzeylerinin Sağlıklı ve Romatizmal Hastalığa Sahip Bireylerle Karşılaştırılması(2019) Emirzeoğlu, Levent; Öktenli, Çağatay; Terekeci, M. Hakan; Çelik, Serkan; Nalbant, SelimAntiendotel hücre antikorları (AEHA), endotel hücreleri üzerindeki çeşitli antijenik determinantlara karşı oluşmuş heterojen yapıda antikor grubudur. AEHA düzeyleri vaskülitle seyreden romatizmal hastalıklarda yüksektir. Aort anevrizmaları yüksek mortalite ve morbidite oranları ile önemli kardiyovasküler hastalıklardan biridir. Aort anevrizması gelişimde birçok faktör rol oynamaktadır ve bu nedenlerden biri de otoimmünitedir. Çalışmamızda aort anevrizmalı hastaların AEHA seviyelerini, sağlıklı kontroller ve romatizmal hastalıklı bireylerle karşılaştırmayı amaçladık. Çalışmaya 40 aort anevrizmalı hasta, 40 romatizmal hasta ve 40 sağlıklı kontrol alındı. AEHA serum düzeyleri ölçümünde Enzyme-Linked Immunosorbent Assay (ELISA) yöntemi kullanıldı. Anevrizmal grupta AEHA düzeyi ortalaması 19.75 ng/mL olarak bulundu. CRP düzeyleri nefelometrik yöntemle ölçüldü. Eritrosit sedimentasyon hızı Vacuette SRS 100/II analizörü ile değerlendirildi. Aort anevrizmalı hastalarda AEHA seviyelerini sağlıklı kontrol grubuna göre yüksek bulduk (19.75±23.99, 6.34 ±7.13; p<0.01). AEHA seviyelerinde romatizmal grup ile anevrizmal grup arasında fark yoktu (19.75±23.99, 20.07±27.58; p=0.981). Anevrizmal hastalık grubunda AEHA ile CRP düzeyleri arasında pozitif korelasyon tespit edildi (r:0.400; p<0.05). Anevrizmal hastalık grubunda AEHA ile sedimentasyon hızı arasında pozitif korelasyon tespit edildi (r:0.532; p<0.01).Yayın Are increased carotid artery pulsatility and resistance indexes early signs of vascular abnormalities in young obese males?(WILEY-BLACKWELL, 2012) Ozari, H. Onur; Oktenli, Cagatay; Celik, Serkan; Tangi, Fatih; Ipcioglu, Osman; Terekeci, Hakan M.; Top, Cihan; Uzun, Mehmet; Sanisoglu, Yavuz S.; Nalbant, SelimPurpose: To provide insight into the factors by which obesity in itself may directly lead to early arterial damage, we aimed to determine early sonographic markers of obesity-related vascular dysfunction in young obese males. Methods: Thirty-five young obese males and 23 age-matched healthy male volunteers were recruited into the study. Common carotid artery pulsatility index and resistance index were calculated from blood flow velocities curves obtained by pulsed Doppler ultrasonography. Results: The mean pulsatility index, resistance index, body mass index, waist circumference, systolic and diastolic blood pressure, homeostasis model assessment for insulin resistance, plasma fasting glucose, insulin, C-peptide, triglycerides, low-density lipoprotein cholesterol, and high-sensitivity C-reactive protein were statistically higher in obese subjects than in healthy controls. Conclusions: Our results suggest that depressed vessel compliance and increased vascular resistance are features of young, obese, normotensive subjects independently of and in addition to cardiovascular risk factors. As changes in arterial wall properties may be incipient in young obese subjects, future studies will be required to demonstrate whether early intervention such as diet and exercise in this population can improve vascular functions. (C) 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 2012Yayın The association of endoplasmic reticulum aminopeptidase-1 (ERAP-1) with Familial Mediterranean Fever (FMF)(SAGE PUBLICATIONS INC, 2016) Sezgin, Gulbuz; Dabak, Resat; Kaya, Fatih Oner; Kotevoglu, Nurdan; Uygur-Bayramicli, Oya; Nalbant, SelimBackground: The ERAP1 gene cleaves the receptors and reduces their ability to transmit chemical signals to the cell that affect the process of inflammation and, secondly, it cleaves many types of proteins into small peptides that are recognized by the immune system. Objective: ERAP-1 gene mutations may create a sensitivity for Familial Mediterranean Fever (FMF). Method: We included 15 FMF patients with the M694 (+) mutation in the study in order to exclude patients without pyrin gene mutations and create a homogeneous study group. Fifteen patients with ulcerative colitis formed the control group. Results: There wasn't any case without ERAP-1 gene mutations. At least one mutation at exon 3 or exon 10 was found in all cases in both groups. There were 14 ERAP-1 gene mutations at exon 10 and 11 at exon 3 in patients with FMF. Interestingly, if there were ERAP-1 gene mutations at exon 3, a p.Arg127 Pro (c.380G>C) mutation always existed for three FMF patients with polymorphic mutations at this exon. There were 11 ERAP-1 gene mutations at exon 10 and 12 gene mutations at exon 3 in patients with ulcerative colitis. Exon 3 mutations were usually single p.Arg127 Pro (c.380G>C) mutations for 12 patients with ulcerative colitis as seen in the patients with FMF. The single mutation was always p.Ser453 Ser (c.1359T>C) for patients with ulcerative colitis at exon 10. Conclusion: There are more ERAP-1 mutations in the FMF group in comparison to the ulcerative colitis group. So, there may be a strong susceptibility to ERAP-1 gene mutations in FMF patients according to our results. However, further studies with larger study and control groups are needed.Yayın Bağ dokusu hastalıkları ve karaciğer(Maltepe Tıp Dergisi, 2017) Kaya, Fatih Öner; Sezgin, Gülbüz; Nalbant, SelimKaraciğer genel fizyonomi içerisinde hem metabolik hem de inflamatuvar olaylardan etkilenen bir organdır. Dolayısıyla, bağ dokusu hastalıklarından etkilenmemesi düşünülemez. Ancak, bu etkileşim çoğu zaman göz ardı edilmektedir. Bu etkileşim: Sistemik bağ dokusu hastalıklarına bağlı karaciğerin etkilenmesi, otoimmün karaciğer hastalıkları ve bu hastalıklarda kullanılan ilaçların karaciğer üzerindeki etkileri şeklinde özetlenebilir. Her zaman bu üçlü etkileşimi bir birinden ayırt etmek mümkün olmasa da tedavinin başarısı açısından dikkat edilmesi gereken önemli bir faktördür.Yayın Bağışıklık sistemi ve Covid-19 ilişkisi(Maltepe Üniversitesi, 2020) Nalbant, Selim; Çiçek, Meltem; Karasar, ŞahinKonağa yabancı yapılara (bakteri, virüs, kanser hücresi, yabancı cisim, organ nakli materyali, vs) karsı direnci sağlayan hücrelerin, dokuların ve moleküllerin oluşturduğu bütüne “İmmün Sistem”: bu hücrelerin ve moleküllerin oluşturdukları koordineli reaksiyonlara “İmmün Yanıt” denir. Bu reaksiyon; yabancı olarak tanınan yapının başta protein bileşenlerine ve küçük kimyasallara karsı yapılandırılır. Ancak, bazı durumlarda bu çok elzem gibi görünen yapı doku hasarı ve hastalığa da neden de olabilir.Yayın Bağışıklık sistemi ve Covid–19 ilişkisi(Maltepe Üniversitesi Yayınları, 2020) Nalbant, Selim; Çiçek, Meltemİmmün Sistemin Temel İlkeleri: Konağa yabancı yapılara (bakteri, virüs, kanser hücresi, yabancı cisim, organ nakli materyali, vs ) karsı direnci sağlayan hücrelerin, dokuların ve moleküllerin oluşturduğu bütüne “İmmün Sistem”; bu hücrelerin ve moleküllerin oluşturdukları koordineli reaksiyonlara “İmmün Yanıt” denir. Bu reaksiyon; yabancı olarak tanınan yapının başta protein bileşenlerine ve küçük kimyasallara karsı yapılandırılır. Ancak, bazı durumlarda bu çok elzem gibi görünen yapı doku hasarı ve hastalığa da neden de olabilir (1). İmmün Sisteme ait yapıların bir kısmı “kalıtımsal (innate)” ve aynı türün bütün bireylerinde hemen hemen aynı iken (cilt,kompleman sistemi vs); bir kısmı zaman içinde “çevresel faktörlerin etkisi ile kazanılır (adaptif)” (1).Yayın Blood oxidative stres biomarkers in patients with Familial Mediterranean Fever (FMF)(Thieme Publishing Group, 2010) Çelik, Serkan; Öktenli, Çağatay; Terekeci, Murat Hakan; İpçioğlu, Osman; Sanisoğlu, Yavuz S.; Sayan, Özkan; Yeşilova, Zeki; Yıldız, Oğuzhan; Tunca, Yusuf; Nalbant, SelimInterest in the relationship between oxidative stress and inflammation has increased in recent years. Familial Mediterranean fever (FMF) represents a suitable autoinflammatory disease model for investigation of this relationship. We aimed to determine blood oxidative stress biomarkers in patients with FMF in both acute attacks and in attack-free periods, and to evaluate its associations with pyrine mutations and C-reactive protein (CRP) levels. The mean levels of CRP and serum lipid hydroperoxide were higher and serum superoxide dismutase and catalase activities were lower in patients with FMF than in healthy volunteers. Serum lipid hydroperoxide levels were higher and antioxidants were lower in FMF patients during an acute attack than in the attack-free period. Serum lipid hydroperoxide levels were significantly higher, and antioxidants were significantly lower in patients with the M694V homozygous mutations than the other genotypes. Our data imply that higher serum lipid hydroperoxide and lower antioxidant enzyme activities in FMF may indicate inflammation-related 'oxidative stress'. Our findings also raise interesting questions on oxidative stress and its associations with pyrine mutations in FMF and awaits further investigations.Yayın Can Cytokines be used as an Activation Marker in Rheumatoid Arthritis?(Bentham Science, 2021) Kaya, Fatih Öner; Ceylan, Yeşim; Öngen İpek, Belkız; Özünal, Zeynep Güneş; Sezgin, Gülbüz; Nalbant, SelimAims: The etiopathogenesis of Rheumatoid Arthritis (RA) is not clearly understood. However, the role of the cytokines play an important part in this mechanism. We aimed to bring a new approach to the concept of 'remission' in patients with RA. Background: RA is a chronic, autoimmune, inflammatory disease that involves small joints in the form of symmetrical polyarthritis and progresses with exacerbations and remissions. Pain, swelling, tenderness and morning stiffness are typical of the joints involved. Although it is approached as primary joint disease, a wide variety of extra-articular involvements may also occur. It is an interesting pathophysiological process, the exact cause of which is still unknown, with many environmental, genetic and potentially undiscovered possible factors in a chaotic manner. Objective: In this cross-sectional study, sedimentation rate (ESR), C- Reactive protein (CRP), Tumor necrosis factor (TNF)-?, soluble-TNF-? receptor (TNF-R), Interleukin (IL)-1B and IL-10 were measured in three groups which were healthy volunteers, patients with RA in the active period, and patients with RA in remission. Disease activity score-28 (DAS-28) was calculated in active RA and RA in remission. Methods: This study included 20 healthy volunteers, 20 remission patients with RA and 20 active RA patients. Venous blood samples were collected from patients in both healthy and RA groups. Results: RA group consisted 43 (71.6%) female and 17 (28.4%) male. Control group consisted 11 (55%) female and 9 (45%) male. TNF-R was significantly high only in the active group according to the healthy group (p=0.002). IL-10 was significantly high in active RA, according to RA in remission (p=0.03). DAS-28 was significantly high in active RA, according to RA in remission (p=0.001). In the active RA group, ESR and TNF-R had a positive correlation (r:0.442; p=0.048). In the active RA group, there was also a positive correlation between TNF-R and CRP (r:0.621; p=0,003). Both healthy and active RA group had significant positive correlation between ESR and CRP (r: 0.481; p=0.032 and r: 0,697; p=0,001 respectively). Conclusion: TNF-R can be the main pathophysiological factor and a marker showing activation. TNF-R can be very important in revealing the effect of TNF on the disease and the value of this effect in the treatment and ensuring the follow-up of the disease with CRP instead of ESR in activation.Yayın A case of Weil's syndrome developing steroid resistant immune haemolytic anaemia(Informa, 2005) Solmazgül, Emrullah; Turhan, Vedat; Ünver, Suat; Nalbant, Selim; Danacı, MehmetWeil's syndrome is known in a serious clinical form, but the development of immune haemolytic anaemia related to Leptospira in human beings is a very rare clinical presentation, and we encountered only 1 case report in a literature scan. In this paper we present a case of Weil's syndrome in which immune haemolytic anaemia findings, and haemolysis could only be controlled by intravenous immunoglobulin (IvIg) treatment.Yayın Comparison of the therapeutic efficacy of 4-methylpyrazole and N-acetylcysteine on acetaminophen (paracetamol) hepatotoxicity in rats(Taylor & Francis Online, 2002) Küçükardalı, Yaşar; Cinan, U; Acar, H. Volkan; Özkan, Sezai; Top, Cihan; Nalbant, Selim; Çermik, Hakan; Çankır, M. Salih Zeki; Danacı, MustafaObtaining effective analgesia with a minimal erosive effect on gastric mucosal tissue has increased the consumption of acetaminophen (paracetamol), especially among the elderly. However, the hepatotoxic effects of acetaminophen have also increased. We aimed to compare the effects of 4-methylpyrazole (4-MP), N-acetylcysteine (NAC) and their combined use on the hepatotoxicity of acetaminophen in a rat model. Male Wistar Albino rats were divided into six groups. Groups 1-5 received 2,000 mg/kg acetaminophen by gavage while the control group was group 6. Group 2 animals were given NAC (loading dose 140 mg/kg followed by seven doses at 4 h intervals); group 3 received 50 mg/kg 4-MP; group 4 received 200mg/kg 4-MP; and group 5 received NAC as in group 2 plus 200 mg/kg 4-MP. Blood samples were taken for measurements of serum AST and ALT levels. The livers of the rats were removed for microscopic examination and grading of hepatic necrosis. AST and ALT levels in groups 2-5 were lower than that of group 1 (p < 0.001), although no significant difference was noted between groups 2-5 (p > 0.05). Higher levels of ALT were found in group 5 than in group 2 (p < 0.05), and higher levels of AST were found in group 5 than in group 3 (p < 0.01). Median necrosis scores were 3.36 for rats receiving acetaminophen alone (p < 0.001, compared with groups 2-6), 1.45-1.81 for groups 2-5 (p > 0.05, compared with each other), and 0.18 for control rats (p < 0.001, compared with groups 1-5). In conclusion, the administration of 4-MP and/or NAC after 4 h of administering toxic dose of acetaminophen, inhibits hepatotoxicity in rats. There was no difference between the 4-MP and NAC-treated groups as reflected by comparable levels of serum transaminases and the degree of hepatic necrosis. Combining of 4-MP and NAC offers no benefit.Yayın Cor triatriatum düşündüren interatrial septal deviasyon: Bir geç dönem rastelli tip a olgusu(T.C.Maltepe Üniversitesi, 2023) Kumrular, Merve; Yılmazer, Mustafa Serdar; Yudum Tunç, Melisa; Nalbant, SelimOstium primum tip atrial septal defekt (ASD), endokardiyal yastık defekti olarak da bilinen atrioventriküler (AV) kanal defektlerinin alt başlığı olan intrakardiyak şantlı, konjemtal bir kalp hastalığıdır. Sol-sağ şant düzeltilmediğinde sağ kalp boşluklarında basınç artışı, sağ boşluklarda genişleme ile karakterizedir. ASD olgularında nadiren de olsa Eisenmenger sendromu gelişebilir. Sağ kalp boşluklarında artmış basınç neticesinde interatrial septumda sola itilme gözlenebilir. Olgumuzda 61 yaşında, 29 yaşındayken doğumsal kalp hastalığı nedeniyle öpere olduğunu belirten bir kadın hasta, kliniğimize nefes darlığında artış nedeniyle başvurdu. Transtorasik eko- kardiyografik incelemede hem parasternal uzun aks hem de apikal 4 boşluk görüntülerinde sol atrium içerisinde cor triatriatum düşündüren hiperekojen raphe benzeri imaj izlendi. Ayrıca sağ kalp boşluklarında ve sol atriumda genişlemeyle birlikte triküspit ve mitral kapaklarda ciddi yetersizlik akımı saptandı. Transözofageal görüntülemede interatrial septumun ileri derecede sola deviye olduğu bu nedenle 2D transtorasik ekokardiyografik görüntülemede sol atrium içerisinde aldatıcı bir ikinci septum görümü yarattığı saptandı. Bu olgu sunumunda operasyon sonrası uzun dönemde tekrar intrakardiak şant gelişen bir Rastelli Tip A hastasında artmış sağ kalp basınçları nedeniyle interatrial septumun sola deviasyonu ve bu nedenle transtorasik ekokardiyografi görüntülerinin cor triatriatum ile benzerliğini göstermek istedik.Yayın Criteria sets for primary Sjogren's syndrome are not adequate for those presenting with extraglandular organ involvements as their dominant clinical features(SPRINGER HEIDELBERG, 2017) Kabasakal, Yasemin; Kitapcioglu, Gul; Karabulut, Gonca; Tezcan, Mehmet; Balkarli, Ayse; Aksoy, Adem; Yavuz, Aule; Yilmaz, Sema; Kasifoglu, Timucin; Kalyoncu, Umut; Dalkilic, Ediz; Tufan, Abdurrahman; Mercan, Ridvan; Yildiz, Fatih; Senturk, Taskin; Onen, Fatos; Bes, Cemal; Erken, Eren; Tunc, Ercan; Kamali, Sevil; Tarhan, Emine; Yazici, Ayten; Duzgun, Nursen; Bicakcigil, Muge; Yilmaz, Sedat; Ozmen, Mustafa; Ocal, Lale; Alibaz-Oner, Fatma; Solmaz, Dilek; Cobankara, Veli; Nalbant, Selim; Gunal, Esen Kasapoglu; Kaskari, Derya; Goker, BernaPatients with primary Sjogren's syndrome (pSS) may go undiagnosed or be misclassified due to the insidious nature and wide spectrum of the disease. The available several classification criteria emphasize glandular findings. We aimed to analyze the efficiency of various classification criteria sets in patients diagnosed on the clinical basis by expert opinion and to compare those pSS patients who fulfilled these criteria with those who did not. This is a multicenter study in which 834 patients from 22 university-based rheumatology clinics are included. Diagnosis of pSS was made on the clinical basis by the expert opinion. In this study, we only interviewed patients once and collected available data from the medical records. The European criteria, American-European Consensus Group (AECG) and American College of Rheumatology (ACR) Sjogren's criteria were applied. Majority of the patients were women (F/M was 20/1). The median duration from the first pSS-related symptom to diagnosis was significantly shorter in men (2.5 +/- 2.3 vs 4.3 +/- 5.9 years) (p = 0 < 0.016). When the European, AECG and ACR Sjogren's criteria were applied, 666 patients (79.9%) satisfied at least one of them. In total, 539 patients (64.4%) satisfied the European, 439 (52.6%) satisfied the AECG, and 359 (43%) satisfied the ACR criteria. Among the entire group, 250 patients (29.9%) satisfied all and 168 (20.1%) met none of the criteria. The rates of extraglandular organ involvements were not different between patients who met at least one of the criteria sets and those who met none. There is an urgent need for the modification of the pSS criteria sets to prevent exclusion of patients with extraglandular involvements as the dominant clinical features.Yayın Cytokine profile in Behçet uveitis(AEPress, 2008) Nalbant, Selim; Şahan, Burak; Durna, Murat; Erşanlı, Dilaver; Kaplan, Mustafa; Karabudak, Özlem; Ünal, MelihObjectives: Investigate the role of cytokines in Behçet uveitis. Background: Cytokines may take part in this pathogenetic mechanism. Elevated and/or altered levels of specific cytokines have been found in patients with Behçet's disease in many studies. Methods: Twenty patients with Behçet uveitis and 20 patients with Behçet's disease without uveitis were included to the study in compliance with International Study Group Criteria. Twenty non-Behçet uveitis patients were included in the study. In this group, active uveitis was found in 30 % and arthritis in 35% of patients. Serum levels of cytokines (Interleukin-2-4-6-8, IL-2-4-6-8), tumor necrosis factor-alpha, TNF-alpha) and local growth factor (vascular endothelial growth factor, VEGF) were measured. Results: Levels of all cytokines were highest in Behçet patients without uveitis except for IL-2 and IL-6. These cytokines were also highest in patients with non-Behçet uveitis too. Despite the tendency of this distribution of cytokines, only three cytokines, TNF-alpha, IL-8 and IL-4 were significantly different from the controls. The levels of TNF-alpha, IL-8 and IL-4 were significantly lower in patients with Behçet uveitis than in Behçet patients without uveitis. Interestingly, the levels of IL-2 and IL-6 were statistically similar in all groups. VEGF showed no significant difference between the studied and control groups. However, in contrast to cytokines, only the levels of VEGF were correlated with the activity of uveitis (p<0.05). Conclusion: Consistent with previous reports of different immune effectors in Behçet uveitis, it may be suggested that its underlying immunopathogenesis may be much different from other causes of endogenous uveitis (Tab. 3, Fig. 1, Ref. 20). Full Text (Free, PDF) www.bmj.sk.Yayın Demir eksikliği anemisi tablosu ile ortaya çıkan paroksismal nokturnal hemoglobinüri: olgu sunumu(Maltepe Üniversitesi, 2014) Kızılkılıç, Ebru; Sezgin, Gülbüz; Kaya, Fatih Öner; Nalbant, SelimParoksismal nokturnal hemoglobinüri (PNH), periferik kanda sitopeni, tromboz ve hemolitik anemi ile ortaya çıkan nadir bir kemik iliği yetersizlik hastalığıdır. CD55 ve CD59 isimli iki glikozilfosfotidilinositol (GPI) çapası olan proteinlerin yokluğu nedeniyle kontrolsüz kompleman aktivasyonuna bağlı hemoliz ve diğer PNH bulguları ortaya çıkar. Erken tanı bu hastaların prognozu ve yönetiminde temeldir. Eculizumab, kronik kontrolsüz kompleman aktivasyonunu spesifik olarak inhibe eden ve terminal kompleman yolundaki C5’i hedef alan monoklonal antikordur. Çocuklarda ve erişkinlerde PNH tedavisi için onaylı ilk ve tek ilaçtır. Bu yazıda demir eksikliği anemisi tablosu ile başvuran ve Eculizumab ile başarılı şekilde tedavi edilmiş bir PNH olgu sunulmaktadır.Yayın Dissection of the thoracic aorta in a patient with autosomal dominant polycystic kidney disease(ScienceDirect, 2004) Keskin, Özcan; Kalemoğlu, Murat; Atasoyu, Enes Murat; Ünver, Suat; Küçükardalı, Yaşar; Nalbant, Selim; Evrenkaya, Tevfik RıfkıAutosomal dominant polycystic kidney disease (ADPKD) is a systemic illness with a number of extrarenal manifestations. A 61-year-old male patient with known ADPKD was admitted to the emergency room of our hospital in May 2003 with severe chest pain radiating to his neck and back, and a sense of breathlessness. There was no history of trauma. On admission, he was hypotensive (90/50 mmHg) and his heart rate was 110 beats/min. He had a midsystolic murmur, which was most marked at the left sternal edge. His peripheral pulses were weak. Bilateral basal crepitations were found on pulmonary examination. Abdominal examination was normal except for large palpable polycystic kidneys. He had no focal neurologic signs. Laboratory examination showed no significant abnormalities except for raised serum urea (121 mg/dL) and creatinine (4.1 mg/dL). An electrocardiogram showed depression of ST segments in the anterior leads. Emergency computerized tomography scanning of the thorax and abdomen demonstrated dissection and intramural thrombus within the descending thoracic aorta and bilateral polycystic kidneys (Panels A and B).Yayın Does rofecoxib increase TNF-alpha levels?(Clinical and Experimental Rheumatology, 2006) Nalbant, Selim; Akmaz, İbrahim; Kaplan, Mustafa; Avşar, K.; Solmazgül, Emrullah; Şahan, BurakObjective: Rofecoxib (Vioxx), the first COX-2 selective non-steroidal anti-inflammatory drug (NSAID), was recently withdrawn from the market due to the increased risk of acute myocardial infarction. The precise mechanism responsible for this phenomenon still remains unknown. Tumor necrosis factor alpha (TNF-alpha) is a cytokine, possibly most responsible for mortality in patients with acute myocardial infarction. However, this study was designed to study possible effects of rofecoxib on the level of TNF-alpha by using MSU crystal induced inflammation in the rat subcutaneous air pouch model. Methods: Rat subcutaneous air pouches were produced and examinations commenced 6 days later. Control groups received only MSU crystals, or no crystals or drugs. To begin with, rofecoxib (30 mg/kg), indomethacin (20 mg/kg) or diclofenac (3 mg/kg) were administered to groups of 5 rats each. Thirty minutes later, MSU crystals were injected into air pouches, except for the negative control group. Twenty-four hours later, the rats were sacrificed for aspiration of fluid and for the dissection of pouch walls to determine leukocyte counts, pouch wall histology, and to assay IL-10 and TNF-alpha. Results: Intra-pouch injection of MSU crystals, compared to non-injected pouches, caused an increase in white blood cell count (WBC) (30 +/- 44.7 versus 4508 +/- 792.3 cells/mm3), in the numbers of pouch wall vessels (vascular index) (4.8 +/- 0.3 versus 11.4 +/- 1.5 vessels/high-power field) and in TNF-alpha (50.0 +/- 13.4 versus 70.34 +/- 20.9 ng/mL), but not in interleukin-10 (IL-10) (60.6 +/- 63.0versus 61.48 +/- 7.1). WBC and vascular index were significantly reduced in all study groups compared to the control group (p < 0.05). Levels of TNF- in fluids were unexpectedly and significantly (p < 0.05) increased in all cases. The highest level of TNF-alpha was found in the rofecoxib group. In contrast to TNF-alpha, IL-10 levels were significantly (p < 0.05) decreased in all three drug groups. Indomethacin tended to suppress inflammation more effectively. However, there was no significant difference between the groups for IL-10 (p > 0.05). Conclusion: All three NSAIDs exhibited anti-inflammatory activity against MSU crystal induced inflammation. The difference in anti-inflammatory effects of these three non-steroidal drugs is seen not only in the anti-inflammatory effect on MSU induced inflammation but also in the nature of the effects. Refocoxib tended to increase the TNF-alpha level. Whether increased TNF-alpha levels can help explain the side effect of COX-2 specific inhibitors still requires further studies.Yayın Effect of uncomplicated obesity on QT interval in young men(Polish Society of Internal Medicine, 2010) Arslan, Erol; Yığıner, Ömer; Yavaşoğlu, İrfan; Kardeşoğlu, Ejder; Nalbant, SelimQT prolongation and obesity are associated with ventricular arrhythmia and sudden cardiac death. The relationship between uncomplicated obesity and QT interval prolongation is not clear. OBJECTIVES: The aim of the study was to investigate the effects of uncomplicated obesity on QT interval in young men. PATIENTS AND METHODS: A total of 122 men, including 59 obese patients and 63 controls, were recruited into the study. Patients with hypertension, diabetes mellitus, and ischemic heart disease were ineligible. Body mass index (BMI) of all patients was calculated. QT interval was measured from the precordial lead – V5, and corrected QT (QTC) was calculated using the Bazett’s formula. RESULTS: Mean age, BMI, and waist circumference (WC) of obese patients and controls were as follows: 22.0 ±3.0 years, 36.2 ±2.2 kg/m², and 114 ±8.1 cm; 22.6 ±2.9 years, 24.7 ±2.5 kg/m², and 81.6 ±7.5 cm, respectively. There was a statistically significant difference between the obese and control groups with regard to BMI and WC (P <0.001). Furthermore, statistically significant differences were observed between the 2 groups in terms of QTC (407.9 ±17.1 ms vs. 397.7 ±14.0 ms, respectively, P <0.001), systolic (126.9 ±8.2 mmHg vs. 114.2 ±11.1 mmHg, respectively, P <0.001) and diastolic blood pressure (78.3 ±4.5 mmHg vs. 66.9 ±10 mmHg, respectively, P <0.001). There was a positive correlation between QTC interval and both WC (r = 0.357, P <0.001) and BMI (r = 0.424, P <0.001). There was no association between QTC and blood pressure. CONCLUSIONS: Uncomplicated obesity in young men is associated with QT interval prolongation. Weight gain may inversely affect cardiac repolarization in uncomplicated obesity.Yayın Evde kal: Covid-19 günlerinde sağlık ve iletişim stratejileri(Maltepe Üniversitesi Yayınları, 2020) Karasar, Şahin; Kök Kendirlioğlu, Burcu; Thomas, David Terence; Eroğlu, Erhan; Eyüboğlu, Ezgi; Ülger, Gürdal; Nalbant, Selim; Öztek, Zafer; Çiçek, MeltemBU DA GEÇER! 2020 yılının ilk günlerinde pandemi sözcüğünün ne anlama geldiğini tüm dünya acı kayıplar yaşayarak öğrendi. Wuhan’da ortaya çıkan COVID-19 salgını, bulaşıcılığının çok yüksek olması sebebiyle hızla tüm dünyaya yayılarak binlerce insanın yaşamını yitirmesine neden oldu. Mart 2020 ortalarında ülkemizde görülen ilk vaka ile salgın yanı başımıza geldi. Ülkemizde özverili bir çalışmayla başarıyla yönetilen pandemi günleri, hepimiz için ders alınacak günlerdi. Sağlıklı bir nefesin değerini anlamak, virüsün yuvamızdan alıp götürdüğü sevdiklerimizin acısını unutmadan ayakta kalmak, birlik ve beraberliğin gücünü ortaya koymak suretiyle birlikte başarmak… Çok şey alıp götüren bu salgın, çok şey de öğretmişti. Bâğ-ı dehrin hem hazânın hem bahârın görmüşüz Biz neşâtın da gâmın da rûzgârın görmüşüz (rüzgar:zaman, dehr: dünya, neşât: sevinçler) Klasik şiirimize hikemî üslûbu kazandıran Nâbî’nin ünlü dizelerinde dile getirdiği gibi insanoğlu dünya bahçesinin gamını, kederini yaşıyordu ama hepimiz biliyorduk ki neşâtın eli çok yakınımızdaydı. Umudu yitirmeden virüsle savaşıyordu dünya! “Bu da geçer Yâ Hû!” diyen dilimize, gönlümüz de inanıyordu! Bu kitap, salgın günlerini iletişim ve sağlık çalışmaları bağlamında mercek altına almak üzere Sayın Rektörümüz Prof. Dr. Şahin Karasar Hocamızın verdiği ilhamla kaleme alındı. Bu çalışmayla okuyucuya bir yandan Tıp gözünden salgına dair bilgi vermek, bir yandan da salgın günlerinin iletişim çalışmalarından kesitler sunmak istedik. Evde geçen günlerde benim için de adeta taze bir nefes olan kitabımızda Değerli Yazarlarımız Hocalarımız, COVID-19 mücadelesindeki yoğunluklarına rağmen davetimizi kabul ederek bu çalışmaya anlam kattılar. Ben de bir kez daha ne kadar şanslı olduğumu hissederek şükrettim. Malumumuz; şükür, her zaman nimetin kapılarını açar. Her biri alanında özel bir isim olan böylesine kıymetli Hocaların yazılarının yer aldığı bir kitabın editörlüğünü yapmak benim için büyük bir şanstır, onurdur, mutluluktur. Kelimelerle tarifi zor bir duygu... “Dil, hükmünü onu işitmeyi bilene bırakır.” diyen Lacan yardım etsin burada; gönül gözüyle görüp, işitelim... Teşekkürlerimle… Bu kitabın okuyucuyla buluşmasını sağlayan bölüm yazarlarımız Değerli Hocalarımıza en içten teşekkürü bir borç biliyorum. Sayın Rektörümüzün bizlere sunduğu bu ortak çalışma fırsatı da hem akademik açıdan hem manevi açıdan çok kıymetlidir, kendilerine de bir kez daha saygı ve şükranlarımı sunuyorum. COVID-19 salgınında hayatını kaybedenleri rahmet ve saygıyla anıyor; pandemi günlerinin bir daha geri gelmemesini temenni ediyorum. Sürç-i lisanın affıyla,
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